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CONTACT: BECKY SOGLIN
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e-mail: becky-soglin@uiowa.edu

Release: June 6, 2000

UI study: pregnant women with cervical cancer should deliver by cesarean

IOWA CITY, Iowa -- Pregnant women with cervical cancer should deliver their babies by cesarean section rather than vaginally, according to a University of Iowa Health Care study.

The recommendation is based on the finding that women diagnosed with cervical cancer within six months after delivering a baby, particularly vaginally, had poorer survival and higher risk of recurrent disease than women who were diagnosed with cervical cancer during their pregnancy. The findings were published in the June issue of the journal Obstetrics and Gynecology.

The study is believed to be the first to formally examine the relationship between cervical cancer survival, recurrence and modes of delivery, said Anil K. Sood, M.D., UI assistant professor of gynecology and obstetrics, and the study's primary author and principal investigator. Previous related cervical cancer studies combined findings for women diagnosed after delivery with those diagnosed during their pregnancies.

"Survival for patients diagnosed within six months after delivery was significantly worse compared to patients diagnosed during pregnancy, and vaginal delivery was the most significant predictor of higher risk of cervical cancer recurrence," Sood said.

Sood said the concern with vaginal deliveries in women with cervical cancer is that tumor cells could potentially be pushed into the blood vessels during the process of cervical dilation. The cancerous cells can then migrate to other parts of the body.

"Patients whose cancers recurred after vaginal deliveries were more likely to develop distant recurrences, which points to tumors disseminating during delivery," Sood said.

Using a tumor registry for cervical cancer patients treated at the UI Hospitals and Clinics between 1960 and 1994, the investigators compared the cases of 56 women who had cervical cancer diagnosed during pregnancy and 27 women whose cancers were diagnosed within six months postpartum. The study also involved a control group of women who were diagnosed with cervical cancer five or more years since their last delivery.

Of the 27 women diagnosed with cervical cancer within six months postpartum, seven delivered a baby by cesarean, 17 delivered vaginally and three had miscarriages. One of the seven women (14 percent) diagnosed with cervical cancer within six months after a cesarean section had a cancer recurrence. However, 10 of the 17 women (59 percent) diagnosed postpartum who delivered vaginally had a recurrence.

Sood said the findings suggest that all pregnant women should be screened for cervical cancer through pap smears. Previous studies have shown that if a pregnant woman has an abnormal pap smear, it is safe to perform further evaluation with colposcopy and biopsy.

While cervical cancer is not common during pregnancy it is the most common cancer associated with pregnancy.

In addition to Sood, the UI department of obstetrics and gynecology investigators involved in the study included Joel I. Sorosky, M.D., professor of gynecologic oncology; Nina Mayr, M.D., associate professor of radiation oncology; Barrie Anderson, M.D., professor of gynecologic oncology; Richard E. Buller, M.D., Ph.D., professor of gynecology and obstetrics, and director of gynecologic oncology; and Jennifer Niebyl, M.D., professor and head of obstetrics and gynecology. Mayr is also a physician at the Veterans Affairs Medical Center in Iowa City.