Embargoed until February 10, 1998
Contact: Johanna Spangenberg
Phone: (703) 527-7424
Contact: Barbara Halpern
Phone: (202) 332-7353
NEWS ROOM: February 6-11, 1998
Walt Disney World Dolphin
Orlando, Florida (407) 560-2675
DELIVERING BY VAGINAL BIRTH MAY RETURN ABNORMAL, PRE-CANCEROUS PAP SMEARS TO NORMAL
Medical researchers from the University of California-Irvine and the State University Hospital at Stony Brook, NY, have determined that a vaginal delivery will result in an increased postpartum regression rate for pregnant women with abnormal antepartum cervical cytology. Their findings will be presented at the 29th Annual Meeting of the
Society of Gynecologic Oncologists.
Orlando, FL -- Women who undergo vaginal delivery rather than cesarean section may trigger regression of pre-cancerous changes in the cervix. This is one of the key conclusions reached by seven medical researchers in their new study, "The Effect of Route of Delivery on Regression of Abnormal Cervical Cytology in the Postpartum Period." The participants in this research effort were David Ahdoot MD, Philip DiSaia, MD, G. Scott Rose, MD, Devansu S. Tewari, MD, Tom Kurasaki, MS, and Nicole J, Nguyen, BA, all from the University of California-Irvine Medical Center, Orange, CA; and Kristi M. Van Nostrand, MD, from the State University Hospital at Stony Brook, Stony Brook, NY.
Dr. Ahdoot will represent his colleagues as he presents the research results on February 10, 1998, before the 29th Annual Meeting of the Society of Gynecologic Oncologists (SGO) being held at the Walt Disney World Dolphin Resort, Orlando, FL, February 7-11, 1998.
Background: Widespread use of the Papanicolaou (Pap) smear has resulted in a significant decline in cervical cancer rates among women. At the same time, the Pap smear has revealed an increased incidence of cervical intraepithelial neoplasia (CIN) (dysplasia or pre-cancerous changes.) An abnormal Pap smear is not an uncommon finding in pregnant women, since the peak incidence of CIN is in the 20's and 30's, coinciding with the most common child-bearing years. Consequently, screening for the detection of carcinoma of the uterine cervix, with Pap smears, is a standard part of prenatal care.
Previous research studies have found that pregnancy had no effect on CIN, whereas other medical reports noted regression of cervical dysplasia in the postpartum period. No study, however, examined whether the route of delivery (cesarean section or vaginal delivery) influenced the postpartum regression rates for cervical dysplasia.
Methodology: Between 1990 and 1997, 446 women with abnormal cervical cytology at their initial prenatal visit were identified at clinics at the University of California-Irvine Medical Center and State University Hospital at Stony Brook, NY. Complete records were available for 138 women; of that group, 109 (79%) delivered vaginally and 29 (21%) delivered via cesarean section.
The initial antepartum, or prenatal, cytologic data on all 138 women were separated into three groups: atypical squamous cells of determined significance (ASCUS), low-grade squamous intraepithelial lesions (LGSIL) and the most severe abnormality, high-grade squamous intraepithelial lesions (HGSIL). Regression was defined as either complete normalization of Pap smear findings or regression of HGSIL to LGSIL.
Results: At their first antepartum visit, 26 women presented with ASCUS, 53 with LGSIL, and 59 with HGSIL.
The key results of the 59 women with HGSIL were:
-- 47 women delivered vaginally and 12 by cesarean section. Cytologic regression was noted in 28 of the 47 (60%) women who had delivered vaginally versus none of the women who delivered via cesarean section.
-- Of the 28 women who delivered vaginally and exhibited cytologic regression, only two had a recurrence of HGSIL at follow-up nine months after the date of delivery.
-- Of the 12 women with HGSIL who delivered via cesarean section, none entered the second stage of labor (or reached full cervical dilation). These women had persistent dysplasia postpartum and were subsequently treated with an excision procedure (or cervical conization).
Benefits: The research team suggests that vaginal delivery offers a number of benefits including an increased rate of cytologic regression. These benefits could be the result of enhanced localized repair mechanisms or stimulation of local immune factors. Essentially, the experience of vaginal birth delivery could trigger the body's natural corrective response to the abnormal cells found in the cervix before birth.
Another consequence of this research effort might be that physicians will not automatically perform a cervical conization, after birth, on women who had an abnormal antepartum Pap smear and subsequently delivered vaginally. Now, a postpartum Pap smear may first be performed to test for spontaneous regression and thereby eliminate the need for additional medical intervention.
The Society of Gynecologic Oncologists (SGO) is a professional society of physicians who specialize in gynecologic oncology. SGO is the only U.S. based medical organization dedicated to the prevention, detection and cure of female cancers. Gynecologic oncologists are cancer specialists trained in all the effective forms of treatment of gynecologic cancers (surgery, radiation therapy, chemotherapy and experimental treatments) as well as the biology and pathology of gynecologic cancers. The organization is comprised primarily of gynecologic oncologists as well as medical oncologists, radiation therapists and pathologists all of whom have a primary professional commitment to the treatment of women with gynecologic malignancies including those of the ovaries, endometrium, uterus, cervix vagina, vulva and trophoblastic disease.
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Editor's Note: For a complete copy of the complete manuscript or to schedule an interview with Dr. Ahdoot contact Johanna Spangenberg (703) 527-7424.
The Informatics Committee of the Society of Gynecologic Oncologists (SGO) has led the development of the Women's Cancer Network under the direction of Drs. Mitchell Morris and Ivor Benjamin. For more information vist the following web site http://www.wcn.org