title: Fertility-conserving surgery for young women with stage IA1 cervical cancer: safety and access.
abstract: OBJECTIVE
  To estimate the safety of fertility-conserving surgery for stage IA1 cervical cancer and to analyze predictors of access to conization.
  
  
  METHODS
  We analyzed women with stage IA1 cervical cancer aged 40 years or younger who were diagnosed between 1988 and 2005 and recorded in the Surveillance, Epidemiology, and End Results database. The outcomes of hysterectomy were compared with fertility-conserving conization. Clinical and demographic characteristics were compared using chi2. Multivariable logistic regression models were constructed to examine predictors of conization. Survival was examined using multivariable Cox proportional hazards models and the Kaplan-Meier method.
  
  
  RESULTS
  A total of 1,409 patients were identified, including 841 (60%) who underwent hysterectomy and 568 (40%) who underwent conization. In a multivariable logistic regression of factors associated with conization, Asian patients, single women, those diagnosed in the later years of the study, and those residing in the eastern United States were more likely to have fertility-conserving surgery. Compared with women younger than 30 years, those older than 35 years were 78% (odds ratio 0.22, 95% confidence interval [CI] 0.16-0.30) less likely to undergo conization. In a Cox proportional hazards model accounting for other prognostic variables, there was no difference in survival (hazard ratio 0.65, 95% CI 0.23-1.47) between conization and hysterectomy. Five-year survival for women who underwent conization was 98% (95% CI 96-99%), compared with 99% (95% CI 97-99%) for those treated with hysterectomy.
  
  
  CONCLUSIONS
  Fertility-conserving surgery is safe for young women with stage IA1 squamous cell carcinoma of the cervix. Young women with microinvasive cervical tumors should weigh the risks and benefits of conization in the context of individual preferences and tumor characteristics.
authors.affiliation: From the Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and Department of Radiation Oncology, Columbia University College of Physicians and Surgeons, New York, New York; and Herbert Irving Comprehensive Cancer Center, New York, New York.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
authors.forename: Ruvandhi
authors.initials: R
authors.lastname: Nathavithrana
authors.forename: Sharyn N
authors.initials: SN
authors.lastname: Lewin
authors.forename: Xuming
authors.initials: X
authors.lastname: Sun
authors.forename: Israel
authors.initials: I
authors.lastname: Deutsch
authors.forename: William M
authors.initials: WM
authors.lastname: Burke
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Herzog
mesh_terms: D000328:Adult; D019092:Conization; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007247:Infertility, Female / Q000517:prevention & control; D053208:Kaplan-Meier Estimate; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018307:Neoplasms, Squamous Cell / Q000473:pathology* / Q000601:surgery*; D016016:Proportional Hazards Models; D018426:SEER Program; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*