title: Addressing challenges in future surveillance after surgery for early-stage cervical cancer.
abstract: OBJECTIVE
  This study examines surveillance after early-stage cervical cancer surgery. Since the 1980s, the value of surveillance has been discussed continuously. The main question explored is whether surveillance serves the purpose of ensuring early diagnosis of recurrence.
  
  
  METHODS
  A retrospective cohort study included 389 women with cervical cancer who underwent surgery as the primary treatment modality at the Department of Obstetrics and Gynecology, Aarhus University Hospital, Denmark, from 1996 to 2011. We used data from patient files and the Danish National Pathology Data Bank. The cumulative risk was estimated by the Kaplan-Meier method and tested by the log-rank test.
  
  
  RESULTS
  Forty-three women (11%) had recurrence. Only 27% of the recurrent cases were diagnosed at a scheduled surveillance appointment, but they were often asymptomatic and seemed to have a better outcome after treatment compared with the recurrent cases diagnosed at self-referral.The 5-year survival was overall 91.3%, recurrence-free survival was 96%, and cancer-specific survival was 54%. The median recurrence-free interval was 23 months (range, 4-144) for the symptomatic patients and 14 months (range, 4-48) for the asymptomatic patients. The median survival after recurrence was 12 months (range, 2-132) for the symptomatic patients and 156 months (range, 40-180) for the asymptomatic patients.
  
  
  CONCLUSIONS
  At the moment, neither the value of surveillance nor the significance of self-referral related to survival after recurrence is known. In this study, those who are diagnosed with recurrence before symptom onset seem to fare better in terms of 5-year survival than those who are diagnosed after self-referral because of symptoms.
authors.affiliation: Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Katrine
authors.initials: K
authors.lastname: Fuglsang
authors.forename: Lone Kjeld
authors.initials: LK
authors.lastname: Petersen
authors.forename: Jan
authors.initials: J
authors.lastname: Blaakaer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D009367:Neoplasm Staging; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D057832:Watchful Waiting; D055815:Young Adult