Invasive squamous cell carcinoma of the cervix in women less than 35 years old: Recurrent versus nonrecurrent disease Donna M. Fedorkow, MD, D. Ian Robertson, MD, PhD, Maire A. Duggan, MB, Jill G. Nation, MD, S. Elizabeth McGregor, MSc, and Gavin C. E. Stuart, MD Calgary, Alberta, Canada Invasive cervical squamous cell carcinoma was diagnosed in 45 patients <35 years old from 1980 to 1985. Thirty·two cases were Stage IB; 10, Stage liB; and three, Stage 1118. Twenty-two patients developed persistent or recurrent disease. Only one of these is now alive with no evidence of tumor. The mean interval from diagnosis to recurrence was 8.7 months (median of 7.0) and from diagnosis to death was 14.7 months (median of 12.0). Eleven of 32 patients with Stage 18 disease developed a recurrence; the intervals to recurrence in Stage 18 disease were similar to those for more advanced stages. Factors predicting recurrence included advanced stage of the disease and tumor bulk (maximum size, depth of invasion, and number of involved quadrants) as well as an exophytic or ulcerative tumor and a symptomatic presentation. These factors may identify the patient at high risk for recurrence who would benefit from adjuvant therapy. (AM J 0BSTET GYNECOL 1988;158:307-11.) Key words: Recurrent cervical squamous cell carcinoma, cervical cancer in young women, prognostic variables As the incidence and prevalence of squamous cell carcinoma of the cervix shift to a younger age group, 1 - 4 increasing attention is being focused on those patients who present with invasive disease at a young age. Between 1970 and 1974, 12.8% of patients diag- nosed as having invasive cervical squamous cell carci- noma were under the age of 35, compared with 37.2% of patients from 1980 to 1984, according to the prov- incial population-based cancer registry. Recently, cases of persistent or recurrent disease first diagnosed from 1980 to 1985 in women <35 years of age have been reported from this institution. 5 Of 22 patients in this group, 21 have died or are alive with clinical evidence of disease. The unfavorable outcome of this study group has prompted a review of all patients <35 years old presenting with invasive cervical squamous cell car- cinoma in an effort to identify those variables that might predict a poor outcome. A more virulent and poorly controlled disease in younger women with invasive cervical squamous cell carcinoma has been alluded to, but not generally agreed on, in the literature.6- 9 Suggestions to account for the poor outcome in younger women include changes in From the Departments of Obstetrics and Gynecology, Pathology, and Epidemiology, Tom Baker Cancer Centre, Foothills Hospital, and the University of Calgary. Presented at the Forty-third Annual Meeting of The Society of Ob- stetricians and Gynaecologists of Canada, Ottawa, Ontario, Can- ada, june 24-27, 1987. Reprint requests: Dr. D. I. 'Robertson, Department of Pathology, Foothills Hospital, 1403-29 St. N. W., Calgary, Alberta, Canada T2N 2T9. tumor virulence or immunologic characteristics and possible differences in the causes or patterns of spread of the disease. 6 · 7 The purpose of this study was to analyze various clinical and pathologic features in young women with invasive squamous cell carcinoma of the cervix to detect those feature(s) that might predict recurrent or persis- tent disease. The time interval (1980 to 1985) and age (<35 years) were chosen to include those cases diag- nosed after the recently documented shift in the age distribution in cases of invasive squamous cell carci- noma of the cervix. These patients would have had similar access to the use of oral contraceptives through- out most or all of their reproductive life with the con- comitant influence on female sexual activity such con- traceptives allow. The long-term use of oral contracep- tives has also been shown to increase the risk for the development of invasive cervical cancer. 10 Material and methods Eighty-three patients registered at the Tom Baker Cancer Centre with a diagnosis of invasive squamous cell carcinoma of the cervix <35 years of age were identified from the cancer registry. Of these, 38 were excluded for the following reasons: 28 had microin- vasive disease; eight cases were miscoded; one com- mitted suicide before staging; and one case was reclas- sified as oat cell carcinoma. The remaining 45 patients were then grouped into those with persistent or recur- rent disease (group 1, n = 22) and those without per- sistent or recurrent disease (group 2, n = 23). The medical records of these patients were reviewed 307