4th International Conference on Cervical Cancer: An overview

TY - JOUR

T1 - 4th International Conference on Cervical Cancer

T2 - An overview

AU - Levenback, Charles

AU - Trimble, Ted L.

AU - Follen, Michele

N1 - Funding Information: The 4th International Cancer Conference was sponsored by the Johns Hopkins Medical Institute, the National Cancer Institute, the Centers for Disease Control, and the M. D. Anderson Cancer Center. It is the second conference co-organized with the European Institute of Oncology, the Medical School of the University of Turin, and Mirano Medical Center. The conference was held at the M. D. Anderson Cancer Center in Houston, Texas, May 18–22, 2005. We acknowledge the passing of our co-organizer Rick Montz, MD, who was a phenomenal inspiration for this conference. We also recognize the loss of Dr. Daniel Dargent, who invented the radical vaginal trachelectomy and taught the procedure to surgeons worldwide. Funding Information: The speakers in this session reminded us of the controversies in the care of patients. Dr. Marc Arbyn of the Scientific Institute of Public Health in Brussels, Belgium; Dr. Diane Solomon of the National Cancer Institute in Washington DC, United States; and Dr. Lynette Denny from the Groote Schuur Hospital in Cape Town, South Africa, were invited. Dr. Marc Arbyn presented two large meta-analyses performed with the Cochrane Gynecological Research Group, the group who established evidence-based medicine. He showed that data that demonstrated the unequivocal superiority of HPV testing (using the Hybrid Capture II test by Digene, Gaithersburg, Maryland) in the triage of women with ASCUS. The advantage of HPV testing was presented as a sensitivity ratio of increased cases detected, an increased sensitivity and specificity, and an increased area under the receiver-operating-characteristic curve compared to the performance of cytology for the triage of patients with ASCUS smears. There was no significant advantage in using HPV testing for the triage of LSIL. Dr. Arbyn then reviewed the use of HPV testing for the follow-up of patients with CIN2/3 who were treated and for whom recurrences were the outcome of interest. Again, HPV testing had an increased sensitivity ratio that was statistically significant compared to both cytology and to resection margins in predicting recurrences. Dr. Diane Solomon spoke of the overall effectiveness of the Papanicolaou smear in reducing mortality from cervical cancer. In the United States, the women who are not screened are those that live in rural areas, poor women, older women, and minority women. There are screening failures: patients lost to follow-up and false negative Papanicolaou results. Computer tracking could help the follow-up losses. New technologies that improve the sensitivity of the Papanicolaou smear could help detect the falsely negative smears. Examples of these technologies include liquid based cytology and computer-assisted imaging (ThinPrep Imaging System, FocalPoint Slide Profiler, and Molecular Tests of HPV [in primary screening and in triage of ASCUS]). Dr. Lynette Denny told us about her work, funded by the Alliance for Cervical Cancer Prevention through the Bill and Melinda Gates Foundation. She called cervical cancer the disease of “inequity of access to resources”. The age-specific incidence rates of cervical cancer in South Africa showed that Black African patients have much higher rates than whites after 30 years old, with rates in 60 years old women 140/100,000 compared to 20/100,000. Tuberculosis, malaria, HIV, and maternal mortality are all competing health needs in Africa. War, civil strife, and natural disasters endemic in many poor countries often have devastating consequences for the health care infrastructure. She reported findings from a published study of cervical screening by Direct Visual Inspection in the South African population. Direct visual examination and HPV testing have both been successful in cervical cancer screening in a see-and-treat protocol using cryotherapy as the treatment. There were few complications and increased detection of high grade lesions compared to the standard treatment arm. She also spoke of her experiences taking care of HIV-infected women there and in survivors of rape experiences.

PY - 2005/12

Y1 - 2005/12

UR - http://www.scopus.com/inward/record.url?scp=28844463500&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=28844463500&partnerID=8YFLogxK

U2 - 10.1016/j.ygyno.2005.07.031

DO - 10.1016/j.ygyno.2005.07.031

M3 - Article

C2 - 16203028

AN - SCOPUS:28844463500

SN - 0090-8258

VL - 99

SP - S1-S5

JO - Gynecologic oncology

JF - Gynecologic oncology

IS - 3 SUPPL.

ER -