Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Tamar Alibegashvili - Challenges facing colposcopy in Eastern Europe/ Central Asia

275 views

Published on

Dr Alibegashvili

Published in: Health & Medicine
  • Be the first to comment

  • Be the first to like this

Tamar Alibegashvili - Challenges facing colposcopy in Eastern Europe/ Central Asia

  1. 1. Dr Tamar Alibegashvili MD, PhD and President of the Georgian Colposcopy Society
  2. 2. “The challenges of colposcopy in Eastern Europe and Central Asia” Alibegashvili Tamar Brussels 16.12.2017
  3. 3. Eastern Europe and Central Asia EECA region Albania Armenia Azerbaijan Belarus Bosnia Hercegovina Bulgaria Georgia Kazakhstan Kyrgyzstan Macedonia Republic Moldova Romania Russian Federation Serbia Tajikistan Turkey Turkmenistan Ukraine Uzbekistan
  4. 4. ≈38,000 new cases of Cervical Cancer ≈18,000 deaths from Cervical Cancer GLOBOCAN 2012
  5. 5. New Cases & Deaths from Cervical Cancer in the Countries of the EECA Region Compared to Finland – Globocan 2012
  6. 6. Cervical Cancer Screening in EEAC countries • CC Screening is opportunistic (Exc. Serbia and Turkey) No centralized data collection, reporting, monitoring and analyses of results
  7. 7. Cervical Cancer Screening in EEAC countries • CC Screening is opportunistic (Exc. Serbia and Turkey) No centralized data collection, reporting, monitoring and analyses of results • Coverage of population is low (≈15-20%) Number of detected precancerous lesions is low Number of new cases of advanced cancer and mortality is high.
  8. 8. Cervical Cancer Screening in EEAC countries • CC Screening is opportunistic (Exc. Serbia and Turkey) No centralized data collection, reporting, monitoring and analyses of results • Coverage of population is low (≈15-20%) Number of detected precancerous lesions is low Number of new cases of advanced cancer and mortality is high. • Mainly Cytology (Pap test) Screening No established Quality control. Old classification - Papanicolaus classes (Ukraine, Belarus) HPV test as a triage test is used very occasionally. VIA screening (Tajikistan).
  9. 9. Cervical Cancer Screening in EEAC countries • CC Screening is opportunistic (Exc. Serbia and Turkey) No centralized data collection, reporting, monitoring and analyses of results • Coverage of population is low (≈15-20%) Number of detected precancerous lesions is low Number of new cases of advanced cancer and mortality is high. • Mainly Cytology (Pap test) Screening No established Quality control. Old classification - Papanicolaus classes (Ukraine, Belarus) HPV test as a triage test is used very occasionally. VIA screening (Tajikistan). • Most countries do not have National Guidelines for Cervical Cancer Screening.
  10. 10. Colposcopy in EEAC countries Role of Colposcopy: • Exclude the normal cervix • Identify the most suitable area for direct biopsy • Detect Invasive Cancer • Identify the type of TZ • Make management decision • Guide treatment • Estimate the severity of underlying disease
  11. 11. • No enough number of well-trained colposcopists • No appropriate technical equipment (colposcope, other instruments) • Absence of colposcopy training program (Albania, Bosnia- Hercegovina), or poor quality program Colposcopy in EEAC countries
  12. 12. How to improve the quality of colposcopy: • Standardized equipment of Colposcopy clinic binocular colposcope endocervical speculum punch biopsy forceps etc.
  13. 13. How to improve the quality of colposcopy: • Standardized equipment of Colposcopy clinic binocular colposcope endocervical speculum punch biopsy forceps etc. • Colposcopy Handbook on native language
  14. 14. How to improve the quality of colposcopy: • Standardized equipment of Colposcopy clinic binocular colposcope endocervical speculum punch biopsy forceps etc. • Colposcopy Handbook on native language • National Colposcopy Society
  15. 15. How to improve the quality of colposcopy: • Standardized equipment of Colposcopy clinic binocular colposcope endocervical speculum punch biopsy forceps etc. • Colposcopy Handbook on native language • National Colposcopy Society • Integration of National Society in the International Organizations (EFC, IFCPC) International Federation for Cervical Pathology and Colposcopy European Federation for Colposcopy & Pathology of the Lower Genital Tract
  16. 16. How to improve the quality of colposcopy: • International conferences and Colposcopy courses
  17. 17. How to improve the quality of colposcopy: • International conferences and Colposcopy courses • Establishment of own Colposcopy training courses
  18. 18. How to improve the quality of colposcopy: • International conferences and Colposcopy courses • Establishment of own Colposcopy training courses • High quality pathology service CIN2
  19. 19. International Training Program in Colposcopy and Cervical precancer Management IFCPC/UNFPA EECARO program
  20. 20. International Training Program in Colposcopy and Cervical precancer Management IFCPC/UNFPA EECARO program Theoretical knowledge 25 lectures delivered online with mandatory questions and answers after each lecture Image recognition skills 50 images with specific colposcopic characteristics Case management skills 100 video cases, each with online questions and answers, again delivered on line Colposcopy cases seen under supervision Direct supervision of 50 cases in a colposcopy clinic with 10 high grade cases. Colposcopy cases seen without direct supervision Submission of 100 colposcopy cases details to nominated trainer for review Exit Assessment on completion of training OSCE
  21. 21. Lyon, IARC, 11.12.2017 International Training Program in Colposcopy and Cervical precancer Management IFCPC/UNFPA EECARO program (OSCE)
  22. 22. • Population of Georgia ~ 3 800 000 •Cervical Cancer (CC)– the second most spread malignancy after Breast Cancer • CC incidence ~ 17.7/100 000 • Annually ~ 340 new cases CC
  23. 23. Cervical Cancer Screening Program in Georgia • CC screening was initiated in 2008 • Screening is based on the conventional Pap test (Bethesda system 2001) • Target ages – 25-60 years • Screening interval – 3 years • Screening is opportunistic (From 2016 the pilot project of organized screening in Tbilisi and Gurjaani region) • All women with abnormal Pap and suspicions for High Grade Lesion are referred to colposcopy
  24. 24. • GSCPC was founded in 2007 • From 2007 GSCPC is a member of EFC • EFC and IFCPC Colposcopy Basic Courses in 2008, 2010, 2013 • Two doctors form Georgia with support from the EFC and BSCCP had 2 weeks colposcopy training in UK
  25. 25. GSCPC composed guidelines for Screening and diagnostic of Cervical Cancer based on Pap test, published in 2010
  26. 26. International Classification of Diseases – ICD10 N86 Erosion and ectropion of cervix uteri Applicable to decubitus (trophic) ulcer of cervix Eversion of cervix
  27. 27. • In 2011 GSCPC one month training course was recognized by the Council of Continuing Professional Development and approved by Ministry of Health Georgia. Colposcopy findings Number Low grade cervical lesion ( LSIL, CIN1) 60-80 High Grade cervical lesion (HSIL, CIN2,3) 20-25 Normal colposcopy findings (ectopy, Normal transformation zone) 60-80 Miscellaneous findings (polyps, inflammation, atrophy, CTZ) 60-80 Invasive Cervical Cancer 1-5
  28. 28. Course also contains: 1 Training in LEEP, 2. Theoretical lectures, 3. Discussion of coploscopy picture patterns on the base of Colposcopy Atlas CD. Final assessment of trainee: 1. Post training questionnaire 2. Independent clinical examination of 20 patients.
  29. 29. Histology Sensitivity % Specificity % PPV % NPV % Normal 56 99 61 94 CIN1 61 88 77 77 CIN2+ 84 70 78 76 ALL 72 86 76 83 Accuracy of Colposcopy for detection of different histological diagnosis (Analysis of 800 LEEP in 2011- 2016 GNSC)
  30. 30. Referral Pap Sensitivity % Specificity % PPV % NPV % HSIL 84 73 92 58 ASC-H 81 80 79 82 LSIL 50 80 67 66 ASCUS 51 60 66 51 Accuracy of Colposcopy for detection of CIN2+ (Analysis of 800 LEEP in 2011-2016 GNSC)
  31. 31. Summary: • Fight against Cevical Cancer is impossible without Screening Program
  32. 32. Summary: • Fight against Cevical Cancer is impossible without Screening Program • Screening Program is impossible without High quality Colposcopy.
  33. 33. Summary: • Fight against Cevical Cancer is impossible without Screening Program • Screening Program is impossible without High quality Colposcopy. • High quality Colposcopy is impossible without good equipment and trained colposcopists.
  34. 34. Summary: • Fight against Cevical Cancer is impossible without Screening Program • Screening Program is impossible without High quality Colposcopy. • High quality Colposcopy is impossible without good equipment and trained colposcopists. • Any woman attending a doctor or nurse colposcopist should expect a minimum standard of both knowledge and competence.
  35. 35. Thank you !

×