“The challenges of colposcopy in Eastern Europe and Central Asia”

1. “The challenges of  colposcopy in Eastern Europe and Central Asia” Alibegashvili Tamar Antalya 19.05.2017

2. Eastern Europe and Central Asia EECA region Albania Armenia Azerbaijan Bosnia Hercegovina Belarus Bulgaria Georgia Kazakhstan Kyrgyzstan Macedonia Republic Moldova Russian Federation Romania Serbia Tajikistan Turkey Turkmenistan Ukraine Uzbekistan

3. GLOBOCAN 2012 ≈38,000 new cases of Cervical Cancer ≈18,000 deaths from Cervical Cancer

4. New Cases & Deaths from Cervical Cancer in the Countries of the EECA Region Compared to Finland – Globocan 2012

5. Cervical Cancer Screening in EEAC countries • CC Screening is opportunistic (Exc. Serbia) • No centralized data collection, reporting, monitoring and • analyses of results

6. Cervical Cancer Screening in EEAC countries • CC Screening is opportunistic (Exc. Serbia) • 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.

7. Cervical Cancer Screening in EEAC countries • CC Screening is opportunistic (Exc. Serbia) • 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).

8. Cervical Cancer Screening in EEAC countries • CC Screening is opportunistic (Exc. Serbia) • 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.

9. 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

10. Colposcopy in EEAC countries • 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

11. How to improve the quality of colposcopy: • Standardized equipment of Colposcopy clinic • binocular colposcope • endocervical speculum • punch biopsy forceps etc.

12. 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

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 • National Colposcopy Society

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 • 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

15. How to improve the quality of colposcopy: • International conferences and Colposcopy courses

16. How to improve the quality of colposcopy: • International conferences and Colposcopy courses • Establishment of own Colposcopy training courses

17. How to improve the quality of colposcopy: • International conferences and Colposcopy courses • Establishment of own Colposcopy training courses • High quality pathology service CIN2

18. International Training Program in Colposcopy and Cervical precancer Management IFCPC/UNFPA EECARO program

19. International Training Program in Colposcopy and Cervical precancer Management IFCPC/UNFPA EECARO program

20. International Training Program in Colposcopy and Cervical precancer Management IFCPC/UNFPA EECARO program (Training of trainers) Lyon, IARC, 23.07.2016

21. 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

22. 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

23. 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

24. GSCPC composed guidelines for Screening and diagnostic of Cervical Cancer based on Pap test, published in 2010

25. International Classification of Diseases – ICD10 N86 Erosion and ectropion of cervix uteri  Applicable to decubitus (trophic) ulcer of cervix Eversion of cervix

26. In 2011 GSCPC one month training course was recognized by the Council of Continuing Professional Development and approved by Ministry of Health Georgia.

27. Course also contains: 1Training in LEEP, 2. Theoretical lectures, 3.Discussion of coploscopy picture patternson the base of Colposcopy Atlas CD. Final assessment of trainee: 1. Post training questionnaire 2. Independent clinical examination of 20 patients.

28. Accuracy of Colposcopy for detection of different histological diagnosis (Analysis of 800LEEP in 2011-2016GNSC)

29. Accuracy of Colposcopy for detection of CIN2+ (Analysis of 800LEEP in 2011-2016GNSC)

30. Summary: • Fight against Cevical Cancer is impossible without Screening Program

31. Summary: • Fight against Cevical Cancer is impossible without Screening Program • Screening Program is impossible without High quality Colposcopy.

32. 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.

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. • Any woman attending a doctor or nurse colposcopist should expect a minimum standard of both knowledge and competence.

34. Thank you !