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Dear Member

Having endured one of the wettest summers in living memory, hopefully we can look forward to a better autumn. One of the most important items on our calendar is recertification which is now due. I hope you all have it in hand and are about to submit your figures soon.

I am very pleased to report that Sharon, Debbie and Elaine are doing a fantastic job running the BSCCP now that Liz has retired. Elaine has been appointed to help with the administration of the society and support Sharon and Debbie. The new structure of the secretariat and the improved office environment will ensure an excellent infrastructure for our society for the years to come.

In the near future, a revised document 20 Colposcopy and Programme Management: Guideline for the NHS Cervical Screening Programme should be published by the end of the year. This will incorporate the role of HPV testing in screening and its subsequent impact on colposcopy management. As always, this evidence based document will be very useful when we draft our local colposcopy guidelines and standards.

Next year, several pilot areas in the UK will be used to evaluate the effectiveness of primary HPV testing with reflex cytology when indicated. Obviously, this will reduce the demand for cytology services but is likely to make the screening programme more robust and cost effective. It is likely that the same sentinel sites for HPV triage will be used to assess primary screening.

I have been involved with a number of BSCCP members in a NICE review evaluating the evidence for new technologies to aid the diagnostic accuracy of colposcopy. There will be several new devices available on the market in the near future that appear to improve colposcopy performance. Some technologies were not included in the review process as the evidence for their effectiveness is only just about to be published. The evidence and recommendations for colposcopy practice make interesting reading. Individual colposcopy units will

Recertification is now due …… have you recertified yet?

Summer 2012

The BSCCP Secretary’s Update decide if they want to invest in such technologies.

The debate continues regarding the effect of excisional treatment and subsequent obstetric outcomes. In a recent study published in the BMJ by Castanon and colleagues, they evaluated outcomes from 12 colposcopy units in the UK. This paper demonstrated an increased risk of prematurity after treatment but not to the same extent found in previous Nordic publications. The increase risk might be due to treatment or might be due to the same risk factors that predispose women to develop disease. I am sure the debate will go on, in the meanwhile I think colposcopists should always aim to perform the most effective treatment whilst at the same time minimizing short and long tem side effects.

And finally, I would like to remind everybody, that the BSCCP has resources to perform colposcopy related audits. Any proposals are always welcome. Advice and a starter pack are available from Sharon Parisi (Sharon.parisi@bwhct.nhs.uk).

All the best.

Pierre Martin-Hirsch Hon Secretary

RCOG World Congress in Obstetrics and Gynaecology

Abstract Submission Deadline: 14 January 2013

Date: 24-26 June 2013 Location: Liverpool, UK Language: English Organiser: Royal College of Obstetricians and Gynaecologists Secretariat: Hampton Medical Conferences Ltd Phone: +44 (0) 20 8979 8300 Email: info@rcog2013.com

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This year’s BSCCP conference in Gateshead highlighted the considerable achievements in colposcopy and the prevention of cervical cancer since the inception of our society in 1972. Raj Naik and his organising committee provided a lively programme in the fantastic facilities at the Sage centre. Albert Singer and Joe Jordan delivered one of the most highly rated presentations on the history of BSCCP (which are available on the website - http://www.bsccp.org.uk/index.asp?PageID=234) and milestones over the intervening year. The current science and debate highlighted how far we have come and how colposcopy practice is suddenly changing.

One concern is the management of women who are seen at colposcopy with a positive HPV test. The information currently available has limitations in guiding our decision making and support for these women and many of us benefit from discussion of our experiences with our colleagues. Importantly, the published results for the NHS CSP sentinel sites confirm the low risk of developing CIN2/3 after a normal colposcopy examination and the safety of returning these women to routine recall. These results highlight the importance of the high standard of colposcopy training and accreditation in the UK and the confidence we should have in our ability to confirm normality.

Currently the information in relation to HPV and HPV testing is being updated on the website. With the development of the new site, further information and support for colposcopists and women will appear. If you have any suggestions, please get in touch. Offers to write material or provide images or cases for the website are always greatly appreciated. The Nurse Colposcopy group are currently reviewing information which addresses the common queries posted on the bulletin board from nurse colposcopists such as prescribing, protocols or job plans.

In Scotland and Wales, women entering the cervical screening programme for the first time are part of the HPV vaccination catch-up programme. Across the UK, we will start to notice the impact of immunisation on abnormal smears and colposcopy from 2015. In anticipation of early impact on our practice, a group including myself, Narendra Pisal and Pierre Martin Hirsch are reviewing the emerging evidence and a summary is available on the website.

Beyond the UK, David Nunn’s talk at Gateshead on the work in Nepal to fight Cervical Cancer generated much discussion on what UK colposcopists can do to help colleagues in developing countries. You may be interested to read Walter Prendiville’s article and request for colposcopy mentor’s at the end of this newsletter. In recognition of the aspirations of BSCCP to support best practice in colposcopy and to celebrate the BSCCP 40th anniversary, the BSCCP executive are offering an additional award for an overseas scholarship or project award in 2012. The awards will be funded up to a total on £10,000. Details of this BSCCP 40th Anniversary Overseas Scholarship can be found later in this newsletter.

A Letter from the President Last year BSCCP were able to help support Jo’s Trust to train volunteers and run a support line. This has been accessed not only by women affected by cervical cancer but by women with abnormal smears and health professionals. Jo’s Trust have posters available for Colposcopy departments with the helpline number and are happy to p r o v i d e t h e s e f o r y o u r o w n c l i n i c . http://www.jostrust.org.uk

If you have any colposcopy or BSCCP issues to discuss, please get in touch with myself or your regional rep. I hope you will be able to make the next BSCCP meeting in Glasgow 2013.

Maggie Cruickshank President

Albert Singer, Maggie Cruickshank, Joe Jordan

An Update from the Certification & Training Committee

MDT meetings should be attended by trainees

Following recent discussions at the executive and the Gateshead meeting, it has been recommended that it will become a requirement for trainees to attend at least 50% of the MDT meetings in their unit during their training period. This will be monitored from 2013 onwards, initially trainers will be asked to certify that attendance has occurred. We will in due course adapt the electronic log book in order to record this in the trainee’s record. Please therefore ensure that your trainees are able to attend these v a l u a b l e e d u c a t i o n a l o p p o r t u n i t i e s . The process of obtaining a place on the OSCE will be more strictly controlled (2013 onwards)

There has recently been some administrative difficulty and inefficiency arising from candidates for the OSCE booking their place well in advance of the exam, before completion of the log book. In some cases these candidates do not complete their requirements for training and places allocated for the OSCE exam are wasted as a consequence. This will not be allowed to occur in future. For 2013 onwards, candidates will be allocated a place on the next available OSCE upon receipt of the following: 1 ) F u l l y c o m p l e t e d E l e c t r o n i c l o g b o o k 2 ) P a y m e n t o f a n n u a l s u b s c r i p t i o n 3) Completion of training form (AC3) signed off by Trainer 4) Confirmation of attendance at Laboratory sessions

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Quality Assurance of Trainers

The Trainer accreditation process is to commence this September.

Details can be viewed at: http://www.bsccp.org.uk/index.asp?PageID=136 where the required form can be downloaded. A list of accredited Trainers is now available on the website.

Recertification

All colposcopists are required to re-certify this September. The criteria for recertification can be viewed at h t tp ://www.bsccp.org .uk/ index .asp?PageID=41 There is an option to recertify using the new criteria, or for 2012 only, using the old criteria. If you have already sent in your paperwork but have not yet received your certificate, please be patient, this is a very busy time for the BSCCP office, please allow up to 6 weeks to receive your certificate.

We would like to inform you of a ‘Training the Trainers’ meeting for colposcopists at the Colposcopy (Virtual) Training Centre, Glyndwr University Wrexham, North Wales on 12th October 2012 details can be obtained from anne.hauke@wales.nhs.uk

John Cullimore Chair, CTC Committee

As another summer ends and a new academic year begins it’s a good time for reflection and forward planning. Work has

started on the new improved BSCCP website which should be up and running by the end of the year. This will provide a fresh new look with improved access to shared information and training materials. It will also be integrated with the BSCCP Vimeo channel as well as Facebook and Twitter to bring our society well into twenty first century modes of communication.

The site will also act as a true web portal improving the efficiency and effectiveness of the service we offer by making it possible to complete many tasks seamlessly on line. This will include registration for training, recertification, membership renewal as well as returning eligibility for the OSCE through successful completion of training. It should enhance the experience formembers as well as protecting our valued secretariat. This development takes careful planning so please be patient… we want to

An Update from the IT Committee

make sure that we deliver a bespoke website which does exactly what it says it should do.

Meanwhile please check out the presentations from Gateshead which have been uploaded onto VIMEO. Simply go to vimeo.com and search BSCCP to see thirty one filmed presentations from the last two years including the historical tour of the BSCCP provided by Joe Jordan and Albert Singer this year. Let us know what you think by leaving comment – we really like feedback and want to hear what you think.

Finally we can always use help at the BSCCP – if you have an interest in all things IT particularly if you have an interest in social networking sites we on the IT subcommittee can always use new enthusiastic volunteers.

Grainne Flannelly Chair IT Committee

We look forward to welcoming the BSCCP back to Glasgow for an exciting conference in 2013. There is an interesting and wide r ang ing s c i en t i f i c programme with invited speakers Prof P Neminem, Prof P Sasieni and Dr K Cuschieri to get us all up to date with HPV testing and screening, talks on the use of new technology and image capture, access for vunerable groups and getting up to speed with the use of social media and how it can help us. We are holding the inaugural Liz Dollery/Jo’s Trust lecture, the popular Question Time and Prof Kitchener will receive the founder’s medal. Conference will be held on the river front in the Crowne Plaza hotel which has excellent facilities with a varied range of other accomodation nearby. Social programme includes a civic reception in the Glasgow City Chambers and a fantastic ceilidh in the stunning Kelvingrove Museum, so book your kilts now! See you next year.

Val Harper Chair Local Organising Committee

An Update from the Certification and Training Committee (continued)

Annual Scientific Meeting Glasgow 25/26 April 2013

City Chambers, Glasgow

Video Presentations from

Gateshead/Newcastle 2012

Are now available online in the members area

(via the Educational page)

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EFC now has 32 member countries. Courses have been held this year in Estonia and Turkey, both in conjunction with the RCOG Eurovision programme. In 2011 representatives of 28 countries met in Berlin to discuss how best to promote high standards of training and practice in colposcopy. 51 core competencies for completion of training and 10 guidelines for the colposcopic management of problems presenting in a colposcopy clinic have been identified and agreed. The next step is to find a means by which completion of a programme of approved training can be recognised in all European countries. The meeting in 2011 identified how this might be achieved and representatives from member countries will meet again in Berlin on 21-22 September 2012. It is hoped that the project can be finalised and presented at the tri-ennial European meeting in Prague 5th – 7th September 2013.

Please put a note in your diary about the Prague meeting and further details will be circulated in the next Newsletter.

Joe Jordan EFC Executive Board

Now in their third year, the Jo’s Trust Cervical Screening Awards are now open for entries. The A w a r d s s e e k t o

unearth innovative screening campaigns from across the UK, which have raised awareness of the importance of cervical screening and directly improved screening rates. Winning an award draws further attention to a campaign and can boost much-needed profile and funding for initiatives. The Awards are open to NHS or voluntary organisations from England, Northern Ireland, Scotland and Wales. Entrants can download an application form at www.jostrust.org.uk/screeningawards. All entries will be judged by a panel of experts including Julietta Patnick, Director of NHS Cancer Screening Programmes in England. Entries close 28 September 2012. Jo’s Trust is the UK’s only charity dedicated to women and families affected by cervical cancer and abnormalities.

A date for your diaries …….

IFCPC 15th World Congress 26 - 30 May 2014

The Queen Elizabeth II Conference Centre, London

HPV & Genital Tract Disease, Yesterday, Today &

Tomorrow

(www.ifcpc2014.com)

The following were elected onto the Executive Committee in April 2012:

Dr M Cruickshank — President Mr J Tidy – President-elect Mr P Martin-Hirsch – Secretary Miss T Freeman-Wang – Treasurer Dr L Pickford – Welsh Representative Dr E Crosbie – North West Representative Mr M Hanneman – South West Representative Dr M Nathan – BASHH Miss V Coneley – Nurse Representative Mr N Myerson—Chair of Certification & Training Committee

Vacancies for Officers and Regional Representatives in April 2013

Nominations are required for the following positions:-

North Eastern Representative Eastern Representative Midlands Representative London Representative Trainee Representative on the Certification &

Training Committee (CTC) The Nomination Form can be found in the ‘Members Area’ of the website in the ‘Newsletter’ section http://www.bsccp.org.uk/index.asp?PageID=38

BSCCP Elections

BSCCP Scholarships and Awards

BSCCP 40th Anniversary Overseas Scholarship

Applicants submit their proposal and the associated costs to the BSCCP secretariat. The proposal needs to demonstrate that the project:

1. Meets the aims of BSCCP 2. Identifies a need for colposcopy training and support 3. Supports a development in poorest or most underserved areas of the world.

4. Identifies alignment with the local/regional or national health plan.

5. Shows sustainability.

6. Ensures that the proposal does not destabilise existing services or creates a problem which does not currently exist.

The deadline for proposals is 19th October 2012 and funding will be decided at the next full executive meeting in December.

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The individual(s) and centre(s) to be visited, their particular expertise and confirmation of the proposed arrangements from that centre.

A short written account of the reasons for and benefits of the work to be undertaken

An undertaking will be given that a structured typewritten report will be provided at the end of the grant period and that the source of grant will be acknowledged in any related publications.

Successful applicant(s) will be encouraged to present their work at subsequent BSCCP annual scientific meeting (oral or poster presentation)

The estimated cost of travel/subsistence/other expenses, together with details of any other financial assistance being obtained or requested.

The award may only be used for the purpose approved by the BSCCP assessment and Executive.

Applications for the awards should be submitted to the BSCCP Secretariat Sharon.Parisi@bwhct.nhs.uk before 21st October 2012

The Travelling Fellowship

This award of £1,000 is made to enable an individual to further his/her research by visiting centres of excellence. Anybody currently engaged in research is encouraged to apply. Please give brief details of your proposed study plan.

The Overseas Scholarship

This award of £1,200 is available to bring a doctor from a less developed country to the United Kingdom to train in colposcopy. If you are in a position to assist someone please send in your proposal. If you wish the Society to consider a reciprocal visit of the host trainer to the applicant’s own country to provide ‘hands on’ experience, then it may be possible to increase the award by a further £1000.

The application should be from a Society member and should include i) Case of need ii) Brief details of training to be offered iii) CV’s of the applicant and proposed trainee.

The Jordan/ Singer BSCCP Research Award

The BSCCP has an aim to ‘promote the best standards of care in colposcopy with structured training, audit and research’. The object of this BSCCP Prize is to encourage research, clinical or laboratory based, or to acquire additional clinical skills within colposcopy and related sciences. The work can be undertaken either within their unit, other centres in the UK or abroad. Up to £10,000 will be available annually. This may be in the form of a single Prize or shared amongst several individuals. The applicant and/or sponsor will be a member of the BSCCP. It will be possible for there to be more than one recipient in any one year, provided the total monies do not exceed the sum available (currently £10,000).

Applications for the Prize are invited for the following:

To provide monies to fund a pilot project, clinical or laboratory based in the field of colposcopy, or to provide monies to fund an extension of an existing project researching colposcopy related issues.

or:

To provide a contribution towards a travelling Fellowship to attend a recognised training centre, either in the UK or overseas, to obtain training in a particular aspect or research methodology relating to colposcopy or related issue.

The following conditions apply:

Curriculum vitae of the applicant (two page summary).

The applicant and/or sponsor should be a member of the BSCCP.

The names of two referees.

BSCCP Scholarships and Awards (cont)

IFCPC/BSCCP Joint initiative 1 to 1 Mentoring

Several BSCCP members have taken up the challenge of training colleagues in developing regions. Indeed several national and regional societies across the globe have begun to address the challenge of reducing the cervical cancer burden in the developing world. Most colposcopists, cytologists, virologists and pathologists live and work in the developed world while most cervical cancer exists in the developing regions. As more and more emerging regions embrace the concept of preventive women’s health and begin cervical screening programmes, so there immediately arises the need for trained colposcopists to manage the screen positive women. Given the numbers required it would be very difficult to train colleagues in the west in the classic BSCCP training model. Other means of training are required.

In 2011 the IFCPC in collaboration with AORTIC (African Organisation for Research and Training in Cancer) conducted a distance learning programme for 20 selected delegates from 10 sub Saharan countries. Each delegate had a colposcope, the support of their department and some form of screening. A series of video recorded lectures were sent over the internet on a fortnightly basis to the delegates. At the end of this course of 25 lectures Patrick Walker, Maggie Cruickshank and myself ran a week-long colposcopy clinic in Cape Town hosted by Prof Lyn Denny at Groot Schur. At the end of this we held an OSCE exam under the kind management of Maggie Cruickshank. Finally

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IFCPC/BSCCP Joint initiative 1 to 1 Mentoring (cont)

we held a round table discussion to determine what the delegates thought that they needed to establish best practice in their own countries. Several initiatives emerged (a global Multi Disciplinary Meeting, another DLC, access to a video library of real cases and finally enthusiasm for a 1 to 1 mentoring). At the end of this seminar the delegates founded the African Federation for Colposcopy and Cervical Pathology.

As 90% of delegates passed the OSCE exam it would appear that the distance learning initiative has been a real success. Ten countries were represented and every one of those who managed to get to Cape Town were hugely appreciative of the lecture content, format and style of delivery. Almost universally the delegates felt that they could not have got the same insight into colposcopy by reading textbooks or searching the internet. The lectures were thought to be informative, insightful and comprehensive. Each lecture was followed by 5 questions and the delegates also appreciated this feedback. A second model of training has been undertaken between Dublin and two centres in Tamil Nadu in Southern India. The project was relatively heavily funded (Irish Dept Foreign Affairs/Health Research Board) whereby registrars were employed in Tamil, formal courses run locally and a full spectrum of colposcopy equipment purchased for two clinics. Again it has been very successful and two thriving colposcopy services are now up and running in Coimbatore and at Ambilikai. The centre in Coimbatore hosted the All India Colposcopy Society meeting earlier this year and is now a training centre.

The Department of Health in Tamil Nadu is about to implement a regional screening service so there is a real and immediate need for trained colposcopists. One of the core planks of the project between Dublin and Tamil was a fortnightly video-conference whereby a clinico-pathological conference was held, with each centre presenting their own cases. Each centre found the experience highly rewarding.

The concept of a 1 to1 twinning project arose out of this and is now a firm proposal. The essentials of 1to1 twinning or mentoring may be summarized as follows :

Approximately 10 colposcopists from the UK and Ireland would host 10 colposcopists from a region with early colposcopy experience.

In this pilot proposal the guest colposcopists will be from Tamil Nadu and Sub Saharan Africa all of whom have undertaken our recent distance learning programme and who have passed the exam and been awarded a certificate by IFCPC.

The host twin will be an experienced BSCCP colposcopist with a desire to help colleagues early in their training.

A commitment of one full hour per fortnight is mandatory from both the host and guest.

Access to the internet and familiarity with skype is necessary

Familiarity with 4-shared or another software package is also necessary. This software is easy to use and allows for videos to be sent and downloaded in advance of the skype call. A clock embedded in the case video ensures exact temporal concordance whereby each twin knows exactly what the other is viewing. I can show hosts how to use the software.

It is not important that the host colposcopist is a senior academic, rather that (s)he is committed, available, experienced and a good communicator.

The main vision behind this initiative is that each twin will get to know each other’s clinical environment and come to understand the different challenges facing each other whilst at the same time being able to consider and discuss the diagnostic and management issues of a number of different cases throughout the year.

At the beginning of the year each host and guest will fill out a simple form describing their service as it is.

At the end of the year each host and guest will fill out a form describing their experience of the scheme and making recommendations for developing the guest colposcopy clinic service.

It is hoped that each twin will become fully aware of the clinical and other characteristics of each others’ service whereby each can be helpful to the other. Understanding the challenges of colposcopy in African and Indian clinics is very likely to allow BSCCP, IFCPC and AORTIC to make more valuable recommendations for improving cancer prevention in those two regions.

The 1 to 1 mentoring scheme is now ready to begin and will be a pilot project of one year. I am actively looking for experienced BSCCP colposcopists to consider taking part in the scheme. Please contact me directly at prendiville.walter@gmail.com or by mail at 64 South Circular Road, Dublin 8 with a brief (one paragraph) description of your colposcopic experience and service throughput. Finally let me know if you speak French or Tamil.

Walter Prendiville