Message from the Secretary General - Patrick Walker

The I.F.C.P.C brings together colposcopists from thirty eight countries, and from four of the five continents. It builds on the established national societies and the developing Federations such as the Latin American and European Federations. A not-for-profit organization it has no formal links to commercial organizations and is funded by the subscriptions from the membership. Compared with many emerging, successful medical societies, which do receive significant commercial sponsorship, I.F.C.P.C. has some difficulties in maintaining the efficient running of an international group, but offers the opportunity to maintain academic and intellectual freedom. As I.F.C.P.C evolves we need to examine how best to maintain intellectual independence, whilst delivering a successful society that fulfills the needs of the national members.

The aims of the society are outlined in the constitution:

The objects of the Federation shall be:

a) To stimulate basic and applied research and the diffusion of knowledge in matters concerning uterine cervical pathology and colposcopy.
b) To stimulate the creation of national societies.
c) To contribute to the standardization of terminology and evaluation of diagnostic and therapeutic procedures in the field of cervical pathology.
d) To hold at regular intervals world congresses, each successively in a different country. To sponsor on request regional or national congresses organized by affiliated societies. Where possible, to help coordinate the dates of conferences which are relevant to the field of cervical pathology.
e) To represent affiliated societies whenever joint scientific action appropriate.
f) To establish and maintain relations with other international organizations and to promote activities which further the objects of the Federation.

To be successful I.F.C.P.C needs the input from as many national societies and individual members as possible. In the electronic era we hope that this website will offer the means for the dialogue to take place. I would like members to consider our future under separate headings:

1. What are the aims of the Federation for the first part of the twenty-first century and how may these have changes since the society was formed?

2. How should we take forward education and training issues?

3. How should we help to define standards and foster quality assurance?

4. How do we continue to evolve our classifications and terminology?

5. How can the Federation best deliver the agenda for the twenty first century?

1. What are the aims of the Federation for the first part of the twenty-first century and how may these have changes since the society was formed?

The many large, successful groups such as AOGIN and Eurogin have emerged against the background of our increasing knowledge about HPV infection and the crucial role it plays in the aetiology of cervical cancer. The role of HPV testing and vaccination involve the major input of commercial organizations. All groups involved in cervical cancer and colposcopy would have the primary aim of reducing the burden of invasive cancer worldwide. However, I.F.C.P.C. with limited funding, would perhaps have to be more focused on contributing to this noble cause rather than achieving it single handed. The strength of I.F.C.P.C. lies in its international links, its lack of commercial influence and as the guardian of the terminology and possibly also training and standards of colposcopic practice.

Colposcopy is practiced in different environments. In the United Kingdom, for example, colposcopy is only used as the secondary triage for the investigation of women identified by the national cytology screening programme with dyskaryosis. U.K colposcopists have to undertake a specific and detailed training before they are allowed to see and investigate women, both in the state and private sectors. Their practice is regularly audited to maintain their registration. They tend to be experts at examining the abnormal cervix but have less developed skills in examining the normal physiological changes within the transformation zone. In other parts of mainland Europe, colposcopy is practiced as part of the annual gynaecological assessment of the normal woman. Such colposcopists will have undergone a different training, will have a different system of registration and will be great experts in examining the intricacies of the normal transformation zone but perhaps have less exposure, less frequently to the abnormal cervix, unless they work in secondary referral units. In the developing world some of the principles of colposcopy are employed at a devolved level in screening programmes such as VIA and VILI and indeed in some areas such as Mongolia pioneers are taking colposcopy out as a traveling clinic into the community for one stop screening and treatment. The fine detail of the colposcopic examination will be modulated by the pragmatic needs of the service. The role of I.F.C.P.C should, I would argue, be to facilitate and underpin colposcopic training, standard setting and practice while acknowledging that although the basic tools and terminology are the same, in different settings there will be different emphases and different needs for different individuals and groups. This brings us back to terminology, education, training and quality assurance.

2. How should we take forward education and training issues?

Traditionally and to some extent currently at this time, I.F.C.P.C. supports local initiatives by organizing teaching courses, often put on at the beginning or the end of a national or international conference. This reduces costs and ensures a reasonable audience and provides genuine experts and specialist teachers. Putting on a stand alone course has been found to be very enjoyable and very valued locally, but is perhaps an expensive and less comprehensive approach. Web based education would seem to be the best way forward. Sylvio Tatti is chairing the education subcommittee and they are examining how best to develop education tools. There are some websites, such as those of the American Society which have good material but some of the access is cost limited, which is a disadvantage to poorer countries who need the material most. The British Society is developing education materials that can be accessed by their website. There will be a password protected access point, free at the point of access to non members such as I.F.C.P.C members and other genuine practitioners

3. How should we help to define standards and foster quality assurance?

The British society was the first to establish some benchmarks for colposcopy practice within a national screening programme and these were published in 1996 in 'Standards and Quality in Colposcopy' edited by David Luesley. The standards have been updated against an evidence base and re-published in 'Colposcopy and programme management within the NHSCSP'. NHSCSP publication 20, June 2004. The European Federation has defined a core curriculum for training in colposcopy and colposcopy competences and is working on the treatment module. However, as mentioned earlier, different clinical settings may require different training programmes; although perhaps it can be argued that standards of diagnostic competence and therapeutic effectiveness should be definable and transferable to different situations. I.F.C.P.C may have a role in harmonising across the international community particularly at the three yearly world congresses

4. How do we continue to evolve our classifications and terminology?

The original colposcopic terminology described by Hinslemann was first revised by I.F.C.P.C. during the second world congress in Graz, Austria in October 1975. The next revision was at the world congress in Rome in 1990. In 1999, Santiago Dexeus honoured me by asking me to chair the Nomenclature committee and we submitted a revised terminology to the World Congress in Barcelona in 2002, subsequently published in Obstet gynecol January 2003. Working with colleagues from different countries on this important exercise showed me how important and how controversial a subject involving description and classification can be. The reason is that essentially terminology is the language by which we communicate for description, for shared diagnosis, for the planning of and estimation of the success of treatments and for research. It is important that it is accurate, effective and also that it evolves over time to reflect changing knowledge and practice. Generally the British approach is practical and treatment orientated, the Latin American and particularly the Germanic tradition is intellectual and tissue orientated. It is interesting how long a discussion can be about the difference between iodine negativity and iodine partial positivity, and the place of the term leukoplakia in the classification. I do think the introduction of the TZ types in the terminology was a step forward to facilitate research and comparison of treatment success. There will be a forum on the website for discussion and a devoted session at the World Congress in Auckland, and then I imagine the President may reconvene the Nomenclature committee with a new chair to report in Brazil in 2011.

5. How can the Federation best deliver the agenda for the twenty first century?

Review the constitution

All prestigious organizations should review their constitution and by-laws on a regular basis. The last amendments to the constitution were made in Barcelona in 2002. We are currently reviewing the documents and will publish any proposed amendments six months before Auckland, October 2008. In fact, I think the constitution apart from some unnecessary repetition in the by-laws, has and will continue to serve us well.

Expand the website

The executive has agreed to spend some of our scarce resources on the website. The website has several major tasks. First, this is the front of house, shop window for the Federation to health care workers and non-professionals. Second, it provides a communication link for all national societies. Third, it provides the opportunity for debate and fora for discussion. Finally it provides a conduit for education for all. Walter Prendiville chairs the IT committee and he is working closely with Sylvio Tatti on the Education committee. One of the ambitions of the President Howard Jones is to establish a research committee to facilitate international collaboration.

Involve the membership in the activities and planning for the Federation

If you have had the fortitude to read through to this point, I thank you. You might ask 'what can I do?' as a member of the Federation to aid its development:

1. Please look at the website regularly and take part in the inter-active sections.
2. Please ensure the details for your national society are correct and liaise with Kathy Poole the administrative secretary to update your details
3. Please share with us you views on the discussion points in this article and I particular bring in new points of discussion about our future
4. Please come to Auckland in 2008
5. Please continue to believe in an organization that crosses international boundaries, that is free from commercial influence and which is dedicated to the care of women in all countries

Patrick Walker, May 2007

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