Presidential Address

It is my great privilege and pleasure to deliver the address in this memorial meeting of IFCPC.

The first meeting of lFCPC was held in 1972 in Mar del Plata, Argentina. So this World Congress is an especially important meeting, us it marks the 10th commemoration. The Congress has return to the mother country after 3 decades.

During these decades there are amazing progresses in the field of cervical pathology and colposcopy. IFCPC has grown up consisting with over 30 member societies and has become the leading international society in this field. It has successfully organized nine Congresses of a high scientific level with good deal of participants.

I like to review shortly the history of our Federation in relation to progress in cervical pathology and colposcopy.

The IFCPC was founded in 1972 during the first World Congress of Colposcopy and Cervical Pathology. In 1975 at the second World Congress in Graz, IFCPC standardized terminology and introduced an International Nomenclature of colposcopic findings. In 1990 at the seventh World Congress in Rome, colposcopic terminology was revised in accordance with the increased knowledge about HPV infection of the cervix. Atypical colposcopic findings were indicated to be minor or major changes.

The cytological screening program for cancer of the cervix has promoted in many developed countries with great success.

Then, what role can colposcopy play?

In 1997 I visited Manila by invitation by Philippine Society for Cervical Pathology and Colposcopy. They told me the situation in that country.

Namely, there were over 3000 islands in Philippines. The patients who came from these for islands can not come again to the doctor.

So, the result of examination mast be announced immediately.

Cytology is a very good technique to detect the cervical cancer. But, it takes time to get the result. By colposcopy we can tell the result just after the examination. If we observe only normal columnar epithelium and squamous-epithelium, we can tell the patient that has no cervical cancer. This is great asset of colposcopy.

First, colposcopy can be used also as a primary screening. Secondary, as you know, colposcopy is an indispensable tool for taking optimum biopsy.

In mass-screening system in Japan, the patients who are detected having abnormal Pap smear, are recommended to have biopsy examination. Some doctors took biopsy under guide by colposcopy; but same did without colposcopy. By biopsy without colposcopy very few dysphasia or carcinoma in situ were detected and one half of the positive cytology were falsely diagnosed as benign. It is clear that minor lesions can not be recognized without colposcopy and are missed by doctors. The final diagnosis of the cervical lesion mast be done by histo-pathology.

In 1961 at the first World Congress of International Academy of Cytology in Vienna, terminology of the precursors was agreed, namely carcinoma in situ and dysphasia. Dysphasia was first subdivided into 2 grade, i.e. low degree and high degree, but later into 3 grade, i.e. mild, moderate and severe. Afterward Dr. Ralph Richart proposed an idea of Cervical Intraepithelial Neoplasia, which was divided into 3 categories, CIN 1, 2 and 3. In 1988 Bethescla system on cytology was delivered which divided these lesions into 2 categories, Squamous Intraepithelial Lesion, low grade and high grade. At first this
system was proposed for cytological diagnosis, but it is now applied also to histo-pathological diagnosis. The grouping has become more simple to get unanimous coincidence of the diagnosis. However, recognition of atypically in epithelial cells has not changed. After these progresses what shall we do in this field in the next century?

The recent advance in medicine debt much on progress in molecular biology. This progress in medical science has been introduced into our field. It is agreed that Human Papillae Virus may have same relationship with cancino genesis of the cervical cancer. In squamous cell carcinoma such as in high grade ClN high risk HPV were detected in about 95% of cases. In the new millenium there will be a new Industrial Revolution. The new power will be information. The modern technology such as tele-communication with artificial satellite or light-fiber cord support world-wide distribution of information. These developments in communication will reduce national border and make the world closer. In the field of medicine, this modern technologies introduce tele-diagnosis of X-royfilms, pathology or many other diagnostic techniques with pattern recognition. Cervicography may become more popular with the method of telecommunication. But, I expect more new device with quite original method of approach.

During these 3 years we have sponsored a symposium in the 10th ESGO (European Society of Gynecological Oncology) meeting in Coimbra, Portugal, and other symposium or workshop in the 15th FIGO (International Federation of Gynecology and Obstetrics) meeting in Copenhagen, Deumark and in the 6th IGCS (International Gynecologic Cancer Society) meeting in Fukuoka, Japan in 1997, in the 7th IGCS meeting in Rome, Italy in this year. We have also started for arrangement to have collaborated symposium in the 16th FIGO meeting in Washington, D.C. in 2000.

All these collaboration will not only strengthen the relationship between each society, but also the recent progresses in Risfield will be distributed more widely.

IFCPC granted to Philippine Society for Cervical Pathology and Colposcopy to have special educational course for colposcopy. This course was held in November 1997 in Manila, and it was very well attended and successful. This kind of support must be one of the important works of lFCPC.

IFCPC may have several activities, i.e. presentation of new knowledge, exchange of information, enhancement of researcher’s communication, supporter education and so on.

Personal communication and exchange of information have been well done in the World Congresses and several previous mentioned collaborative symposia. Supporter education in developing countries will be the most important and may be responsible to the Federation. We mast pay much attention in this direction. IFCPC can demonstrate its merit by such activity.

Finally I like to stress that it is our duty to strive for saving the women of all over the world from suffering the malignant diseases of lower genital tract organs. The gynecologic oncology will only make advances if we continue to make effort in research. Only our effort can change the dream to the realty.

The future diagnostic and treatment methods for gynecologic cancers will become progressively more complex. In such era co-operation will become supremely important. By uniting each other with this Federation we can make more strong power and can win the war against cancer.

Hajime Sugimori, M.D.

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Message from the New President, Santiago Dexeus

In the By-laws of our Federation, the election of the new President takes place previous to the presentation of the candidate's program. As is logical, the nomination of the President Elect, who will be the future President, goes to a person who has been dedicated for a long time to the IFCPC.
Therefore, the new President has no obligation to present an authentic electoral program.
In spite of having already presented in Buenos Aires the policy I wish to follow for the following years, I am taking advantage of this opportunity to summarize it as follows:
To be truly representative on a world level, the IFCPC should try to involve the maximum number of nations interested in lower genital tract (LGT) disease. The IFCPC should supply a supranational service within its economic possibilities.

In my opinion, the best help the Federation can offer is to collaborate with needy nations in CME programs. For this we have a new Educational Committee which is making the rules so that the IFCPC gives credits for scientific events. These credits will permit the candidate to obtain the title of LGT specialist and to apply for an exam during the world congress. In addition, teaching material will be available to any National Society that may request it.
The Scientific Advisory Committee has started work in preparing the next Congress in Barcelona 2002. It is foreseen that all national societies can participate in making the program. This program would reflect the state of the art from basic investigation to infrastructural problems which may condition the high incidence of cancer in developing countries.
The rules for the election of the seat of the congress should probably be reconsidered giving priority to the organization rather than to those exclusively touristic.
Contact with other international organizations will be maintained and I can inform that during the next FIGO Congress in Washington a session has already been scheduled.
Other immediate actions to be taken are: - A web page - A Terminology Committee - The annual meeting of the Executive Board, as stated in the By-Laws. This will allow real control of the IFCPC and not the paper of a mere organization, which supports a congress every three years.
The IFCPC will take into account the validation of new techniques, diagnosis, etc. and will avoid passioned or sentimental defense of the old ones. At the next Congress it will be obligatory to declare any financial support received from any laboratory or industry to present a study. Debates about the pros and cons of any novelty with repercussions on daily behavior will be promoted, avoiding pseudoscientific messages based on doubtful evidence.
I am awarded that these aims are ambitious and that I am taking on a large compromised, even more so by expressing them in this communication. However, I dare to do so because I count on a great team of colleagues in the Executive Committee and on the other committees. I am sure that with their help and work, the IFCPC will begin a new era.
Santiago Dexeus, M.D.

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From the President of X World Congress of IFCPC

Last November, from 7 to 11, the X World Congress of Cervical Pathology and Colposcopy was held in Buenos Aires in an atmosphere of enthusiastic attendance which exceeded the number of people who had attended other events of the IFCPC. Two thousand one hundred twenty four colleagues, coming from different countries, attended the congress.

This vast attendance is an encouraging signal as Argentina is located in one of the southernmost places in the world, far away from other countries. Undoubtedly, there is a growing interest in our practice, which is also reflected by the creation of new National Societies, the Latin-American Federation and the European Federation.

For more than three years the organizing committee devoted attention to the planning and fulfillment of an ambitious and full schedule of communication and promotion. Such schedule was fulfilled by means of National Scientific Societies, mailing lists of prior congresses, publicity in magazines of the practice, creation of a current web page exclusively for the congress and finally, the printing and distribution of 20,000 copies of the final announcement as well as first communication sent all over the world.

The commitment of the chairman of the Scientific Advisory Committee Dr. Guillermo Di Paola, the General Secretary of the IFCPC Dr. Giuseppe De Palo and all the members of the Scientific Advisory Committee in preparing the program of the Congress was excellent.

A meticulous policy of communication and diffusion as well as an excellent scientific schedule and an attractive group of lecturers that IFCPC has always been able to convoke are the bases by means of which a congress is likely to succeed.

A world congress brings several benefits which are described as follows. To the Faculty: exchange of ideas and skills; to the Registered Members: new knowledge, consolidation and debate of prior knowledge, possibilities to meet and listen to well-known personalities in their practices, publication of papers or expression of their opinions, relations between unknown colleagues; to the Societies: consolidation of their international presence, relations between kindred associations, recognition of associates; to the Industry: possibilities to show products to a great number of professionals; to the Patients and the Society that are the first consignees and the reason of medicine: possibilities to be on the equal footing for techniques which allow preservation of health, detection, diagnosis and treatment of the illness in order to improve the quality of the life. As long as women keep on dying from cervical cancer, these high rank scientific meetings will be widely justified and will pave the most appropriate way for the eradication of this disease. Did the X World Congress of Cervical Pathology and Colposcopy fulfill all the aims? The entire scientific schedule was fulfilled: 9 plenary conferences, 37
symposia, 10 debates, 190 lectures, 11 pre- congress courses, 184 scientific papers, 140 posters and 6 videos. Foreign guests were surprised by the vast attendance of those registered to the different sessions; that was the reason why an additional room having simultaneous sound and image had to be opened for those who were unable to participate in the chosen conferences.

Social and entertaining activities were also fulfilled. Undoubtedly, many people who attended the congress must have returned to their homes trying to dance a "tango"! Others may have remember the solemnity of Colon Theater. People from the 5 continents, officers, scientific, cultural personalities, and relatives shared the Opening Ceremony and enjoyed the universal music played by the members of the Stable Orchestra of Colon Theater.

The congress has already finished. The authorities of the IFCPC have been substituted. Mexico was chosen to host the 2005 World Congress. Terms such as genes, oncogenes, immunomodulators and vaccines are still resonating in the halls of the empty rooms. What a strange feeling! Two hours ago, everything was full of noise, movement and lights. Those things that lasted years to fulfill may finish so quickly...

We are already paying all our attention to Barcelona 2002

Roberto Testa, M.D.

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