A New Colposcopy Atlas



One of the reasons of the almost uniform failure of secondary cervical cancer prevention (i.e., screening for early lesions) in the developing world, and specifically in Latin America, is the lack of trained personnel. In this regard, education appropriate for various levels of health professionals, from those responsible for screening to highly specialized oncologists, is a priority. An essential component of this process is the availability of adequate educational material.

Colposcopic evaluation is a very important step in the investigation of women with positive cytology (ASCUS or worse), in order to confirm or exclude the presence of preinvasive disease, to rule out invasion, to determine the size and distribution of lesions, and what is more important, to guide biopsies. Information provided by colposcopy is also critical for selecting the most appropriate therapeutic modality. Although extensive educational materials relating to colposcopy already exist, most relate to the more developed world and do not address aspects of cervical pathology that are peculiar to Latin America. For example, severe cervical inflammatory diseases are common in the region, making differential diagnosis more difficult, although a recent report suggested that the mean size of CIN at the time of diagnosis is larger in Peru than in industrialized countries, making lesions, at least in theory, easier to detect. In addition, such books, and often the procedures and instruments described, are too expensive for the majority of professionals in the region.

One of the main objectives of the “Latin American School for Cervical Cancer Management”, a regional training facility founded at the Instituto Nacional de Enfermedades Neoplasicas in Lima, Peru, under the sponsorship of IARC and INCTR, is the development of appropriate educational materials. With this in mind, a bank of digital colposcopic images was collected in the course of a year and used as the basis for the creation of an Atlas of Colposcopy, which has just been published. This is the first text of its kind in Peru and has two advantages – it includes images of pathological conditions of the uterine cervix prevalent in the region and is affordable for the vast majority of health professionals interested in colposcopy. This useful tool will contribute significantly to capacity building for the fight against cervical cancer. Additional educational tools are to be developed in the near future.

Signing ceremony in Yaoundé, April 6th.

Agreement with Cameroon Ministry of Public Health

On April 6th a Convention between INCTR and the Minister of Public Health, Urbain Olanguena, was signed, establishing a partnership in furthering efforts to control cancer in Cameroon. A national cancer control committee (Comité National de Lutte contre le Cancer, CNLC) has already been created under the chairmanship of Professor Anderson Doh and a national cancer control plan developed. INCTR will establish a branch in Cameroon, to be directed by Dr Paul Ndom, and assist the committee in achieving specific high priority goals in the context of this plan. Particular emphasis will be given to training and education for health professionals in the areas of the early detection and treatment of cancer.


Advanced Palliative Care Workshop in Nepal

A workshop on advanced palliative care took place in Kathmandu, Nepal from 10th to 16th April. The meeting was jointly organized by INCTR’s Nepalese Branch, NNCTR / INCTR, and the BP Koirola Memorial Cancer Hospital, and there was active participation by INCTR’s palliative care team. Representatives from 15 hospitals or hospices in the region, as well as the Nepali Ministry of Health, the Nepal Health Research Council, the Nepal Oncology Society, the Nepal Nursing Council, the SARC Oncology Society and other local organizations attended. The workshop covered a broad range of topics including local and regional palliative care services, symptom control, psychological support, palliative care nursing, the role of radiation therapy and surgery, education and research. Local and regional organizations provided their experiences and perspectives.


Meeting in Vienna on Breast Cancer

INCTR staff attended a meeting in Vienna from 27 to 28th April to discuss collaboration in breast cancer treatment with members of the International Atomic Energy Agency (IAEA) Division of Human Health and representatives from many developing countries.


Events in Tanzania

In the last week in May, a series of meetings and expert visits took place in Dar es Salaam, Tanzania. INCTR’s palliative care team undertook a site visit at the Ocean Road Cancer Institute (ORCI) to discuss plans for developing the small existing palliative care program directed by Dr. Msemo and provide training of ORCI staff. Discussions were also held with International Atomic Energy Agency (IAEA) members regarding the integration of radiotherapy with palliative care services. An IAEA workshop on Evidence-Based Radiation Therapy, in which INCTR also took part, was held simultaneously.

On 25th May, a meeting was held with the Deputy Minister of Health of Tanzania, Dr. Twalib Ngoma, Director of ORCI, INCTR representatives and members of the IAEA PACT (Program of Action for Cancer Therapy). The purpose was to present a report on a previous imPACT mission entitled “Planning for Comprehensive Cancer Control in Tanzania” to the Deputy Minister on behalf of IAEA PACT partners (including the African Region of WHO, the American Cancer Society, INCTR and the International Agency Against Cancer) who have agreed work with colleagues in Tanzania to implement the plan. The Deputy Minister of Health accepted the plan and pledged her support, and that of the Minister of Health, with respect to its implementation.

Christopher Niblett (picture provided by his family).

The Christopher Niblett Memorial Fund

The INCTR is greatly indebted to Chris Niblett, in whose name a Memorial fund was set up to raise money for the INCTR’s continuing clinical trials in African Burkitt Lymphoma.

Chris was a trainee geography teacher and keen footballer, hoping to run the London Marathon for the second time, when he was diagnosed with Burkitt Lymphoma at age 25, in August 2005. Following a second recurrence, he was referred to Professor Ama Rohatiner at St Bartholomew’s Hospital, London. It was through her that Chris found out about the INCTR and, more specifically, the work being done to treat patients with Burkitt Lymphoma in Africa. Chris was deeply moved by the fact that so many young children were suffering from the same illness, but in much poorer circumstances. Before Chris, sadly, died of his illness, he had planned to organize a charity football match on his recovery and, although he was not able to do so, his friends and family fulfilled this wish for him. The match was played between four teams and was refereed by ex-England international player, Gary Mabbutt.

However the fundraising has not stopped there. Since the football match, money has been raised through a whole host of events, including a night of music, a sponsored run, a guided London tour, book sales, cake sales, clothes sales, collections at all the family’s respective schools (Chris’s parents are both teachers) and individual donations.

The INCTR is very grateful for all that has been done. Remarkably, £9000 has already been raised with further events still being planned. The money is being used to buy the chemotherapy for children being treated for Burkitt Lymphoma in Nigeria and Kenya.

Chris was a warm and friendly young man with a great sense of humor, whose popularity has ensured this continuing interest in the fund. It is a fitting testament to the generosity of a young man who, though very ill himself, was able to think of others.