Home > Cervical Cancer

Background to the PHASE Nepal Colposcopy Partnership 

In 2002 the Nepal Network for Cancer Treatment and Research (NNCTR) started the task of introducing mass screening for cervical cancer in collaboration with WHO (World Health Organisation) and the IARC (International Agency of Research on Cancer).  To date over 20,000 women have been screened. The management of screen positive patients was problematic as colposcopy services were poorly developed and many patients were subjected to overtreatment. A Memorandum of Understanding was therefore agreed between the PHASE colposcopy group and NNCTR to develop colposcopy services and training. The PHASE colposcopy group is a collaboration of UK colposcopists working voluntarily to assist the partnership. These web pages outline our work.

 

Aims of the Group 

The purpose of this partnership is to:

  • develop a sustainable, high quality colposcopy service to the women of the Kathmandu valley referred following screening from camps organized by the NNCTR and the local clinicians
  • strengthen existing services through training and education
  • develop a pool of high quality, well trained colposcopists in Nepal
  • Advocacy for fighting cervical cancer at a local and national, Governmental level.
  • help develop the vision of a population based cervical screening programme with the aim of reducing cervical cancer death rates

Achievements 

Our collaboration has achieved to date:

  • Two weekly fully functional colposcopy clinics at the Maternity Hospital, Kathmandu, offering diagnosis and treatment to those who have been referred from the regional screening programmes
  • Three 3 day colposcopy workshops with lectures and hands-on training for Nepalese gynaecologists
  • Four exchange visits to the UK of six senior Nepalese doctors and two Nepali nurses to train in colposcopy.
  • An increase in the number of colposcopists working in the country.
  • Advocacy for a cervical screening programme in the country.
  • One 2 day workshop for pathologists in cervical pathology attended by 25% of the countries pathologists
  • Funding from the UKAID programme for a two year project to train more colpscopists and pathologists

See the REPORTS section for information on our exchange visits and workshops

Monitoring and Evaluation of Programme 

Assessing the success of our programme is important. Measuring the death rates of cervical cancer, however,  would be logistically difficult  in a country like Nepal where data collection on disease like cancer is not obtained on a national level. Another indicator would be the detection of high grade CIN (pre-cancerous cells) on the cervix as we know that one in four women with this disease go onto develop cervical cancer

Data from the Maternity Hospital clinic run by Dr Verma has recently reported results.

April 2010 to October 2011 data (18 months)

Number of women screened:

  • Number screen positive (VIA/VILI) 81 (5%)
  • Number of patients having a colposcopy188 (17.2%)
  • Colp data (total 188)
  • Number of biopsies: 52
  • Number of loops23
  • Number of cryotherapy procedures: 10
  • Number of cases of Low Grade CIN cases: 30
  • Number of cases of High Grade CIN cases28
  • Total number of cases of CIN58
  • Pick up rate of high grade CIN in total screened1.7%

Cervical Cancer And Cervical Screening In Nepal

According to the World Health Organisation, cervical cancer is the most frequent cancer among women in Nepal. The disease is preventable by screening. Such a screening programme requires a coordinated effort from screening camps, to colposcopy (treatment of women who are screen positive), to pathological interpretation of tissue that is removed from the cervix.  A reduction in the death rates from cervical cancer will only happen when all aspects of this process is addressed with on-going training, mentoring and quality assurance through audit. The Government of Nepal has agreed a national cervical screening programme with the aim of reducing deaths from cervical cancer. The plan is for 50% of the population of women to be screened by 2014. To download a copy of this programme please click here (attached PDF*)

 

The UK Team 

The UK colposcopy team are a group of doctors and nurse colposcopists who provide a colposcopy service within the UK National Health service

  • David Nunns (Chair): Consultant Gynaecological Oncologist, Nottingham City Hospital
  • Rafiat Adekunle: Consultant Gynaecologist, Dewsbury Hospital
  • David Fenton: Retired Consultant Gynaecologist
  • Sherryl Goodhall: Nurse colposcopist, Royal Shrewsbury Hospital
  • Esther Moss: Consultant Gynaecological Oncologist, Leicester Royal Infirmary
  • Jane Panikker:  Consultant Gynaecologist, Royal Shrewsbury Hospital
  • Gerda Pohl: General Practitioner, Rotherham
  • Beth Devonald: Retired Colposcopist
  • Chris Ang: Consultant Gynaecological Oncologist, Gateshead

For further information please contact dnunns@ntlworld.com

Our Nepali Partners 

The Nepal Network for Cancer Treatment and Research is the Nepali based screening organisation aimed at cervical and breast cancer screening. PHASE and NNCTR are the facilitators for UK and Nepali Consultants to work together. PHASE and NNCTR signed a Memorandum of Understanding in in 2010.

  • Nepal Network for Cancer Treatment and Research NGO, Banepa, Nepal (NGO, Dr Surendra Bade)
  • Paropkar Maternity and Women’s Hospital, Katmandu, Nepal (clinical contact – Dr Verma)
  • National Public Health Laboratory, Kathmandu, Nepal (pathology contact –Dr Shakya)

Plans for 2013 

In 2013 we aim to consolidate the work carried out so far by building up the capacity of the trained pathologists and colposcopists in the country. Quality will be a clear focus of our work.in 2013 we plan to carry out the following:

  • A visit to the UK by two Nepali training colposcopists (doctor and a nurse)
  • Ongoing quality assurance programme for colposcopy and pathology – data collection
  • The development of web- based educational material for pathologists

Reports 

A range of reports about the PHASE – Colpscopy Partnership can be found by clicking here

Links 

Nepal Network for Cancer Treatment and Research NGO, Banepa, Nepal (NGO, cervical screening contact): www.nnctr.org.np

This our link partner in Nepal who provide cervical and breast screening camps as well as HPV vaccination programmes in the Kathmandu area.

 

International Agency for Research on Cancer: http://screening.iarc.fr/

This is a good resource on cancer screening and cervical cancer. It is from the International Agency for Research on Cancer (IARC) which is part of the World Health Organization. (IARC’s mission is to coordinate and conduct research on the causes of human cancer, the mechanisms of carcinogenesis, and to develop scientific strategies for cancer prevention and control. The Agency is involved in both epidemiological and laboratory research and disseminates scientific information through publications, meetings, courses, and fellowships.) If you look at the online resources – there are lectures (with voice overs), atlases of colposcopy and pathology and lots of info on VIA/VILI and issues surrounding cervical screening.

 

The British Society for the Study of Colposcopy and Cervical Pathology: www.bsccp.org.uk

This is the professional UK organisation who represents colposcopists. The provide education, training and quality assurance in colposcopy.  They have been keen sponsors of our UK-Nepal programme.

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