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Presidents' Picks





  

The January, 2014 Presidents' Pick 
Teresa M. Darragh, MD
ASCCP President

In this issue of the Journal, I recommend a twin pair of articles on the current and future state of cervical cancer prevention in Europe by Leeson et al: “HPV Testing and Vaccination in Europe” and “The Future Role for Colposcopy in Europe”.

The increasing use of HPV testing and typing, coupled with more successful vaccination programs, mandate the continued evolution of cervical cancer screening and management. These two articles give insights into the present and future of these in Europe. They provide an intriguing snapshot into the current state of cervical cancer prevention in Europe, graphically displaying the disparities that exist among the different European countries, and ponder future developments. They are worthy of thorough reading and thoughtful reflection.

How will we screen for cervical cancer in the rest of the 21st with abnormal screening tests? How will the role of colposcopy and the colposcopist change? Will we succeed with primary prevention? Our role as health care providers trying to stem the impact of cervical cancer and the tools we use to accomplish this is rapidly changing. Major inequities exist in cervical cancer prevention services in the US, Europe – worldwide. How will we succeed at preventing this preventable disease?
                     

Teresa M. Darragh, MD is Professor of Clinical Pathology, UCSF and a pathologist in UCSF Medical Center at Mt. Zion’s Department of Pathology and Department of Obstetrics, Gynecology and Reproductive Sciences. Her primary clinical and research interests are focused on HPV-related anogenital tract disease.  

Dr. Darragh is board certified in Anatomic Pathology with an added qualification in Cytopathology. In addition to her clinical work with UCSF’s Cytology Service, she is also an attending physician at UCSF’s Dysplasia Clinic. 






  

The October, 2013 Presidents' Pick 
Teresa M. Darragh, MD
ASCCP President

The current issue of the Journal of Lower Genital Disease is packed with interesting and informative articles – it is well worth reading cover-to-cover! I would like to draw your attention, in particular, to the article by Martin Steinau and colleagues titled: “Human Papillomavirus Prevalence in Invasive Anal Cancers in the United States Before Vaccine Introduction.” This article provides benchmark prevalence and genotype distribution of HPV in a non-cervical HPV-associated cancer – anal cancer. It highlights the importance of HPV 16 and 18 in causing 80% of anal cancer. Albeit partially theoretical, this should also serve an important reminder that we now have the ability to make an enormous impact on all HPV-associated cancers via primary prevention with the HPV vaccines.

I would also like to highlight the editorial by Dr. Thomas Julian, our Journal’s Executive Editor. “Too Much of a Good Thing” notes that due to an increasing number of quality manuscripts accepted for publication, this is the first issue to publish case reports in a digital-only format. These articles are still listed in the print version of the table of contents, but the full content is only available online – so remember to check the web! As an ASCCP member, you can log into the website via the Journal’s link at www.asccp.org.
                           

Teresa M. Darragh, MD is Professor of Clinical Pathology, UCSF and a pathologist in UCSF Medical Center at Mt. Zion’s Department of Pathology and Department of Obstetrics, Gynecology and Reproductive Sciences. Her primary clinical and research interests are focused on HPV-related anogenital tract disease.  

Dr. Darragh is board certified in Anatomic Pathology with an added qualification in Cytopathology. In addition to her clinical work with UCSF’s Cytology Service, she is also an attending physician at UCSF’s Dysplasia Clinic. 







 

The July, 2013 Presidents' Pick 
Teresa M. Darragh, MD
ASCCP President

For the President’s Pick from the latest issue of the Journal of Lower Genital Tract Disease.  I recommend the thoughtful commentary by Drs. Mariani, Sideri, Costa, Cristoforoni, Origoni, and Preti for the Italian HPV Study Group: Human Papillomavirus DNA and Pap Tests: The Need for Cotesting in Opportunistic Setting During the Transition Time.

How we screen women for cervical cancer is rapidly changing. Blink and you may have missed the latest updates on screening and management. The Pap test has done a spectacular job in its 60-plus year history. Yet, it may now be time to say goodbye to our old familiar friend – or at least help ease it into retirement. And the authors endorse just such an easy retirement – a transition time of cotesting with Pap and HPV testing – before adoption of primary HPV testing, particularly in the setting of “opportunistic screening”. This proposal is mirrored in the latest cervical cancer screening guidelines in the United States. Whether implicit or explicit to the US recommendations, the authors also highlight important factors contributing to our reliance on Pap testing. Letting go of the annual Pap continues to be a difficult transition. Thoughtful adoption of the guidelines with cotesting at extended intervals is good medicine and will help prepare clinicians and patients alike for the move to primary screening with HPV testing. Change is hard. And it is hard to do “less”, even if based on good science.
                           

Teresa M. Darragh, MD is Professor of Clinical Pathology, UCSF and a pathologist in UCSF Medical Center at Mt. Zion’s Department of Pathology and Department of Obstetrics, Gynecology and Reproductive Sciences. Her primary clinical and research interests are focused on HPV-related anogenital tract disease. 
Dr. Darragh is board certified in Anatomic Pathology with an added qualification in Cytopathology. In addition to her clinical work with UCSF’s Cytology Service, she is also an attending physician at UCSF’s Dysplasia Clinic.





 


The June, 2013 Presidents' Pick
Alan G. Waxman, MD, MPH
ASCCP Immediate Past President

There are a lot of important articles in this issue of the Journal of Lower Genital Tract Disease.  I highly recommend one that appears in the supplement.  The long awaited "2012 Updated Consensus Guidelines on the Management of Women with Abnormal Cervical Cancer Screening Tests and Cancer Precursors © 2013" by Massad, Einstein, Huh, et.alpresents the recommendations for the 2012 ASCCP Consensus Conference that updated ASCCP's 2006 Consensus Guidelines.
These recommendations are also available in algorithm form on ASCCP's website, and they also have also been adapted to a mobile app available from the Society.   There are several other important articles in the supplement that explain the data that contributed heavily to the guidelines. 

Especially useful in understanding the underlying principle of the 2012 Consensus Conference is the first article by Katki et.al., "Benchmarking CIN 3+ Risk as the Basis for Incorporating HPV and Pap Cotesting into Cervical Screening and Management Giuidelines." 

Another article I recommend is "Screening for Cervical Cancer: A modeling study for the U.S. Preventive Services Task Force" by Kulasingam et.al. I  found this very useful in understanding some of the thinking that went into the U.S. Preventive Services Task Force recommendations on whom to screen, how to screen and how often.  Some of this same modeling data contributed to the screening recommendations of the American Cancer Society, ASCCP, and ASCP published March 2012.
                          

Alan G. Waxman, MD, MPH is professor of obstetrics and gynecology at the University of New Mexico School of Medicine. He is also director of the colposcopy clinics at UNM. 
Dr. Waxman has been an active teacher of colposcopy for over 20 years. He has been on the faculty and a co-director of ASCCP's Comprehensive Colposcopy Courses. Dr. Waxman is chairman of ASCCP's Assessment Committee and co-chair of the Committee on International Education and Humanitarian Outreach.  He is President of ASCCP for the 2012-2013 term and has served on the Board of Directors for a number of years.  He has been course director for colposcopy training programs sponsored by ACOG and the Indian Health Service.   
 Dr. Waxman has served in the past on the Federal Advisory Committee of the National Breast and Cervical Cancer Early Detection Program (BBCEDP) and continues to be active on the medical advisory committees of the New Mexico and Navajo Nation BCCEDP. Dr. Waxman has written numerous journal articles and textbook chapters on colposcopy and cervical cancer screening.



 


The July, 2013 Presidents' Pick 
Teresa M. Darragh, MD
ASCCP President

For the President’s Pick from the latest issue of the Journal of Lower Genital Tract Disease.  I recommend the thoughtful commentary by Drs. Mariani, Sideri, Costa, Cristoforoni, Origoni, and Preti for the Italian HPV Study Group: Human Papillomavirus DNA and Pap Tests: The Need for Cotesting in Opportunistic Setting During the Transition Time.

How we screen women for cervical cancer is rapidly changing. Blink and you may have missed the latest updates on screening and management. The Pap test has done a spectacular job in its 60-plus year history. Yet, it may now be time to say goodbye to our old familiar friend – or at least help ease it into retirement. And the authors endorse just such an easy retirement – a transition time of cotesting with Pap and HPV testing – before adoption of primary HPV testing, particularly in the setting of “opportunistic screening”. This proposal is mirrored in the latest cervical cancer screening guidelines in the United States. Whether implicit or explicit to the US recommendations, the authors also highlight important factors contributing to our reliance on Pap testing. Letting go of the annual Pap continues to be a difficult transition. Thoughtful adoption of the guidelines with cotesting at extended intervals is good medicine and will help prepare clinicians and patients alike for the move to primary screening with HPV testing. Change is hard. And it is hard to do “less”, even if based on good science. 
                           

Teresa M. Darragh, MD is Professor of Clinical Pathology, UCSF and a pathologist in UCSF Medical Center at Mt. Zion’s Department of Pathology and Department of Obstetrics, Gynecology and Reproductive Sciences. Her primary clinical and research interests are focused on HPV-related anogenital tract disease.  
Dr. Darragh is board certified in Anatomic Pathology with an added qualification in Cytopathology. In addition to her clinical work with UCSF’s Cytology Service, she is also an attending physician at UCSF’s Dysplasia Clinic. 

   
 
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