BULLETIN

PSCPC

JUNE 2019

Front Row (L-R): Dr. Rey Delos Reyes, Dr. Christine Padolina, Dr. Brenda Zamora Second Row (L-R): Dr. Benjamin Cuenca, Dr. Erwin De Mesa, Dr. Cecilia Llave, Dr. Ana Dy-Echo, Dr. Jericho Thaddeus Luna

The President’s Corner Benjamin D. Cuenca, MD

MANILA DECLARATION: CALL FOR ACTION ON CERVICAL CANCER PREVENTION AND CONTROL

Dr. Christia S. Padolina presided the first POGS-initiated meeting on May 14, 2019 at the POGS Boardroom to unify efforts towards the prevention and control of cervical cancer in the country. It is the prime objective of the initiative to draw a unified and time-bounded roadmap that will be proposed to the Department of Health (DOH) to be the standard framework for nationwide implementation. In the said roadmap, the roles, commitment and collaboration of all academic societies, government and non-government organizations will be identified and defined to maximize the available funding for cervical cancer control and prevention. For such noble reason, another POGS ad hoc committee was formed to be chaired by Dr. Padolina and co-chaired by Dr. Brenda Bernadette B. Zamora, which will be referred to as Manila Declaration: Call for action against cervical cancer. As an adviser, Dr. Rey H. de los Reyes (2013 POGS president and project director of POGS’ Women First) was present. The other key personalities in the core group were Dr. Cecilia L. Llave (Cervical Cancer Prevention chair), Dr. Jericho Thaddeus P. Luna (Society of Gynecologic Oncologists of the Philippines), Dr. Benjamin D. Cuenca (Philippine Society of Cervical Pathology and Colposcopy), Dr. Ana Victoria V. Dy Echo for Jean Anne B. Toral (Asia Oceania Genital Infection and Neoplasia) and Dr. Erwin de Mesa (Philippine Infectious Disease Society in Obstetrics and Gynecology). The current POGS president, Dr. Mario A. Bernardino, is an ex-officio member. After forging a memorandum of understanding with the DOH, the committee hope to introduce and endorse this national program to be the benchmark in the public health systems of all AOFOG member countries in order to prevent cervical cancer, control its incidence and its resulting morbidity and mortality. Background: In the Philippines and in many parts of the Asia Pacific, the incidence of cervical cancer remains high. Mortality rate, likewise, remains proportionately unchanged because of late diagnosis. This dismal trend has not improved over the decades despite the availability

of a screening tool since 1940’s and more recently, the discovery of a vaccine that will prevent the disease During the 71st World Health Assembly in May, 2018, Dr.Tedrose Adhanon Ghebreyesus, the WHO Director General, issued a call for global partnership against cervical cancer. This “call for action” was also echoed in the Asia-Pacific Economic Cooperation (APEC), JHPIEGO and United Nations Interagency Task Force on the Prevention and Control of Cervical Cancer. Consequently, in the XXII FIGO World Congress in Rio de Janeiro in October 2018, the collaborative partnership was initially discussed with Dr. Pisake Lumbiganon of Thailand. This collaboration among AOFOG countries is aimed to showcase the best practices, innovative strategies and evidence-based clinical protocols thru community approach and technology-enhanced information sharing to prevent, control and treat cervical cancer. More specifically, the program will include HPV vaccination, screening and treatment of pre-invasive diseases, treatment of invasive cervical cancer, symptom management and palliative care. The AOFOG heeds to such call. Hence, in the upcoming 26th AOFOG Congress in Manila in November 2019, the Manila Declaration: Call for action against cervical cancer will be launched.

PSCPC Holds 1st Colposcopy Workshop for 2019

Jennifer Obiles-Madera, MD

Despite the extensive campaign to eradicate cervical cancer in the Philippines, this fatal but supposedly preventable disease remains to be the second most common malignancy and the most common cause of cancer related mortality among Filipino women. The high mortality rate and the low survival rate of this disease has been attributed to the late stage upon diagnosis. This information is very dismal in that cervical cancer, when detected early, is curable. It is with this premise that the Philippine Society for Cervical Pathology was formed, bringing together people with a common goal of decreasing, if not eradicating cervical cancer. Standing true to the mission and vision of the society… that is to set the standards of care in the prevention and treatment of cervical cancer and other anogenital tract diseases and to be at the forefront in decreasing the incidence, morbidity and mortality of cervical cancer and other anogenital tract diseases among Filipino women, it has been one of the objectives of PSCPC to increase the number of colposcopists who will be adequately trained in performing colposcopy. This is for the purpose that patients with suspicious cervix detected through visual inspection with acetic acid as advocated by Department of Health in low resource areas, or those with abnormal pap smears that are detected at different levels of health services, be it from the barangay health centers, primary, secondary or even tertiary health care centers will be properly evaluated using colposcopy. Colposcopy is a diagnostic method useful for the diagnosis and evaluation of premalignant lesions of the cervix, such that more pre-malignant lesions will be detected instead of advanced stages.

With this in mind, the 2019 PSCPC Board under the leadership of Dr. Benjamin D. Cuenca, pursued the previously started Colposcopy Workshop for General OB-GYNs. Having a total 651 OB-GYNs who attended the 1st and 2nd Post-graduate Credentialing Course in Basic and Advanced Colposcopy last November 5-6, 2016 and November 12-13, 2018, it is the goal of the PSCPC Board to help these participants complete the series of steps to be able to become certified colposcopists. One of these steps is to be able to have a hands on training workshop on colposcopy (Step 3). This year, the first workshop was held at Tondo Medical Center last April 10, 2019 under the supervision of Dr. Ma. Julieta V. Germar, Workshop Project Director, with the help of Dr. Jennifer O. Madera and Dr. Irene M. Tagayuna, Workshop Project Coordinators. There were 10 participants who attended the first run of colposcopy workshop this 2019. The workshop was done in close coordination with the community service committee headed by Dr. Judith G. Cabanela, wherein a total of 125 patients were screened through visual inspection with acetic acid (VIA). These patients came from adopted barangays of Tondo Medical Center.

During this time, the participants of the workshop had their orientation and review course on the basics of colposcopy, slide show on the different pictures of normal and abnormal colposcopic findings followed by an evaluation exam. Once the review course on colposcopy was done, participants were the ones who were given the chance to do the VIA on the patients with the guidance of PSCPC workshop team.

Those who were found to be VIA positive or those with suspicious cervix were then advised to undergo colposcopy and ushered to a separate room wherein three colposcopy stations were set up. The participants were properly guided by the PSCPC workshop team members in the step by step procedure in performing colposcopy, and biopsy of suspicious lesions if indicated. There were 29 patients who underwent colposcopy. Among these, 10 patients underwent biopsy, 5 underwent polypectomy and 3 underwent cyrotherapy. All the patients who were screened were advised to proceed to a counselling station where the results of their screening and subsequent follow up were discussed. All patients were likewise given the info-comics “Ang Kwento ni Anita” launched by PSCPC to further enhance dissemination of information on cervical cancer to the lay people.

The colposcopy workshop was followed by the Loop Electrosurgical Excision Procedure (LEEP) and Cryotherapy workshop in the afternoon. The afternoon session was started off with a short review course on the equipments needed, proper technique and do’s and dont’s in performing LEEP and cryotherapy. This was subsequently followed by a Demo-return-demo in performing LEEP using ox-tongue and in performing cryotherapy using hotdog models placed inside a cylinder to simulate cervix(hotdog) inside the vaginal canal (cylinder).

Overall, April 10, 2019 was a fruitful day not only for the participants who attended the workshop but also for the PSCPC workshop team members who all felt accomplished despite the big task at hand. It is the hope of the society that these participants who completed the step 3 workshop will be able to eventually complete the step 4, which is to be able to perform 100 cases of colposcopy within the next 2 years under the direct supervision of an identified PSCPC mentor, and eventually pass the exam given by the certifying board as the step 5 to be able to finally become a certified colposcopist, and be part of the PSCPC in achieving our utmost goal… eradicate cervical cancer in the Philippines! The success of the workshop was not without the support of the Tondo Medical Center Staff with special thanks to the Medical Center Chief II of Tondo Medical Center, Dr. Maria Isabelita M. Estrella MD, MHA, FPOGS, who wholeheartedly accepted our request to host the first 2019 PSCPC workshop.

Aruga Para Sa Mga Kababaihan Judz Cabanela, MD and Avic Agulto-Mercadal, MD

Kalusugan ng Kababaihang Pangkabayanan, Inc (KnKPInc) is a non-government, non-profit organization composed of medical and paramedical professionals with an aim to promote women’s health and empowerment through charitable medical-surgical missions, especially among poor and marginalized Filipino women in the country side. Its mission is to help in addressing the most common health issues of Filipino women including prenatal care, OB GYN ultrasound services, breast and cervical cancers by conducting breast evaluations and VIA (visual inspection with acetic acid) missions regularly throughout the year, with available cryotherapy machine promoting the “see and treat approach” program.

The Philippine Society of Cervical Pathology and Colposcopy joined forces with KnKPInc last April 28, 2019 to enhance its campaign against cervical cancer by early detection of premalignant lesions using VIA as screening and colposcopy and biopsy as definitive diagnostic tools.

KnKPInc was represented by Dr. Concepcion S. Pijuan-Alfiler, Founder and Chairwoman; Dr. Felicitas C. Manalastas-Lector, Vice President and Treasurer; and members: Dr. Ramonina Gerona, Remy Pijuan, Criscel Torrecampo-Pagkatipunan and Luz Baltazar-Fernando. The PSCPC was represented by its President, Dr. Benjamin D. Cuenca, Treasurer/Chair of Community Service, Dr. Judith G Cabanela, PSCPC Member, Dr. Leniza Ultra with the Gynecologic Oncology Fellows from Jose R. Reyes Memorial Medical Center (JRRMMC) Drs. Roxanne Rivera, Marivic Agulto-Mercadal, Joan Kristel Abrenica, Zelda Sue De Leon, Martha Isabel Parroco and Marilou Yu.

A total of 164 patients were served during the activity. A lay forum was also conducted among the participants on cervical cancer prevention and was given by Dr. Cabanela. VIA screening was done on 82 patients with 11 of them requiring further colposcopic evaluation and 17 patients underwent cervical biopsies. KnKPInc likewise performed 82 prenatal consultations and OB ultrasound, and a lecture on reproductive health.

The mission was held at Marikina City Health Office, Marikina City, through its head Dr. Albert Herrera. This activity was sponsored by Rotary MANPASAN (Mandaluyong, Pasig and San Juan), headed by its President, Mr. Francis Alpas.

Cervical cancer is a preventable disease. A routine screening, early detection and timely management of premalignant cervical lesions can eradicate this disease and eventual a healthy women’s community.

Babae! Mahalaga ka! Magpa screening na!

NOTE FROM THE EDITOR: Dear Readers, This is a special PSCPC Bulletin highlighting the Declaration of Manila of War Against Cervical Cancer and our recent activities. We would also like to remind the membership regarding the Business Meeting on July 27, 2019 7:30 AM at the Edsa Shangri-La Hotel. Much awaited is the second issue of our newsletter which features the National VIA Day last May 23, 2019. Watch out for that! Renee Vina G. Sicam, MD Editor-in-Chief

SAVE THE DATE:

ANNUAL BUSINESS MEETING

July 27, 2019 7:30-10:00 AM

Edsa Shangri-La Hotel