The topic I was presenting today was I am a member of the FIGO Cancer Committee and we changed the staging for cervical cancer so we’ve a new staging procedure. Staging itself, of course, is just a language as to the disease spread normally at presentation. As the international language we use staging is very, very important so that we understand what we’re talking about at big meetings like this and that stands for all cancers. On this occasion one of the issues we’ve had for many years in cervical cancer is that women with a stage 1 disease could have disease spread to the lymph glands in the pelvis but they would also, if it was positive or negative, they would all be deemed stage 1 even though the outcomes are very, very different.

So in essence the main change to the staging procedure for cervical cancer now is the acceptance of the fact that those women where the disease has spread into the lymph glands in the pelvis or elsewhere will now be called stage 3 patients and that there are two ways you can determine that. One is you might do some imaging, generally speaking it may well be an MRI or CT scan or more likely a PET scan, and secondly you can also stage them pathologically i.e. when you do an operation thinking the nodes were negative and you find they’re positive, we call that that a pathological staging. So this is trying to embrace an issue that’s been ongoing, actually, for quite a few decades where clinicians were very uncomfortable and didn’t see the logic of why a person called stage 1b could have no spread and could also have spread, it intuitively and logically made no sense. So this is addressing quite a long term issue in the field of cervical cancer staging for many years.

The reception to it has already been very positive. It will mean, of course, that when you make these kinds of moves it’s possible that for stage 1 disease you might actually see the survival patterns changing slightly because you’re taking out a group of patients who do worse. So you get this phenomenon that occurs is that by moving patients with a poorer outcome from one stage to a different stage where the outcome is the same you get this blip. It’s called the Will Rogers phenomenon and looks like stage 1 patients are doing well or even better than before but it’s only a movement of patients to another stage. So that will probably happen.

But the important thing is getting the message out that the change is now published just a couple of months ago and to get people around the world to gradually adopt this within standard clinical practice. So that was the main thrust of the first meeting was to present the international stance, if you like, on the new staging of cervical cancer plus discussions on others that we haven’t changed and the reasons why we’re not changing those but what may develop in the future for some of the other gynaecological cancers. So primarily it was about that and it seemed to be very well received, in fact most people seemed to be very happy that this change has eventually occurred.

How long do you expect this to take to roll out and could there be any problems in doing this?

One of the issues is it will take some time. It could probably be up to a year depending on where people are working. For example, if we take the UK base we have cancer registries; the data we can start collecting now but the amalgamation of that data in the full adoption might take up to twelve months but we’ll be encouraging people to keep the old staging and the new staging in parallel. But for some of the systems within the cancer registries, for them to adjust to the new staging they have to go through quite a lot of processes to make sure they have everything and the computer is correct. You would think that could be done by the flip of a button, it doesn’t work that way. So it may well be for it to be fully embedded where we’re gathering the information purely using that staging to get population outcomes might take probably up to a year we’re giving that.

Will there be any impact on patients?

I think it means that for patients we’d always been able to say to them that you have a stage 1 but the nodes were involved. We’ll automatically give them further treatment so it doesn’t really impact on the patients in the sense that they knew that if the nodes were positive compared to a person with node negative cervical cancer that the outcome was going to be different because it had spread. So it doesn’t alter what we’re doing with the patients, it’s just the fact that the identification is more in parallel with the outcomes as well. So we’ve been managing the patients appropriately, it’s just mixing both these groups together was not probably the correct way of doing it in the longer term.