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Arriving, for
the first time ever at a national meeting, at the York University
Campus without the provided paperwork (i.e. maps, directions etc.),
relying totally on the fact that I had been there before, and my
son living locally, I was dismayed to find that the usual AA/RAC
notices directing delegates, were not in evidence.
However, this
was the only omission in an otherwise excellent meeting, and Sharon
Roberts-Gant and Mike Rowell, looking equally lost, came to
my rescue.Having registered, settled into comfortable accommodation,
showered and changed after a somewhat prolonged journey north along
the A1, I found myself in the midst of the Friday evening Trade
Show, already swarming with delegates, some disguised in beach wear!
The Trade, as usual, provided us with a great variety of stands,
enticing us to view their wares with various competitions, with
champagne or even a camera as rewards. During the evening we were
well fed with a Greek-style cold buffet, and then to the beach-party
disco, with the fancy dress competition being won by a team of very
well-endowed life-savers from Colchester. I wondered how David Jefford
was able to get them near a microscope!
Saturday dawned
grey and miserable, so it was pleasing to see that the scientific
programme promised a varied and interesting day, and we were not
disappointed. Dennis Williams opened the meeting with his
Presidential address, remarking that the change in venue had not
affected numbers, there being almost 500 delegates present, with
more travelling from north of the border. He introduced the first
speaker Mr. Joe Jordan, well known to we older Cytologists,
who gave us his views on cervical cancer prevention in the next
100years. After
showing slides of pioneers of cervical cytology as we know it today,
Betty Attwood, David Melcher, Liz McKenzie, Mr Jordan reminded us
that since the cervical screening programme began in the U.K. in
1986, cervical cancer by 1994, had been reduced by12%, and was becoming
a rare disease; a success story indeed, and one in which we should
all be proud to have played our part. He felt that what was needed
now was to target the less affluent in society. LBC and HPV testing
together with automation, would be the way forward, to reduce the
false negative and inadequate rates, and workload, and thereby combat
the problem of recruitment and retention of staff. But above all
the success of cervical screening depended on us, and there was
no room for complacency.
This excellent
review was followed by a global over-view of cervical cytology by
Saloney Nazeer , a gynae oncologist from Geneva. She produced
many facts and figures, but those that made an impression on me
were: cervical cancer affects 450,000 women world- wide, 80-85%
of these being diagnosed at a late, incurable stage. Only 8% of
women are screened in developing countries, which should make us
all realize how lucky we are to have the NHS, for all its imperfections.
The World Health Organisation (WHO) has set up guidelines for screening
in 3rd world countries, where it may only be possible to screen
once in a woman's lifetime. She also reminded us that coverage is
the most important factor for screening success.
The final speaker
before coffee was Dr. Thomas Giles from Liverpool, whose
talk was entitled " False negative rules - O.K ". He quoted
from the most recent edition of Cytopathology (June 2003 - Vol.
14 No.3, P. 101), a personal review written by his colleague, Dr.
Peter Smith, " we owe as much duty to a woman with a normal
cervix to call her negative smear negative, as we do to a woman
with CIN3 to call her abnormal smear abnormal". This, I thought
succinctly summed-up his talk, that false positives are as important
as false negatives, as they may lead to unnecessary anxiety, and
excessive treatment, which may lead to complications
Following coffee,
we heard three further excellent lectures from well-known supporters
of the NAC - Dr. John Smith, Dr. David Luesley, and Dr. Christine
Waddell. John Smith began his always lively talks with a
somewhat naughty lyric (I did not manage to write it down!), and
went on to speak of the various infections which may be associated
with CIN, and those which have now been shown to have no part in
its aetiology. Dr. Luesley managed to present his talk on
New Colposcopy Guidelines, due to be implemented in 2004, which
could have been deathly boring, in an interesting way. Christine
Waddell had entitled her talk 'Lumps and Bumps', showing us
drawings of micro-biopsies in the shapes of animals from Papanicolaou's
book published in 1957. These we are still seeing in smears today,
and her talk re-enforced the well-known difficulties we sometimes
have in making a definitive diagnosis.
After a sustaining
lunch, while visiting the Trade, and queuing for microscopes, to
take part in an educational quiz organized by Nick Dudding,
we returned across the lake to the lecture theatre for talks on
those current topics - Agenda for Change by Sarah May, IBMS,
and an up-date on the progress of LBC by Dr. Ray Lonsdale of
Norwich. The session before tea was enlivened by Penny Chandiok,
with a talk on sexually transmitted diseases, which had us all nearly
"rolling in the aisles", and certainly awakened us for
the final session of the day which was to include the AGM.
Margaret
Stoddart, a veterinary surgeon, gave the final lecture of the
day on veterinary cytology, interspersed with her memories of a
vet in practice, James Herriott style! Not only was this highly
entertaining, but for those delegates who have a knowledge and interest
in non-gynae cytology, this was a most interesting talk, with plenty
of audience participation, eager to show their diagnostic skills.
The audience
rather thinned, as always for the AGM, which is a great pity, as
this is where so many topics, which should be of interest to the
membership, are discussed and voted on. This is particularly so
this year with controversy over Cytoscreeners state registration,
and re-grading in Agenda for Change. A lively discussion ensued,
and delegates were asked to write to Julietta Patnick and their
local M.P. regarding these matters.This discussion continued on
Sunday morning, with David Houliston, the trade union delegate
for AMICUS imparting his knowledge, and details of (private) discussions
with the Department of Health. He urged members to join AMICUS -
they are the only people who have a vote in Agenda for Change, and
their pay and future conditions of service depend on their vote.During
the Sunday session, Dennis Williams gave us his experiences
of sitting the Advanced Practitioners exam in cervical cytology,
and warned prospective candidates that there was no quick route
to success, or substitute for experience. He also quoted from Peter
Smith's article in Cytopathology, and advised all prospective candidates
to read it.
David Brooke
and Nick Dudding were the final speakers of the meeting, David
on rapid Pre-view, which, he felt, proved the discovery of more
errors than rapid Re-view, but was more time-consuming. Then finally
Nick Dudding gave us the answers to the quiz. Quote- " look
at that group - it's like shopping at Morrison's (crowded group),
but look at these, they are like Sainsbury's - lots of room in the
aisles - I like Sainsbury's". This, I think is brilliant -
it fixes the morphology of smears in ones mind eternally. An excellent
teacher is Nick.
So ended the
14th NAC meeting, with a substantial Sunday roast I'm told. I have
not been to all of them (possibly only 10), but I have to say that
this must be one of the best. Changing venue from Warwick to York,
might have been a gamble, but it proved highly successful, and the
standard of lectures was higher than ever. Not once did I feel like
nodding off, and that was not because I had this report to write.
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