The optimum organization for the delivery of colposcopy service in Ontario: a systematic review.

OBJECTIVE: To determine the optimum organization for colposcopy service delivery in Ontario, Canada. METHODS: A multidisciplinary expert panel was convened to develop a systematic review to inform organizational guidelines. MEDLINE, EMBASE, CINAHL, HealthSTAR, and the Cochrane Library databases were searched from 1996 to February 2006 for articles that reported guidance or outcomes relating to improved outcomes in colposcopy training, qualifications, accreditation, maintenance of competency, the delivery of colposcopy, reducing default from colposcopy clinics, and/or strategies to improve patient satisfaction or comfort. In addition, an environmental scan identified unpublished documents related to the delivery of colposcopy services. RESULTS: Sixteen guidance documents related to the delivery of colposcopy services were identified; 5 from the published literature and 11 from the environmental scan. These documents were used by the panel to inform the systematic review and companion guidelines. CONCLUSIONS: Overall, the Ontario Colposcopy Guidelines Development Group believes that the benefits associated with the implementation of colposcopy recommendations in Ontario will result in greater organization of care and improved patient outcomes. In addition, the group anticipates that these recommendations will provide useful guidance to regional planning authorities, hospital administrators, and Cancer Care Ontario, as well as colposcopists and other practitioners, in the planning of integrated regional and provincial cancer screening services.

Human papillomavirus--lessons from history and challenges for the future.

Human papillomavirus (HPV) is the most common sexually transmitted infection, and HPV-associated cervical cancer is a significant cause of morbidity and mortality worldwide. Recent advances in molecular biology have facilitated testing for HPV infection. Over the last decade, national and international cervical cancer screening programs have added HPV testing to their guidelines. The use of HPV prophylactic and therapeutic immunization may expand the need for systematic HPV testing to help define eligible subgroups for intervention. Given the worldwide variation in HPV subtype prevalence, basic Pap testing will continue to play an important role in cervical cancer screening, and methods to improve Pap smear sensitivity may help to improve screening in the future. This review focuses on the genetics and cellular biology of HPV infection, the natural history and prevalence of HPV infections, cervical cancer screening around the world and in Canada in particular, and evolving research to improve screening methods.

Laparoscopic excision of a cystic retroperitoneal adenocarcinoma arising in a focus of extra-ovarian endometriosis.

We report an unusual case of a retroperitoneal cystic adenocarcinoma arising in a focus of extra-ovarian retroperitoneal endometriosis. The lesion was completely excised using a transperitoneal laparoscopic approach without the need for any adjuvant chemotherapy or radiation therapy. The patient remains clinically well with no evidence of recurrent or metastatic disease after 3 years of follow-up. To our knowledge, this is the first reported case of this type of rare extra-gonadal endometriosis-associated neoplasm with successful laparoscopic excision.