Cervical Cancer is the 4th commonest female cancer. Maternal mortality rates have greatly improved over 15 years. Cervical cancer is preventable, detectable, and curable if detected early.
Dr. Theresa Freeman-Wang discusses the aetiology, prevention and treatment of cervical cancer. Colposcopically directed cervical biopsy has been the gold standard for the detection of cervical intra-epithelial neoplasia and cancer following an abnormal cervical smear. Colposcopy has an accuracy at least 65% for high grade cervical intra-epithelial neoplasia with a sensitivity of 55-95% and specificity 58-86%. The deficiencies of colposcopy, differences in colposcopy practice, training, quality assurance and the future of colposcopy are analysed.
Newer technologies include the Mobile ODT mobile phone and 3D printed case, fiber-optic confocal microscope, DySIS - a digital video-colposcope using dynamic spectral imaging technology to measure the rate, extent and duration of aceto- whitening of cervical epithelium and Zedscan based on electrical impedance spectroscopy. In the future, colposcopy will be aided by biomarkers, biomedical devices and image recognition applications.
Miss Freeman-Wang trained at Bristol University, qualifying in 1989.As a medical student she developed an interest in Obstetrics and Gynaecology with electives spent at Harvard Medical University and Shanghai Medical University.
She moved to the Royal Free Hospital in 1991 to pursue a specialist career. As part of her training she spent a year at the Institute of Urology and then a year at Queen Charlotte’s Hospital. As a registrar, she worked for Mr Patrick Walker at The Royal Free Hospital and developed her interest in colposcopy, which has continued. Her research looked at methods of reducing the anxiety experienced by women with cervical pre-malignancy and was one of only a few studies to show how video information can significantly reduce anxiety.
She also developed her love of teaching which continues locally, nationally and internationally. In 2002 she was appointed as a full time gynaecology consultant to the Whittington Hospital. She remains lead clinician for both the colposcopy and vulval services. She has also been a Clinical Director for Women and Children’s Health and a Joint RCOG tutor for trainees. Between 2004-10, She represented London on the executive committee of the BSCCP. Miss Freeman-Wang is currently the Quality Assurance Lead Colposcopist for London, being responsible for the quality of colposcopy services provided across the capital. In a similar vein, in private practice, she chairs the Colposcopy Users Group at the Portland Hospital in London.
Miss Freeman-Wang's experience in managing women with vulval problems, particularly vulval pain, has taught her the value of a multi-disciplinary approach, which sometimes requires co-ordinating input from allied specialities including dermatology, urogynaecology, surgery, anaesthesia, physiotherapy, psychosexual counselling and complementary therapists.