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Epidemiology of carcinoma in situ of the cervix.
Jordan, Joseph A
Uterine Cervical Neoplasms
Joseph Jordan of Birmingham Maternity Hospital, in discussion with Geoffrey Chamberlain, Institute of Obstetrics and Gynaecology, London. Firstly, Jordan attempts to show whether or not death from squamous carcinoma of the cervix is preventable. He describes how squamous carcinoma is usually, if not always, preceded by a pre-cancerous lesion known as carcinoma in situ, and explains how regular screening by cervical cytology (Pap test) may help to reduce mortality from this disease. Explanations are also suggested which attempt to show recent research into how and why carcinoma of the cervix arises in the first place.
Segment 1 Chamberlain and Jordan are seated for discussion with a display board set up between them. Chamberlain introduces the lecture series and gives a brief account of Jordan's background. Jordan gives statistics for incidence and death rates from cancer in situ in the UK. He talks about the first discovery of a carcinoma in situ lesion by Sir John Williams, in London, 1886. He describes how carcinoma in situ is a microscopic, cellular change, bounded by the basement membrane and that at this stage it is known as stage 0. Time start: 00:00:00:00 Time end: 00:04:51:10 Length: 00:04:51:10 Segment 2 Jordan differentiates between stage 0 and stage 1 cancer. Stage 1 cancer has gone beyond the in situ stage but is still confined to the cervix. He describes the difference between stage 1a and stage 1b cancer. Jordan then suggests looking at how carcinoma in situ is believed to develop. He shows a chart which helps him explain the process of 'metaplasia', which occurs in all women, and changes aspects of the cells of the epithelium. The cells undergoing change are very susceptible to carcinogens. He describes how squamous carcinoma of the cervix is essentially a venereal disease, brought about by an as yet unknown carcinogen in sperm. Chamberlain then asks him what amount of women with carcinoma in situ will go on to develop more advanced stage cancers. Jordan says this is unknown, but he gives some statistics from across the globe. Time start: 00:04:51:10 Time end: 00:10:45:00 Length: 00:05:54:14 Segment 3 Jordan talks about how difficult it is to diagnose abnormal cells from a sample on a glass slide. He and Chamberlain discuss other methods of diagnosing carcinoma in situ, that don't need a small biopsy of cervical tissue. Jordan describes the use of the colopscope, 'a pair of binoculars on a stick with a light source.' This is as good, he says, as any diagnosis a pathologist could make from a tissue biopsy. Time start: 00:10:45:00 Time end: 00:15:13:07 Length: 00:04:28:07 Segment 4 Chamberlain invites Jordan to discuss cervical screening programmes. Jordan quotes from the David Boyes programme in Vancouver, set up in 1948, which provides 31 years of evidence on whether or not screening programmes are valuable. They talk about the practicalities of such a programme, such as how frequently women should be tested and what to do when faced with false-positive results. Jordan then demonstrates how a spatula should be used to get a sample of the cervical cells effectively. Time start: 00:15:13:07 Time end: 00:20:03:11 Length: 00:04:50:04 Segment 5 Chamberlain and Jordan discuss different methods for obtaining samples from the cervix. As some women find having their cervix scraped with a spatula rather painful, they discuss a newly invented do-it-yourself kit.The then discuss the reasons why some smear tests obtain either false negative or false positive results; they discuss statistics for this. After this they move on to discussing how women are having regular smears.bTime start: 00:20:03:11 Time end: 00:25:18:13 Length: 00:05:15:02 Segment 6 Chamberlain and Jordan discuss the amount of women diagnosed with carcinoma of the cervix before and after cervical screening became available. The figures they refer to are mainly from a 30-year long study from Vancouver. They compare and discuss various other statistics from around the world. Time start: 00:25:18:13 Time end: 00:30:13:14 Length: 00:04:55:01 Segment 7 Chamberlain and Jordan discuss possible reasons for changes in the prevalence of carcinoma of the cervix. Sexual promiscuity is discussed. They finish the discussion by pointing out the positive data which shows that cytological screening is proving very beneficial in the early detection and treatment of carcinoma of the cervix. Time start: 00:30:13:14 Time end: 00:37:00:01 Length: 00:06:46:11
Discussed by Mr Geoffrey Chamberlain and Mr Joseph Jordan. Produced by Jennie Smith. Made for British Medical Federation in association with the Blair Bell Research Society. Made by University of London Audio-Visual Centre.
This video is one of around 310 titles, originally broadcast on Channel 7 of the ILEA closed-circuit television network, given to Wellcome Trust from the University of London Audio-Visual Centre shortly after it closed in the late 1980s. Although some of these programmes might now seem rather out-dated, they probably represent the largest and most diversified body of medical video produced in any British university at this time, and give a comprehensive and fascinating view of the state of medical and surgical research and practice in the 1970s and 1980s, thus constituting a contemporary medical-historical archive of great interest. The lectures mostly take place in a small and intimate studio setting and are often face-to-face. The lecturers use a wide variety of resources to illustrate their points, including film clips, slides, graphs, animated diagrams, charts and tables as well as 3-dimensional models and display boards with movable pieces. Some of the lecturers are telegenic while some are clearly less comfortable about being recorded; all are experts in their field and show great enthusiasm to share both the latest research and the historical context of their specialist areas.
Current Research in Obstetrics and Gynaecology