This talk is in the cervix cancer session and it is all about the possibility of actually retaining the uterus while you do surgery for cervical cancer. It’s only applicable to women with very early cancer of the cervix; it’s definitely only for women with stage 1 disease where the cancer of the cervix is indeed then only in the cervical stroma present. Very often these women are diagnosed on a cone biopsy which is a biopsy where you remove the bottom part of the cervix and the cancer is often confined to the cone. This is especially true in series from the developed world where women are now often diagnosed with cervical cancer following a screening programme. In Africa, of course, tumours tend to occur later and we have more women with late stage disease and this type of situation is more scarce. However, in Africa the sparing of fertility, or uterus sparing surgery, is something that is very, very important for women. Very often fertility is related to the whole social system of a woman and if she loses fertility her uterus and menstruation, she is seen as someone that does not deserve a husband any more. So in that way it’s something that we really need to do. So that’s basically the talk. Also, then, how we can use the data from the developed world and interpret it in a good way and use it in Africa.

Could women with non-fertility sparing treatments lose their husbands?

Yes, that’s actually not so scarce. Even women diagnosed with cervical cancer who get radiation for cervical cancer and don’t even lose the uterus but, of course, still lose fertility are often in a divorce situation. Even women who have not been married lose the opportunity to get married. For many women in developing countries that is the only way of subsistence, really, to have a husband that will look after her.

What about radical hysterectomies?

Again, this talk was about using the data from the developed world for women in Africa. Now, in the developed world, as already said, cancer tends to be diagnosed earlier and earlier now and it’s often really small tumours that are detected on the cervix, very often detected during a screening programme in a woman completely asymptomatic. Therefore, the very radical surgery initially developed to remove cancer of the cervix is not applicable anymore. So I can almost say the whole world, or a lot of the world that counts, that writes all the articles and manuscripts in the scientific journals, are moving away from radicality. However, radicality is also the most important aspect of surgery for cancer and if you use inappropriate radicality you lose cure. Therefore, in Africa it’s extremely important that we should educate surgeons and cancer surgeons, everyone working in this field, to interpret this new data moving away from radicality for what it is and use it only in situations where it’s truly applicable. In women with large tumours, in my view, we should not be moving away from radicality.

There’s another aspect that’s really of importance and that is that we often salvage less radical surgery by adding radiation as an adjuvant therapy or an extra therapy after the surgery. In cervical cancer in Africa this is a very inapplicable way of thinking because radiation resources are so scarce. So we should not be thinking of doing less radical surgery because we can always irradiate the woman - if we weren’t radical enough just radiate. That is very, very wrong if you have very scarce resources. There are actually many centres in Africa where women do not have any access to radiation but if we can develop surgical skills better, surgery is much, much cheaper than radiation, it requires less upkeep, less technology and therefore it is something that can save many women’s lives, especially if we can apply the correct radicality for the correct tumour.