Why are ObGyns Talking Toxins ?

Let’s make environmental health part of health care

Doctors from 125 countries want policies to prevent exposure to toxic chemicals

Produced for PRHE by Susan Lamontagne, Public Interest Media Group, for the International Federation of Gynecology and Obstetrics (FIGO) XXI World Congress on September 30, 2015.

Why are Doctors Talking Toxins ?

And how to reduce exposure to toxic chemicals worldwide ?

It’s time to shift the burden of proof, from scientists, back to the chemical industry

Video published on 5 June 2019, by UCSF Program on Reproductive Health and the Environment.

Cancer of the cervix uteri

Half a million new cases of cervical cancer are added each year

Abstract

Since the publication of the last FIGO Cancer Report there have been giant strides in the global effort to reduce the burden of cervical cancer, with WHO announcing a call for elimination. In over 80 countries, including LMICs, HPV vaccination is now included in the national program. Screening has also seen major advances with implementation of HPV testing on a larger scale. However, these interventions will take a few years to show their impact. Meanwhile, over half a million new cases are added each year. Recent developments in imaging and increased use of minimally invasive surgery have changed the paradigm for management of these cases. The FIGO Gynecologic Oncology Committee has revised the staging system based on these advances. This chapter discusses the management of cervical cancer based on the stage of disease, including attention to palliation and quality of life issues.

Reference.

FIGO Cancer Report 2018

Presention of the management of gynecological cancers

The FIGO Committee for Gynecologic Oncology is pleased to present the third edition of the FIGO Cancer Report. Since 2012, this report has been presented triennially in the current format, which aims to present the state of the art management of gynecological cancers in our endeavor to ensure women worldwide receive an acceptable standard of care. The excellent readership of the previous edition encouraged us to produce an updated edition. A series of carefully reviewed and presented articles covers each of the gynecologic cancers. Chapters on pathology, targeted therapy, psychosexual health, and end‐of‐life care have been updated. New chapters have been added on surgical anatomy in gynecologic oncology, essential surgical skills for gynecologic oncologists, enhanced recovery after surgery, role of imaging in endometrial cancer, and cancer in pregnancy. This edition is Open Access to ensure wide dissemination. The 2015 edition of the Cancer Report was translated into Portuguese and Spanish, and the 2018 edition will also be translated to ensure greater readership.

Undeniably, this does not do away with the need for data. The situational analysis done during the tenure of the previous committee had indicated the need to position dedicated data entry managers to get good quality data from low‐ and middle‐income countries (LMICs). However, this project could not find funding. It is apparent that in these days of widespread internet use and mobile health, new methods will have to be found. The Committee initiated a survey to understand changing practices, the results of which will be presented at the XXII FIGO World Congress, held in Rio de Janeiro, Brazil, October 14–19, 2018. It is hoped that increased use of these techniques will bring more insights.

In the last three years, FIGO Gynecologic Oncology Committee members have been actively engaged in organizing and participating in several educational activities including conferences, workshops, and training programs in various countries. They have developed educational aids including handbooks and slide sets. An e‐learning course in collaboration with the Catalan Institute of Oncology (ICO) has been implemented. Cadaver training programs have been initiated for skills development in open and laparoscopic surgery. A smartphone mobile application (free to download and use ofline) for staging and resource‐based management of gynecologic cancers was developed in collaboration with the International Atomic Energy Agency (IAEA).

One of the major objectives of the Committee has been to work with governments to inform policy regarding the implementation of the HPV vaccine program. Members have been engaged in advising various governments during this period. The Committee has collaborated with international and nongovernmental organizations to support this cause in different regions.

By far one of the most challenging tasks undertaken by the Committee was the revision of the staging of cervical cancer. Hitherto staged by clinical methods only, it was insensitive to the advances in technology that had improved the quality of imaging and brought in minimally invasive surgery to facilitate access. However, being a disease largely confined to LMICs, there was widespread belief that a revision would not be applicable where it was needed most. Various rounds of discussions, extensive literature review, interaction, face‐to‐face meetings with the major gynecologic oncology societies internationally, in collaboration with the International Union for Cancer Control (UICC) and the American Joint Commission on Cancer (AJCC), finally resolved the impasse and the 2018 revision now allows the use of imaging and pathology in a way that can be practiced at all levels of resources. The revised staging has been endorsed by the FIGO Executive Board and will be published in the International Journal of Gynecology and Obstetrics (IJGO).

The members of the FIGO Committee for Gynecologic Oncology during this term were: Neerja Bhatla (Chair), India; Kanishka Karunaratne (Co‐Chair), Sri Lanka; Lynette Denny (Immediate Past Chair), South Africa; Seija Grenman (Vice President FIGO, Ex officio member), Finland; Jonathan Berek, USA; Mauricio Cuello Fredes, Chile; Sean Kehoe, UK; Ikuo Konishi, Japan; Alexander Olawaiye, USA; Jaime Prat, Spain; Rengaswamy Sankaranarayanan, France.

Going forward, the Committee will continue its work on FIGO staging, the next cancer to be updated will be cancer of the vulva. FIGO also hopes to work closely with WHO in response to the call for elimination of cervical cancer. Collaboration with the International Agency for Research on Cancer (IARC) will help to gain insights on incidence and survival statistics from different regions to understand the inequities and direct our efforts to promote appropriate education and skills training as we work together to lessen the burden of gynecologic cancers.

Reference. FIGO Cancer Report 2018.

The International Federation of Gynecology and Obstetrics World Congress 2018

XXII FIGO 2018, Rio de Janeiro, Brazil

The FIGO World Congress of Gynecology and Obstetrics is the single largest global congress on maternal and infant health, bringing together obstetricians, gynecologists and related health professionals from around the world.

The #FIGO2018 XXII FIGO World Congress of Gynecology and Obstetrics will take place in the beautiful city of Rio de Janeiro, Brazil from 14-19 October 2018.

Environmental threats to human health

FIGO Media Briefing, Environmental Health, London, 1 October, 2018

In the last 40 years, there has been a global increase in human exposure to a variety of potentially toxic chemicals in the environment.

Research shows that whether we are concerned with reproductive health, cancer, infertility, neonatal and childhood health or neurodevelopment; toxic exposures are implicated.

World leaders have acknowledged that minimising environmental threats to human health and reproduction is a necessity if we are to substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination, and therefore progress towards the 2030 Agenda for Sustainable Development (SDGs).

“We are at the very beginning of a tsunami that will require local leadership: California has placed a priority on energy independence which can improve air quality and reduce birth defects, prematurity, asthma and heart disease. The European Union has limited exposure to endocrine disruptors. China instituted a host of measures in 2013, so that by 2018 there has been a reduction of air particulate matter by 32%. They declared a war on pollution and are winning!”

Jeanne Conry, MD, PhD, Co-Chair, FIGO Working Group on Reproductive and Developmental Environmental Health, USA.

91% of the world’s population lives in places where air quality exceeds WHO guideline limits. Air pollution is a major environmental risk to health. By reducing air pollution levels, countries can reduce the burden of disease from stroke, heart disease, lung cancer, and both chronic and acute respiratory diseases, including asthma. The lower the levels of air pollution, the better the cardiovascular and respiratory health of the population will be, both long- and short-term.

“Our first challenge is awareness: Most clinicians are not aware that environmental exposures impact health. Most of us assume that the chemicals released into the environment, that we are exposed to as we apply make-up, prepare food, or breathe air, have been studied. They have not. Clinicians need to understand that the lack of research doesn’t mean they are safe, and makes the burden of proof very difficult, because our patients are exposed repeatedly to many chemicals in many ways through many types of exposure”.

Jeanne Conry, MD, PhD, Co-Chair, FIGO Working Group on Reproductive and Developmental Environmental Health, USA

This month, October 14 – 19, over 10,000 health professionals are attending FIGO World Congress 2018 in Rio de Janiero. Environmental Health is a core theme throughout the event, with key sessions being covered include:

  • Impact of Environmental Toxics on Global Women’s Health
  • Environmental Reproductive Health and the Heath Care Provider: Evidence based approaches to providing advice
  • Research agenda to illuminate how the environment affects reproductive and developmental health
  • “Training the Trainers” to talk with their patients and the public about environmental impacts on health

“Our challenge is priorities: When we are faced with maternal mortality, cancer, and violence, it may seem we do not have the “band width” or capacity to discuss the environment. BUT we need to help clinicians understand they are equipped to discuss this subject and lead their patients in awareness, and that advocacy for change is essential”.

Jeanne Conry, MD, PhD, Co-Chair, FIGO Working Group on Reproductive and Developmental Environmental Health, USA.

Reference.

Talking Toxic Chemicals: EDCs Expert Scientists urge Prevention

A global problem that need a global solution: time to act on a global scale

Video published on 1 Dec 2015 by PRHE UCSF‘s channel

Exposure to toxic environmental chemicals among women and men of reproductive age is ubiquitous and threatens healthy human reproduction.

The International Federation of Gynecology and Obstetrics (FIGO) World Congress attendees learned more about the science that links exposure to toxic environmental chemicals to poor health outcomes and what physicians and health care providers can do to prevent harm

More information

FIGO Opinion on Reproductive Health Impacts of Exposure to Toxic Environmental Chemicals

FIGO champions environmental justice by pushing against endocrine disruptors and toxic chemicals

International Federation of Gynecology and Obstetrics opinion on reproductive health impacts of exposure to toxic environmental chemicals.

Publisher: International Journal of Gynecology and Obstetrics, FIGO, December 2015.

Widespread exposure to toxic environmental chemicals threatens healthy human reproduction. Industrial chemicals are used and discarded in every aspect of daily life and are ubiquitous in food, water, air, and consumer products. Exposure to environmental chemicals and metals permeates all parts of life across the globe. Toxic chemicals enter the environment through food and energy production, industrial emissions and accidents, waste, transportation, and the making, use, and disposal of consumer and personal care products.

Overview

  • Introduction
  • Vulnerable people, communities, and populations
  • Nature and extent of prenatal and preconception exposure to toxic environmental chemicals
  • Health impacts of preconception and prenatal exposure to toxic environmental chemicals
  • Global health and economic burden related to toxic environmental chemicals
  • Recommendation for prevention
  • Conclusions
Sources and more information

Reproductive Health and the Environment Symposium 2015

International Federation of Gynecology and Obstetrics (FIGO) XXI 2015 World Congress

Video Overview

The video mentions the Diethylstilbestrol and Thalidomide tragedies…

  • 00:40 Introduction: Reproductive Health, OBGYNs and the Environment, Jeanne A. Conry, MD, PhD, Past president, American College of Obstetricians and Gynecologists, Assistant Physician-in-Chief North Valley, Kaiser Permanente.
  • 08:40 From Silent Spring to Silent Night, Tyrone B. Hayes, PhD, Professor, Integrative Biology, University of California, Berkeley.
  • 28:40 Environmental Reproductive Health in Developing Countries, Katsi Cook, Program Director for Indigenous Communities, NoVo Foundation.
  • 54:40 Global Reproductive Health and the Environment: What Does the Evidence Say? Tracey J. Woodruff, PhD, MPH, Professor and Director, University of California, San Francisco, Program on Reproductive Health and the Environment.
  • 01:18:10 Vision for the Future. Dr. Jennifer Blake, CEO, The Society of Obstetricians and Gynaecologists of Canada.
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Environmental Exposures and Reproductive Outcomes: A Call to Action!

UCSF Linda Guidice lectures on reproductive effects of chemical exposures

Check out the slide at 09:40 – includes a DES advert. At 19:00 Linda C. Giudice mentions the Diethylstilbestrol and Thalidomide tragedies…

Presented by Linda C. Giudice, MD, PhD, MSc, Distinguished Professor and Chair, UCSF Obstetrics, Gynecology, and Reproductive Sciences (UCSF OB/GYN & RS) and Past President of the American Society for Reproductive Medicine (ASRM)

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