On May 31, 2026, Tbilisi hosted the 11th Annual International Conference of the Georgian International Medical and Public Health Association (GIMPHA), bringing together hundreds of physicians, researchers, and healthcare professionals from Georgia and abroad. For years, GIMPHA has served as an important platform where Georgian and international medical experts exchange scientific knowledge, clinical experience, and the latest developments in medicine. Founded in the Netherlands in 2012, the organization\u2019s mission is to promote evidence-based medicine and strengthen healthcare systems in Georgia and beyond.<\/p>\n
This year\u2019s conference featured a diverse scientific program covering oncology, cardiology, infectious diseases, public health, and many other medical disciplines. According to media reports, approximately 600 delegates participated in the event, representing both local and international healthcare communities.<\/p>\n
One of the most thought-provoking presentations during the gynecologic oncology session was delivered by Dr. Madona Jugeli, President of the Georgian Federation of Colposcopy. Her lecture, entitled \u201cWhy Colposcopy Alone Is Not Enough? \u2013 Complete Lower Genital Tract Assessment for HPV-Associated Cancer Prevention,\u201d<\/em> addressed one of the most important contemporary challenges in gynecologic oncology: the detection and prevention of multifocal HPV-associated disease.<\/p>\n The central message of the presentation was that evaluating only the cervix is no longer sufficient in modern clinical practice. Accumulating scientific evidence suggests that high-risk human papillomavirus (HPV) infection frequently affects multiple anatomical sites simultaneously. The virus may involve the cervix, vagina, vulva, and anal canal, making a cervix-centered diagnostic approach inadequate for assessing a patient\u2019s overall oncologic risk.<\/p>\n The presentation began with an overview of the global burden of HPV-associated cancers. According to data from the World Health Organization (WHO) and the International Agency for Research on Cancer (IARC), approximately 662,000 new cases of cervical cancer are diagnosed worldwide each year, resulting in nearly 349,000 deaths. Most of these cases occur in low- and middle-income countries. Dr. Jugeli also highlighted the increasing incidence of vulvar and anal cancers, particularly those associated with HPV genotype 16.<\/p>\n A particularly important part of the presentation focused on the concept of the \u201cfield effect.\u201d This theory suggests that HPV infection should not be viewed as a localized disease of a single organ. Instead, infected epithelial cells may simultaneously exist at multiple sites throughout the lower genital tract. Dr. Jugeli cited the work of Vinokurova and colleagues, demonstrating that HPV DNA was detected in 93% of patients with multifocal lesions, while nearly half harbored identical HPV genotypes across different anatomical locations. These findings indicate that cervical intraepithelial neoplasia (CIN) may represent a marker of a broader epithelial disease process rather than an isolated cervical pathology.<\/p>\n Another key element of the lecture was the discussion of the ANCHOR trial, one of the most influential studies in HPV-related oncology in recent years. Published in 2022, this randomized clinical trial demonstrated for the first time that treatment of anal high-grade squamous intraepithelial lesions (HSIL) significantly reduces the risk of developing anal cancer. The study enrolled 4,459 HIV-positive adults with biopsy-confirmed anal HSIL. Compared with active monitoring alone, treatment reduced the incidence of anal cancer by 57%.<\/p>\n According to Dr. Jugeli, these findings fundamentally change clinical thinking. For decades, medicine has accepted that treating cervical precancerous lesions effectively prevents cervical cancer. The ANCHOR study established a similar preventive principle for anal HSIL, suggesting that neglecting anal lesions in patients with CIN2 or CIN3 may represent a significant missed opportunity for cancer prevention.<\/p>\n A particularly valuable aspect of the presentation was its focus on practical implementation. Dr. Jugeli proposed an integrated diagnostic model combining colposcopy, vulvoscopy, and high-resolution anoscopy (HRA) within a single patient visit. The rationale behind this approach lies in the substantial overlap among these techniques. They rely on similar optical principles, the use of acetic acid, and comparable biopsy methods. Consequently, learning HRA may be a natural extension of the skill set already possessed by experienced colposcopists.<\/p>\n The presentation was enriched by several real-world clinical cases. One case involved an HIV-positive woman diagnosed with CIN3. Under a conventional management strategy, she would likely have undergone a LEEP procedure and been considered adequately treated. However, comprehensive assessment revealed previously undetected anal HSIL that would otherwise have remained unnoticed. According to the presenter, such cases demonstrate the clinical value of integrated lower genital tract evaluation.<\/p>\n Another case described a 38-year-old HPV16-positive woman diagnosed simultaneously with CIN, VIN, and AIN. This example clearly illustrated the multifocal nature of HPV-associated disease. Had the assessment been limited to the cervix alone, significant pathology at other anatomical sites would have been missed.<\/p>\n A third case highlighted the persistence of risk in postmenopausal women. The patient had been treated for CIN3 eighteen years earlier but subsequently developed anal HSIL. This case emphasized that a history of high-grade HPV-associated lesions may confer lifelong susceptibility to multifocal disease.<\/p>\n The presentation also reviewed contemporary clinical guidelines, including the latest recommendations from the American Society for Colposcopy and Cervical Pathology (ASCCP), the updated WHO position statements, and recent consensus documents from the European Society of Gynaecological Oncology (ESGO) and the British Society for Colposcopy and Cervical Pathology (BSCCP). Although these organizations differ in certain details, all increasingly recognize the importance of evaluating HPV-related disease beyond the cervix alone.<\/p>\n Importantly, the lecture did not merely summarize existing evidence but also identified important unanswered questions. Further research is needed to determine whether integrated screening reduces the overall burden of HPV-associated cancers at the population level, whether such approaches are cost-effective, and which non-HIV patient populations would benefit most from routine HRA screening.<\/p>\n Ultimately, Dr. Jugeli\u2019s presentation represented more than a clinical recommendation\u2014it reflected a broader paradigm shift in gynecologic oncology. Its core message was simple yet profound: HPV does not respect anatomical boundaries, and clinicians should not limit their assessment to a single organ. Contemporary evidence increasingly demonstrates that diseases of the cervix, vulva, and anal canal are often different manifestations of the same underlying pathological process.<\/p>\n If the latter half of the twentieth century was defined by the prevention of cervical cancer, the post-ANCHOR era may be characterized by a more comprehensive strategy aimed at preventing HPV-associated disease throughout the lower genital tract. In this context, Dr. Jugeli\u2019s presentation was among the most clinically relevant and forward-looking contributions to GIMPHA 2026. The question she posed\u2014\u201cHave we examined only the cervix while the disease may be present throughout the epithelial field?\u201d\u2014is likely to become increasingly important in future gynecologic practice.<\/p>\n","protected":false},"excerpt":{"rendered":" On May 31, 2026, Tbilisi hosted the 11th Annual International Conference of the Georgian International Medical and Public Health Association (GIMPHA), bringing together hundreds of physicians, researchers, and healthcare professionals from Georgia and abroad. 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