Is it true that up to half of women neglect prevention at the gynecologist?
Unfortunately yes. In the Czech Republic, doctors offer, in addition to conventional care, several so-called screening programs aimed at the early diagnosis of cancer. For example. Only half of women still participate in cervical cancer screening. At the same time, it is a tumor that can be detected already at the stage of pre-tumor changes, that is, without the development of a malignant tumor at all. However, the condition is that the woman regularly visits her gynecologist. In addition to the cytological examination, screening for the presence of the papillomavirus (HPV) at the age of 35 and 45 is now part of the screening, which will make it possible to distinguish more precisely between women at low and high risk of changes. pretumoral or cervical. cancer and focus more specifically on the pursuit of prevention. We meet the worst tumors in women who do not undergo preventive examinations. Nearly half of the tumors are inoperable, they are treated by other approaches, most often radiotherapy or chemotherapy with a high risk of recurrence. Women often visit a gynecologist for the last time during pregnancy or when they need to prescribe contraception. After menopause, they often miss visits, although this period is the most critical for the development of cancer.
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Has the pandemic changed that?
Yes, especially in the beginning. In the spring and summer of 2020, although paradoxically there were not as many infected people in the Czech Republic, far fewer women consulted the doctor as part of prevention and due to difficulties. This then returned to normal during the fall and winter of 2020, again paradoxically at the peak of the biggest wave. However, it was during this period that many institutions, especially district ones, were transformed into covid hospitals, and even if the woman needed an examination, it often had to be postponed. I therefore fear that the 30,000 victims of a pandemic will be joined by a number of patients who suffer unnecessarily or undergo more demanding treatments because the health system has not been able to take care of them at most strong of the covid wave.
Which gynecological examinations are the most important for prevention?
Of course, all of them. In the context of cancer prevention, this is mainly a cervical smear, that is, a cytological examination or an examination for the presence of papillomavirus. Moreover, find out all the difficulties of a woman which can reveal any hidden disease. As part of prevention, the gynecologist also sends a woman over 45 for a mammogram.
What problems do women bring to you most often?
The spectrum of diseases detected is relatively broad. However, the very symptoms that bring a woman to repeat and are worth paying attention to: inability to get pregnant, off-cycle bleeding, heavy menstrual bleeding, very painful periods or pain related to the menstrual cycle, embarrassing discharge, abdominal pain, increase in abdominal volume. Each of these can be a common problem, such as endometriosis or vaginitis, but there can also be a malignancy.
Does it help prevent HPV vaccination? Is it also chargeable for adult women?
Vaccination against HPV is the only way to completely prevent pretumoral changes and cervical cancer. Vaccination is extremely safe and effective. It does not cure an existing infection, but aims to prevent infection, both in early sexual life, which is critical for HPV infection, and in vaccinated women in adulthood who have undergone cervical surgery for pre-tumor changes or working on the immune system alone. Vaccination is currently paid for for girls and boys aged 13 to 14, when two doses of vaccine are given. Unfortunately, vaccination coverage is still not at the level that we would like to get rid of cervical cancer in the future, and it continues to decline. Currently, about 60% of girls and only between 25 and 30% of boys are vaccinated. The fault clearly lies with the relatively vociferous anti-vaccination wave, which is based on totally misinformed and illogical principles. If we wanted to get rid of cancer of the cervix, as well as cancer of the penis, rectum, and head and neck – because most of these tumors are caused by HPV infection – within 15 at age 20, we would then need more than 70% of the girls to be vaccinated and the boys. Boys are much better off because they don’t have a cervix. However, they can develop penile or rectal cancer and, of course, they also transmit the infection to girls. Vaccination may also be suitable for adult women. We recommend it, for example, for women undergoing conization, that is, surgery on the cervix, which removes pre-tumor changes. Vaccination can significantly reduce the risk of recurrent pretumor changes. Of course, any woman who wants to increase her chances of not developing cervical cancer in the future can get vaccinated. The protection is probably not as high as the pre-sex vaccination, but it is important.
There is a lot of talk now about hormonal contraception, because its users are said to be in decline. Is this really the case? What is your opinion on this?
The number of users of hormonal contraception is really decreasing. The reason is similar to vaccination. The general public is increasingly confident in commenting on professional issues, but lacks the ability to obtain and critically evaluate data, to distinguish between reliable and unreliable sources and data. However, a number of doctors who may spread nonsense or may not be able to provide structured and clear information also play a role. Hormonal contraception has been used since the mid-1960s, for more than 60 years. It is a very reliable contraceptive. Its beneficial effects are also very well known, for example reduction of the risk of ovarian cancer, effect on the skin, lower risk of formation of ovarian cysts, positive effect on endometriosis. Its risks are minimal and mainly relate to the possibility of blood clots in women with a hereditary predisposition to excessive blood clotting. From the cancer risk side, contraception can be considered very safe. However, it should also be pointed out that hormonal contraceptives protect against pregnancy, but not against sexually transmitted diseases. This includes HPV, for example. Barrier contraceptives, such as condoms, can provide such protection. So even a girl using hormonal contraception should think about using a condom in a situation where she wants to protect herself from infection.
September 17, 2021
September 29, 2021