Jornal Médico – Fátima Faustino: “It may be possible to reach the goal of eradicating cervical cancer by 2030”

Fátima Faustino: “It may be possible to reach the goal of eradicating cervical cancer by 2030”

In an assessment of the health of Portuguese women, Fátima Faustino points out that “Portugal has gone from the worst indicators in Europe to one of the best in the world in terms of maternal and child health”. According to the coordinator of the gynecology and obstetrics unit of the Lusíadas Lisboa Hospital, although “there is still a long way to go” in areas such as hormone replacement for menopause or the prevention of osteoporosis and colorectal, endometrial and ovarian cancers, “greater importance has been attributed to the diagnosis and treatment of female gynecological pathologies in Portugal”. Read the full interview.

Medical Journal (JM) | In Portugal, the evolution of maternal and child health and its indicators is impressive. How is women’s health doing nearly 43 years after the National Health Service was established?

Fatima Faustino (FF) | According to data from the General Directorate of Health (DGS), in Portugal, in 1970, 63% of births were non-hospital; many women spent days in labor, at home, without any analgesia or medical assistance, with high rates of maternal and/or fetal mortality and morbidity. At that time, maternal mortality was 73.4/100,000 live births and perinatal mortality was 38.9/1,000 births. Over the years, hospital conditions, access to care and its humanization have improved considerably, despite the difficulties inherent in human resources and the improvement of facilities in some hospitals of the National Health Service (SNS). For example, in 2000, out-of-hospital births fell to 0.3%, the maternal mortality rate to 2.5/100,000 and perinatal mortality to 6.2/1,000. The percentage of out-of-hospital births had a minimum of 0.1% in 2010. Over the past decade, from 2010 to 2019, the percentage of out-of-hospital births was 0.7%, the maternal mortality rate was 7.15/1,000 and the mortality perinatal of 3.9/1,000. In the years 2017 and 2018, for example, maternal mortality outside of hospital was 25 times higher than in hospital. By comparing this data with that of other countries, we can see that Portugal has gone from the worst indicators in Europe to one of the best in the world, in terms of maternal and child health. I would also like to emphasize that despite some “noise” and divergent opinions concerning the humanization of childbirth, I refuse to accept the term “obstetric violence” and I continue to believe that all health professionals working in this field, whether in the NHS or privately, they do everything to improve maternal well-being and the health of the newborn.

jm | What is your current view of the panorama of women’s gynecological health?

FF | I think that women are more attentive to their complaints and that certain “myths” are no longer accepted with the same ease. Currently there is wide access to information on the Internet, and whether good or bad, the truth is that it has the advantage of raising doubts, leading women to consult a health professional. The nurse has a huge role in guiding them, while the doctor has the vital role of diagnosing, clarifying and providing treatment.

jm | Do you consider that, in general, greater importance has been given to the diagnosis and treatment of female gynecological pathologies in Portugal?

FF | In general, I think so, that greater importance has been given to the diagnosis and treatment of female gynecological pathologies in Portugal, with the safeguard of the inherent limitations in human resources in some NHS hospitals. In my opinion, the limited access to medical courses for several years is currently resulting in a shortage of professionals in certain fields, exacerbated by the high number of doctors who have reached retirement age. In this way, even if you want to give an answer, it is not always possible in the desired time frame.

jm | What is the role of the family physician in the diagnosis and referral/monitoring and treatment of female gynecological diseases?

FF | I believe that the family doctor, through his contact with the general population, can intervene in a privileged way at different levels in the primary and secondary prevention of gynecological diseases, playing a fundamental role in the orientation of the main pathologies for hospital services. reference or in specialized centres.

jm | In your opinion, what are the areas of women’s gynecological health that have experienced a more positive evolution and that have been the most neglected and that need to be revitalized?

FF | Undoubtedly, there has been a very positive development in the field of maternal-fetal medicine, which is reflected in the aforementioned indicators, despite the high number of women who, due to socio-professional and family instability, postpone their first pregnancy at older ages, with a consequent increase in pathologies such as gestational diabetes, preeclampsia, prematurity, fetal growth retardation and postpartum complications. Reproductive medicine, for the same reason, is also facing growing and overcoming challenges. In the field of Gynecology, the implementation of cervical cancer screening, the generalization of effective treatments and the adherence of the population to vaccination against HPV suggest that it is possible to achieve the goal of eradicating cervical cancer by 2030. It should also be noted that the HPV vaccine is included in the National Vaccination Program (PNV) for 10-year-old girls, but since October 2020, the boys born from 2009 can also be vaccinated free of charge within the PNV perimeter. Furthermore, the detection and treatment of breast cancer is another constantly evolving field, both diagnostically and therapeutically, and benign pathologies such as uterine fibroids and endometriosis have also been widely discussed in the relentless research. new medical therapies that may delay or avoid surgery. I think that we should perhaps pay more attention to the pathologies of the most advanced age groups, whose well-being is essential given the increase in longevity. In this context, I consider that hormone replacement therapy for menopause, the prevention of osteoporosis, urogynecology, as well as the prevention of colorectal, endometrial and ovarian cancers, are areas to be promoted for reach the entire female population.

jm | How are gynecological screenings currently carried out?

FF | As we have already pointed out, screening for breast and cervical cancers is evolving rapidly. As for endometrial and ovarian cancer screening, unfortunately we do not have effective primary prevention as in the case of cervical cancer Cervical Cancer: Primary Prevention and Extensive Vaccination against HPV in men. Ovarian cancer: PARP inhibitors, a form of oral chemotherapy, currently used in tumors with mutations in the BRCA1 and BRCA2 genes, but thought to be used in all types of ovarian cancer ovary. Uterine fibroids: New molecule based on relugolix, estradiol and norethisterone for the treatment of moderate or severe symptoms, namely abnormal uterine bleeding. Endometriosis: Much research on the development of new therapeutic molecules, particularly in the group of GnRH antagonists and aromatase inhibitors and also in the use of old molecules such as metformin. Contraception (pill): New pill with progestin, drospirenone, without estrogen and more recently the association of a bio-identical estrogen, estetrol and drospirenone. Innovations in the fields of… the uterus (vaccination) and screening by gynecological examination and transvaginal ultrasound are not effective in asymptomatic women in reducing mortality. However, I insist on the fact that it is up to the gynecologist to take advantage of the so-called annual routine consultation to rule out possible risk factors and assess symptoms such as abnormal uterine bleeding, in peri or post-menopause. In the case of ovarian cancer, it is even more difficult because it is a tumor with very few symptoms and whose diagnosis is, in many cases, late.

jm | What are the most recent diagnostic and therapeutic developments in the field of female gynecological health pathologies?

FF | Specifically in gynecological cancer, I emphasize early diagnosis, which has seen innovations in the field of genetics and in the application of artificial intelligence methods. Regarding the treatment, I emphasize the role of immunotherapy, used in addition to other therapies or as a first line, leading to an activation of the immune system in order to specifically fight against tumor cells, thus reducing damage to healthy tissues, with fewer debilitating side effects. I also highlight therapies aimed at molecular targets, the fact that we have less aggressive radiofrequency than conventional radiotherapy and less invasive surgeries, that they use 3D laparoscopy, robotics and even artificial intelligence.

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