Fátima Faustino: “It may be possible to achieve 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 having the worst indicators in Europe to being one of the best in the world in terms of maternal and child health”. According to the coordinator of the Gynecology and Obstetrics Unit at Hospital Lusíadas Lisboa, although “there is still a way to go” in areas such as menopausal hormone replacement or prevention of osteoporosis and colon, endometrial and ovarian cancers, ” attributed to the diagnosis and treatment of women’s gynecological pathologies in Portugal. ”Read the full interview.
Medical Journal (JM) | In Portugal, the development of maternal and child health and its indicators were impressive. How is women’s health after almost 43 years since the founding of the National Health Service?
Fatima Faustino (FF) | According to data from the Directorate-General for Health (DGS), 63% of births in Portugal in 1970 were non-hospital; many women spent days in childbirth, at home, without any form of analgesia or medical care, with high mortality and morbidity in mothers and / or fetuses. 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 health care and their humanization have improved significantly despite the difficulties associated with human resources and the improvement of facilities at some National Health Service (SNS) hospitals. For example, out-of-hospital births in 2000 rose to 0.3%, maternal mortality to 2.5 / 100,000 and perinatal mortality to 6.2 / 1,000. The proportion of non-hospital births had a minimum of 0.1% in 2010. In the last decade, from 2010 to 2019, the percentage of out-of-hospital births was 0.7%, maternal mortality was 7.15 / 1,000 and perinatal mortality of 3.9 / 1,000. In the years 2017 and 2018, for example, maternal mortality outside the hospital was 25 times higher than in the hospital. If we compare these data with data from other countries, we can see that Portugal has gone from having the worst indicators in Europe to being one of the best in the world in the field of maternal and child health. I would also like to point out that despite some “noise” and divergent views on 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, regardless of whether it is in the NHS or at the private level, they do everything to improve the well-being of the mother and the health of the newborn.
JM | How do you currently view the panorama of women’s gynecological health?
FF | I believe that women are more aware of their complaints and that the acceptance of certain “myths” no longer happens with the same ease. Currently, there is wide access to information disseminated via the internet, and whether it is good or bad, the truth is that it has the benefit of raising doubts, prompting women to consult a health professional. The nurse has a huge role in their orientation, while the doctor has the vital role of diagnosing, clarifying and providing treatment.
JM | Do you think that in general more emphasis has been placed on the diagnosis and treatment of women’s gynecological pathologies in Portugal?
FF | In general, I believe that greater emphasis has been placed on the diagnosis and treatment of women’s gynecological pathologies in Portugal, ensuring the inherent limitations of human resources in some NHS hospitals. In my opinion, the limited access to medical education for several years currently translates into a shortage of professionals in certain areas, exacerbated by the high number of doctors who are of retirement age. As much as you want to give an answer, it is not always possible at the desired time.
JM | What is the role of the family doctor in diagnosing and referring / following up and treating women’s gynecological diseases?
FF | I believe that the family doctor, because of his contact with the general population, can intervene in a privileged way at different levels in the primary and secondary prevention of gynecological diseases and play a fundamental role in guiding the main pathologies of the hospital services. or to specialized centers.
JM | In your opinion, what are the areas of women’s gynecological health that have undergone a more positive development, and which have been most neglected, and which need to be strengthened?
FF | There has undoubtedly been a very positive development in maternal-fetal medicine, which is reflected in the aforementioned indicators, despite the high number of women who, due to social and family instability, postpone their first pregnancy to later ages, with the resulting increase in pathologies such as gestational diabetes, preeclampsia, preterm birth, fetal growth limitations and postpartum complications. For the same reason, reproductive medicine is facing growing and overcoming challenges. In the field of gynecology, the implementation of cervical cancer screening, the generalization of effective treatments and the population’s adherence to HPV vaccination lead us to believe that it is possible to achieve the goal of eradicating cervical cancer by 2030. It should also be noted that HPV the vaccine is included in the national vaccination program (PNV) for 10-year-old girls, but since October 2020, boys born from 2009 onwards can also receive the vaccine free of charge under the PNV. In addition, screening and treatment of breast cancer is another area in constant development, both in terms of diagnosis and therapy, and benign pathologies such as uterine fibroids and endometriosis have also been widely discussed in the relentless search for new medical treatments that can delay or avoid surgery. I think it may be necessary to pay more attention to the pathologies of the most advanced age groups, whose well-being is crucial in view of the increased life expectancy. In this context, I consider that the treatment of hormone replacement therapy during menopause, the prevention of osteoporosis, urogynecology and the prevention of colorectal, endometrial and ovarian cancer are areas that must be promoted to reach the entire female population.
JM | How are gynecological screenings at the moment?
FF | As already mentioned, screenings for breast and cervical cancer are rapidly evolving. Regarding endometrial and ovarian cancer screening, we unfortunately do not have effective primary prevention as in cervical cancer Cervical cancer: Primary prevention and extended vaccination against HPV in men. Ovarian cancer: Inhibitors of PARP, a form of oral chemotherapy currently used in tumors that have mutations in the BRCA1 and BRCA2 genes but are thought to be used for all types of ovarian cancer. Uterine fibroids: New molecule with relugolix, estradiol and norethisterone for the treatment of moderate or severe symptoms, namely abnormal uterine bleeding. Endometriosis: Much research into the development of new therapeutic molecules, namely 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 progestogen, drospirenone, without estrogen and recently the combination of a bioidentical estrogen, estetrol and drospirenone. Innovations in the fields … uterus (vaccination) and screening by gynecological examination and transvaginal ultrasound are not effective in asymptomatic women to reduce mortality. However, I emphasize that it is up to the gynecologist to use the so-called annual routine consultation to rule out possible risk factors and assess symptoms such as abnormal uterine bleeding, peri or post-menopause. In the case of ovarian cancer, it is even more difficult because it is a tumor that is very bad for symptoms and diagnosis, in many cases late.
JM | What are the latest diagnostic and therapeutic developments in women’s gynecological health diseases?
FF | Specifically in the field of gynecological cancer, I highlight early diagnosis, which has seen innovations in genetics and in the use of artificial intelligence methods. In terms of treatment, I emphasize the role of immunotherapy, used as a supplement to other therapies or as a first line, which results in an activation of the immune system in order to fight specifically against tumor cells and thus reduce the damage to healthy tissue, with fewer disabling side effects . I also highlight the therapies that target molecular targets, the fact that we have less aggressive radio frequency than conventional radiation therapy and less invasive surgeries, whether we use 3D laparoscopy, robot technology and even artificial intelligence.