Fatima Faustino: “It may be possible to achieve the goal of eradicating cervical cancer in 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 one of the best in the world in maternal and child health”. According to the coordinator of the Gynecology and Obstetrics Unit at Lusíadas Hospital in Lisbon, although “there is still a long way to go” in areas such as hormone replacement at menopause or the prevention of osteoporosis and colorectal, endometrial and of ovary, “has had a greater importance. has been attributed to the diagnosis and treatment of gynecological pathologies of women in Portugal ”. Read the full interview.
Medical Journal (JM) | In Portugal, the evolution of maternal and child health and its indicators was 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 of Health (DGS), in Portugal, in 1970, 63% of births were outpatient; many women spent days giving birth at home, without any analgesia or medical care, 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 health care and humanization have improved significantly, despite the inherent difficulties in human resources and the improvement of the facilities of some hospitals of the National Health Service ( SNS). For example, in 2000, outpatient births rose 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 was at least 0.1% in 2010. In the last decade, from 2010 to 2019, the percentage of out-of-hospital births was 0.7%, with a maternal mortality of 7.15 / 1,000 and perinatal mortality. of 3.9 / 1,000. In 2017 and 2018, for example, out-of-hospital maternal mortality was 25 times higher than in-hospital mortality. Comparing these data with those of other countries, we can see that Portugal has gone from having the worst indicators in Europe to one of the best in the world, in maternal and child health. I would also like to point out that despite some “noises” and divergent opinions regarding 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 on a private level, they do everything to improve the maternal well-being and health of the newborn.
JM | How do you see the gynecological health of women today?
FF | I believe that women are more attentive to their complaints and that the acceptance of certain “myths” is no longer as easy. Currently, there is wide access to information disseminated through the Internet and, whether good or bad, the truth is that it has the advantage of generating doubts, making women consult a health professional. The nurse plays a big role in your guidance, while the doctor plays the vital role of diagnosis, clarification and treatment.
JM | Do you consider that, in general, more importance has been given to the diagnosis and treatment of women’s gynecological pathologies in Portugal?
FF | In general, I believe that more importance has been given to the diagnosis and treatment of women’s gynecological pathologies in Portugal, while safeguarding the limitations inherent in human resources in some NHS hospitals. In my opinion, the limited access to the course of Medicine for several years now translates into a shortage of professionals in certain areas, aggravated by the high number of doctors of retirement age. Thus, no matter how much you want to give an answer, it is not always possible in the desired time.
JM | What is the role of the family doctor in the diagnosis and referral / follow-up and treatment of women’s gynecological diseases?
FF | I believe that the family doctor, due to his contact with the general population, can intervene in a privileged way at various levels in the primary and secondary prevention of gynecological diseases, playing a key role in guiding the main pathologies of hospital services. reference. or to specialized centers.
JM | In your opinion, what are the areas of gynecological health for women that have undergone a more positive evolution and that have been more neglected and need to be strengthened?
FF | Undoubtedly, there has been a very positive evolution in the field of Maternal and 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 to later ages. , with the consequent increase in diseases such as gestational diabetes, preeclampsia, premature birth, restrictions on fetal growth and postpartum complications. Reproductive Medicine, for the same reason, also faces 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 HPV vaccination lead us to believe that it is possible to achieve the goal of eradicating cervical cancer in 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, children born after 2009 can also receive the vaccine free of charge in the field of PNV. In addition, breast cancer screening and treatment is another area in constant development, both in terms of diagnosis and therapy, and benign conditions such as uterine fibroids and endometriosis have also been widely discussed in the field of breast cancer. incessant search for new medical therapies that can delay or prevent. surgery. I think that perhaps more attention should be paid to the pathologies of the older age groups, whose well-being is essential given the increase in longevity. In this context, I consider that the treatment of hormone replacement at menopause, the prevention of osteoporosis, urogynecology, as well as the prevention of colorectal, endometrial and ovarian cancer, are areas that need to be strengthened to reach all female population.
JM | How are the gynecological tests currently?
FF | As already noted, breast and cervical cancer tests are evolving rapidly. With regard to screening for endometrial and ovarian cancer, unfortunately we do not have effective primary prevention as in cervical cancer Cervical cancer: Primary prevention and widespread HPV vaccination 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 in all types of ovarian cancer. Uterine fibroids: new molecule with relugolix, estradiol and norethisterone for the treatment of moderate or severe symptoms, ie abnormal uterine bleeding. Endometriosis: Much research on the development of new therapeutic molecules, specifically 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, estrogen-free and more recently the combination of a bioidentical estrogen, stetrol and drospirenone. Innovations in the areas … uterus (vaccination) and screening through gynecological examination and transvaginal ultrasound are not effective in asymptomatic women to reduce mortality. However, it is important for 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, peri or postmenopause. In the case of ovarian cancer, it is even more difficult because it is a tumor that is very poor in symptoms and, in many cases, late in diagnosis.
JM | What are the most recent diagnostic and therapeutic advances in women’s gynecological health diseases?
FF | Specifically in gynecological cancer I highlight the early diagnosis, which has seen innovations in the field of genetics and in the application of artificial intelligence methods. In terms of treatment, I highlight the role of immunotherapy, used as a complement to other therapies or as a first line, resulting in an activation of the immune system in order to specifically fight tumor cells, thus reducing the damage. to healthy tissues, with fewer debilitating side effects. Also noteworthy are molecular target therapies, having less aggressive radiofrequency than conventional radiotherapy, and less invasive surgeries, whether with 3D laparoscopy, robotics, and even artificial intelligence.