Fátima Faustino: “It may be possible to reach the goal of eradicating cervical cancer in 2030.”
In an assessment of women’s health in Portugal, Fatima Faustino points out that “Portugal has become one of the worst indicators of maternal and child health in Europe and the best in the world.” According to the coordinator of the gynecological and obstetrics unit at Lusíadas Lisboa Hospital, “there is still a way” in areas such as menopausal hormone replacement and prevention of colorectal cancer, colorectal cancer, endometrial cancer, and ovarian cancer. She stems from the diagnosis and treatment of gynecological pathology in Portuguese women. ” Please read the interview completely.
Medical Journal (JM) | In Portugal, the evolution of maternal and child health and its indicators was impressive. What is the health of women about 43 years after the establishment of the National Health Service?
Fatima Faustino (FF) | In 1970, 63% of births were non-hospital, according to data from the Portuguese Directorate of Health (DGS). Many women had high maternal and / or fetal mortality and morbidity and spent days at home delivering without painkillers or medical assistance. At that time, the maternal mortality rate was 73.4 / 100,000 births and the perinatal mortality rate was 38.9 / 1,000 births. Over the years, some hospitals on the National Health Service (SNS) have significantly improved hospital status, access to health care, and their humanization, despite the inherent difficulties and improvements in human resources. it was done. For example, in 2000, out-of-hospital births increased to 0.3%, maternal mortality increased to 2.5 / 100,000, and perinatal mortality increased to 6.2 / 1,000. The percentage of out-of-hospital births in 2010 was at least 0.1%. Over the last decade from 2010 to 2019, the out-of-hospital birth rate was 0.7%, the maternal mortality rate was 7.15 / 1,000, and the perinatal mortality rate was. 3.9 / 1,000. For example, in 2017 and 2018, maternal mortality outside the hospital was 25 times higher than in the hospital. Comparing these data with data from other countries shows that Portugal has become one of the best indicators of maternal and child health in the world, from the worst indicator in Europe. Also, despite some “fuss” and disagreements about the humanization of childbirth, I refuse to accept the term “obstetric violence” and work in this area, whether NHS or not. We continue to believe in all medical professionals. Or at a private level, they do everything to improve the well-being of their mother and the health of their newborn.
JM | How do you currently see the panorama of women’s gynecological health?
FF | Women pay more attention to their complaints and think that acceptance of a particular “myth” is no longer just as easy. Currently, access to information transmitted over the Internet is widespread, and whether it is good or bad, it has the advantage of raising questions, leading women to consult medical professionals. it’s truth. Nurses play a major role in orientation, and doctors play an important role in diagnosing, clarifying, and providing treatment.
JM | In general, do you think the diagnosis and treatment of female gynecological pathology is more important in Portugal?
FF | In general, the diagnosis and treatment of female gynecological lesions is more important in Portugal, and I believe that some NHS hospitals adhere to the inherent limitations of human resources. In my opinion, restrictions on access to medical courses for several years are now exacerbated by the shortage of specialists in certain areas and the large number of retired doctors. Thus, as long as you want to answer, it’s not always possible at the desired time.
JM | What is your GP’s role in diagnosing and referral / follow-up and treatment of women’s gynecological disorders?
FF | Because of their contact with the general public, their physicians can privilegedly intervene at various levels in the primary and secondary prevention of gynecological disorders and play a fundamental role in guiding the main pathology of hospital services. I think it’s done. Or to a specialized center.
JM | In your opinion, what are the areas of women’s gynecological health that have evolved more positively and need to be most ignored and boosted?
FF | Undoubtedly, there has been a very positive evolution in the field of maternal-fetal medicine. This is reflected in the indicators mentioned above, despite the large number of women who postpone their first pregnancy due to social professionals and family instability. Diseases such as illness, preterm birth, restricted fetal growth, and postpartum complications increase. And for the same reason, assisted reproductive technology faces growth and overcomes challenges. In the field of gynecology, the goal of eradicating cervical cancer in 2030 will be achieved by conducting screening for cervical cancer, generalizing effective treatments, and adhering to the population for HPV vaccination. We believe that it is possible. The HPV vaccine is included in the National Vaccination Program (PNV) for 10-year-old girls, but boys born after October 2020 and after 2009 will also be able to get the vaccine for free within the scope of PNV. be careful. In addition, breast cancer screening and treatment is another area of constant development from both a diagnostic and therapeutic perspective, and benign medical conditions such as uterine fibroids and endometriosis are also a constant new medical treatment. Not widely discussed in the quest. Surgery. Considering longevity, I think it is necessary to pay more attention to the medical conditions of the elderly, whose happiness is essential. In this context, I promote the treatment of menopausal hormone replacement therapy, prevention of osteoporosis, urogenital science, and prevention of colorectal, endometrial, and ovarian cancers to reach the entire female population. I think it is an area that needs to be done.
JM | How about gynecological screening now?
FF | As already pointed out, screening for breast and cervical cancer is evolving rapidly. Unfortunately, when it comes to screening for endometrial and ovarian cancers, there is no as effective primary prevention as cervical cancer. Cervical cancer: Primary prophylaxis and long-term vaccination against HPV in men. Ovarian Cancer: An inhibitor of PARP, a type of oral chemotherapy, currently used in tumors with mutations in the BRCA1 and BRCA2 genes, but is thought to be used in all types of ovarian cancer. .. Uterine fibroids: New molecules containing lergolix, 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, a group of GnRH antagonists and aromatase inhibitors, and the use of older molecules such as metformin. Contraceptives (Pills): New pills with progestogen, drospirenone, estrogen-free, and more recently biologically identical combinations of estrogen, estetrol, and drospirenone. Innovations in this area … Uterine (vaccination) and gynecological examinations and screening by transvaginal ultrasound are not effective in reducing mortality in asymptomatic women. However, it is the responsibility of the obstetrician and gynecologist to use so-called annual routine visits to rule out possible risk factors and assess symptoms such as abnormal uterine bleeding, peri-menopausal or post-menopausal symptoms. Emphasize that. Ovarian cancer is often delayed and even more difficult because it is a tumor with very poor symptoms and diagnosis.
JM | What are the latest diagnostic and therapeutic developments in the field of women’s gynecological health disorders?
FF | Especially in gynecological cancer, we focus on early diagnosis, where innovations have been seen in the field of genetics and the application of artificial intelligence techniques. When it comes to treatment, it emphasizes the role of immunotherapy, which is used as a complement to or as a front-line treatment for other therapies. This activates the immune system to specifically fight tumor cells and reduces damage to healthy tissue. There are few debilitating side effects. There are also less invasive, less invasive surgeries than traditional radiation therapies, regardless of whether they use molecular-targeted therapies, 3D laparoscopy, robotics, or even artificial intelligence. Emphasize the facts.