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– Only compulsory pap smear tests could reduce the mortality rate from cervical cancer in Poland – says Prof. dr hab. med. Jerzy Stelmachów – national consultant in the field of gynecological oncology.
— Poland is at the forefront of Europe in terms of cervical cancer mortality. How to change it?
– Regular Pap smears are the best way. They are cheap and available. If a woman has a cytology every two years, we are able to detect neoplastic lesions at the pre-invasive stage, when a simple surgical procedure consisting in shortening the cervix is enough to completely heal. It is a procedure that you do not have to wait for months in a queue and much cheaper than chemotherapy or radiotherapy.
— Although pap smear is simple and inexpensive, mortality rates are not improving as fast as we expect?
– That’s true. This is because test registration is dramatically low. In addition, it is difficult to change this situation, because there are no legal instruments of compulsion to undergo medical examinations, and, unfortunately, health prophylaxis does not fit into the most current problems that a woman, as the head of the family, has to solve.
— However, the National Health Fund tries to remind about prophylaxis and sends invitations to all women for such tests?
-Letters and research invitations will never bring the expected results. Maybe 40 years ago, when people were more attached to one place of work and residence. Today, many people migrate and are difficult to reach.
— So what can be done?
– One of the possible solutions is, for example, entering the cytology on the list of tests necessary for admission to work, and then including it in the list of obligatory periodic examinations.
— Does only cytology allow for early detection of changes? Today, more and more often is it said about testing for the presence of HPV viruses?
– Thanks to the identification of oncogenic viruses, i.e. viruses that may contribute to the development of cervical cancer, it has become possible to recognize them. The problem, however, is that we are not yet able to fight these viruses. Perhaps in 5 or 10 years the range of drugs will increase. It should also not be forgotten that the lack of oncogenic viruses in the body does not mean that a woman cannot develop cervical cancer. The coexistence of a viral infection with cancer does not mean that the virus causes the cancer. There are cervical cancers that develop without viral infection. It should also be remembered that viruses have the ability to mutate. So the form of the oncogenic virus today may be different from the one that will be responsible for cancer in five years. Meanwhile, cytology examines dead exfoliating cells for the presence of neoplastic changes, often still pre-invasive.
— Due to the fact that so many women in Poland die of cervical cancer, should we not introduce mandatory HPV vaccination of girls?
– Vaccines are major discoveries in medicine. Unfortunately, they are very expensive. If we wanted to vaccinate the population of girls aged 12 years across the country, it would cost the system from PLN 100 million to PLN 200 million, provided that pharmaceutical companies would grant discounts. These are activities that may result in a reduction in the disease in 30 or 40 years. Meanwhile, today a woman diagnosed with cervical cancer has to wait almost 3 months in Warsaw to start radiotherapy. This is because there are too few cancer centers. The construction of such a center equipped with radio-chemotherapy equipment costs PLN 65 million. The cost of vaccination is therefore equal to the construction of two such centers. With the shortage of public funds for health care, I am in favor of building new centers.
— But some local councils finance HPV vaccination in their area?
Local government programs are different. If I am asked for an opinion on the organization of vaccination by local governments, I always support it. This is also the position of all provincial consultants. If the local government is able to find funds for such acts, it is very good. I believe that if he financed such vaccinations as to the eye, he could negotiate significant cuts in vaccine prices with pharmaceutical companies. However, it should be remembered that vaccination does not exempt from regular Pap smear tests. Vaccination must therefore be accompanied by education. Otherwise, they could do harm instead of good.
— Who should get vaccinated for HPV?
– The most favorable time to vaccinate a woman is around 12-16 years of age – before she starts sexual intercourse. But you can get vaccinated at any age. The woman, although she started intercourse, may not have come into contact with the HPV virus or her body has fought it. However, the results of studies covering a longer observation period will appear in a dozen or so years, and only then will it be possible to assess the impact of human papillomavirus (HPV) vaccines on the incidence of cervical cancer. However, I would like to emphasize once again that the vaccine should be one of the elements of prophylaxis. Regular cytology must absolutely take the first place.
Text: Halina Pilonis