Breast, ovarian, cervical and endometrial cancer – every year more and more women suffer from gynecological cancers. Unfortunately, after two years of the pandemic, it can be seen that the situation has worsened. Difficult access to doctors and tests may lead to an increase in morbidity. Magdalena Władysiuk, president of the CEESTAHC Association, vice president of HTA Consulting and co-author of the report “Women’s cancers – social challenges, therapeutic challenges”, explains what is the most lame in Poland when it comes to female cancers.
The Journalists for Health Association: How does it assess neither the health of Polish women after two years of the pandemic?
Magdalena Władysiuk: It’s a very difficult question. However, if I were to use a five-point scale, we are somewhere with a weak three. The health of women during the pandemic deteriorated mainly due to the so-called social health, which is shaped by factors such as the burden resulting from the functioning of households, schools and workplaces. Research shows that they translate into the psycho-emotional state. Women suffer from depression more often than men, for example.
If we look at life expectancy more broadly, here, unfortunately, the prognosis has worsened during the pandemic. This applies to both women and men. Ladies are more likely to survive COVID-19 than men, but overall the pandemic has cut our life expectancy by a year. At the same time, we observe a surplus of deaths among men. All forecasts, including those from before the pandemic, said we would be a rapidly aging society. Now we know that this aging will have a very feminine face as there will be even more ladies among the oldest people.
Long before the pandemic, we heard the alarm that gynecological cancers are detected too late. Now the situation has even worsened because access to specialists is more difficult, but we have postponed these visits for many reasons. What do the statistics say? Which cancers do women suffer from most often?
For years, lung cancer has been in the first place, followed by all types of cancer that are characteristic of women, including breast cancer that is typical for women, but also occurs in men. In addition, endometrial cancer, often called endometrial cancer, ovarian cancer, and cervical cancer. A lot is said about breast cancer because many women suffer from it, so awareness of the problem is relatively high. For endometrial cancer, which affects rather elderly women, diagnosis is relatively simple: any abnormal vaginal bleeding is a worrying sign for a woman. She should see a gynecologist urgently to find out why this is happening, and most women do. The doctor checks whether the bleeding is physiological or whether it is a sign of a more dangerous process.
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In the case of ovarian cancer, called an assassin, diagnosis is much more difficult. This neoplasm causes very late, often nonspecific symptoms that can be confused with, for example, gastric ailments. In this specific case, the presence of, for example, breast cancer in the family should be a reason for additional genetic tests.
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In the case of cervical cancer, we have a screening program in Poland and every young woman from the very beginning of “adulthood”, even before sexual initiation, should know that pap smear is crucial in the diagnosis of cervical cancer. Fortunately, the incidence of this cancer is falling as one of the few in Poland.
It is also important to emphasize the role of the doctor and the importance of own oncological vigilance, self-observation of the body in terms of various symptoms or ailments. It is also worth knowing what diseases the women in the family fell ill with – this will allow you to take care of your own health more effectively and encourage preventive examinations. Research – such as cytology – they are the first step to early diagnosis, and early detection of cancer significantly increases the chances of its cure.
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What is the epidemiology of gynecological neoplasms in Poland? Can we brag about anything against the background of Europe, or should we rather be worried?
In comparison with the developed countries, to which we belong, after all, the cancer burden in Poland is growing, the fastest for endometrial cancer, then for breast cancer. Even if we improve survival rates for five years, the incidence of cancer, unfortunately, is high in our country. So we have a lot to do. Generally, this indicator for all gynecological neoplasms is worse in Poland than for the average of European countries. For ovarian cancer, Polish data for 5-year survival are approx. 10%. lower compared to the Scandinavian countries, but this cancer creates diagnostic problems everywhere.
What are the reasons for this situation?
There are many of them. The first is the diagnostic possibilities. An oncological network is being created, individual activities aimed at early cancer detection are carried out in Poland, but at the level of systemic care, we are only seeing seeds. The availability of services is also a problem: women in large cities have better diagnostic possibilities than women in smaller towns or villages. There is still insufficient awareness among women that regular examination and self-care are the most important for maintaining health. Therefore, the problem is both the deficiencies in system solutions and the approach of women.
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And how is access to therapy in Poland?
Let us remember that oncology is among the priorities of the minister of health for the coming years. Poland has adopted the National Oncology Strategy, an oncology network is being established, as well as pilot programs, e.g. for a cervical cancer screening program.
When it comes to therapies, we must first of all improve the speed of the diagnostic path and at the same time – the ability to perform surgery, chemotherapy and radiotherapy. Regarding drugs, it is essential to introduce modern immunotherapies into everyday practice. Compared to other countries, we are lagging behind, and our approval period for treatment of new, more effective drugs is usually several years from the moment of their registration in other countries.
The best situation is for breast cancer, there are many treatments available. But in the case of ovarian cancer, until recently we had very limited options for using modern drugs. Fortunately, since January 1, the situation has changed thanks to the spread of PARP inhibitors, which now also receive patients without mutations in the BRCA1 / 2 genes, even in the advanced stage of the disease. This allows you to extend the time until the next relapse.
New drugs for immunochemotherapy are also emerging in the case of endometrial cancer. The incidence of this type of cancer is increasing rapidly, which is why we are starting to deal with a large number of sick women, mainly after the age of 60. In the case of this cancer, apart from systemic treatment, it is crucial, especially for patients with advanced and recurrent cancer, to treat e.g. I got a limab. The patients hope that this modern therapist will soon be available to them.
Let’s get back to the statistics. What are the conclusions of the report “Female cancers – social challenges, therapeutic challenges” on the prevention of gynecological cancers?
Prophylaxis should be divided into three types. The first is health promotion. When we are healthy, we should take care of a proper lifestyle: eat properly, avoid stimulants, including alcohol, keep an appropriate weight and remember about physical activity. This is crucial for a long, active life.
Another type is – in the case of incl. some female cancers – primary prophylaxis in the form of vaccinations. Since November last year, HPV vaccines are covered by a 50% reimbursement for girls and boys. Adult women can also get vaccinated. Taking into account the results of foreign ten-year studies on the vaccinated young population, we can expect that the number of pre-cancerous conditions in Poland will decrease significantly thanks to vaccinations. We can already observe the harbingers of this trend.
The third type of prophylaxis is secondary prophylaxis. This includes screening tests to find cancer at an early stage of development. We have two screening programs in Poland. The first is a mammogram screening for breast cancer and the second is a cervical cancer prevention program.
Currently, new solutions are being tested as part of a pilot that will allow women to better test themselves for cervical cancer. This year, we will receive the first results of the pilot, and perhaps they will result in a systemic change to reach women who were not previously included in the screening program. However, when it comes to endometrial cancer, the most important thing is your own oncological vigilance and a quick response to irregular or unusual bleeding. Most cases of endometrial cancer are detected in the early stages, giving you a good chance of defeating the cancer.
How do you assess the availability of genetic tests in terms of mutations in the BRCA1 and BRCA2 genes?
We already have genetic counseling programs, but we are actually still at the beginning of the road. Today, women often test themselves privately, because universal access to genetic testing is a distant prospect for now. When it comes to general cancer research, in Poland we create and develop units dedicated to individual organs, such as the Breast Cancer Unit. In turn, in the field of pathomorphological diagnostics, standards must be developed that will give biopsy patients a chance for properly performed immunohistopathological tests. This will accelerate the application of targeted immunochemotherapy as needed.
And what is the problem of gynecological neoplasms in numbers?
Almost 177 people live in Poland. women with breast cancer, and the annual incidence is nearly 19 thousand. 56 thousand patients suffer from endometrial cancer. women, about 6 more are contracted every year. About 15 thousand Polish women have ovarian cancer and every year we diagnose almost 4. new cases. 13 patients suffer from cervical cancer. women, with an annual incidence of 2,4 thous.
What should we call on all women?
Every woman who experiences prolonged fatigue, unusual abdominal pain, weakness – not only physical, but also manifested by problems with concentration – should contact her gynecologist. Let’s not forget about the annual check-ups. Despite many responsibilities, let us take care of our health. Let’s test ourselves and be vigilant!
We encourage you to listen to the latest episode of the RESET podcast. This time we devote it to the problems of the perineum – a part of the body just like any other. And although it concerns all of us, it is still a taboo subject that we are often ashamed to talk about. What do hormonal changes and natural births change? How not to harm the pelvic floor muscles and how to care for them? How do we talk about perineal problems with our daughters? About this and many other aspects of the problem in a new episode of the podcast.
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Authorized press interview prepared by the Journalists for Health Association in connection with the debate “Gynecological cancer – TIME TO ACT! The importance of modern diagnostics ”, organized as part of the Quo Vadis Salus Feminae series? 2022