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Gynecological revisions
Summary of the
exposition and debate on gynecological revisions in the “VII seminar of auto
formation of the CAPS net (Net of Health Professional’s Women)” in
Barcelona. October 2005.
Seminar organized by the “Women, Health and Life Quality” program of CAPS
http://www.caps.pangea.org
sponsored by the Women Institute in Barcelona.
Cervix cancer
The terminology has been changed and instead of dysplasia CIN, SIL (squamous
intraepithelial lesion) is proposed, since many of the atypias regress and
don’t develop into cancer.
This cancer is not very frequent in Spain (3.6%) but very frequent in women
from South America and Africa (40%). Due to the immigration to Spain, this
data is being changed and the incidence of neck cancer is increasing every
day.
It is considered the proposal of the SEGO (Spanish society of Gynecology and
Obstetrics) programme of carrying out cytologies with Pap test, with an
annual control starting at the age of 25.If the result turns out negative
for three times, the suggestion is to carry out the control every 3 years or
even 5 years. At the age of 65 controls can be interrupted if the result has
been negative for the last 10 years.
It has been also agreed to include the HPV test (Papilloma virus) since if
this infection caught from a virus remains chronic, contributes to the
development of cervix cancer.
The risky population is:
• Women or their couples with very active sexual life
• Women with repeated infections, genital warts, HPV
• Women with HIV held by them or their couples
• Multiparous women because of pregnancies or abortions
• Oral contraception for a long time
• Women with pathological cytology
• Tobacco addicts
• Other genital infections
In these cases more frequent cervix controls are recommended, every one or
two years.
The speakers commented that women themselves request it every year, although
they are recommended to lower the frequency. Sometimes recommendations are
not followed and controls are carried out in excess. They also insisted on
the fact that some women, the most risky ones, don’t do the necessary
controls.
Breast Cancer
The mammography is recommended to women from 45 to 64 years old, every two
years. It is because it has demonstrated its efficiency in detecting tumors
long before being palpable in women between 45 and 64 years old, that we
still recommend it, in spite of the cancerigenic radiations.
There are risk indicators in the Clinic History. The endogenous and
exogenous estrogens are a key factor in breast cancer as well as the
excessive use of oral contraceptives, the family history, the substitutive
hormonal therapy (SHT) during menopause, the intoxication through
insecticides, drugs, and food. It seems that progesterone can protect.
The mammography is a risky test, it is to be contemplated that there is a
10% of false positives, women who are diagnosed the illness when it doesn’t
really exist, and there exist false negatives, in which the cancer is not
detected.
For this reason it would be better not to do so many mammographies in the
severe fibrocystic breast and carry out scans as a less aggressive method to
control and follow up solid or cystic lesions found through mammography.
In spite of scans being a complement of mammographies, incipient lesions are
not seen in scans so mammographies are necessary to detect them.
After this update, I think that gynecological revisions are much more than
the result of an exam and a laboratory test. It is a more complete and
complex instance since this is how it is for the woman.
When coming to the consultation, she doesn’t only brings her body or her
genital apparatus, but she comes with her doubts, disquiets, fears, and the
feeling of not knowing how to continue along the different stages of her
life. Doubts related to menopause, the different proposals regarding
infertility, etc.
It is part of the doctor’s duty to carry out a good gynecological exam but
also to listen, clarify and support.
For women the relationship with her gynecologist is very important because
their bodies are in permanent change since puberty and it should be the
doctor the right person to share it.
Patients come to the revision feeling scared. Many times the fear is
manifested with a sigh of relief when they are told that everything is fine.
Then, they go out of the consultation and …1 more year. The fear keeps
operating the whole year.
The sanitary system promotes a precocious detection, which scares year after
year, maybe during 20 years. And we have to take into account that this fear
is present in women as an extra factor to help illnesses.
Regarding this topic, I will never stop insisting in the importance of
informing the patient since the clearer and more complete the information is
the more elements the woman will have to decide with freedom and not fear.
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