Most women throw away invitations to a free Pap test. At the same time, every day 10 Polish women find out that they have cervical cancer. Half of them die. These data are boringly quoted, but they do not change the attitudes of many women who believe that they do not need a pap smear.
Fewer and fewer women come to the freePap smears , which allows early detection of cervical cancer. In 2011,free cytologytempted 24.4 percent. of women who received invitations, in 2012 only 23.3 percent. Last year, over 3 million personalized invitations were sent out, and only 760,000 signed up for the study. women. Cervical cancer was diagnosed in 1700 of the examined women, in 20 thousand mild changes. Why is this reluctance to perform important research? Do Poles lack knowledge, or rather common sense? On the other hand, the neoplasm is detected to a high degree of advancement in women who have performed cytology regularly. Why is this happening?
We talk to Dr. n. med. Jacek Tulimowski, a gynecologist who devotes part of his professional life to popularizing knowledge about the prevention and treatment of gynecological diseases.
- Why in Poland is cervical cancer diagnosed only in the third or fourth stage of the disease?
Jacek Tulimowski, MD, PhD : There is no simple answer here. In Poland, a smear test can be performed by women between 29 and 59 years of age for free once every 3 years. But that's not the biggest problem. The quality of the collected material is important for the correct result of the Pap smear test. Therefore, it is important who takes the swab and what and who evaluates the obtained material. Another problem is that there are still laboratories that report the Papanicolau score instead of the Bethesda system as mandated by the World He alth Organization.
- Why is the method of downloading the material so important?
J.T .: If the result says that the collected material did not contain cells from the cervix, the test should be repeated. This is extremely important because the number of neoplasms originating from glandular tissue, and not only from epithelial tissue, is growing.
For correctAs a result of the Pap smear test, the quality of the collected material is important. Therefore, it is important who takes the swab and what, as well as who evaluates the obtained material.
Ok. 96 percent cervical tumors are still neoplasms originating from epithelial tissue, but the growing number of neoplasms originating from glandular tissue should make doctors pay special attention to the quality of the material collected for examination. The epithelium may be normal, but the patient may be inflamed and this information should also be included in the test report. The consequence of this is treatment and, after its completion, another cytology. Unfortunately, women often do not come back for re-examination. Therefore, it is not known if the inflammation has healed. If it doesn't, it will get worse and the changed cells can turn into cancer cells. Treatment of all gynecological infections is extremely important, because infection with fungi, yeasts, chlamydia increases the body's tendency to become infected with HPV, i.e. a virus that promotes the development of cervical cancer. I would like to add that there are more and more such infections.
J.T .: I don't blame pharmaceutical companies for introducing over-the-counter preparations to pharmacies. It is their right, but women should use them wisely. Each report contains information that if the symptoms persist after 3-4 days of treatment, you should see a doctor. Our ladies often don't. They prefer to use the experiences of a friend whose "something" helped. It happens that they are treated with pills or pessaries that were used by a friend.
J.T .: I would not like to confirm this, but global statistics show that we are in one of the last places in the world in this respect. Doctors, e.g. from Scandinavia, come to Poland to see what advanced cervical cancer looks like, because they do not have such opportunities at home. The fact that HPV vaccines are not reimbursed is also not the best proof.
J.T .: This is a very optimistic assumption. The material submitted for the study should be analyzed in a facility that assesses a minimum of 2.5 thousand people each year. research. The material should be evaluated by large laboratories where many specialists work, so that in case of doubts during the evaluation it is possible to consult another doctor. Only a pathologist with extensive experience canevaluate the swab well. It should be added that the evaluation criteria have become stricter in recent years. When examining a smear, the patient's age is also taken into account, because further diagnostic procedures and treatment depend on it.
J.T .: This is for many reasons. One is that the Polish Gynecological Society has not issued a recommendation for describing the results of a Pap test in the Bethesda system. Another - that not all gynecologists are able to read the examination description presented in this way.
J.T .: For ladies, it is important to know if the swab was properly taken and whether it allowed for a reliable assessment of the condition of the cervix. If the pathologist writes that the material was collected incorrectly (e.g. there were not enough cells), the doctor should repeat the cytology. If the description shows inflammatory changes, the woman should be treated, and after the treatment has finished, she should undergo a checkup and re-cytology. Neglecting to identify a pathologist can have unpleasant consequences, because these people know very well that an inflammatory lesion, e.g. type A, turns into cancer after many years.
J.T .: He can always ask if the brush has international approval. A good brush allows you to extract the maximum number of cells, which is important for the correct assessment of your he alth. The woman has the right to ask if the swab will be scored on the Bethesda system. You may want to know if your doctor is using disposable specula. There is nothing to be ashamed of and fear the doctor's reaction to. And if the doctor avoids answering such questions, leave the office and look for another specialist. My patients ask such questions and I don't see anything wrong with that. More to say, I believe this shows that they really do take care of themselves.
J.T .: A horse with a row of people who can answer it. My observations show that Poles are convinced that it is better not to test, because they will discover something else. Recently, I had a young patient who was brought to the office by her mother, concerned about her he alth. When I asked when she was doing the Pap smear herself, I heard that a few years ago, but she can't remember. I offered to examine and download it for freecytology. She disagreed, explaining that she was not prepared. I don't know why women don't care so much about themselves. After all, cancer can ruin your entire life, take away your fortune, and destroy your career. I used to think it was a matter of money. But no. I have recently lectured for Polish business women. I made an anonymous mini-questionnaire. The result was terrifying. Over 30 percent The women in the room had had cytology 10 years earlier, and most of them could hire a private gynecologist full-time. Besides, if it's a question of money, why are so few ladies taking advantage of free research. In my opinion, it's a matter of mentality. You see a doctor when something hurts, and a gynecologist when there is abnormal bleeding. One more note about the smear test: Many women who get a bad result look for another doctor instead of starting treatment, and have another smear smear test because they think the previous one was wrong. Of course, it may be so, but it is better to undergo an in-depth diagnosis than to look for evidence that the cytology result is a mistake. In the case of cancer, this is very important because some changes disappear from the surface of the epithelium over time and move deeper into the body. The delay in correct recognition may then end badly.
J.T .: Cytology is considered a screening test that covers the age groups most at risk of developing the disease. But when assessing the smear, the pathologist may recommend another examination in a year. And it will also be carried out free of charge. In addition, the number of cancers found in the 3-year surveys is not much different from the number of lesions found in the annual surveys.
J.T .: There is no age that exempts a woman from visiting a gynecologist and doing cytology. Even when a woman has her uterus and ovaries removed, she should have a Pap smear every year, because she has a cervix and a vagina. A patient with a cervix removed should also be examined because she has a vagina. Although vaginal cancer is very rare, it is a cancer that is very difficult to treat. Cytology is also needed to assess atrophic changes in the epithelium (mucosa) that can cause bleeding, itching, etc. A woman who cares for herself should see a gynecologist for the rest of her life.
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