THE ROLE OF THE GYNAECOLOGIST AT THE PRIMARY LEVEL IN DECREASING THE INCIDENCE OF INVASIVE FORMS OF THE CERVICAL CANCER
Abstract
Background. Since 1993, an average annual crude incidence rates for cervical cancer has increased from 14/100,000 (1979–1993) to 23/100,000 (1997). Untill 1993, there was no permanently employed gynaecologist in the Šmarje pri Jelšah country. In the period 1988–1992 the ratio between non-invasive vs. invasive cervical cancer was 1/18. In the same period the average annual incidence for cervical cancer was 28/100,000 women. The author was interested in whether the active approach of the gynaecologist at the primary level affected the non-invasive: invasive cervical cancer ratio, and whether that changed ratio further influenced the average annual incidence of invasive forms of cervical cancer.
Methods. The data from the outpatient clinic in Rogaška Slatina showed that in the period 1993–2000 there were 54 diagnosed cases: 45 (84%) cases of non-invasive and 9 (16%) cases of invasive forms of cervical cancers. For diagnostic purposes 63 colposcopic punch biopsies were performed. Besides punch biopsies 7 diagnostic cone biopsies and 6 curretage of the cervical canal were also performed. HPV-DNA testing was performed in three women.
Results. Of the 63 biopsies 45 (72%) showed CIN III and 18 (28%) other non malignant changes of the cervical canal. The CIN III cases were treated by conization in 44 cases, and by hysterectomy in 1. Mean 3 PAP smear were taken to make the diagnosis. From the first suspicious PAP smear to the diagnosis average 5.1 month were needed, and average 8.3 month to the surgery and/or the definitive diagnosis. The number of patients with invasive cervical cancer increases proportionally with the number of years the women did not visit the gynaecologist according to the FIGO classification.
Conclusions. Active, combined approach of the gynaecologist at the primary level might improve the non-invasive: invasive ratio of the cervical cancer in a certain region. Thus, the average annual incidence of invasive forms of the cervical cancer could also be improved. All gynaecologists at the primary level have to carry out an active screening and should be well trained in diagnostic and interpretation procedures of the cervical pathologic changes. Almost 50% of Slovenian women do not visit the gynaecologist regularly or not at all. And in these women the incidence of invasive forms of the cervical cancer is the highest. In Slovenia the problem has not yet been solved.
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