Gynecological cancers include all types of cancer of the female reproductive system – cervical, ovarian, endometrial, vaginal and vulvar. They account for about 20% of the number of new cancer cases registered annually among women in Romania. World Gynecological Cancer Day (September 20) is dedicated to awareness of risk factors, symptoms, early detection and prevention.
It is estimated that more than 8,000 women are diagnosed annually in Romania with gynecological cancer, according to a press release. Cervical cancer is the most common type of gynecological cancer diagnosed in Romania and the third most common type of cancer among women in our country, but the second most common among women aged 15-44. The HPV virus is the causative agent for the overwhelming majority of cervical cancer cases (99%), precancerous lesions and early forms of cervical cancer, as well as for most vulvo-vaginal cancers.
About 8 out of 10 women are infected with the Human Papilloma Virus (HPV) at least once at some point in their lives. Although it is the most common sexually transmitted infection in humans, HPV infection is most often asymptomatic, remaining underdiagnosed. In 9 out of 10 cases, the body’s immune system manages to eliminate the HPV infection in about 2 years. However, persistent infections with certain types of HPV lead to the appearance in 10-20 years of the primary infection of some cancers in the infected areas.
Cervical cancer can be prevented
Reducing the risk of infection with the causative carcinogen is the most effective solution to prevent cervical cancer, this can be achieved by vaccinating girls against the HPV virus, starting at the age of 11, but also sexually active adult women who are not they benefited from vaccination in adolescence. A second effective method of reducing the consequences of cervical cancer among women, as well as the associated risk of death, is the identification of precancerous lesions and early, treatable forms of cervical cancer. This can be done through periodic investigation, in an organized screening regime, through Babes-Papanicolau testing or HPV testing. Early detection of cervical lesions allows treatment in curable stages.
“Cancers caused by HPV infection are among the few malignancies that benefit from an effective primary prevention solution – by anti-HPV vaccination – and, in the case of cervical cancer, by treating precancerous and cancerous lesions detected through active secondary prevention measures, namely through screening. The systematic implementation of such health interventions has led to the situation where there are currently several nations that are approaching the goal of eliminating cervical cancer among women in the respective countries. For example, in the UK studies show that the HPV immunization program has almost eliminated cervical cancer in women born after September 1, 1995 (who were vaccinated at age 12-13). The incidence of advanced CIN lesions, which can later evolve into cancer, was also significantly reduced. Let’s not talk about Australia, the most advanced country from this point of view, which aspires to eliminate cervical cancer by 2028-2035”, said Prof. Dr. Patriciu Achimaş-Cadariu, president of the Romanian Society of Surgery and Gynecology Oncological.
More affordable vaccines
Currently, in Romania, vaccination against HPV infections is included in the National Vaccination Program, being free for girls aged 11-18. Vaccination is carried out by the family doctor, at the request of the parents. According to the data of the National Institute of Public Health, more than 70,000 doses of the HPV vaccine were administered in the first part of this year. Bucharest, Cluj and Brasov are among the counties that managed to protect the most girls through anti-HPV vaccination.
At the initiative of the Ministry of Health, starting in December 2023, the HPV vaccine will become more accessible for women between 19 and 45 years of age who did not benefit from anti-HPV vaccination in adolescence, they will be able to purchase the anti-HPV vaccine in the compensated.
“The prevention policy in the field of cancer is a priority of the Ministry of Health, which fundamentally changed the way in which access to HPV vaccination is achieved by introducing the full compensation of the vaccine for girls and boys aged between 11-19 years and by introducing compensation of 50% for women between the ages of 19 and 45, declared the Minister of Health”, said university professor. Dr. Alexandru Rafila, Minister of Health.
Immunotherapy, promising results
At the level of the European Union, Romania records the highest incidence and the highest mortality rate. The incidence is 2.5 times higher than the EU average, and the mortality rate more than 4 times higher. Thus, every year, almost 3,400 women in Romania are diagnosed with cervical cancer and 1,805 women lose their lives because of this disease.
The fact that the contribution of cases from Romania to the total number of deaths in the EU is greater than to the total number of new cases of cervical cancer indicates that, in addition to the delayed detection of the disease, there may also be difficulties and even inequalities related to access to treatment. The results of immunotherapy are already promising in treating advanced forms of cervical cancer.
“Among gynecological cancers, cervical cancer causes the greatest burden in Romania, both from the perspective of the impact on patients and their families, as well as from the community and societal perspective. It is essential for the Health of the population in Romania to encourage prevention through vaccination of girls and boys, participation in women’s screening programs, but also access to treatments that increase the chances of survival and the quality of life of patients diagnosed with cervical cancer”, he emphasized Mihaela Geoană, President of the Renaissance Foundation.
Recently, starting in 2022, immunotherapy has also entered the European first-line therapeutic arsenal, which for certain types of patients with cervical cancer in metastatic forms has demonstrated an improvement in overall survival.
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