Due to the coronavirus pandemic, in the previous two years, it was more difficult for women to get to the chosen gynecologist in health centers. Citizens most often claim that it is difficult to make an appointment by phone or application, that there is a long wait for an examination and that there are large crowds in front of clinics, which are the reasons for going to private surgeries.
Of the 263 women who filled out the questionnaire on the "Vijesti" portal, 28 state that they do not have a gynecologist selected at the health center. The majority of women who stated that they do not have a chosen gynecologist visit a gynecologist once a year or more often and come from the municipalities of Podgorica, Tivat, Nikšić, Bijelo Polje, Herceg Novi, Tuzi and Petnjica.
Of all the women who filled out the questionnaire, 120 claim that since the beginning of the coronavirus epidemic, it has been difficult for them to access gynecologists in health centers. Most of them are from Podgorica, but there are also women from other municipalities - Nikšić, Herceg Novi, Tivat, Barane, Kotor, Žabljak, Budva, Tuzi, Bar, Petnjica, Danilovgrad.
This year's campaign of the Institute for Public Health (IJZ), which marks the European Cervical Cancer Prevention Week from February 17 to 23, points to the importance of preventive measures - regular visits to the gynecologist, implementation of the screening program for early detection of cancer and the establishment of HPV vaccination in Montenegro Burning.
However, Montenegro lags behind European and neighboring countries when it comes to the introduction of HPV vaccination, the start of which has been delayed for several years. Despite promises by the Ministry of Health that vaccination would begin in the fall of 2021, this did not happen.
113 women fell ill in 2020
Cervical cancer is among the leading malignant diseases of women, right after breast cancer. The IJZ says that it occurs worldwide in women between the ages of 40 and 45, but more often in women under 30.
"Despite the fact that it is curable in the early stages, every year in the world over half a million women die from this disease. Namely, the situation regarding regular gynecological control is not encouraging, because according to the data, only one in five women responds to examinations by their gynecologist in order to detect changes on the cervix, before they take on a malignant form", say the IJZ.
According to estimates by the International Agency for Research on Cancer (IARC) for 2020, 113 new cases of cervical cancer were registered in Montenegro.
According to the available data of the Institute of Public Health for 2013, the total number of newly diagnosed women with cervical cancer in Montenegro is 106 and occupies the fourth position in the ranking of the number of women with all types of cancer with 8,9 percent. More than two-thirds of the affected women are between the ages of 35 and 59. According to estimates by the International Agency for Research on Cancer (IARC) for the year 2020, the number of new cases of cervical cancer was 113.
Worldwide data show that cervical cancer is the second most common cancer in women, with high mortality rates worldwide, especially in underdeveloped countries. According to IARC estimates for the year 2020, about 604.000 women were diagnosed with cervical cancer, of which 342.000 died from the disease.
IJZ reminds that the screening program for the early detection of cervical cancer was established in 2016, but its work has been suspended for the last two years due to the epidemiological situation.
The reduced number of preventive examinations, they claim, will negatively affect the detection of new cancer cases and the timely application of appropriate therapies and treatment, which may lead to the diagnosis of patients with advanced stages of the malignant disease in the following year.
It takes 15 minutes a year to save your head
Regular gynecological examinations and vaccination against human papillomavirus are the surest ways to prevent getting sick and dying from cervical cancer, experts advise.
Dr Božana Stepanov, specialist in gynecology and obstetrics and subspecialist in sterility and fertility at Genesis Hospital in Novi Sad, says that a gynecological examination and a PAPA test are the simplest way to detect the problem at a stage when it is curable.
"With this type of cancer, as with all other diseases, the big problem is that women react late, waiting for their body to signal that something is wrong. Early cervical cancer, as well as premalignant lesions that precede it, are usually not accompanied by any symptoms. "Spontaneous or contact bleeding, i.e. bleeding after sexual intercourse, occurs in the later stages of the disease," says Stepanov.
She says that only 15 minutes a year are needed for a gynecological examination, which gives the opportunity to monitor and preserve reproductive health.
"A complete gynecological examination includes everything necessary for us to be able to say that you are gynecologically healthy. There is a gynecological and ultrasound examination, a pap test and a group of vaginal secretions, as well as a colposcopy. This is the only way to detect even the smallest changes that can precede serious and dangerous diseases," Stepanov claims.
She points out that the HPV vaccine, according to some studies, reduces the number of cervical cancer cases by almost 90 percent.
"The HPV vaccine is significant and it is very important that it be accepted by the wider population, and in this the pediatricians play a crucial role, who will advise mothers to vaccinate girls from the age of nine. "HPV vaccination is most effective when girls and boys receive it before entering into sexual relations," emphasizes Dr. Stepanov.
When asked how often should be checked women who have already been operated on, i.e. had their uterus or ovaries removed, Stepanov says that the examination of these patients does not differ much from the examination of healthy women.
"Therefore, it is also important for women who have undergone surgery to have a regular gynecological examination, to take vaginal secretions for analysis (not a PAPA test, since the cervix is usually removed during the removal of the uterus) and to perform an ultrasound examination - checking the ovaries if they are left after the operation, or we only examine the small pelvis, the area of the urinary bladder and large blood vessels," concludes Stepanov.
The colposcopy is waiting for a month
Several citizens confirmed to "Vijesti" that scheduling is difficult over the phone, while some claim that if you are not pregnant and have no pain, you can get an appointment in a month. One of them cites as a problem the fact that female patients in health centers cannot have a colposcopic examination, as well as a referral for this type of service in a Clinical Center (KC) or a private institution.
The patient from Nikšić claims that the health center refused to see her twice, even though she duly scheduled an examination through the eHealth app in her spare time.
The interlocutor of "Vijesti" from Podgorica claims that the problem arose when the health center at the Old Airport, where her chosen gynecologist is, was turned into a covid center, which is why it was not possible to schedule a regular examination.
"During my pregnancy, I somehow went to check-ups at the Block 5 Health Center. After giving birth, it is necessary to have a gynecological examination four to six weeks after giving birth, there was no way to schedule it. They offered me a free appointment only in two or three months, so I went to a private institution. That was in December 2020," says another interlocutor.
In Kolašin, there is only one gynecologist working in the Health Center, and the work schedule has not been significantly changed, so patients were mostly able to have an examination and a Pap test. By the way, there are no private gynecologists in this municipality.
In Nikšić, two gynecologists per 8.000 women
In the Health Center in Nikšić, where two gynecologists have been working since June, the waiting time for examinations is no longer than 15 days, claims the head of the sector, elected doctor and gynecologist Tamara Mijušković.
"Until March 2020, we are screening for cervical cancer. Then, due to covid-19, the Institute told us to stop and we hope to continue with it again. As for 2020, then there was a smaller number of female patients, probably due to the fear of covid, while last year there were at the same level as the previous ones. We have an isolated room for covid-positive patients who need a gynecologist. "You don't have to wait more than 15 days for examinations, while emergency examinations are completed immediately," said Mijušković.
She said that "depending on the need, they do cervical cancer screening sporadically".
He states that two gynecologists are not enough for 8.000 registered citizens of Nikšić. She claims that she and her colleague, gynecologist Dragoljub Raičević, work overtime if necessary so that they achieve everything, and the patients do not have to wait.
The director of the Nikšić General Hospital, Marko Mitrović, told "Vijesta" that they have seven gynecologists and one doctor on specialization.
"We have regular work in gynecology and the maternity ward, regardless of covid-19. There are places that are isolated for female patients who are covid positive," Mitrović said.
After treatment, women can become mothers today
Women who have been treated for cervical cancer today have a chance to have children, says Dr. Viktorija Vucaj Ćirilović, radiology specialist and oncology sub-specialist at Genesis Special Hospital in Novi Sad.
"Pregnancy was once thought to be a risk for women who were being treated for cancer because of the unfavorable impact on the course of the disease. If they became pregnant, they had to terminate the pregnancy. The first reason for concern is mainly the fear that pregnancy increases the risks of the tumor returning," she says.
He points out that pregnancy is not possible during the therapy, which is carried out with radiation and cytostatics.
"However, when the treatment is over, the doctors give an assessment of the possibility of pregnancy, that is, when it is time for a baby. This, among other things, depends on whether long-term therapy is needed, whether hormones have a bad effect on the tumor, and many other mandatory analyses. If the doctors agree that you will be safe to become pregnant, you can start the process of in vitro fertilization. That's why it's important to discuss everything in detail with your professional team", explains Vučaj Ćirilović.
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