All women should visit their gynaecologist at least once a year for a preventive check-upArticle
26. 04. 2022 Gynecology
“Most women we see that get diagnosed with a malignant tumour, are unfortunately usually those, that neglect preventive healthcare. They usually haven’t been to a preventive check-up for three or more consecutive years,” says Dr Miroslav Verner, head of gynaecology at Canadian Medical.
For someone considering a membership at Canadian Medical, what would you say is the biggest benefit?
I don’t want this to sound a little too banal or oversimplified, but the two most important things in life are health and time. Both of which is something that we provide at Canadian Medical. I’m not talking about some all-encompassing recipe for health, but we do have a large team of very educated and skilled professionals, who know how to care for your health. The facilities and organisation of the clinic also allow for enough time to be allocated to each individual patient.
The clinic offers day surgery procedures. What type of procedures does this include?
Day surgery, as the name suggests, is a procedure that can be done within the scope of a day, where you arrive at the clinic in the morning and are home the evening of the same day. In my field, this includes procedures such as hysteroscopy, laparoscopy, conization or cosmetic procedures on the external genitalia.
What if something doesn’t go to plan, are you able to take care of your patient for longer than a day?
Of course, we are prepared for the reality that sometimes, a planned day surgery may require the patient to stay a little longer than expected. Additionally, in case any complications arise, or in case the surgery becomes more complex than we expected, we closely cooperate with the Institute for the Care of Mother and Child.
It is recommended that you should see your gynaecologist for a preventive check-up at least once a year. What conditions among the population is this screening for?
During preventive checkups, we are screening mainly for various forms of carcinoma, including cervical, breast and large intestinal cancer. All three of these fall under the gynaecologist as the primary point of contact.
Issues of the large intestine?
Yes, allow me to explain: we do not of course treat large intestine cancer, but during a regular gynaecological check-up, all women over 50 years of age should undergo a faecal blood sample test. If positive, the patient will be referred to a specialist who will follow up with a treatment plan. The gynaecologist also reminds their patient when they need to go for their first mammography screening.
Going back to cervical cancer- the vaccine against human papillomavirus (HPV) which is the leading cause of cervical cancer, has been available for several years now. Do you recommend your patients get vaccinated?
Absolutely. Ideally before they begin to be sexually active and this includes boys as well. Nowadays, we can confidently say, that the vaccine reliably protects most women against cervical cancer. It’s a little confusing to me, that most of us are scared of cancer, but we wouldn’t get vaccinated for being too scared of vaccines. Of course that there is a minor risk of side effects, but as with most vaccines, the positives far outweigh any risks. It is a very safe vaccine.
Is cervical cancer a common diagnosis? Who does it tend to affect the most?
This disease has two peaks of highest incidence - first around age 40 and then around 50. But much younger women can be affected as well. However, with a tight screening system in place as part of preventive care, and with the introduction of vaccinations, a lot of these cases can be prevented. The number of newly diagnosed diseases ( incidence rate) has been falling since the mid-1990s. This trend has been further accelerated through the introduction of systematic screening in 2008. One of the key players in the prevention of this cancer is an active and well-organised network of specialised outpatient clinics that perform expert colposcopy.
Nonetheless, it's still true that we can only successfully prevent or diagnose early on, only when the patient comes to our clinic regularly. The sad truth is that most women who get cancer are unfortunately those who have neglected prevention for a long time and have not been to a preventive check-up for over three years.
What exactly is a colposcopy?
A procedure where a colposcope is used to check the appearance of the cervix, vagina and external genitalia. It is performed by a specially trained physician who is licensed and trained in the diagnosis of precancerous changes. We are fortunate to have such a colleague on our team.
What are the steps when the procedure actually reveals pre-cancerous changes?
This depends on several factors - the severity of the changes, age, and whether the patient is planning children. The expert colposcopist will evaluate everything and suggest a procedure that is safe for the patient while taking into account the above-mentioned circumstances.
You have a special membership programme for pregnant women at your clinics- Materna. How does it work?
The basic idea behind the programme is to offer pregnant women healthcare from A to Z so that everything they need is done in one place. All recommended and voluntary examinations are included. This includes a dental check-up, a check-up by a general practitioner or perhaps even physiotherapy and nutritional counselling.
The Materna program also works to a large extent thanks to close cooperation with the Institute for Mother and Child Care. Some of our colleagues there provide care for Materna members at birth, which is one of the great benefits, and they also help us when more serious complications arise.
We have been fighting the Covid-19 pandemic for the last two years. Have you noticed a high incidence of infected pregnant women?
The incidence of infection in pregnant women closely copies the trend of the general population. We've seen pregnant women who have had covid, and I have to knock on wood, most had only a mild course of the disease. However, pregnant women are considered an at-risk group, as are the elderly or people with weakened immune systems. They are at risk of premature birth, and some women have ended up on ventilation in intensive care units.
Can pregnant women get vaccinated?
I say yes to the basic vaccination and the booster dose. My opinion stands in line with the recommendations from both the World Health Organisation as well as our professional gynaecological and obstetric society.
On the other hand - what about women who do not plan to have a child. What are the options in terms of contraception? Something revolutionary?
As of yet, there is no revolutionary method in the books, but coincidentally at the beginning of this year, a new product with a novel type of oestrogen (one that is naturally produced in the human body) was introduced on the market. According to studies, it should have minimal adverse effects on the cardiovascular system. Of course, there are other options, such as patches, rings, or IUDs. The offer today is so wide that every woman can choose what suits her body and lifestyle the best.
I would like to conclude by mentioning one rather pressing topic that is not talked about very much, which in my opinion is a big mistake. It is about conception and fertility. When sexual education is discussed in schools, venereal diseases and contraception are mentioned, but not much is said about human fertility and its limits. Yet this is one of the problems that I deal with more and more often in my practice. The ideal age for conception is under 30. But I meet patients who are thirty-five, gradually running out of biological time, and yet they really want children. Many of them rely on IVF centres because of the current advances and changes in thinking, but they can’t solve everything. Of course, I realize that age is not the only important factor here, but it is one of the biggest factors, especially at a time when infertility is becoming a really big problem.