In Spain, every four hours, a health professional sits down in front of a woman to tell her that she has cervical cancer. Even if he doesn’t say it, this professional knows that approximately two out of every six women to whom he gives the news will not survive. Would it be possible to reduce, if not avoid, these scenes?
In their search for answers, the professional may remember how important it would be to have more extensive screening programmes, and also the need to raise awareness among the population about existing prevention measures. This image of the loneliness of the professional and the anguish of the patient in the face of the harsh reality must go beyond those four walls, come to light and be placed at the centre of the debate on what kind of public health we want. Women’s health cannot continue to be postponed on the public agenda, because together with care for the elderly and children, it is one of the three pillars that support public health in a decent Welfare State.
In terms of women’s health, cancer is one of the main problems that we must combat: according to the annual report “Cancer figures in 2023” by the Spanish Society of Medical Oncology (SEOM), 2,326 new cases of cervical cancer were diagnosed in Spain last year. This pathology, caused in most cases by an infection by the human papillomavirus (HPV), is responsible for the development of a new type of cancer. the death of nearly 700 women last yearAnd this is one of the relatively rare types of cancer: in its most widespread variant, breast cancer, around 35,000 new cases were detected in our country in 2023 alone, that is, 96 new cases every day.
In the fight against cancer, and especially in the prevention of cancer in women, the most solid, effective and successful strategy is population screening. Screening is key to reducing deaths, as it helps to considerably improve survival rates from the disease by detecting it in time.
A study by the Canarian Government in 2015 quantified how and to what extent breast cancer screening and testing are much more cost-effective than other routine interventions when carried out with the necessary scope and quality. This report It was clear that, in order to maximise its benefits, it is necessary to promote a population screening programme not only at the regional level, but also at the national level.
Spanish women have made great strides in terms of awareness and prevention, and today we can say that screening is already a common practice: up to 92% of women in Spain 50 to 69 years of age participate in breast cancer screening programmes at least once every two years. Although this is a higher rate than in neighbouring countries such as France, Italy, Belgium or Germany, we are still far from meeting the recommendations of the European Union (EU), which advises extending the scope of these breast cancer screening programmes to women aged between 45 and 74 years.
While screening through regular mammograms is an excellent strategy for early detection, in the prevention of cervical cancer we are moving forward with a dual preventive strategy that combines population vaccination and screening. The Consensus Document on the modification of the cervical cancer screening programme, from 2023, recommends bringing forward the age of primary screening to determine the high-risk human papillomavirus (HR-HPV) from 35 to 30 years, in line with the recommendations of the EU Council and the World Health Organisation (WHO).
But as we refine preventive strategies for cancer, we find that the real alarm facing women’s health today is sexually transmitted infections (STIs).
While breast and uterine cancer are well-known public health problems, STIs, in Spain and around the world, are reaching epidemic proportions, especially among young women. Two examples: cases of gonorrhoea in women have skyrocketed by 766% since 2012, while cases of chlamydia have grown by 366% since 2016 among younger women.
Part of the explanation for this increase is that Spain still has low rates of medical testing: only 5% of Spanish women have undergone an STI screening test in the previous year, according to the Global Hologic Women’s Health Index, published in 2023. This percentage contrasts with the 8% average among countries in the European Union and the world average of 10% that this study reflects conducted in conjunction with the Gallup Institute.
It is clear that STI screening in Women’s Health should go from being recommended to being mandatory; at least until reaching the participation rates of our European neighbours. Strengthening prevention is an essential strategy in the care of women’s health. It has worked with cancer and should work with STIs. Working together, medical professionals, administrations, patients and society will be able to increase screening rates among women and, therefore, improve the health of the entire – including men – Spanish population.
Just as women have internalized that our health benefits not only ourselves, but also our loved ones, women should also be able to find time in our schedules to make our care the first of our responsibilities. That is why society as a whole, starting with the State and the Administration, must understand that, in matters of health, prevention is never too much.
