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Received: October 22^nd 2014

Accepted: May 15^th 2015

Cervical cancer and human papillomavirus. A glance from a family medical viewpoint

Juan José Flores-Pulido,^a Mónica Martínez-Correa^b

^aUnidad de Medicina Familiar 1, Delegación Sur, Instituto Mexicano del Seguro Social, Distrito Federal

^bJefatura de Salud Reproductiva, Servicios de Salud de Tamaulipas, Tamaulipas

México

Communication with: Juan José Flores-Pulido

Telephone: (55) 11 02 64 70

Email: dr_flores77@hotmail.com

Cervical cancer is a health population problem that affects all the world. It remains globally the second leading cause of death in women according to the reports of the International Agency for Cancer Research. In 2008 it was reported an incidence of 8.8 %, which represents a total of 530 232 new cases worldwide and a mortality rate of 8.2 %, meaning a total of 275 008 deaths from this pathology that year. If we bear in mind that the affected group is composed by women in reproductive age, we can size the sociodemographic and family consequences that this pathology brings. So the integral level approach with emphasis on the preventive area is the key to the reduction of morbidity from this disease. This premise suggests the need to offer a broad outlook about the role played by health personnel with care in Family Medicine.

Keywords: Uterine cervical neoplasms, Family medicine.

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Epidemiological overview of cervical cancer and human papillomavirus

Reproductive healthcare today is defined as the constellation of methods, techniques, and services that contribute to reproductive health and well-being by preventing and solving problems related to this health area. It includes sexual health, the purpose of which is the enhancement of life and personal relationships and not just counseling and care related to reproduction and sexually transmitted infections.¹

Cancer is the leading cause of death in developed countries and the second in developing countries. According to worldwide projections, the incidence of this disease will continue to increase the world over, and 13.1 million deaths are estimated for the year 2030.²

We can observe from reports from the International Agency for Research on Cancer, that in 2008 an incidence of cervical cancer of 8.8% was found, which resulted in 530,232 new cases annually worldwide, as well as a mortality rate of 8.2%, which accounted for 275,008 deaths from this disease.³

In Mexico, according to figures from the Instituto Nacional de Estadística y Geografía (INEGI), in 2011 it was reported that among the top cancers that were fatal for the population age 20 and up, significant differences were observed between men and women. Women died of breast cancer (13.8%), cervical cancer (10.4%) and stomach cancer (7%). Meanwhile, men were dying of prostate cancer (16.9%), bronchial and lung cancer (12.8%) and stomach cancer (8.6%).⁴    

We can also see that the results of the Encuesta Nacional de Salud y Nutrición 2012 (ENSANUT 2012) show that a higher proportion of women aged 20 to 65 years came in for a screening test for cervical cancer in the last 12 months compared to results from ENSANUT 2006 and ENSA 2000. Thus, in 2012 it was found that 44.3% of women aged 20 to 65 went to a medical facility for a Pap smear during the year prior to the survey, while 37.1 and 29.4% had done it the year before the ENSANUT 2006 and ENSA 2000, respectively. Added to this figure from 2012 are the women went to get tested for the detection of the human papillomavirus (HPV) (information not previously collected), with 10.3% of women 35 to 50 years.⁵

The infection caused by the human papillomavirus (HPV) has increased exponentially in recent decades and has come to be considered a serious public health problem that mainly affects groups of teenagers and young women, and occasions the emergence of cervical cancer and precursor lesions, which tells us about behavior in sexual activities at an early age. Cervical cancer can be prevented as long as diagnosis and appropriate management of precursor lesions are done.³

It is critical to know the implications of HPV infections in men and women, as well as the environment of safety that the affected partner could have, especially due to secondary implications for trust within a relationship and treatments to be followed in the immediate future.

While the implications or malignant changes of penile HPV lesions in men are known to be very rare, in women infectious repercussions undoubtedly have a very different connotation from the male counterpart. They produce a climate of anguish, fear, and intense concern because of the possible malignant implications, even when we know they are the minority; however, the patient having these dysplastic changes will not understand the statistical figures but directly suffer the consequences of infection. The man will distance himself from his partner, to not inflict greater chance of infection, plus it causes a feeling of guilt that does not go away, especially due to the recurrence of the disease. Sometimes this happens to women in their third decade of life who have not yet had children, so there are greater implications regarding the vital expectations of starting a family.

The role of the family physician in primary healthcare

Family Medicine, which by definition is the medical specialty effecting primary healthcare (PHC), like most other medical specialties, has a body of knowledge that is proper to it, as well as tools and skills to differentiate the object of their practice. Since the purpose and the functional unit of primary care is the family and not the individual, the approach to healthcare for family medicine is developed within this micro-social context, preventing the family group fragmenting into different components, each one with a different health provider.

Family Medicine is the clinical specialty that deals with maintaining and solving common health problems in individuals, families, and communities, regardless of age, sex, or the affected organ or system. It is also the specialty that profoundly integrates biological, clinical, and behavioral sciences. The family physician must consider each patient encounter as an opportunity for education or prevention.

There are two important strategies to improve compliance with preventive practices: screening and case finding. Undoubtedly, the latter is the most effective. As a strategy, clinical case finding is defined when it is the doctor who initiates the intervention, even when the patient attends the appointment for other reasons. If we consider that, on average, each patient sees their primary doctor at least twice a year, the chances to implement preventive services multiply, as well as the difference between what it means to be healthy or sick to the doctor, on one hand, and to the patient, on the other (functional problems, alcoholism, domestic violence and other social ills, having cancer, tuberculosis, or AIDS in different ethnic groups, etc.).

Knowing the important role played by the family doctor, we can say it is crucial to integrate and combine the efforts of the multidisciplinary team of family medicine units to perform specific and systematized actions to achieve early diagnosis and timely referral, helping to reduce the very high morbidity and mortality rates and social cost, which we cannot see in numbers, but we can infer that orphans and family breakdown are part of the burden of these diseases, which, far from diminishing, climb with a marked predominance in developing countries.

References

1. Hernández-Ávila M, Lazcano-Ponce E. Aplicación 13, Salud reproductiva y género. In: Salud pública: teoría y práctica. Patricia Uribe Zuñiga, Aurora del Río Zolezzi. México: Instituto Nacional de Salud Pública-Manual Moderno; 2013. p. 579-92.
2. Programas mundiales del cáncer [Internet] [citado 5 feb 2013]. Available from: http://www.cancer.gov/espanol/instituto/prioridades/programas-mundiales.
3. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Globocan 2008 v2.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase n. 10. Lyon, France: International Agency for Research on Cancer, 2010 [Internet]. [Cited 2013 April 23]. Available from: http://globocan.iarc.fr
4. Instituto Nacional de Estadística Geografía e Informática. [Cited 2013 February 20]. Available from: http://www.inegi.gob.mx
5. Gutiérrez JP, Rivera-Dommarco J, Shamah-Levy T, Villalpando-Hernández S, Franco A, Cuevas-Nasu L et al. Encuesta Nacional de Salud y Nutrición 2012. Resultados Nacionales. Cuernavaca, México: Instituto Nacional de Salud Pública; 2012.

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