General gynecology in China

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Roberta Speyer: Hello, this is Roberta Speyer. I am reporting for OBGYN.net. I am in Beijing with Dr. Zhou and Dr. Mi. Tell me where you are from. They are both general gynecologists. Why don’t you introduce yourselves to our viewers?

Dr. Zhou: I am from Peking University First Hospital. I am a general gynecologist.

Robert Speyer: So you see a little of everything but you have a special interest in laparoscopy.

Dr. Zhou: Yes, including malignancy.

Robert Speyer: Malignancy! And doctor? You are from?

Dr. MI: From Beijing District Hospital.

Robert Speyer: Does he also perform similar interests in malignancy, in hysteroscopy?

Dr. Zhou: Yes.

Robert Speyer: When you say in China that you are a general gynecologist, when I think of that in the United States I think that they are in a practice and they are seeing lots of patients in their office and a lot of it has to do with well care. What does a gynecologist do in China? Is it similar? Or are there differences?

Dr. Zhou: You say well care?

Robert Speyer: Well care; a woman comes in for a pap smear, she comes in for an annual checkup, and unless they find a problem maybe that is all. Do general gynecologists here perform those?

Dr. Zhou: You mean screening? Yes, in Beijing, in China we do mass screening in many units. In our hospital we do mass screening for cervical cancer in some area. But for some poorer areas, such as rural, we need to do mass screening for every two or three years.

Robert Speyer: So is this a problem in a country as large as China, with a large rural population, is cervical cancer still…it’s pretty much under control in the United States because there is so much annual pap screening. How about here, I know it is getting better, but is that still a problem in the population, in the rural population for cervical cancer?

Dr. Zhou: Yes, China has a big population, biggest population of the world. And also has the biggest patient population of cervical cancer. Because we do mass screening of cervical cancer we know the instance of cervical cancer in China, especially the invisio, the advanced cervical cancer has been decreased in recent years. But in rural areas for instance, this also is still relatively higher.

Robert Speyer: How high?

Dr. Zhou: In Shanghai and Beijing for instance maybe five per 10,000 of women a year. It is relatively lower in large cities.

Robert Speyer: What about the rural population? Is it large like ten percent, 15% or 20%, what is it?

Dr. Zhou: Around 15% I think.

Robert Speyer: Isn’t cervical cancer almost, you will get it eventually if you live long enough and you don’t get screened and treated? I understand that with a lot of people their cancer outlives them. They get it when they are 70 years old and it grows very slowly. Meantime they die of natural causes before they die of cervical cancer. So, it is in the younger woman, and the woman now living longer, that it is becoming more of a problem if it is not screened. Is this true?

Dr. Zhou: For many cancers age is a problem. But for several cancers it is not true because several cancers have two peaks. One is between 20 and 30 years of age, and the other is around 50 years of age. As we know, several cancers are caused by viruses, not by aging. So if the woman is not infected at this time by a high-risk virus, the HPV virus is very important, if there is no infection of this high-risk HPV, I do not think a patient will suffer from cancer.

Robert Speyer: And this has always been the case, but now you can screen people also for HPV, and new vaccines are coming out now that can vaccinate someone so that they won’t be susceptible. Tell us about that, is that available also?

Dr. Zhou: So far as I know, the vaccine is not used in clinical practice but it is said that a vaccine will soon be available in clinical practice.

Robert Speyer: Yes, we are just seeing it in the United States now. But also very controversial in the United States, because it is a problem to make the judgment that you are saying your daughter is going to maybe have sex. So, to give the vaccine, is to say, “I think my daughter is going to have sex”. Americans have to fight about everything, so they say, “Well should we say it’s for cancer or should we say it is for HPV”, but of course it is for the HPV, which then leads to the cancer. So there is a social issue there in our country. But I do not know if that will be a problem here. We are seeing that problem in the United States with the acceptance, not from the medical community but from the mothers, the parents wanting to seek the treatment, the vaccine.

So that will be something interesting to see how that also plays out.

I appreciate very much you taking the time to come and talk to us, and I wish you both all success with your practice. I think what we are seeing here is that this is really going to be in the future something like polio, which is a thing of the past. Do you agree?

Dr. Zhou: Yes, it is very good.

Robert Speyer: Thank you very much.