El segundo Congreso Mundial de la Federación Internacional de Patología Cervical y Colposcopia (IFCPC) tuvo lugar en la ciudad de Graz (Austria) en 1975. Organizado por la prestigiosa clínica ginecológica de su Universidad, fue presidido por su director el Prof. Erich Burghardt (1921–2006).

Al ser el primer congreso de la IFCPC que se celebraba en Europa se quiso hacer una revisión del estado de la colposcopia en los diversos países europeos, a los 50 años de su introducción por el Dr. Hans Hinselmann. La presentación de la experiencia española corrió a cargo del Dr. José Maria Matéu-Aragonés, y constituye un acreditado documento para conocer la implantación y el desarrollo de la colposcopia en España, desde sus inicios.

The Present Status of Colposcopy in Spain (1975)
José M. Mateu-Aragonés

Publicado en:

Although colposcopy has only quite recently become widespread in Spain, there are, however, some pioneers who, for many years, have been drawing public attention to the importance and value of this technique.

In this respect, mention must be made of Professor Manuel Usandizaga, who was the first to write about this procedure which he mentions in the prologue to our "Colposcopy Atlas":

... when I first began to face the question of colposcopy in 1939, I was influenced by Hinselmann. In 1935, when I was competing for my first professorship, my thesis contained extensive references to colposcopy which was a great novelty and almost unknown to us at that time. After that, I carried in with my interest in the subject and wrote a paper on "Cervicitis" in 1941 which must be the first time colposcopy was mentioned in print in the Spanish language. Shortly after, one of my students Carlos Alba wrote an excellent doctoral thesis, based on work done in my department. This thesis devoted entirely to the subject of colposcopy was to be published later as a series of articles.

These are the words of Usandizaga recalling the introduction of colposcopy in this country. However, the first articles on colposcopy published in Spain which we have been able to find are those by Martínez de la Riva (1944) on the value of colposcopy in the prevention of carcinoma of the cervix and Alba (1947) stressing the value of this method of exploration. For several years nothing was written on the subject in our gynecological journals. Nevertheless, this did not mean that the method was unappreciated by the great figures of the time; it must be kept in mind that the best Spanish gynecologists of that era (Conill Montobbio, Población, Bonilla Martí, to mention only a few) had been trained in Germany and had an excellent knowledge of pathology.

At the end of the fifties, there seemed to be the beginning of a timid popularization of colposcopic exploration on the part of Várela (1957), and Rodríguez Soriano (1958) who drew attention to its importance in the field of early diagnosis of cervical cancer.

These first studies were followed by a series of publications by González Merlo (1960, 1961) and González Merlo y Silvan (1961), the former making the first official contribution on colposcopy at a Spanish gynecological congress.

At about that time my first investigations of atypical colposcopic patterns were published (1961) and shortly thereafter, in association with J.A. Usandizaga, a study of colposcopy in pregnancy. The latter publication, together with those by J.C. Señor and Rodríguez Soriano, constituted the first session of a regional gynecological society (Barcelona Obstetrical and Gynecological Association) which was devoted exclusively to colposcopy (1961).

José M. Matéu-Aragonés (centro) y Luis M. Puig-Tintoré, con sus esposas,
en el banquete del "Second World Congress of Cervical Pathology
and Colposcopy". Graz, Austria. Octubre 1975

After this time, the number of publications increased. It is difficult to quote all the authors who have dealt with the subject. The following, however, are deserving of mention: the early works of Dexeus et al. (1962, 1963) and Moreno y Torres (1963), Gil Vernet et al. (1964) who studied the colposcopic effects of the transformation area of leucoplakia, and Carretero (1964) who first applied colposcopy to research problems (Research into Hydroperoxidase in the Cervix).

Many of these publications were written by authors who only made sporadic use of colposcopy. Since that time, a series of my own articles were published (1964, 1965) which drew attention to the importance of the vascular pattern within the context of the colposcopic patterns and presented an original classification of the different vascular patterns into five types which have been generally accepted among Spanish colleagues. My interest in this technique and personal conviction of its usefulness led me to publish a series of articles (1966, 1967, 1968, 1969) studying certain interesting aspects of the subject such as the correct preparation of the cervix, histopathological results, dysplastic lesions, and irregular colposcopic patterns. Some of these articles have been presented at different medical congresses (Hispano-Luso, II National Congress of the World Association for Cancer Prevention).

The first information appeared, at this time, on the results obtained in the Department of Early Diagnosis of Genital Cancer in women at the National Health Hospital in Madrid (Calvo de Mora 1966; Zamarriego, Calvo de Mora et al. 1969). This Department was the first well organized center for anticancer diagnosis in Spain which was accessible to all classes of society. Later, I was responsible for setting up a similar department at the National Health Hospital in Barcelona. Another department was established at the Barcelona Provincial Maternity Hospital under the direction of S. Dexeus. Later other such centers were established at University clinics and in other branches of the National Health Service. These developments have brought about an awareness, if not on the part of a vast proportion of the population, at least in medical circles and in certain sectors of the general public.

At the present time it can be said that colposcopy is now an integral part of gynecology in Spain and is specifically mentioned both in gynecologic publications (Conill 1969) and specialized articles devoted to the study of the cervix (Bonilla Musoles 1969; Balaguero 1971). Furthermore, all gynecological training and, on a wider scale, all specialist courses include courses on colposcopy.

New publications are constantly appearing from work groups in Barcelona and Madrid (Carrera y Dexeus 1970, 1971; Hernández, Calvo de Mora et al. 1971; Mateu-Aragonés 1971, 1972). My 1972 publication may well be the first systematization of "colposcopy in gynecological practice" for the medical practice here.

At the time of writing, this method is quite popular. Calvo de Mora presented a compendium of his important findings at the First World Congress in Mar del Plata. This compendium included more than 30,000 colposcopies. The first National Symposium for the Fight Against Cancer was held this year. Its goal was twofold: to co-ordinate the terminology and the practical application of this campaign, and to exchange and discuss experiences in the various centers. At this symposium, Calvo de Mora himself presented a paper on the terminology accepted at Mar del Plata. At the round-table discussion of which I was the chairman, representatives of the majority of the university departments and National Health Centers participated. During this discussion some modifications were proposed in the terminology which initially had been accepted. These suggestions will be thoroughly discussed by a panel of experts at this congress.

The year 1973 was outstanding for the development of colposcopy in this country, due to the almost simultaneous publication of "Tratado y Atlas de Colposcopia" by Carrera, Dexeus and Coupez and my own "Atlas de Colposcopia. Fundamentos Histopatologicos: Signifícacion clínica". One could, perhaps, add that the latter is the first completely Spanish book on colposcopy.

Even more recently, Puig Tintoré and González Merlo (1974) published a work on the importance of white glandular orifices which was later incorporated in their monograph "The Cervix". Both Calvo de Mora and I insisted, in 1974, on the value of colposcopy in the special significance of certain patterns such as areas of atypical transformation. The latter along with the evaluation of the vascular pattern was the theme, of our contribution to the II Arbeitsgemeinschaft für Cervix Uteri which was held in 1975 in Valencia.

By way of a summary and as a corollary to what has been said, it can be stated that, at the present time, there is widespread use of colposcopy in Spain. This is probably the result of the systematic introduction of the method at the university clinics of Madrid and Barcelona and to the influence of González Merlo and myself, encouraged by our respective professors, Botella Llusiá and Usandizaga.

Later on, the practice of colposcopy was extended to other university clinics, and at the same time, many responsible gynecologists used it in their private practices. When it was still difficult to import the Zeiss and Leisegang colposcopes (types most generally used in this country), Conill Serra devised an economical "portioscope" which, within the limits imposed by the lack of a good light source, was reasonably useful.

What has been perhaps a definitive step in the introduction of colposcopy is the inauguration of the first large, well equipped National Health centers with departments or sections for the early diagnosis of female genital cancer in Madrid and Barcelona. They have served as a model for other centers. Apart from the amount of research conducted, considerable amount of statistics have come out of these institutions (Calvo de Mora, Madrid; Mateu-Aragonés, Barcelona).

I feel that five basic factors have contributed to the acceptance and routine use of colposcopy:

1. The constant work of pioneers who, with their persistent silent effort, have kept an interest in colposcopy alive from the very beginning.
2. The more complete and improved training of Spanish gynecologists, especially in the field of pathology.
3. The systematic introduction of colposcopy in all university clinics, especially in those departments headed by younger professors.
4. The creation of a new inter-city and inter-hospital network in the Spanish National Health Service.
5. The fact that, because of the factors mentioned under rubrics 3 and 4, most young gynecologists are now able to practice and broaden their knowledge of colposcopic technique.