A few days ago, a national conference was held entitled “Modern multidisciplinary behavior in breast cancer“, which was under the auspices of the Bulgarian Surgical Society. About 300 physicians participated in the forum. What are the challenges in treatment in our country… Surgeon Prof. Dr. Svilen Maslyankov from the capital's “Alexandrovska Hospital“ speaks to FACT.
- Prof. Maslyankov, why is breast cancer killing more and more women. Do you have an explanation? Breast cancer is beginning to affect more and more women, but this is the case, as is the case with all other oncological diseases, which have a permanent tendency to increase in recent years. The industrial life we lead, the chemicalization of the food we eat, is of great importance for their increase. There are many visible and invisible harmful effects that cause a series of mutations in our organism. We simply cannot protect ourselves from everything, because we cannot escape from chemicalization - and from the pesticides for fruits and vegetables that go into the soil. We had accidents in Chernobyl and Fukushima - harmful effects that we cannot see. Even the use of a microwave oven affects, because there is uneven heating of fats in our daily food intake. The cars in our country are old and emit poisonous gases on our roads. These are many, many factors that accumulate in our body.
- Does the disease rejuvenate... What are your impressions?
- Unfortunately, there may be a small form of subjectivism here, because I am a doctor who actively practices. And when you are in demand, I mean people with more unusual conditions, when they turn to me, it is very difficult to understand exactly what is happening. There is such a thing as rejuvenation. But the problem here is also the inactivity of the National Cancer Registry for several years. And this is something that absolutely must work in order to be able to analyze in which direction things are going. A very serious attitude must be taken, but I do not see anything being done in this direction. The state must take a serious attitude, because we will have nothing to compare ourselves to, and this will deepen the feeling that we are at the bottom of Europe. What are the current statistics?
- It shows that in our country about 3500-4000 women are registered with breast disease per year. Is it a lot, a little... Where is Bulgaria...
- Recently, a colleague presented unofficial statistics at a small scientific forum and announced that for 2024 we will have about 4700 new patients with breast cancer. She rummaged through the NHIF system for last year. Yes, there may be some inaccuracy, there may be a repeated path. There may be fewer people than 4700. A patient may appear twice in this scheme, due to two surgical interventions, because surgeons do this to earn more. This is not a good decision, but…
- He may have had a complication, for example…
- This is one thing, but I want to draw attention to the so-called partial breast cancer surgeries, which are not a good decision for the patient. I encounter such cases and in my opinion it is right that they should not be financed by the Health Insurance Fund. When surgery is performed, it should be done qualitatively, and not thinking about the path and the money. If we assume that we have about 4700 new patients per year, this means that Bulgaria is heading towards a maximum incidence of morbidity. As is the case in the USA, in European countries, where we are talking about “1 in 8“. This is a serious matter. I am a practicing surgeon and I treat this cancer. I can definitely say that we have a constant and year-round epidemic of breast cancer that is growing.
- Do women pay attention, or when they come to you, things are quite difficult as a clinic?
- The question is twofold. There are people who neglect their condition, but there are those who are at the other extreme - they go to the doctor for no reason. They start looking for something in themselves that is not there. Unfortunately, it is the hardest when women come who are in very and even dramatically advanced stages. You just wonder what they have been doing for so long. It is not that we cannot do something and put this cancer into some kind of remission, because it has different forms, but it is very difficult. It happens that women come to me only when they already have changes in the skin, discharge, and sometimes even blood. Then very little can be done.
- Surgery is a last resort. Let's say what should women watch out for?
- For solid formations - lumps. But it should be known that not every lump in the breast is cancer, but the absence of a lump does not always mean that there is no cancer. In this regard, there are women who say to themselves "… yes, but I have had this thing for a long, long time“. But it grows, and they accept it as normal. On the other hand, there are those who always find something in the breast, and it is not there at all. There are cysts, there are painful tissues in the breast, which are often absolutely normal conditions.
- In many countries there are programs for targeted screening of breast cancer. Where is Bulgaria…
- As with many other things, the state has absolutely abdicated from prevention. And here I will return to the fact that we do not have a working National Registry of Oncological Diseases. Currently, the registry is given to some information specialists who do not understand anything about medicine, and in the end we have nothing. We have no information about what oncological diseases are in the country. We also have pseudo-activity when we talk about targeted screening. I say strong words, but it is true. Currently, everything in the field of prevention goes through GPs. They are given the opportunity under the Health Insurance Fund to send women for an ultrasound scan, to a mammologist every 2 years. We are talking about the contingent between 50 and 69 years old, because this is the age at which women are most often affected. Women can go for an ultrasound scan between the ages of 40 and 50 under the Health Insurance Fund. But there is something very important here that I want to draw attention to –
GPs HAVE THE RIGHT, but they are not obliged.
And here comes the tragedy of prevention. Only in October, when a number of campaigns are held, is the topic more commented on. I have personally participated in such campaigns since the beginning of my practice, being at the oncology dispensary in Veliko Tarnovo. But as a young doctor, I was told that I go to such and such a place to examine. And women come to me for examination, so that something can be established. Let's imagine that in Bulgaria 1/3 of the ladies are conscientious about their health - they feel themselves, monitor themselves, if something bothers them, they go to the doctor (even more often than some should).
The question is about those remaining 2/3 - they should be covered. They should be OBLIGED to go to the doctor.
On the other hand, the patients themselves always find excuses why they can't take time for themselves. So targeted screening is a good thing, but it should be done like people. Otherwise, excuses like "I'm busy now", "I'll go tomorrow" are easy and there are thousands of them. These women need to be influenced, they need to be covered. And because this is desirable in our country, things are difficult when we encounter the problem. I will give you an example of what it is like in Switzerland. There, women in the risk age that I mentioned receive calls, notifications, text messages that they need to go for a preventive examination. There are many modern communication channels. When they go, they receive opinions from two different specialists about their tests. If they do not go for a preventive examination, but later get sick with breast cancer, their treatment is at their own expense. They decide how to take care of themselves. In other European countries, there is a practice where, when you take out a loan, the insurer asks you to take tests for basic serious diseases, so that they can be sure that you will be healthy, work and be able to service the loan in the next 10-15 years. For as long as the term is. And it works.
- We are definitely far from that in Bulgaria…
- I'm just giving examples. A lot can be done. Someone needs to sit down, make a pyramid and know who is doing what in order to improve this. But here another very serious question will come up. When we talk about prevention, let's answer the question of whether we have the specialists who will do the preventive examination qualitatively. Do we have colleagues in small towns who do quality ultrasound, mammography, etc. In smaller towns it is not like in big cities, but that's another topic. And I'll add something else here. When the health insurance company takes over a mammogram examination, it's only one picture? Why only one picture in one projection, I ask. I just encounter patients who go for a mammogram, they get a picture taken and that's it. The doctors at the mammogram tell the patient that if they want a picture in another projection, they have to pay for it!? Only one projection cannot adequately assess the condition of the breast. There are radiologists who are literally willing to scare the patient into taking another scan in order to pay (even without having an illness, for example). Why has the Health Insurance Fund decided that it will only pay for one scan… Let someone answer this question. Do we have quality radiologists and ultrasound technicians throughout the country!? We have a very common form of cancer, but do we have enough trained people in different places in the country to do a quality examination? Someone in the Ministry of Health simply needs to sit down very seriously and think about what and how to do in the structure of such an activity. It is clear that this will not happen overnight. That is certain.
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In 2012, Dr. Maslyankov started working at the capital's Alexandrovska Hospital. In 2017, he became an associate professor, and in 2024, a professor. He also teaches at the Medical University in the capital, where he passes on knowledge and experience to future doctors. Over the years, he has participated in 11 scientific projects, four of which are international. Prof. Dr. Svilen Maslyankov has over 140 publications in international and Bulgarian periodical medical journals and as many published abstracts in domestic and international forums. Over 600 citations of his works are known in large national and international medical databases. In 2015, he published a monograph on the topic of “Rectal Cancer - Contemporary Aspects”, and in 2021 he was the main reviewer in the monograph “Multidisciplinary Approach to the Diagnosis and Treatment of Breast Carcinoma”. The famous physician has conducted a number of specializations in surgical clinics in Greece, Spain, Croatia, England, Russia, etc., as well as over 70 participations in congresses and conferences in our country and abroad. In 2023, he was awarded the honorary sign “SIGNUM LAUDIS” on a leather plaque for special merits for the functioning and development of MU - Sofia during the years of his professional realization.