Assoc. Prof. Natalia Chilingirova, MD: Prevention and screening are the key in the fight against cancer in Bulgaria

On World Cancer Day we talk to Assoc. Chilingirova, head of the complex oncology center in ‘Heart and Brain’ Pleven – the only Bulgarian member of the European organization of cancer institutes

– Assoc. Prof. Chilingirova, what do the latest World Health Organization data on cancer show?

– Every year, almost 20 million people hear the severe diagnosis and about 9.7 million die from the disease. However, it is important to know that around 40% of cancers can be prevented by avoiding risk factors and implementing prevention strategies that have been proven to work. The spread and severity of these diseases can also be reduced by early detection of new cases and timely therapeutic management. Many cancers have a high chance of cure if diagnosed early and treated adequately.

In 2020, 2.7 million people were diagnosed with cancer in the European Union and 1.3 million people died from the disease. It is expected that cancer mortality in Europe will rise by more than 24% by 2035.

But beyond the statistics, every patient is first and foremost a person, with his or her own destiny. The oncologist’s mission is to be with their patients throughout the process – together they choose the best treatment strategy and achieve the best possible quality of life.

– What is the situation in Bulgaria?

– To a large extent, Bulgaria follows the global trends in morbidity and mortality, lung cancer is the most frequently diagnosed malignancy in men and breast cancer in women. Unfortunately, however, most cancers are diagnosed at an advanced stage. The lack of long-term national policies on screening and prevention remains a problem, as does the inability to diagnose most cancers early. The appearance of symptoms is generally indicative of advanced disease, so it is important to see a doctor and have annual screening.

– Just a few days ago, an international scientific conference related to innovations in oncology concluded. Please tell us more.

– It focused on a multidisciplinary approach and communication. I was impressed by the lively discussions and the rooms full of medical professionals because I believe that this is where solutions and great ideas are born. Colleagues from Bulgaria and abroad took part, from different specialties, but united around the cause of fighting cancer. And the key to success is a team approach. Central in the discussions took the new possibilities of medicine and pharmacy in the fight against the disease, the possibilities of artificial intelligence as an additional tool to help the diagnosis of treatment.

We commented on new therapeutic options in the treatment of lung cancer. We focused on the key role of genetics in modern diagnosis and treatment, discussed new therapeutic options in the treatment of melanoma, and addressed the important role of screening and prevention with a focus on cervical cancer. We showed innovations in surgical approaches -robot-assisted surgery, presented our own data and analyses from clinical practice. In short, we dove into the infinity of modern diagnostic and treatment options, with an eye to the future of medicine.

– What are the takeaways and what are your goals for fighting cancer from here?

– Science is moving forward, and with it the fight against cancer. If I can summarise, I would say that our successes in the war against this disease are based on tireless teamwork and innovation at every stage from diagnosis through treatment and patient follow-up.

It makes sense that in this era of precision medicine and innovation in oncology, we should focus on advanced prevention and screening options to make a positive change to the dismal statistics. Early detection necessitates the introduction of digital technologies and platforms, telemedicine into actual clinical practice. And the goal is to offer adequate screening to target populations (patients at increased risk of disease), e.g. for breast, cervical, lung, colorectal cancer, etc. Such programmes are already underway in a number of other countries at national level.

Another crucial prerequisite for an excellent therapeutic response and good long-term outcomes is the availability of comprehensive cancer centres, where every step from diagnosis through treatment and follow-up happens in one place, without the patient and their relatives having to wander between separate institutions at such a difficult time.

‘Heart and Brain’ is an example of this. For nearly five years now, the comprehensive cancer centre has been applying a modern, multidisciplinary and high-tech world-class approach – in one place. Not surprisingly, we are the only full member and the first Bulgarian member of the largest network of oncology centres and institutions in Europe (OECI).

– What more needs to be done in terms of prevention?

– Prevention and screening are the key to fighting cancer – given the main risk factors for cancer, we could largely prevent or avoid them. For example, smoking is clearly associated with lung cancer, i.e. reducing and stopping it would reduce the risk of developing this cancer. Regular check-ups and vaccination would reduce the incidence of cervical cancer. Vaccines against the human papilloma virus, some of whose subtypes cause cervical cancer, are available in this country and can be administered. Above all, responsibility for health is a matter of personal choice.

Part of the process is raising public awareness, social engagement and providing relevant, accessible and accurate medical information.