“The national plan is already a fact, but it is only the first step on the road to improving cancer care for patients.” This was announced in the media by the chairman of the Bulgarian Oncology Scientific Society, Prof. Dr. Assen Dudov.
About the anti-cancer plan and the need for it, to be counted among the European countries, which will use the funding and mutual assistance provided by the European Anti-Cancer Plan, we talked about in a previous post. The document was not yet prepared then. As of today, the Working Group at the Ministry of Health must continue the work on finalizing the document, in collaboration with the National Cancer Alliance, in which they are also members 25 non-governmental, patiently, scientific and social organizations.
Why does the Bulgarian patient need this anti-cancer plan? What will be the first steps in optimizing oncology care? And the most important: cancer in 2022 year, in Bulgaria, is it a judgment and where does the stigma end? I am talking to Prof. Dudov:
Professor Dudov, does cancer continue to be accepted in people's minds as the most serious diagnosis?
Cancer is the most common diagnosis. But it should be kept in mind, that these are 200 various diseases. Modern industrial society, in whose “golden billion” we also fall from humanity, gives us a longer life with that too – more likely to meet our cancer. Because of the good control of vascular disease (cerebral and cardiovascular), cancer has begun to catch up with vascular diseases and in the coming years we expect cancer to significantly exceed them in incidence.
Hopefully not in terms of mortality!
Hopefully! Currently, Europeans and Americans die mostly from vascular disease and from cancer. In some African countries and areas with low average survival rates, infectious diseases and trauma are the most common. We live longer and have more time for these spontaneous genetic mutations, which lead to most cancers; we also have plenty of time for some of the hereditary forms of cancer, so we have to accept it as a part of being.
Fortunately, cancer is very well treated and controlled in most people these days. But what do we notice?? We notice these, who suffer, these, who walk around with an altered appearance, these, which we lose. Why isn't anyone talking about these, who are cured and forget about the disease. And they are becoming more and more.
If in 1900. the median 5-year survival was only 5%, only after 50 years, through 1950 she already is 50%, and now it is 87-88%. That's the good news. It's more important, that at its core cancer has become a disease, whose flow can be broken.
Something like a chronic disease, but from which one can be cured?
Exactly! To control. No one is cured of diabetes, but with good control it can live and 40 years after diagnosis.
Many therapies exist, different approaches, requiring different equipment. Where does Bulgaria rank compared to the average European level of control and quality in oncology therapy?
Bulgaria is at a very high level in medical treatment. We have access to some of the most advanced technology. Some of the therapies from “highest aerobatics” are accessible, possible and applicable, but unfortunately, they are used in very advanced stages of the disease. The bad is, that along with the Pandemic, not a small part of the patients started coming late, when the disease has advanced. On the other hand, there is a lack of screening programs.
There are many health facilities in Bulgaria with different funding – private and public. Is there a control over the therapies, Does he know what kind of equipment he has?, what specialists? You presented the National Cancer Plan, but data and information have yet to be collected…
Europe has written to us in 39 pages (The European Anti-Cancer Plan) what do we have to do. Europe has provided us with the money, to do it. She clearly mentioned, that some of the countries have an uneven start. We are infinitely unequal with no screening, with the lack of information systems and digitization in healthcare. At the same time, we have the highest technologies, but for one to reach them, so that this country can plan what part of the budget should go to the Treasury, to cover the costs of these high technologies, he needs to know how many patients there are with a given localization, what is their histological characteristic. I don't mean that, that already from 11 years there has been no anti-cancer registry (it even passed the time of the registers!). It is about such a digitization of the environment, which i hope people, who have the power and depend on them to do so, that information can be extracted based on certain criteria about not just how many patients there are at the moment, and what is their stage, their histology, their treatment. This way it will be understood with additional information and what is the effect of the treatment. This, which Europe does, is to enable us to have funds.
In this National Cancer Plan we, as experts, we wrote this, which needs to be done in the field of oncology, that is, whatever the screening program is, what to cover. These are breast cancer, colon cancer, prostate cancer, the possibility of a new screening, such as lung cancer, which is new even for Europe. I'll give you just an example, that in our hospital we have a licensed scanner for such a prophylactic examination of the lungs, which took us 2 years of struggle with the institutions, to prove, that we have achieved this low radiation dose with the appropriate software, so that the examination can be done prophylactically. We even had to find a phantom – device, which is put on the device instead of a person, to prove its safety to regulatory authorities. We have already licensed the scanner and imagine how this remains hidden from someone, who is at high risk of lung cancer, who does not know, that he may go and examine himself, or that this is not provided as an option by the Treasury.
Do you think so?, that in this money, which the European Anti-Cancer Plan provides, can be misused, as often happens in our country?
I have no worries about that, it's even the only one, which makes me optimistic, since the resource cannot be allocated inappropriately, because the regulatory mechanisms are very strong. This, what worries me though is, that for subjective reasons we may not “upload” at this “a train”, because someone is disinterested or because of the high control it is not an attractive activity. Let's hope for the best! Everything is prepared and hopefully we have the good will so that this does not happen “Bulgarianized” and be done so, as written by the European Commission.
Do you think, that steps and measures should be given more publicity, which are undertaken in this direction?
Yes, people need to know about it. I believe, that when the public is aware, it begins to observe and demand results. To seek an account.
Cancer will statistically affect one in two of us in one way or another. This is off topic, from which we can look away, because it doesn't concern us at the moment.
This, what you say sounds logical, but also anxious. Has the stigma against oncological diseases lifted?? I have a feeling, that one is inclined to accept all diseases with greater dignity and ease, if only it wasn't cancer?
I remember the years, in which oncology was one plus several dispensaries in the country. Then I could see how people, who live around, they pass on the other sidewalk. This stigmatization will hardly go away. Things have broken down a lot and are far from being like that anymore, and much easier to accept.
A heart attack is not preferable? It is much more dangerous than an early breast cancer, which will be perfectly cosmetically operated, will undergo a high-tech radiation treatment, which is already with accelerated electrons, rather than x-rays, as once upon a time on the old devices. There is currently no damage, no burns are caused. Things are infinitely better. If I had to choose, I would prefer something like that, than a heart attack.
Few people are aware of this, however. BUT, those, successfully passed through it, as you mentioned, they don't want to go back there. How information reaches knowledge? With cancer, everything seems to be bad PR…
I'll tell you something: Through 1964 r. seven enthusiasts gather in the States and form the American Association of Clinical Oncologists (DISGUST). At that time they have 3-4 medicines, derived from chemical warfare agents, (that's why the method is called “chemotherapy”). They establish this organization, to do the maximum for a group of people, that they can help. Today these people are 73 thousands of people worldwide – leading experts, with such a palette and range of possibilities to control this disease, which once sounded like fiction. No one imagined then, that patients in the 4th stage will live for many years in the complete absence of the disease, which is currently happening. And we are not talking about exceptions, and these are a huge part of the patients.
Are we talking about Bulgaria now??
Yes, even for Bulgaria! All, which have been successfully cured, I understand, that they don't even want to remember it, but I'm angry, that they don't want to share it with enough people or at least encourage them, precisely because of this stigmatization. What is actually happening?
We only see these, who perish, and not very most, who have been cured. But eventually things change even in terms of acceptance and sharing, as well as, Fortunately, Cancer treatment is going well.
We are on the verge of a new epidemiological wave. I do not want to discuss the measures in detail, but say a little more about the vaccines and the technology, which they use. It's about the mRNA vaccines.
Well, we work from 20 years with this technology. When the COVID vaccines were made everyone jumped on it, that they are made quickly. And actually the technology is old and well known. It's just whether you're going to add a particle of the virus envelope or it's going to be something else, which to us, in oncology, we will need it, to get our work done, does not matter, because it's just a medium.
We also want to be carriers, but of good and encouraging news. We hope, that opportunity, which is provided to us through the European Commission and their anti-cancer plan, it will make us look at the problem in its entirety and with real goodwill adopt working good practices. To lose – we have nothing to lose. The world is moving in a certain direction and science will not stop looking for ways to optimize healthcare systems, because health is important. Not! It is vitally important. And everyone knows that, diagnosed with cancer.