Assoc. Dr. Nikola Vassilev is the head of the Clinic for General and Oncological Gynecology at the Academy of Medical Sciences. He worked at the National Oncology Center, SBALSM “Pirogov”, University Hospital “Mother’s House”, etc. There are specialties in obstetrics and gynecology, pathology and oncology. Abroad, he specializes in operative obstetrics and gynecology (Japan), laparoscopy (Germany), laser surgery (Austria), etc. Assoc. Dr. Nikola Vasilev is the chairman of the Bulgarian Association of Oncogynecology. Since 1999, he has been a national consultant in obstetrics, gynecology and reproductive medicine. He was declared the best obstetrician-gynecologist in Bulgaria for 2006. Since 2008, he has also been working as a consultant at the Second General Hospital “Sheynovo” in the capital. What proportion of Bulgarian women undergo a Pap test, the so-called pap smear, at least once a year? Nobody in Bulgaria knows the answer to this question, due to the existence of a vicious system and practice. When every woman goes to a gynecologist, she is given a Pap test and the number of pap smears is counted. Let’s say, for example, that the number is 100,000, however, many women who simply did not go to the gynecologist during that time were not smeared, but those who went several times a year were examined every time . I.e. one woman had 3 or 4 pap smears taken and another had none. Therefore, it is very difficult to give an exact answer to this question. Cervical cancer cases in Bulgaria are constantly growing. How can a woman protect herself from being infected with HPV (human papillomavirus), which is considered the main cause of the malignant disease? A woman cannot protect herself from HPV. The human papilloma virus is an organism, part of living nature, that affects at least once in a lifetime a sexually mature person, be it a man or a woman. In fact, 80% of people encounter HPV at least once. It is everywhere, we cannot avoid it entirely. The condom protects, but not completely, not enough. Rather, a person can protect himself from the consequences that the virus can have on the body. This is already done through screening examinations and vaccination. Each vaccination protects the body in the same way – it stimulates it to produce antibodies. If a person is tested for HPV and is told that they have HPV, he or she usually panics and starts thinking that they are going to get cancer. This is absolutely not true. He may not get sick. The risk of developing cancer is 1:2000, i.e. relatively low. The detection and proof of the papilloma virus by DNA analysis is important enough to provoke the person in whom the virus has been proven to go to a specialist gynecological examination to see if this virus has any effect on the cells so that they go on the path of malignant transformation. In a large percentage of cases, they do not start, but even if they do, this process is very slow, sometimes stops and goes back. Therefore it cannot be saidthat there is some dark predestination about this matter. And the representatives of the male sex who are carriers of HPV, what is important to know, how to protect their partner from infection? Men will continue to be carriers, nothing can prevent that. They can be vaccinated, of course, but experts in vaccinology say for now that there is no point in administering the vaccine to them. It is believed that in terms of the balance between cost and benefit, the result tends to be negative. Only in Austria do they vaccinate boys. It is too early to talk about the results of the measure. The vaccine exists and has been used since 2008. The interval between persistent infection with the virus and the development of cancer is 10-15 years. We hope that it will have some effect, but whether Austrian women will be less affected by cervical cancer than, for example, Italian women, is a big “X”, because in Italy, as in most European countries, they only vaccinate girls , while boys are also vaccinated in Austria. Are there, and if so, what are the risks of side effects after vaccination? All modern modern vaccines are high-tech products in which any risks of unpleasant side effects, including fatal ones, are reduced to an absolute minimum. The vaccine does not contain any genetic material of the virus and it is practically impossible for a person to be infected with it. Furthermore, the vaccine components themselves do not grow on any other organisms. For example, they accused a vaccine, but not against cervical cancer, of being grown in monkey tissue, and they carried the AIDS virus, and through the vaccine one could get AIDS. This is not true, there is no such risk with her or the cervical cancer vaccine. As a species, they are absolutely synthetic vaccines that are produced in laboratory conditions and do not carry any risk of active biological presence of the real causative agent. What are the differences between opportunistic and organized population screening? The essential difference is that in organized population screening, all women in a certain age range, for example between 30-60 years, are strongly invited to have a screening examination. Opportunistic screening does not cover all women between the ages of 30 and 60. First, the women who want to have it go to screening, by choice, second – the insurer, say the NHIF, declares certain groups of women to be at risk and obliges their general practitioners to refer them to a screening examination. For women to be referred for screening, some organization is required, which implies a complex information system. Bearing in mind the alarming data for Bulgaria – high morbidity and mortality from cervical cancer, what should be the measures and steps that the state should take to change these statistics in a positive direction? A national cervical cancer prevention program should be made,as well as at least 2 more types of cancer, as recommended by the European Council of Ministers and the European Commission. These are cervical cancer and breast cancer in women, as well as colon cancer in both sexes. For each of these three locations of malignant diseases, there should be a national prevention program. Especially for cervical cancer, it consists of screening examinations and vaccination. What are the chances that the vaccine will make it onto the 2012 immunization schedule? I think they are minimal. At the moment, the health administration is betting that the vaccine will remain on the recommended list of immunizations, but that there will be some reimbursement, and that it will be possibly 25%, and the remaining 75% will be paid by the patient. This step is too small to encourage people to enter any vaccination program. 60% reimbursement from the state for example would be more reasonable, as it is in France.