Dr. Ivan Dimitrov is an obstetrician-gynecologist, specialist profiled in oncogynecological prevention. He works at the “Dr. Shterev” Medical Complex, Department of Oncoprophylaxis and Preventive Medicine. Dr. Ivan Dimitrov graduated from the Medical University – Pleven in 2008, after which he was enrolled for specialization in obstetrics and gynecology at PSAGBAL “St. Sofia”. In 2010, he became part of the team of AG Hospital “Shterev” with the main focus on oncological prophylaxis under the leadership of Prof. Atanas Shterev. In 2012, he acquired the specialty “Obstetrics and Gynecology”. He has additional qualifications in the field of diagnostic laparoscopy in gynecology (2011, London), basics of colposcopy under the guidance of Professor Albert Singer, consultant at University College and Whittington Hospitals, England (2012, Sofia), “A to Z Suturing Laparoscopy Course” under the supervision of Dr. Rudy Campo, Dr. Stephan Gorts and Professor A. Vatier (2012, Leuven, Belgium), Colposcopy and destructive treatment of cervical precancers” under the supervision of Professor Victor Zlatkov, SBALAG “Mother’s House” (2013, Sofia), transvaginal laparoscopy (2013) Dr. Dimitrov’s main interests are in the field of operative gynecology and more specifically the application of endoscopic techniques, oncogynecology and oncological prophylaxis in the field of gynecology. He is a member of the Bulgarian Medical Union, the Bulgarian Association for Sterility and Reproductive Health and the European Society of Human Reproduction and Embryology (ESHRE). – To this day, the question remains controversial whether cytology or colposcopy is a better method for diagnosing precancerous conditions of the cervix. The cytological method is well known to almost every woman. There is no patient who did not have an oncocytoma smear taken during a prophylactic gynecological examination. Unfortunately, few patients are offered colposcopy at the time of examination. – Dr. Dimitrov, briefly describe what the two methods are? The cyto smear, or the so-called A PAP test is a microscopic examination of cells from the cervix for the early detection and diagnosis of cervical cancer. The test was developed in 1928 by the pathologist George Papanicolaou and is therefore also known as the PAP test. It is recommended that the examination be carried out once a year for all women between the ages of 21 and 65, as well as for girls under 21 who are sexually active. In women with an increased risk, the examination is carried out once every six months, or depending on the doctor’s recommendation. Colposcopy is a specialized non-invasive gynecological examination in which the cervix, vagina and external genitals are examined with a special microscope (colposcope). The optical magnification that is applied reveals inaccessible structures, both for the “unaided” eye and for microscopic examination.The aim is to screen the normal and benign epithelial findings from the suspicious and malignant ones that need histological examination (targeted biopsy). Colposcopy is not a new method. The creator of the method and the first colposcopic apparatus was Hans Hinselmann in 1924. In Bulgaria, the method began to be used routinely by Dr. Vassilev in the “Mother’s House” hospital in 1953. Nowadays, the method is rarely used, which is one of the reasons why Bulgaria ranks one of the first places in terms of morbidity and mortality from cervical cancer in Europe. – What are the advantages and disadvantages of the two methods? Oncocytosmear is a suitable method for mass screening, can be taken by average medical personnel, is amenable to automation and is cost-effective. On the other hand, the study cannot precisely localize the source of tumor cells, give information about the boundaries and spread of the lesion. From a purely organizational point of view, the examination goes through many stages between patient, cytologist and gynecologist, which creates a danger of errors and, last but not least, there are quite a few false negative results. Colposcopy is an indispensable tool in the fight against cervical cancer – it precisely localizes the change, provides information about the boundaries and distribution of the lesion, reliably differentiates inflammatory and atrophic changes from neoplastic ones and has a high diagnostic value. An additional advantage of the study is the direct contact between the patient and the obstetrician-gynecologist. Along with its advantages, the colposcopic method also has some disadvantages. For example, it is not applicable for mass screening, the presence of an additional trained and qualified doctor is necessary, it is not subject to automation, it is economically disadvantageous and to some extent inadequate for detecting endocervical changes. NEWS_MORE_BOX The truth is, however, that both methods should not be in competition with each other, but rather complementary. The disadvantages of one method are complemented by the advantages of the other. As a result of this diagnostic synergism, when applying both methods simultaneously, the diagnostic certainty can reach 100%. – What is the practice in Bulgaria? In Bulgaria, at the moment, there are no developed programs for mass screening to guarantee that every woman will have an oncocytosmear smear at a certain period of time. Only in the presence of mass screening, colposcopy can be applied as an additional method to clarify patients with doubtful or positive results of the cytological examination. Relying on opportunistic screening (as is the case in Bulgaria), that is to perform an oncoprophylactic examination of every patient who enters the office, the colposcopic examination must be an invariable part of the examination.Since there is no state commitment to this socially significant disease and due to the lack of mass screening, every obstetrician-gynecologist should become more actively involved in the fight against cervical cancer. It is imperative to use all methods to examine the cervix in order to have a better and earlier diagnosis of precancerous lesions. We should not forget that with increasingly hectic and busy lifestyles, there is very rarely time left to devote to our health. A small part of patients allow themselves the luxury of being examined every year, which gives a high diagnostic certainty. At best, some patients visit their gynecologist once every few years. In these patients, receiving a negative smear result creates a false sense of security (presence of false negative results). By performing a colposcopic examination of every patient visiting the office for a preventive gynecological examination, we could guarantee with much greater accuracy the absence of precancerous changes. The normal (negative) result of the oncocytosmear, unfortunately, does not always mean the absence of precancerous changes. – In this regard, what is your advice to ladies who care about their health? I strongly recommend a prophylactic gynecological examination once a year, including oncocytosmear and colposcopy. Aware of the importance of timely prevention, in the “Dr. Shterev” Medical Complex, a sector for oncoprophylaxis and preventive medicine has been operating quite recently. An oncoprophylactic office was opened, which is equipped with a video colposcopic apparatus of the latest generation. An electronic file of the screened patients has been created, which allows better follow-up of patients and the possibility of consultation with colleagues electronically. We have developed preferential prophylactic packages so that more women can afford a quality oncoprophylactic examination. We have also created a histopathology laboratory on the territory of the hospital, which on the one hand shortens the path between patient – cytologist – gynecologist and the risk of errors, and on the other hand, the close collaboration and information interconnection between the colposcopist, cytologist and histologist leads to a more accurate and timely diagnosis . The results of the database of this sector strongly indicate the need to perform routine colposcopy. There are quite a few patients with negative for precancerous smears and suspicious colposcopic findings with histologically (by biopsy) proven changes. In conclusion, I would like to emphasize once again that colposcopy and cytodiagnostics should not be used as methods of independent examination of precancerous lesions of the cervix. Colposcopic examination is an indispensable part of oncogynecological prevention. Using both methods at the same time would lead to better diagnosis and reduction in the incidence of cervical cancer.It is imperative to use all methods to examine the cervix in order to have a better and earlier diagnosis of precancerous lesions. We should not forget that with increasingly hectic and busy lifestyles, there is very rarely time left to devote to our health. A small part of patients allow themselves the luxury of being examined every year, which gives a high diagnostic certainty. At best, some patients visit their gynecologist once every few years. In these patients, receiving a negative smear result creates a false sense of security (presence of false negative results). By performing a colposcopic examination of every patient visiting the office for a preventive gynecological examination, we could guarantee with much greater accuracy the absence of precancerous changes. The normal (negative) result of the oncocytosmear, unfortunately, does not always mean the absence of precancerous changes. – In this regard, what is your advice to ladies who care about their health? I strongly recommend a prophylactic gynecological examination once a year, including oncocytosmear and colposcopy. Aware of the importance of timely prevention, in the “Dr. Shterev” Medical Complex, a sector for oncoprophylaxis and preventive medicine has been functioning quite recently. An oncoprophylactic office was opened, which is equipped with a video colposcopic apparatus of the latest generation. An electronic file of the screened patients has been created, which allows better follow-up of patients and the possibility of consultation with colleagues electronically. We have developed preferential preventive packages so that more women can afford a quality oncological preventive examination. We have also created a histopathology laboratory on the territory of the hospital, which on the one hand shortens the path between patient – cytologist – gynecologist and the risk of errors, and on the other hand, the close collaboration and information interconnection between the colposcopist, cytologist and histologist leads to a more accurate and timely diagnosis . The results of the database of this sector strongly indicate the need to perform routine colposcopy. There are quite a few patients with negative for precancerous smears and suspicious colposcopic findings with histologically (by biopsy) proven changes. In conclusion, I would like to emphasize once again that colposcopy and cytodiagnostics should not be used as methods of self-examination of precancerous lesions of the cervix. Colposcopic examination is an indispensable part of oncogynecological prevention. Using both methods at the same time would lead to better diagnosis and reduction in the incidence of cervical cancer.It is imperative to use all methods to examine the cervix in order to have a better and earlier diagnosis of precancerous lesions. We should not forget that with increasingly hectic and busy lifestyles, there is very rarely time left to devote to our health. A small part of patients allow themselves the luxury of being examined every year, which gives a high diagnostic certainty. At best, some patients visit their gynecologist once every few years. In these patients, receiving a negative smear result creates a false sense of security (presence of false negative results). By performing a colposcopic examination of every patient visiting the office for a preventive gynecological examination, we could guarantee with much greater accuracy the absence of precancerous changes. The normal (negative) result of the oncocytosmear, unfortunately, does not always mean the absence of precancerous changes. – In this regard, what is your advice to ladies who care about their health? I strongly recommend a prophylactic gynecological examination once a year, including oncocytosmear and colposcopy. Aware of the importance of timely prevention, in the “Dr. Shterev” Medical Complex, a sector for oncoprophylaxis and preventive medicine has been functioning quite recently. An oncoprophylactic office was opened, which is equipped with a video colposcopic apparatus of the latest generation. An electronic file of the screened patients has been created, which allows better follow-up of patients and the possibility of consultation with colleagues electronically. We have developed preferential prophylactic packages so that more women can afford a quality oncoprophylactic examination. We have also created a histopathology laboratory on the territory of the hospital, which on the one hand shortens the path between patient – cytologist – gynecologist and the risk of errors, and on the other hand, the close collaboration and information interconnection between the colposcopist, cytologist and histologist leads to a more accurate and timely diagnosis . The results of the database of this sector strongly indicate the need to perform routine colposcopy. There are quite a few patients with negative for precancerous smears and suspicious colposcopic findings with histologically (by biopsy) proven changes. In conclusion, I would like to emphasize once again that colposcopy and cytodiagnostics should not be used as methods of self-examination of precancerous lesions of the cervix. Colposcopic examination is an indispensable part of oncogynecological prevention. Using both methods at the same time would lead to better diagnosis and reduction in the incidence of cervical cancer.A small part of patients allow themselves the luxury of being examined every year, which gives a high diagnostic certainty. At best, some patients visit their gynecologist once every few years. In these patients, receiving a negative smear result creates a false sense of security (presence of false negative results). By performing a colposcopic examination of every patient visiting the office for a preventive gynecological examination, we could guarantee with much greater accuracy the absence of precancerous changes. The normal (negative) result of the oncocytosmear, unfortunately, does not always mean the absence of precancerous changes. – In this regard, what is your advice to ladies who care about their health? I strongly recommend a prophylactic gynecological examination once a year, including oncocytosmear and colposcopy. Aware of the importance of timely prevention, in the “Dr. Shterev” Medical Complex, a sector for oncoprophylaxis and preventive medicine has been operating quite recently. An oncoprophylactic office was opened, which is equipped with a video colposcopic apparatus of the latest generation. An electronic file of the screened patients has been created, which allows better follow-up of patients and the possibility of consultation with colleagues electronically. We have developed preferential prophylactic packages so that more women can afford a quality oncoprophylactic examination. We have also created a histopathology laboratory on the territory of the hospital, which on the one hand shortens the path between patient – cytologist – gynecologist and the risk of errors, and on the other hand, the close collaboration and information interconnection between the colposcopist, cytologist and histologist leads to a more accurate and timely diagnosis . The results of the database of this sector strongly indicate the need to perform routine colposcopy. There are quite a few patients with negative for precancerous smears and suspicious colposcopic findings with histologically (by biopsy) proven changes. In conclusion, I would like to emphasize once again that colposcopy and cytodiagnostics should not be used as methods of self-examination of precancerous lesions of the cervix. Colposcopic examination is an indispensable part of oncogynecological prevention. Using both methods at the same time would lead to better diagnosis and reduction in the incidence of cervical cancer.A small part of patients allow themselves the luxury of being examined every year, which gives a high diagnostic certainty. At best, some patients visit their gynecologist once every few years. In these patients, receiving a negative smear result creates a false sense of security (presence of false negative results). By performing a colposcopic examination of every patient visiting the office for a preventive gynecological examination, we could guarantee with much greater accuracy the absence of precancerous changes. The normal (negative) result of the oncocytosmear, unfortunately, does not always mean the absence of precancerous changes. – In this regard, what is your advice to ladies who care about their health? I strongly recommend a prophylactic gynecological examination once a year, including oncocytosmear and colposcopy. Aware of the importance of timely prevention, in the “Dr. Shterev” Medical Complex, a sector for oncoprophylaxis and preventive medicine has been operating quite recently. An oncoprophylactic office was opened, which is equipped with a video colposcopic apparatus of the latest generation. An electronic file of the screened patients has been created, which allows better follow-up of patients and the possibility of consultation with colleagues electronically. We have developed preferential prophylactic packages so that more women can afford a quality oncoprophylactic examination. We have also created a histopathology laboratory on the territory of the hospital, which on the one hand shortens the path between patient – cytologist – gynecologist and the risk of errors, and on the other hand, the close collaboration and information interconnection between the colposcopist, cytologist and histologist leads to a more accurate and timely diagnosis . The results of the database of this sector strongly indicate the need to perform routine colposcopy. There are quite a few patients with negative for precancerous smears and suspicious colposcopic findings with histologically (by biopsy) proven changes. In conclusion, I would like to emphasize once again that colposcopy and cytodiagnostics should not be used as methods of self-examination of precancerous lesions of the cervix. Colposcopic examination is an indispensable part of oncogynecological prevention. Using both methods at the same time would lead to better diagnosis and reduction in the incidence of cervical cancer.we could guarantee with much greater accuracy the absence of precancerous changes. The normal (negative) result of the oncocytosmear, unfortunately, does not always mean the absence of precancerous changes. – In this regard, what is your advice to ladies who care about their health? I strongly recommend a prophylactic gynecological examination once a year, including oncocytosmear and colposcopy. Aware of the importance of timely prevention, in the “Dr. Shterev” Medical Complex, a sector for oncoprophylaxis and preventive medicine has been operating quite recently. An oncoprophylactic office was opened, which is equipped with a video colposcopic apparatus of the latest generation. An electronic file of the screened patients has been created, which allows better follow-up of patients and the possibility of consultation with colleagues electronically. We have developed preferential prophylactic packages so that more women can afford a quality oncoprophylactic examination. We have also created a histopathology laboratory on the territory of the hospital, which on the one hand shortens the path between patient – cytologist – gynecologist and the risk of errors, and on the other hand, the close collaboration and information interconnection between the colposcopist, cytologist and histologist leads to a more accurate and timely diagnosis . The results of the database of this sector strongly indicate the need to perform routine colposcopy. There are quite a few patients with negative for precancerous smears and suspicious colposcopic findings with histologically (by biopsy) proven changes. In conclusion, I would like to emphasize once again that colposcopy and cytodiagnostics should not be used as methods of self-examination of precancerous lesions of the cervix. Colposcopic examination is an indispensable part of oncogynecological prevention. Using both methods at the same time would lead to better diagnosis and reduction in the incidence of cervical cancer.we could guarantee with much greater accuracy the absence of precancerous changes. The normal (negative) result of the oncocytosmear, unfortunately, does not always mean the absence of precancerous changes. – In this regard, what is your advice to ladies who care about their health? I strongly recommend a prophylactic gynecological examination once a year, including oncocytosmear and colposcopy. Aware of the importance of timely prevention, in the “Dr. Shterev” Medical Complex, a sector for oncoprophylaxis and preventive medicine has been operating quite recently. An oncoprophylactic office was opened, which is equipped with a video colposcopic apparatus of the latest generation. An electronic file of the screened patients has been created, which allows better follow-up of patients and the possibility of consultation with colleagues electronically. We have developed preferential prophylactic packages so that more women can afford a quality oncoprophylactic examination. We have also created a histopathology laboratory on the territory of the hospital, which on the one hand shortens the path between patient – cytologist – gynecologist and the risk of errors, and on the other hand, the close collaboration and information interconnection between the colposcopist, cytologist and histologist leads to a more accurate and timely diagnosis . The results of the database of this sector strongly indicate the need to perform routine colposcopy. There are quite a few patients with negative for precancerous smears and suspicious colposcopic findings with histologically (by biopsy) proven changes. In conclusion, I would like to emphasize once again that colposcopy and cytodiagnostics should not be used as methods of self-examination of precancerous lesions of the cervix. Colposcopic examination is an indispensable part of oncogynecological prevention. Using both methods at the same time would lead to better diagnosis and reduction in the incidence of cervical cancer.which, on the one hand, shortens the path between patient – cytologist – gynecologist and the risk of errors, and on the other hand, the close collaboration and information relationship between the colposcopist, cytologist and histologist leads to a more accurate and timely diagnosis. The results of the database of this sector strongly indicate the need to perform routine colposcopy. There are quite a few patients with negative for precancerous smears and suspicious colposcopic findings with histologically (by biopsy) proven changes. In conclusion, I would like to emphasize once again that colposcopy and cytodiagnostics should not be used as methods of self-examination of precancerous lesions of the cervix. Colposcopic examination is an indispensable part of oncogynecological prevention. Using both methods at the same time would lead to better diagnosis and reduction in the incidence of cervical cancer.which, on the one hand, shortens the path between patient – cytologist – gynecologist and the risk of errors, and on the other hand, the close collaboration and information relationship between the colposcopist, cytologist and histologist leads to a more accurate and timely diagnosis. The results of the database of this sector strongly indicate the need to perform routine colposcopy. There are quite a few patients with negative for precancerous smears and suspicious colposcopic findings with histologically (by biopsy) proven changes. In conclusion, I would like to emphasize once again that colposcopy and cytodiagnostics should not be used as methods of self-examination of precancerous lesions of the cervix. Colposcopic examination is an indispensable part of oncogynecological prevention. Using both methods at the same time would lead to better diagnosis and reduction in the incidence of cervical cancer.