Dr. Ludmil Elenchev is an obstetrician-gynecologist and oncologist, head of the Second Department of Obstetrics and Gynecology at the “Nadezhda” Women’s Health Hospital, Sofia. He graduated from the Higher Medical Institute in Pleven. There are recognized specialties in obstetrics and gynecology, oncology and health management. – Dr. Elenchev, Bulgaria is at the forefront of cervical cancer in Europe. To what do you think this black statistic is due? First, we need to distinguish between morbidity and mortality rates. Bulgaria is in second or third place in Europe in terms of incidence of cervical cancer, but it is in first place in terms of mortality from this disease. This does not mean that Bulgarian patients are not treated in a correct and effective way, on the contrary – studies show that the treatment of carcinoma in the various stages of the disease is very successful. For example, in stage four, the 5-year survival rate for women with cervical cancer is 5-8 percent. In stage three, the survival rate is about 20-30%, and in stage one, which is also an advanced carcinoma, the survival rate can reach 85%. The dark statistics about the high mortality rate in Bulgaria can be explained by the late detection of the disease. – How many new cases of cervical cancer are registered annually in Bulgaria? About 1100-1200 new cases are discovered in Bulgaria every year. Worldwide, this number is about 500,000. At the same time, 350 – 400 women die from this disease in our country each year. This means that every day one woman dies of this type of cancer. – Why do you think the disease is detected late? The ratio of patients in whom we find invasive carcinoma to those with precancerous or stage zero cervical cancer should be 30 to 70 in favor of stage zero women. But, unfortunately, the opposite is the case with us. What is more frightening is that almost every third of these approximately 77 – 80% women with invasive carcinoma are at such an advanced stage of the disease that their survival rate reaches only 8% to 30% in 5 years. – What are the dangerous strains of HPV that cause cervical cancer and how can a woman protect herself from them? The highest risk strains of human papillomavirus are 16 and 18, which are “accused” of causing cervical cancer. They are included in both prophylactic vaccines that are administered in Bulgaria. – But they are subject to many attacks and contradictory opinions. Are they harmless after all? There is no medication that is completely harmless to health. Vaccines are a modern technological achievement, a product of genetic engineering, and by presumption we should know that they are safe. Some side effects are known, such as redness around the injection site, a short-term increase in body temperature and feeling unwell. There are recorded cases in which vaccinated girls have died, but after thorough investigation, it was found that their death was caused by something incidental to the vaccination of the patient, and not the vaccine itself. – With what symptoms does the woman,carrier of the dangerous strains of HPV, should see a doctor for an examination? NEWS_MORE_BOX Human papillomavirus infection is often asymptomatic. Unfortunately, the first symptoms of cervical cancer are actually late symptoms. This means that the disease has already developed. One of the leading signs of the disease is contact bleeding – bleeding during sexual intercourse and physical exertion, outside of the regular monthly cycle. One of the first symptoms, which is often overlooked, is the so-called “white discharge”. It is not a cancer-specific sign, but it is an indication that something is going on. – Nearly a year ago, a special program for the prevention of cervical cancer was started at “Nadezhda” Medical Center. Could you tell us more about it and the results achieved? At the beginning of last year, during the European Cervical Cancer Prevention Week, a campaign for completely free prevention with a full set of necessary tests was held at the Nadezhda Women’s Health Clinic. Then, on the occasion of the hospital’s birthday, we decided to give a gift to the women in the capital, and so within two weeks, many ladies had a preventive examination. Subsequently, this has become an internal tradition of ours and we now subject all our patients at the reproductive center to a mandatory examination before their conception procedures begin. In those two weeks, we found one invasive carcinoma of the cervix, which has been completely cured to this point, and also a large number of pre-cancers that the women had not even suspected. – When we talk about papilloma viruses and cervical cancer, our attention is understandably focused on women. However, what is the role of the man and what should be his behavior in the presence of the infection? In a psychological aspect, as far as the support that a man should give to the woman next to him is concerned, it depends on the culture of the society, on folk psychology even. From a health point of view, we have to keep in mind that 80% of people have at some point been carriers of the HPV infection, distinguishing the infection from the diagnosis of cervical cancer. Just because someone is infected with this virus does not mean that they are sick or that they will ever get sick. There are individual countries, Australia for example, where men are also vaccinated against the human papilloma virus. But the benefit-harm balance must be found here, the benefit being that there is no danger of the man transmitting the infection to the women with whom he communicates intimately, and the harm relates to the financial part of the matter, since this vaccination is not cheap. So there is no practice for prevention in men. What is your advice to the ladies? My advice is to conduct regular preventive gynecological examinations with Pap smears.the first symptoms of cervical cancer are actually late symptoms. This means that the disease has already developed. One of the leading signs of the disease is contact bleeding – bleeding during sexual intercourse and physical exertion, outside of the regular monthly cycle. One of the first symptoms, which is often overlooked, is the so-called “white discharge”. It is not a cancer-specific sign, but it is an indication that something is going on. – Nearly a year ago, a special program for the prevention of cervical cancer was started at “Nadezhda” Medical Center. Could you tell us more about it and the results achieved? At the beginning of last year, during the European Cervical Cancer Prevention Week, a campaign for completely free prevention with a full set of necessary tests was held at the Nadezhda Women’s Health Clinic. Then, on the occasion of the hospital’s birthday, we decided to give a gift to the women in the capital, and so within two weeks, many ladies had a preventive examination. Subsequently, this has become an internal tradition of ours and we now subject all our patients at the reproductive center to a mandatory examination before their conception procedures begin. In those two weeks, we found one invasive carcinoma of the cervix, which has been completely cured to this point, and also a large number of pre-cancers that the women had not even suspected. – When we talk about papilloma viruses and cervical cancer, our attention is understandably focused on women. However, what is the role of the man and what should be his behavior in the presence of the infection? In a psychological aspect, as far as the support a man should give to the woman next to him is concerned, it depends on the culture of the society, on folk psychology even. From a health point of view, we must keep in mind that 80% of people have at some point been carriers of the HPV infection, distinguishing the infection from the diagnosis of cervical cancer. Just because someone is infected with this virus does not mean that they are sick or that they will ever get sick. There are individual countries, Australia for example, where men are also vaccinated against the human papilloma virus. But the benefit-harm balance must be found here, the benefit being that there is no danger of the man transmitting the infection to the women with whom he communicates intimately, and the harm relates to the financial part of the matter, since this vaccination is not cheap. So there is no practice for prevention in men. What is your advice to the ladies? My advice is to conduct regular preventive gynecological examinations with Pap smears.the first symptoms of cervical cancer are actually late symptoms. This means that the disease has already developed. One of the leading signs of the disease is contact bleeding – bleeding during sexual intercourse and physical exertion, outside of the regular monthly cycle. One of the first symptoms, which is often overlooked, is the so-called “white discharge”. It is not a cancer-specific sign, but it is an indication that something is going on. – Nearly a year ago, a special program for the prevention of cervical cancer was started at “Nadezhda” Medical Center. Could you tell us more about it and the results achieved? At the beginning of last year, during the European Cervical Cancer Prevention Week, a campaign for completely free prevention with a full set of necessary tests was held at the Nadezhda Women’s Health Clinic. Then, on the occasion of the hospital’s birthday, we decided to give a gift to the women in the capital, and so within two weeks, many ladies had a preventive examination. Subsequently, this has become an internal tradition of ours and we now subject all our patients at the reproductive center to a mandatory examination before their conception procedures begin. In those two weeks, we found one invasive carcinoma of the cervix, which has been completely cured to this point, and also a large number of pre-cancers that the women had not even suspected. – When we talk about papilloma viruses and cervical cancer, our attention is understandably focused on women. However, what is the role of the man and what should be his behavior in the presence of the infection? In a psychological aspect, as far as the support that a man should give to the woman next to him is concerned, it depends on the culture of the society, on folk psychology even. From a health point of view, we have to keep in mind that 80% of people have at some point been carriers of the HPV infection, distinguishing the infection from the diagnosis of cervical cancer. Just because someone is infected with this virus does not mean that they are sick or that they will ever get sick. There are individual countries, Australia for example, where men are also vaccinated against the human papilloma virus. But the benefit-harm balance must be found here, the benefit being that there is no danger of the man transmitting the infection to the women with whom he communicates intimately, and the harm relates to the financial part of the matter, since this vaccination is not cheap. So there is no practice for prevention in men. What is your advice to the ladies? My advice is to conduct regular preventive gynecological examinations with Pap smears.that something is happening. – Nearly a year ago, a special program for the prevention of cervical cancer was started at “Nadezhda” Medical Center. Could you tell us more about it and the results achieved? At the beginning of last year, during the European Cervical Cancer Prevention Week, a campaign for completely free prevention with a full set of necessary tests was held at the Nadezhda Women’s Health Clinic. Then, on the occasion of the hospital’s birthday, we decided to give a gift to the women in the capital, and so within two weeks, many ladies had a preventive examination. Subsequently, this has become an internal tradition of ours and we now subject all our patients at the reproductive center to a mandatory examination before their conception procedures begin. In those two weeks, we found one invasive carcinoma of the cervix, which has been completely cured to this point, and also a large number of pre-cancers that the women had not even suspected. – When we talk about papilloma viruses and cervical cancer, our attention is understandably focused on women. However, what is the role of the man and what should be his behavior in the presence of the infection? In a psychological aspect, as far as the support that a man should give to the woman next to him is concerned, it depends on the culture of the society, on folk psychology even. From a health point of view, we have to keep in mind that 80% of people have at some point been carriers of the HPV infection, distinguishing the infection from the diagnosis of cervical cancer. Just because someone is infected with this virus does not mean that they are sick or that they will ever get sick. There are individual countries, Australia for example, where men are also vaccinated against the human papilloma virus. But the benefit-harm balance must be found here, the benefit being that there is no danger of the man transmitting the infection to the women with whom he communicates intimately, and the harm relates to the financial part of the matter, since this vaccination is not cheap. So there is no practice for prevention in men. What is your advice to the ladies? My advice is to conduct regular prophylactic gynecological examinations with Pap smears.that something is happening. – Nearly a year ago, a special program for the prevention of cervical cancer was started at “Nadezhda” Medical Center. Could you tell us more about it and the results achieved? At the beginning of last year, during the European Cervical Cancer Prevention Week, a campaign for completely free prevention with a full set of necessary tests was held at the Nadezhda Women’s Health Clinic. Then, on the occasion of the hospital’s birthday, we decided to give a gift to the women in the capital, and so within two weeks, many ladies had a preventive examination. Subsequently, this has become an internal tradition of ours and we now subject all our patients at the reproductive center to a mandatory examination before their conception procedures begin. In those two weeks, we found one invasive carcinoma of the cervix, which has been completely cured to this point, and also a large number of pre-cancers that the women had not even suspected. – When we talk about papilloma viruses and cervical cancer, our attention is understandably focused on women. However, what is the role of the man and what should be his behavior in the presence of the infection? In a psychological aspect, as far as the support that a man should give to the woman next to him is concerned, it depends on the culture of the society, on folk psychology even. From a health point of view, we have to keep in mind that 80% of people have at some point been carriers of the HPV infection, distinguishing the infection from the diagnosis of cervical cancer. Just because someone is infected with this virus does not mean that they are sick or that they will ever get sick. There are individual countries, Australia for example, where men are also vaccinated against the human papilloma virus. But the benefit-harm balance must be found here, the benefit being that there is no danger of the man transmitting the infection to the women with whom he communicates intimately, and the harm relates to the financial part of the matter, since this vaccination is not cheap. So there is no practice for prevention in men. What is your advice to the ladies? My advice is to conduct regular prophylactic gynecological examinations with Pap smears.In those two weeks, we found one invasive carcinoma of the cervix, which has been completely cured to this point, and also a large number of pre-cancers that the women had not even suspected. – When we talk about papilloma viruses and cervical cancer, our attention is understandably focused on women. However, what is the role of the man and what should be his behavior in the presence of the infection? In a psychological aspect, as far as the support a man should give to the woman next to him is concerned, it depends on the culture of the society, on folk psychology even. From a health point of view, we must keep in mind that 80% of people have at some point been carriers of the HPV infection, distinguishing the infection from the diagnosis of cervical cancer. Just because someone is infected with this virus does not mean that they are sick or that they will ever get sick. There are individual countries, Australia for example, where men are also vaccinated against the human papilloma virus. But the benefit-harm balance must be found here, the benefit being that there is no danger of the man transmitting the infection to the women with whom he communicates intimately, and the harm relates to the financial part of the matter, since this vaccination is not cheap. So there is no practice for prevention in men. What is your advice to the ladies? My advice is to conduct regular preventive gynecological examinations with Pap smears.In those two weeks, we found one invasive carcinoma of the cervix, which has been completely cured to this point, and also a large number of pre-cancers that the women had not even suspected. – When we talk about papilloma viruses and cervical cancer, our attention is understandably focused on women. However, what is the role of the man and what should be his behavior in the presence of the infection? In a psychological aspect, as far as the support that a man should give to the woman next to him is concerned, it depends on the culture of the society, on folk psychology even. From a health point of view, we have to keep in mind that 80% of people have at some point been carriers of the HPV infection, distinguishing the infection from the diagnosis of cervical cancer. Just because someone is infected with this virus does not mean that they are sick or that they will ever get sick. There are individual countries, Australia for example, where men are also vaccinated against the human papilloma virus. But the benefit-harm balance must be found here, the benefit being that there is no danger of the man transmitting the infection to the women with whom he communicates intimately, and the harm relates to the financial part of the matter, since this vaccination is not cheap. So there is no practice for prevention in men. What is your advice to the ladies? My advice is to conduct regular prophylactic gynecological examinations with Pap smears.