For the past 4 years, a European Cervical Cancer Week has been held, usually in the last week of January. Bulgaria joined this initiative in 2008, according to Assoc. Dr. Nikola Vasilev, with whom we talk about the risks of developing cervical cancer after infection with papilloma viruses, the spread of the disease in our country and the level of its treatment. From January 24 to 29, 2011, our country will participate in the fourth European Week to fight cervical cancer, which is our third consecutive participation in the event. Assoc. Dr. Nikola Vassilev is the head of the General and Oncological Gynecology Clinic at the Academy of Medical Sciences. He worked at the National Oncology Center, SBALSM “Pirogov”, University Hospital “Mother’s House” and others. 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. Prof. Vassilev 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. How dangerous are papilloma viruses? There are hundreds of types of human papillomaviruses. A large part of them can cause (may or may not cause) diseases. Some of these diseases are life-threatening – this applies to different types of cancer. Even when they do not pose such a risk, the clinical manifestations of the virus are unpleasant. A virus, for example, can cause warts. They are too annoying, sometimes downright painful – without being cancer. Which types carry a potential risk of developing cervical cancer? Especially for cervical cancer, the highest risk are HPV-types 16, 18, 45, 31 and 33. They cause about 82% of all cases of cervical cancer in the world, and for Bulgaria – nearly 97%. Is cervical cancer common? With what frequency in the world, in Bulgaria? Recently, in Bulgaria, 25-30 out of every 100,000 women fall ill with cervical cancer. About 340-360 women die from this disease annually. Roughly speaking, every Christmas Day a Bulgarian woman dies of cervical cancer. Compared to most European countries, this is an excessively high morbidity and mortality rate. Compared to some third world countries (e.g. Liberia and Sierra Leone) it can be said that we are doing a bit better. Can we talk about the presence of a trend towards an increase in cases of cervical cancer? What caused this? For twenty years, a permanent trend of increasing incidence of cervical cancer has been established in Bulgaria. This is due, both to the low level of prevention of this disease, and to the increased risk of infection with HPV associated with the more relaxed manners of the population. We should not forget that precisely these types of HPVs,that cause cervical cancer are exclusively sexually transmitted. What should be done when these viruses are present? In a huge percentage of cases, the body heals itself from the human papilloma virus. This means that we should not panic if our papillomavirus DNA test is positive. We can help self-healing by taking drugs from the group of immunostimulators prescribed by a doctor. Cervical cancer develops in only 1 in 2,000 women infected with HPV. A much larger number of these women, however, develop precancerous conditions. What is the prevention of cervical cancer? The prevention of cervical cancer consists of two equally important actions: regular (every 1-3 years) preventive examinations with Pap smears and vaccination against oncogenic HPV types. None of these actions can lead to a full-fledged result by itself, i.e. without being combined with the other. By “complete result” I mean complete or almost complete eradication of cervical cancer – as smallpox, malaria and plague have been eradicated in our lands. What is the treatment for cervical cancer? Treatment for advanced cervical cancer can be surgery, radiation, antitumor drugs, or a combination of these methods. It is always more or less crippling for the woman. Alas, often the treatment starts so late that the result is doubtful. What is the level of prevention and treatment of cervical cancer in our country according to the leading world standards? In which medical institution in our country is cervical cancer treated most successfully? Currently, the level of cervical cancer prevention in our country is outrageously low. I have some reason to hope that in the near future this situation will undergo a change for the better. As for the treatment of this cancer, I think that the Bulgarian oncology school adheres to world standards. I would even say that we have more experience in treating advanced cervical cancer than many other advanced countries. This is not a reason to be proud – it’s just that prevention there is at such a level that cases with advanced cancer are extremely rare and doctors simply do not have the opportunity to gain experience in their treatment. A vaccine against cervical cancer has been invented. In your opinion, does it provide effective protection against papilloma viruses? The cervical cancer vaccine gives almost 100% protection against the two HPV vaccine types (16 and 18) and is less effective against another 2-3 virus types. Some types of HPV, which also cause – although less often – cervical cancer are not affected by existing anti-HPV vaccines. This makes it imperative that all women – both unvaccinated and vaccinated – attend preventive examinations. Is it known if the vaccine has side effects and what are they? Every modern vaccine is studied most thoroughly for the so-called safety profile.The safety profile of anti-HPV vaccines is very good. So far, after several tens of millions of doses of the vaccine have been administered worldwide, there are still no proven cases of a causal relationship between vaccination and newly emerging severe disease. For which women is the vaccine intended? Mass vaccination is recommended before starting sexual life, namely for girls aged 12-13 years. Women who have crossed this age can be vaccinated later. The benefit of vaccination slowly declines with age. Which test is most reliable for detecting papillomaviruses? Is a Pap smear enough? When should an HPV test be done and for which types do you recommend? A Pap smear does not detect viruses because they are not visible under an ordinary microscope. The smear detects cell changes that may (with varying degrees of probability) be caused by viruses. A DNA test for HPV can be done at any time. If you intend to get vaccinated in the near future, it is good (but not necessary) that this test targets the vaccine types of HPV. If not, the so-called screening DNA test. There are countries in the EU where anti-HPV vaccination is carried out massively and for boys – is there any logic in this? Mass vaccination of boys is carried out in Austria. I don’t think there are mass anti-HPV vaccination programs for boys in other EU countries. There is, of course, logic in vaccinating boys – girls are not infected with HPV from the air, namely from boys. However, there is still no conclusive evidence of the benefit of mass vaccination of boys.there is logic – girls do not get infected with HPV from the air, namely from boys. However, there is still no conclusive evidence for the benefit of mass vaccination of boys.there is logic – girls do not get infected with HPV from the air, namely from boys. However, there is still no conclusive evidence for the benefit of mass vaccination of boys.