Main topics included in the talk were:
1. The project "Patients Pathway for Breast Cancer"
2. Diagnostics and staging
Bulgaria lacks a national breast cancer screening program and generally recognized national guidelines for diagnosis and treatment.
Dr. Vasileva explained that the patient's journey begins with a preventive examination or when a breast mass is detected by the patient herself. In the case of a suspicious mass, a triple evaluation is performed: clinical examination, imaging studies and a core needle biopsy (the so-called "core needle biopsy").
Biopsy is extremely important because removing the tumor before diagnosis may deprive the patient of effective treatment.
Staging is determined by imaging studies and histological analysis of the biopsy material, which includes the type of tumor, its differentiation, and the status of the receptors for estrogen, progesterone, HER2, and the proliferative index Ki-67.
3. Treatment and ovary suppression
Assoc. Prof. Yordanov emphasized that patients in Bulgaria are not sufficiently informed, as the information is often not based on global guidelines. He categorically stated that patients should actively participate in decisions about their treatment.
Ovarian suppression, which is required in young women with hormone-sensitive breast cancer, was discussed.
Suppression can be medical or surgical (removal of the ovaries).
The surgical method is suitable for patients with metastatic cancer or with a BRCA1 mutation.
The advantages of medical suppression are that it is reversible and allows for the restoration of menstruation and preservation of reproductive function.
From a financial point of view, Assoc. Prof. Yordanov noted that surgical castration becomes more cost-effective after two years compared to drug suppression.
As the first choice for non-metastatic patients, current guidelines point to drug suppression, while in metastatic patients the better option is surgical removal of the ovaries.