Patients Talk - The Path of a Patient with Breast Cancer - August 2025

On 1st August we held a patients talk on The Path of a Patient with Breast Cancer hosted by Bulgarian Breast Cancer Association. The event was moderated by Dr. Anita Angelova, a specialist in obstetrics and gynecology. The discussion was attended by Dr. Mariela Vasileva, chairwoman of the society and specialist in general surgery, and Assoc. Prof. Angel Yordanov, specialist obstetrician-gynecologist with a second specialty in medical oncology.

Main topics included in the talk were:

1. The project "Patients Pathway for Breast Cancer"

The project started more than an year ago with support from America For Bulgaria Foundation.. It includes different initiatives by the associationsuch as an interactive map on the association's websitethat contains sections on prophylactics, screening and diagnostics. Dr. Vasileva emphasized that the goal of the map is to direct patients to various talks and podcasts to obtain as much information as possible about the patient's journey. The association has translated the European Society of Medical Oncology's recommendations for patients, which are available as a free booklet on the website. В сътрудничество с Bulgarian Association Lymphedema we have published two books on lymphedema after treatment for breast cancer and gynecological cancer, co-authored by Dr. Miroslava Chortova and Assoc. Prof. Yordanov.

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.