She acquires two speci alties - internal medicine and oncology. Dr. Krasteva specialized in university hospitals in Turin (Italy), Athens (Greece), Munich (Germany), Basel (Switzerland). She worked at the Medical Oncology Clinic at Tsaritsa Joanna University Hospital - ISUL in Sofia and at the Department of Medical Oncology at Serdika Hospital, Sofia.
Since September 2019, Dr. Rositsa Krasteva heads the Oncology Center at Uni Hospital, which includes the Department of Medical Oncology, the Department of Radiotherapy and the Department of Nuclear Medicine.
We talk to Dr. Rositsa Krasteva about how cancer is like any other chronic disease and not a taboo diagnosis that instills terror and fear of the future.
Dr. Krasteva, let's start with the question, did the cases of lung cancer increase during these two years of the pandemic. How did it affect, especially in terms of timely diagnosis?
- Unfortunately, the pandemic has affected in a negative way. For these two years, worldwide, the diagnosis of cancer patients has slowed down. Screening programs have also been delayed or stopped altogether. This has led to a decrease in early-stage carcinomas worldwide.
On the other hand, there were also many cases where patients who sought medical attention due to suspected lung damage from the viral infection were diagnosed with lung carcinoma
- We can certainly say that for these two years, lung cancer was being diagnosed at a late stage. Even in the last six months we have had patients who failed to get treatment – they were diagnosed so late. We will have to wait and see how the statistics will turn out and if there is an increase in lung cancer cases.
There may also be an apparent decrease in the number of cases as they simply have not been diagnosed. Not to mention the cases where patients deteriorate too quickly and cannot even be diagnosed except by imaging.
How did your patients fight cancer during this period?
- It is important to understand that "battle" is not the most correct association for cancer treatment. People need to know that cancer is a disease like any other and has its specificities, just like diabetes, autoimmune, cardiovascular diseases. What exactly is cancer, how is cancer treated - these topics are not very popular in Bulgaria for two reasons.
First, because this diagnosis has always been taboo, or in other words, you hear the diagnosis of cancer, grab your head and die. This has been the position of both the ruling and medical professions for many years. But in the last 20 years, new discoveries that have been introduced into practice have proven that it is a chronic disease that is treatable and can be kept under control.
To my patients, not only in the last two years, but throughout my conscious work as a medical oncologist, I strive to show that life does not end with this diagnosis. But a certain period of 6, 10 months and sometimes longer is required in which the certain treatment should be carried out.
If one experiences himself as a warrior and thinks this is a battle, so be it. For me, it is better that the opponent is known and the attitude towards him is normal, elegant, almost friendly. This is what we are trying to show with the "Winners" initiative of the "Uni Hospital" Oncology Center, aimed not only at the patients undergoing treatment, but also at the entire public. We explain to the patient what the treatment is, what his goal is, and we help him continue his life in the most fulfilling way.
Calls to stay at home during the pandemic have restricted and stressed many people and delayed many diagnoses. Many of the clinics that diagnosed cancer by biopsy were also transformed into covid-wards. For this reason, many patients could not even be diagnosed. People's fear has not gone away, and I fear it will have quite lasting effects.
Some people have changes in their psyche and consciousness. It's not normal today to walk down the street, see a close friend you would otherwise hug, and now wonder where to put your hands. It's even more disheartening to see people driving alone in their cars and wearing a mask. Many things have suffered a severe deviation, and the psyche of many will hardly return to normal. People are yet to have problems with this instilled fear and terror.
Can we say that some of the lung cancer cases are a post covid complication or is it too early to say
- I think it's a stretch to christen everything post-covid post-covid. There are criteria and principles of differential diagnosis. It must be categorically clear that there is no such connection.
Virus infection cannot by itself be the cause of cancer. I have commented many times that cancer is a disease that accompanies people throughout their history. Unfortunately, there will be cancer with or without covid. 9,600,000 people die from cancer every year in the world and this will not change. It is recommended that people diagnosed with cancer get vaccinated, just like everyone else. The recommendations of the global he alth community have been known for a year and the information is absolutely accessible.
We recommend our patients to get vaccinated, as it is believed that RNA vaccines are the most suitable for them. Patients on active treatment should discuss with their treating oncologist which is the best time to get a vaccine in relation to their current therapy.
There are many cases of vaccinated patients with us - those undergoing active treatment, under dispensary observation, in remission… We always adapt the vaccination recommendation to their condition by monitoring certain indicators.
I ask you to concentrate on recalling the most characteristic of lung cancer, emphasizing the novelties in treatment…
- The revolution is in the treatment of cancer in general. If the people of Ancient Egypt believed that the tumor had to be removed in order to cure the patient, nowadays we think that the cancer appeared in a certain place because there is a problem there. Something genetic is damaged, a tumor appears, and our task is to find out what is the reason for its appearance. In about 30% of cases, we manage to understand this, thanks to certain biomarkers that indicate what activated the tumorigenesis.
One of the examples of this is adenocarcinoma of the lung, where, in addition to targeted, we also have immunotherapy. In our practice, we already have cases of patients with stage 4 disease and survival of 4, 5, 6, even 10 years. Let me point out that we are talking about diagnoses where, until recently, survival did not exceed 1 year.
If covid has shown something positive, it is that we can exchange information, speed up the registration of medicines, as this is already happening with medicines for the treatment of oncological diseases. Only that no one comments on it because politicians and journalists are not involved. It is not acceptable to talk about cancer, let alone to report every morning on the television screen how many are newly diagnosed and how many have died from malignant diseases, as is done with the coronavirus.
Dr. Krasteva, due to a question from our reader, I ask you to talk about the so-called gastrointestinal stromal tumors. I assume they are rare?
-Gastrointestinal stromal tumors arise from mesenchymal cells and account for 1.5% of all malignancies worldwide. We started talking about this disease after 1999
Before this diagnosis did not exist. This type of tumor is successfully treated with targeted therapy. Here we also have predictive markers, genetic analysis should be done to see what mutations the tumor has and which treatment option is suitable for it. It is a disease that can be successfully treated even when detected at a later stage.
What is your position and comment on the National Cancer Plan being prepared?
- Anti-cancer plan has many sides. It concerns the he alth of the nation and it is essential that it become a top priority, a matter directly affecting national he alth policy. The national anti-cancer plan includes measures for the prevention of malignant diseases, for their early diagnosis, treatment, follow-up, as well as the provision of financial and human resources to develop, invest in research, and apply innovative methods in treatment. This is an extremely expensive undertaking that cannot be campaigned.
A methodical, durable, sustainable, permanent policy in this direction is needed, with the goal of enforcing the messages of this anti-cancer plan as a behavior for the prevention and treatment of malignant diseases along the entire chain from the general practitioner to the medical oncologist. In certain cancer centers, this is already happening. It will be expensive, of course, but the EU provides resources in this direction. Bulgarians must be sure that their treatment will be comparable to that in other European countries.