“About 30% of cancer patients have rare malignant diseases, which are 186 in number. 70% of the mortality from malignant diseases in the world is in countries with low and middle incomes", said the national consultant in clinical hematology Prof. Dr. Georgi Mihailov. "High technologies, innovations in the treatment of patients with rare diseases and in relation to hematological diseases are also available in our country, with technology we still have a lot to catch up with Europe", Prof. Mihailov is critical.
He graduated in medicine in 1981 and his entire professional career has been devoted to oncohematology. He is the Deputy Director of the National Specialized Hospital for Active Treatment of Hematological Diseases and leads the Hematology Clinic to it. He participated in the first stem cell transplants in Bulgaria. He is a member of the leadership of the Bulgarian Society of Clinical Hematology and Transfusion, the European Transplantation Federation, the leadership of the Eastern European Leukemia Treatment Group and the American Association of Hematology.
Prof. Mihailov, are cancer diseases the first cause of mortality worldwide?
- I use this opportunity through you to thank the organizers of the National Alliance of People with Rare Diseases for the meeting to clarify the situation surrounding rare diseases in Bulgaria. A meeting that has very serious goals to promote through you, the media, among the public the importance of timely and adequate treatment of rare diseases. Bulgaria joined the Lisbon Treaty a long time ago and accepted its obligations, but there are still many things that can be done in the treatment of these diseases, and we as representatives of one of the most difficult areas in clinical medicine - oncohematology and oncology as overall - we also have our very professional and serious attitude to the problem of the treatment of rare diseases.
Yes, not cardiovascular diseases, but oncological diseases are the cause of great mortality.
Is there a register of rare types of cancer in our country?
- There is no register of Bulgarians with rare diseases, nor statistics of the number of these diseases. These diseases affect between 6 and 8% of the population. 30% of cancer patients struggle with some of the rare forms of cancer.
There are 186 rare malignant diseases, nearly 4 million Europeans live with such a diagnosis. In fact, 22% of all newly diagnosed cancers annually in Europe are rare. Those whose occurrence is observed in less than 1 in 3000 people are considered as such.
30% of Europeans with cancer have one of its rare forms, which affect 1 in 100,000 people - ie
these are ultra rare diseases
Every year 40,000 Bulgarians hear such a diagnosis: You suffer from a rare disease. Unfortunately, due to the insufficient focus of society on the problems of patients with rare malignant diseases and their treatment, their survival is 5 times lower than that of patients with common types of cancer - colon, breast, lung, the prostate for example. Not everyone knows, but every year in our country more than 3000 women get breast cancer, but their survival rate is higher than those with rare diseases.
What is the reason for this?
- The main reason is the sharp change in the structure of our population. The Bulgarian population is totally aging, and malignant diseases are a priority in a person's life after the 5th and 6th decade. It is the aging but also the new screening technologies that have led to a sharp increase in cancer patients, which creates tension in he alth insurance and treatment. 90% of Bulgarians have medium and low incomes, although treatment is free, many of them cannot afford to buy their medicines, nor allocate funds for cancer prevention. That is why in our country the number of deaths from cancer is much higher than in countries with high incomes.
What are the possibilities of modern medicine in the treatment of cancer?
- The possibilities of modern medicine to fight cancer are enormous, different approaches are used to treat tumor diseases. These are cell therapy, which includes stem cell transplants, as well as a "hot" discussion for several weeks about interventions in Bulgaria with a cyberknife, ultra-precise radiotherapy, personalized chemotherapy, robotic surgery, targeted therapy, vaccines, gene therapy. They gave a new direction in modern medicine, but at the same time made the treatment more expensive. But I have always said and believe that cancer control rests on four main components -
prevention, early detection, diagnosis and access to treatment
Most important, however, is the work with the low socio-economic strata. Because in Japan, for example, he alth insurance does not cover those residents who do not follow the preventive rhythm to control carcinoma of the colon, breast and prostate. Screening for them makes their early detection and very effective treatment possible. In our country, there is a serious need to assess he alth technologies with a view to cost optimization, continuous updating of treatment guidelines, careful search for personalization of therapy, creation of expert centers and registries for rare neoplasias. When screening becomes widespread, we will not have hopeless cancer patients… We must finally grow up - not only in years, but also with a he alth culture - so we will live long and without diseases.
The uninsured Bulgarians…
- A huge part of the Bulgarian population is uninsured. A significant number of them have high incomes - but remain in the gray economy. When such a patient comes to us, it is almost impossible to deny him treatment because
it's always a life-threatening disease
Despite this problem, the control of malignant diseases in our country has increased significantly in recent years. Oncohematology became the modern leader in antitumor therapy because the idea of high-dose, multicomponent chemotherapy as well as targeted therapy was constructed.
What does “treatment-free remission zone” mean?
- Most malignant diseases are subject to permanent treatment and monitoring. But it is now possible to follow very precisely, at the molecular level, the volume of residual disease in a patient. Cancer is like an iceberg, we only see the surface when its clinical manifestations begin. The zone is when we manage to eradicate the disease from the body.
This allows treatment interruption in individual patients. But I strongly hope for the creation of the registers in order to know what the incidence of rare oncological diseases is in our country. As well as our transition from a world of broad-spectrum treatment to a world based on targeting and genetic features of malignancies, and finding molecules that detect distinct pathogenetic mechanisms in the biogenetics of the tumor cell. This is the future of modern oncology.
You call Bulgaria a “bleeding country”…
- At one time, Ireland was called a "bleeding country" because of the strong withdrawal of its human potential to the USA, and now Bulgaria is a "bleeding country" because 90% of its newly graduated doctors emigrate and this is a very serious problem for medicine in our country.
Since July, we have been operating without money with a cyberknife in our country
There will be news for patients in public he alth this year as well. From July 1, 2015, people who need cyberknife surgery will be able to receive it here, and the costs will be covered by the He alth Insurance Fund.
Usually, such an intervention is required for serious diseases such as cancer. Currently, Bulgarian patients most often go to Turkey for surgery and pay for it themselves. From the summer, however, they will be able to be treated here as well, without spending such large sums. Several hospitals are preparing to offer the service in our country as well.