Dr. Krasteva, at what pace and to what extent are cancers growing?
- Statistics show that the number of people with cancer in the world will increase by 68% from 2008 to 2030, and the number of people who die from cancer will increase by 73%. In 2014, in the USA, 223,000 women fell ill with breast cancer and 40,000 died. We do not have such statistics for Bulgaria yet, but according to the cancer registry for 2011, the new cases of breast cancer were 3,885, and the deaths were 1,284..
Is there breast cancer in men?
- Yes, although rare, men also have breast cancer - about 1% of all cases. Men are less likely to pay attention to themselves, and that is exactly why breast cancer in them is detected at a late stage. This year I am treating six men with breast cancer. Two of the cases are in an advanced stage. One patient was in a skin clinic and colleagues did not biopsy the tumor. The other patient ignored the symptoms. Both men have metastatic disease. One has HER2 positive breast cancer. We treat him with both Herceptin and targeted therapy, and we also give him hormones. For now
we influence metastases well
My other four patients are adjuvant although two of them also have HER2 positive breast cancer and we treated them with Herceptin for a year.
Are the symptoms the same as in women?
- Yes - a lump in the nipple area or some lump in the breast. If a person does not pay attention to it and does not go to a doctor, and if he does not come across a colleague who thinks in this direction, the diagnosis is made too late. Of course, no doctor can and should not understand everything. But if you don't understand something, ask someone who does. For example, the other day I had a patient with an extremely rare disease. I treated one such 18 years ago. I called at least five of my colleagues and eventually found a doctor who had a lot of experience with these tumors and referred the patient. This saves a lot of inconvenience, wondering and ensures the most correct treatment for these patients. Therefore, men are diagnosed with breast cancer a little later than women. It represents actually several diseases - at least six types. Among them is Paget's disease. It is usually seen as a skin disease, but underneath the skin cancer is invasive breast carcinoma. In some cases, the disease actually only affects the skin.
What are the risk factors for breast cancer?
- Low-risk factors are the age at which the woman became pregnant and gave birth, whether she breastfed. Nutrition is extremely important. Fuller women who eat more fat are thought to be at greater risk of developing breast cancer. They also have great importance
the introduction of hormones into the body
in some way - whether to prevent pregnancy, or to prolong menopause, and also hormone replacement therapy. Therefore, all colleagues who prescribe hormone therapy, either to young women or to older women, really monitor them and we manage to catch the cancer at an early stage.
High-risk factors for this disease are family burden - if a mother, grandmother or aunt has breast cancer. When we talk about genetic mutations, these are the VRS1 and VRC2 genes. A risk factor for developing breast cancer is some benign breast disease, because anything that appears where it doesn't belong tends to turn malignant. The biggest risk factor is previous breast cancer. When it is surgically removed, cancer can reappear in the remaining parenchyma, as well as in the other breast. In some cases, it is recommended to do a bilateral mastectomy, i.e. both breasts to be removed.
Are bilateral mastectomies performed prophylactically in Bulgaria, as the actress Angelina Jolie did?
- Four prophylactic bilateral mastectomies have been performed in Bulgaria in the last three years. I work with these patients. These cases are concentrated with me.
- What is a personalized approach in oncology?
- Until the Angelina Jolie case, no one could understand what a personalized approach to the patient was. It means, thanks to the pathoanatomical and genetic tests in the particular patient, to assess what are the risks of developing or not developing cancer, and if it already exists, what are the risks of metastasis
and what can be done to prevent or cure cancer. A personalized approach leads to better, correct and safe patient treatment. Because it is tailored to his stage and histology. It also leads to longer survival.
To improve the diagnosis, treatment and survival of our patients, a good collaboration between surgeon, pathologist, chemotherapist, radiation therapist and radiologist is needed.
What are the types of treatment for this carcinoma?
- Surgery is the first line of treatment for breast cancer unless it is a very advanced disease.
Target therapy is the modern treatment that we routinely use and that Bulgarian patients could receive in the USA, in Italy, and anywhere in the world. The third agent of choice is hormone therapy, which is widely used in breast cancer. The future treatment of cancer is combinations of targeted therapy. We still use cytostatics, but if we really want to stop cancer or make it a long chronic disease, we have to specifically treat our patients, know which receptor to block to stop tumor growth.