Self-examination is often underestimated and overlooked by women, when in fact it should be leading the way because no one knows our bodies better than ourselves.

Interview with Dr. Vanya Mitova, Head of the Breast and Reconstructive Surgery Department at the Oncology Hospital in Sofia

Introduce yourself in a few words - what would you like patients to know about you.

My name is Dr. Vanya Mitova. I am the Head of the Breast and Reconstructive Surgery Department at the Oncology Hospital in Sofia, which is the largest specialized unit in the field of diagnosis, treatment and follow-up of patients with breast diseases in Bulgaria with over 1200 surgeries per year. I am also a lecturer in Surgery for medical and English Medicine students at the Medical Faculty of Sofia University. Kliment Ohridski". I am proud to share that the idea for the creation and the algorithm for the behavior of the first Bulgarian multimodal mobile application for breast cancer screening, prevention and follow-up BreastHelp, is mine.

What do the current statistics show about the incidence of diseases in your professional field?

Breast cancer is the most common and most socially significant malignancy in women worldwide, and Bulgaria is no exception in this respect. Around 4 000 patients are newly diagnosed with breast cancer every year in our country, of which between 40 and 50 are men. As a percentage of all women with cancer, 26.2% have breast cancer, and 17.6% of them lose their battle with the disease every year. This makes breast cancer also the most common cause of death from malignancy in women in Bulgaria. And speaking of statistics, according to one of the largest studies in Europe (EUROCARE-5) related to the survival of cancer patients, breast cancer patients in Bulgaria have an 11.1% lower 5-year survival rate compared to the European average, i.e. for every 100 women diagnosed with breast cancer in our country, 11 die much earlier. Unfortunately, these current statistics again show the need for targeted efforts to improve the prevention, diagnosis and treatment of cancer patients in Bulgaria.

What is most important for breast cancer prevention - your message to the ladies?

Breast cancer prevention can be seen in two ways. The first is in relation to lifestyle and how to minimise risk factors (naturally those that we can influence) for developing breast cancer. The second strand relates to preventive examinations, which must also be divided into two types - one is the so-called self-examination and the second is the examination by a specialist. It is extremely important not to underestimate either type of prevention, because comprehensive management is the key to improving the above statistics. This is also my message to all ladies - through the full range of breast cancer prevention measures we can be assured of success.

What are the factors and conditions in our lifestyle that each of us would do well to monitor in order to talk about good and timely prevention?

There are a number of risk factors that can lead to the development of breast cancer. Some of these are lifestyle related and can be controlled, for example avoiding contraceptives and hormonal drugs, giving birth before the age of 30, breastfeeding, avoiding abortions, weight control, etc. However, when we are talking about risk factors that we are unable to control, such as familial burden, carrying genes (BRCA1, BRCA2, ATM, CDH1, CHEK2,NF1,NBN, PTEN, STK11, TP53) with mutations, chest irradiation between the ages of 10 and 30, etc., then timely and good prevention involves precisely carrying out examinations, which, as I have already pointed out, include so-called self-examination and examination by a specialist. Self-examination is often underestimated and overlooked by women, when in fact it should be leading the way because no one knows our bodies better than ourselves. This is why we are the ones who might be the first to detect if there is an unusual change in it. This is why every woman should be trained to perform a self-examination of her breasts once every month. It is also necessary to have an examination by a specialist at least once a year, and more often in some women with more risk factors. Only in this way can we be sure of timely prevention.

How did you decide to create the BreastHelp App and how does it help patients and your work?

My idea for the BreastHelp mobile app came about 4 years ago. It was prompted by my daily encounters with breast cancer patients, most of them at an advanced stage of their disease, who had never been screened and a huge proportion of them didn't know what to do. Other patients were seeking help because they had relapsed after not being followed up for years. All of this, together with the combination of increasingly busy specialists and fewer and fewer doctors, made me think that we should be looking for a more practical solution to the problem. Thus, our mission was born - to prevent late diagnosis of breast cancer and help patients on their path to a cure. We set ourselves the difficult goal of raising health awareness about breast cancer, to build an algorithm for prevention, screening and follow-up: healthy women, patients already diagnosed with the disease and to facilitate the doctor-patient relationship with breast cancer on a professional level.I think that at the moment the whole team is doing a pretty good job, because we already have diagnosed patients thanks to the app, and more and more women with breast cancer are using the diagnosed module, where they can find a lot of useful and practical information from what exercises to do, what referrals from their GP they need to what bra to choose after their surgery. We've also had success with the first online oncology panel specialising in breast cancer, which patients consult for more complex cases, seek second opinions and even discuss their treatment options so they can be sure of their path to a cure. And it's all in their hands because each of us uses our phones daily and constantly. Everything I have listed makes me confident that BreastHelp will continue to gain friends in the form of its users and allies in the form of the doctors who are directly involved with breast cancer.