Cervical Cancer Screening with Dr. Konstantsa Tosheva Daskalova

“Every year, 500,000 new cases are registered. When caught early, cervical cancer is 100% treatable,” says Dr. Konstantsa Tosheva Daskalova, a gynecologist at the Medical Center “Pentagram”.

Among women aged 20 to 25, the prevalence is between 30% and 60%. Cervical cancer is a disease that leads to loss of working capacity in the most active age of women or fatal outcomes. In Bulgaria, there is a persistent trend of increasing morbidity and mortality from cervical cancer. In recent years, it has reached about 29 per 100,000 women, making cervical cancer a major issue for Bulgarian healthcare.

Screening for cervical cancer has proven its health, demographic, and economic effectiveness in all countries.

Dr. Tosheva, is every woman required to have a preventive screening for cervical cancer?

Every woman who has the opportunity to test for HPV (human papillomavirus) is encouraged to do so. The Bulgarian Society of Obstetrics and Gynecology and the Bulgarian Association of Oncogynecology recommend conducting both cytological and virological examinations for every woman.

Why is the human papillomavirus (HPV) so dangerous?

Cervical cancer is the second leading cause of mortality among women globally. Every year, 500,000 new cases are registered. In 99.7% of cases, it is due to the effects of the human papillomavirus (HPV).

What are the causes of the emergence of this HPV virus?

At a meeting held in Sofia on the issues of cervical cancer, English professor Albert Single highlighted the connection between smoking, daily stress, unprotected sexual intercourse, and oncological diseases. The papillomavirus is widely circulated, and many women carry it. Whether it finds an environment in which to develop depends on the lifestyle.

How is it transmitted?

HPV infection is the most common sexually transmitted disease, with a prevalence between 30% and 60% in individuals aged 20 to 25. Most sexually active women are exposed to HPV infection at least once in their lifetime. In most cases, it is transient and regresses spontaneously as the virus is cleared by the immune system. However, in about 20% of women, the infection can remain persistent, which may lead to the development of lesions (so-called sores) on the cervix or to cancer.

Why is it important to know our HPV status?

Precancerous conditions and the early stages of the disease usually do not cause pain or other symptoms. Therefore, regular gynecological exams and tests should be conducted. Targeted detection of these precancerous conditions is an important aspect of cervical cancer prevention, as they are 100% treatable if caught in time. The development of cervical cancer generally progresses through phases of precancerous changes. The time it takes for pre-invasive changes to turn into invasive cervical cancer is quite long, approximately ten or more years. This provides an opportunity for the changes to be detected and specified through appropriate tests and to be treated without the patient being exposed to risks related to delays. Adequate treatment of precancerous changes leads to their complete cure, and the risk ceases to exist.

How can we determine our HPV status?

In prevention, determining HPV status through annual gynecological exams with cytological testing, high-risk HPV carrier testing, and testing for viral E6/E7 oncoproteins is of great importance.

How often should a Pap smear be performed?

Each year, for all women leading an active sexual life. However, if there are any changes that need to be monitored and treated, it may be necessary to visit their gynecologist more frequently.
The recommendations for HPV screening are: women under the age of 25 should not be screened as their risk is low. Women aged 25-49 should be screened every 3 years. Women aged 50-64 should be screened every 5 years. Screening at 64+ years; only if they have not undergone cytology testing since the age of 50 or if the last three tests indicate atypical results.

Is it possible, by taking a single sample from the cervix, to perform all three tests to determine the HPV status?

Yes. The comprehensive exam, which includes cytology testing, DNA detection, and determining the E6/E7 oncoproteins of the human papillomavirus, provides an opportunity for reliable diagnosis and determination of HPV status in the cervix.

Can it be treated with medication?

There are various products that boost immunity, and almost all of them work well, but they are not a panacea. Recently, the product “Silaut” has been introduced to our market, which when applied vaginally increases local cellular immunity, restores the barrier functions of the cervical mucosa, and improves the prognosis. In persistent cases, local destructive techniques are used: laser evaporation, cryotherapy, diathermy, cold coagulation, and loop electrosurgical excision procedure (LEEP) of the lesion in a single pass. These procedures are quite gentle. After that, young women who haven’t given birth can conceive and deliver a healthy baby.

Do you advise young girls to get vaccinated against cervical cancer? of the uterus?

Yes. Personally, I support the vaccine. Although opinions on this matter are very controversial. There are people who oppose any vaccines. We cannot influence them.

Did you vaccinate your daughter with such a vaccine?

Yes. I vaccinated my daughter with such a vaccine when she was 16 years old.

What is your appeal to women?

The ideal treatment method does not exist. Each organism gets sick individually, and every woman should look not for the most eloquent doctor but for one capable of healing her. My only appeal is that women undergo annual preventive gynecological exams with the right doctor. There should be trust between the doctor and the patient, so the expected results can be achieved.

“The goal of life is not to eliminate unhappiness but to minimize it.”