Prof. Panayot Kurtev to FAKTI: It is necessary to reconsider the attitude towards screening programs in oncology

On the role of screening when it comes to cancer. What did the results of the last program in 2024 show… Prof. Dr. Panayot Kurtev, surgeon, oncologist, oncologist, heads the oncovascular surgery team at the University Hospital “Lozenets“, spoke to FAKTI.

- Prof. Kurtev, you are the founder of colon cancer screening in our country. What did the results of the last program in 2024 show - more hope or more anxiety?
- The results of the last program showed that Bulgarian society is willing to participate in screening when clear information is provided about the purpose and methods of conducting the study. This is important because with proper explanation and support, people are more motivated to get involved. However, although the results show a positive response from the population, it must be emphasized that at the institutional level there is still a lack of serious commitment to conducting full-scale screening. To achieve success, political will and resource provision are needed, which, unfortunately, do not yet exist on the necessary scale.

Therefore, for the moment there is more anxiety than hope. It is necessary to reconsider the attitude towards screening programs and invest in them,

as well as to adopt the occult blood test as part of the standard preventive package for people aged 50-74.

- Is it surprising how many people actually live with the disease without knowing it?
- It is not surprising that so many people live with an unrecognized disease, since the symptoms of colon cancer,

especially in the early stages, can be weak or even completely absent.

Many patients begin to feel symptoms when the tumor is already in a more advanced stage, which reduces the chances of a successful outcome from treatment. The issue of low prevention also plays a role - in many cases people do not undertake tests because they do not experience obvious symptoms, and are often not aware of the risks. It is important to emphasize that if annual prevention and screening were available, many cases would be detected at an earlier stage, which is key to successful treatment.

- Why exactly is colon cancer one of the “silent killers“ – symptoms often appear late, but early detection can be life-saving. How can we make people aware of this?
- To make people aware of the importance of early diagnosis, we need to conduct larger-scale information campaigns that emphasize not only the risks, but also the benefits of early detection. Examples from other countries that have achieved success with similar programs should serve as a motivating force. It is important to educate both the population and medical professionals to think about this problem, even when the patient does not complain of specific symptoms. This is where prevention comes in -

testing for occult blood in the stool annually, even over 45 years of age, and referral for fibrocolonoscopy if the result is positive.

In cases of family history, prevention should start much earlier, and at the slightest gastrointestinal discomfort, a consultation with a gastroenterologist should be sought.

- Bulgarians often say: “If it doesn't hurt, then I'm healthy“. How dangerous is this attitude?
- This attitude is extremely dangerous because it often leads to ignoring potential health problems that can develop slowly and not appear immediately. The question is not whether we have pain, but whether we do everything possible to make sure that we don't have serious diseases that are not obvious. This is the basis of prevention – to prevent diseases before they actually develop. In Bulgaria, this attitude is often associated with low health literacy and the lack of sufficient information about the benefits of prevention.

- Why do you think that the fear of diagnosis is stronger than the desire for prevention?
- The fear of diagnosis

is at the root of many missed opportunities for early diagnosis.

This is due to various factors. Many people still associate a cancer diagnosis with an inevitable end, which is not only wrong, but also dangerous. When people are informed that there are effective treatment methods and that early diagnosis significantly increases the chances of successful treatment, this fear can be overcome. We must actively work to break the stereotypes surrounding cancer.

- How can this change – with education, with personal example, or with firm policies?
- Change can be achieved by combining all these factors. Education is key to creating a better health culture, which also includes understanding the importance of prevention. The personal example of medical professionals and influential public figures also plays an important role in motivating people to undergo examinations. In addition, the state must adopt serious policies,

which include mandatory and funded screening programs, as well as ensuring that preventive tests are widely available.

Only with an integrated approach that combines education, personal example and political commitment can we achieve significant change.

- Can we then say that screening is “cheaper“ from treatment?
- Without a doubt, the investment in prevention and screening is fully justified, since, in addition to saving lives, it saves costs for expensive therapies in the treatment of later stages. Investment in prevention programs pays off many times over, significantly reducing the costs of treating patients in advanced stages, as well as the costs of hospitalization.

- The occult bleeding test is simple, painless, non-invasive and affordable. What prevents it from becoming a mandatory preventive test after a certain age, as is the case in a number of other countries?
- The main obstacle is the lack of a sufficiently good organization of the health system and the will to integrate this test into regular preventive examinations. Also, there is not always enough information that this test is essential for the early detection of colon cancer. In order to achieve its inclusion in mandatory prevention, a strategy must be developed at the state level to support the organization and financing of such tests. GPs should also be supported so that they can effectively fulfil their key role as frontline providers. This also requires a change in Regulation 8 on preventive examinations and medical check-ups.

- If you had to boil it down to one sentence – what is the most important thing that every Bulgarian should understand about prevention?
- Health is the most valuable thing we have. And when we lose it, then we understand the enormous loss.

- Is there anything that gives you hope that in 5 years we will be talking about prevention not as a “cause“, but as a part of normal life?
- Even in the darkest night there are always stars, but we just have to see them. I believe that despite the difficulties we are currently facing, change is possible. There is always hope and light at the end of the tunnel. If we can unite the efforts of the state, the medical community, non-governmental organizations and society as a whole, we can achieve significant progress in making prevention a part of the daily life of every Bulgarian.

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Prof. Dr. Panayot Kurtev is a surgeon, oncologist and onco-surgeon with many years of clinical and academic experience. He specializes in the surgical treatment of solid tumors, including adjacent or infiltrating large blood vessels. He leads the oncological part of the oncovascular surgery team at the University Hospital "Lozenets" and is responsible for the strategies for the overall treatment of the patient.