Bulgaria launches nationwide cervical cancer screening to tackle high mortality rate [Advocacy Lab Content]

3 months ago 18

The Bulgarian government will carry out a broad cervical cancer screening programme in an attempt to get closer to the EU average, providing initial funding of €4.5 million, which will be transferred to the National Health Insurance Fund.

“Cervical cancer is the second most common type of cancer among women between the ages of 15 and 44 in Bulgaria,” the government remarked in its decision.

The state will finance free medical examinations by a gynaecologist for every Bulgarian woman, testing of the biological material, as well as the interpretation of the results by a specialist in clinical pathology.

Thousands to be examined

The programme includes all women aged 20 to 49, regardless of whether they have health insurance.

About 25% of Bulgarians do not pay health insurance, which blocks their access to the country’s health system. This is mainly due to the large share of the ‘grey economy’ in the country, which accounted for about 30% in 2023, according to a European Parliament working group.

At least 90,000 Bulgarian women are expected to be examined by the end of this year. Mobile offices will also be available for remote and hard-to-reach places. The government will also finance an information campaign, for which €1 million will be allocated.

According to data from the Bulgarian Oncological Scientific Society, the coverage of cervical cancer screening among women aged 20-69 in Bulgaria is 45.5%, which is well below the EU average of 59.9%.

Cervical cancer is a big problem

In Bulgaria, two women die every day from cervical cancer, and the disease is the second most common among women after breast cancer.

The 5-year survival rate of cancer patients in Bulgaria is decreasing and remains much lower than the average in the EU. For cervical cancer, it is 55% against 64% in the EU.

For the past five years, with an identical number of new cases of oncological diseases per year, about 27,000, the state budget for cancer treatment has increased from €320 million to €735 million, mainly due to the increased costs of cancer drugs.

But Bulgaria remains the only country in the EU where the death rate from cancer is increasing.

Mortality increased from 229 cancer deaths per 100,000 population in 2011 to 242 cancer deaths per 100,000 in 2019 and 247 per 100,000 in 2020.

On average, in the EU, mortality decreased from 268 per 100,000 people to 252 per 100,000, according to 2020 data from the European Cancer Inequalities Registry.

Anti-vaxxers and HPV

Cervical cancer is defined as a cancer of the young, experts explain. The increase in incidence is most pronounced in two of the age groups – in women aged 30-39 and 40-49. In contrast, the rates of increase in incidence in women over 60 and in 20-29-year-olds are relatively low.

Prevention is achieved through vaccination against the human papillomavirus (HPV), which is the leading cause of this type of cancer.

According to the WHO, 140 countries have introduced HPV vaccination to their immunisation programmes. Girls and, gradually, in more countries, boys who have not yet started their sexual life, between the ages of 9 and 13, are eligible for the vaccine.

In Bulgaria, the state program currently covers only girls, but there are plans for free vaccination of boys from 2025. However, the target population coverage remains low, at about 3%, because of widespread vaccine hesitancy.

“Bulgaria occupies a very sad place in these vaccination statistics. The bad thing is that we have a state program, but it is not being implemented,” commented Prof. Dr. Radka Argirova, chairperson of the National Expert Board on Virology.

In 2023, there were 1,928 girls in the age group 10-13 that had received the completed vaccination course of the quadrivalent vaccine against human papillomavirus.

From January to April of this year, 1,425 girls in the same age group received their first dose of a nine-valent vaccine. The vaccination program is funded by over €1.1 million.

[By Krassen Nikolov, Edited by Vasiliki Angouridi, Brian Maguire | Euractiv’s Advocacy Lab]