Breast cancer in Bulgaria prior implementation of a national breast cancer screening program and certified breast centers.

Abstract

Introduction: Breast cancer (BC) survival has improved globally in the past years. Eastern Europe is a region with lack of epidemiological data and traditionally lower BC overall survival (OS). We aimed to investigate the epidemiology of BC in Bulgaria between 2012 and 2022 and the readiness of the state for implementing population based organized screening program.

Methods and materials: This is a retrospective study of 38 576 invasive BC cases registered in Bulgarian National Cancer Registry. We obtained data from publicly available sources - national institutes and regulatory agencies. We report descriptive statistics of distribution of cases and mammography units among the country and the compared survival of patient's groups.

Results: 75% of patients are treated in the 9 biggest cities. They are younger, diagnosed earlier and have significantly better OS than the rest of the patients. Patients over 75 years represent 18.7% of all. The 211 installed mammography systems can secure the implementation of organized BC screening.

Discussion: The survival gap between cities can be due to the limited access to care of older patients living in smaller cities. The model of collaboration between private and state centers can be highly effective in implementing of organized screening since in Bulgaria both can be reimbursed by the National Insurance Fund.

Conclusion: Further centralization of care probably would not have such an impact on treatment outcomes as improvement and monitoring the quality of the provided treatment. Organized BC screening in Bulgaria is needed and technically possible step towards improving survival.