EUROCHIP-2 ACTIVITY ON CERVICAL CANCER

SCREENING

BULGARIA

Year Num of new cases

ASR (W) incidence

Num of deaths

ASR (W)

mortality

1970 514 9.8 164 3.0

1980 542 11.6 179 2.8

1985 745 10.1 256 3.7

1990 710 12.3 260 3.9

2000 985 17.1 340 5.2

2003 1096 19.3 356 5.5

Incidence and mortality of cervix uteri cancer in Bulgaria 1970 - 2003

1

2

3

4

5

6

7

1970 1975 1980 1985 1990 1995 2000 2005

BulgariaNetherlandsUnited KingdomEuropean RegionEU

SDR, cancer of the cervix, 0-64, per 100000

HFA-DB, WHO/Europe, June 2005

Cervical cancer screening in Bulgaria Prophylactic gynecological examinations have been conducted in Bulgaria since 1956 In 1970 K. Tzanev and D. Nikolova introduced cytological screening as a routine test in the practice:

• The screening involves all female population over 30 years and was performed once per two years;• It was conducted by district gynecologists and nurses from all over the country;• Diagnostic cytological tests were performed in 14 labs (13 Regional Oncological Dispensaries and the National Oncological Centre in Sofia);• According to that screening program, 1.5 mill. women were subject to examination.

The screening program gradually stop working at the end of the 80’ies without administrative order or any other decision from the government

Some reasons for cervical cancer screening program failure Faults in organization of the program:

• No team for management• No screening registry• Lack of call and recall system• No unified system for diagnostics of signalized women• No quality control on all levels

Faults in screening tests:• No monitoring quality of cervical smears• No unified system (guidelines) for preparation and storage of the smears• No good synchronization between labs and physicians • No registration in the screening registry

Faults in interpretation of the results: • No unified cytological classification• No internal and external quality control at the labs• No continuous training and education of the staff involved

What’s the situation now?

1. A National Strategy for Prophylactic Oncological Screening in Republic of Bulgaria for the period 2001-2006 was created. It includes breast cancer, cancer of the cervix uteri and prostate cancer.

2. The National Oncological Strategy was accepted by the Council of Ministers on 23rd of April 2001. That Strategy was not realized in practice.

3. Now, there isn't organized population based screening program in Bulgaria.

Two meetings were organized in Sofia, Bulgaria:

The first one was on February 17th 2006 with experts from Italy, Bulgaria and Romania. The subject of the meeting was “Cervical cancer Screening in Bulgaria – past, present and future”. Official representatives from the Government, Professional and Public Organizations of Bulgaria participated in the meeting.

• To underline EUROCHIP aims

• Bulgarian cervical cancer screening: state of the organization and difficulties

• EUROCHIP-2 in Bulgaria

MEETING AIMS

ACTIVITIES UNDER EUROCHIP-2 PROJECT IN BULGARIA

• Second meeting within 2-3 months again in Sofia with participation of other Eastern European countries with specific problems in the diffusion of cervical cancer screening

• All the costs will be under EUROCHIP

• EUROCHIP will invite European cervical cancer screening experts

• MAIN AIM - what we need for changing situation?

• OTHER AIM - to present to European Health Authorities the problems of the Eastern European countries on cancer screening

MEETING CONCLUSIONS

After the meeting the Bulgarian group of experts prepared proposal for action with AIM:

ANALYSIS AND EVALUATION OF THE SITUATION OF CERVICAL CANCER SECONDARY PREVENTION IN BULGARIA AND RECOMMENDATIONS FOR THE FUTURE DEVELOPMENT

1. Available information for secondary prevention of cervical cancer (CC).

2. The law acts in the field of CC secondary prevention.3. Epidemiology of CC.4. The health-care affiliations incurred in CC secondary

prevention.5. Availability and equipment of cytology labs for

completing cervical screening (qualitative and quantitative assessment).

MAIN TASKS

I. STUDY OF:

II. MAIKING of a report with an in-dept evaluation and recommendations

The second meeting was on 22nd May 2006 in Sofia, Bulgaria. Experts from Milan, Torino, Helsinki, Bulgaria, Romania, Latvia, Lithuania and Estonia were invited and participated in the meeting.

The subject of the meeting was “EUROCHIP Task Force on Cervical Cancer Screening Emergency”

DISCUSSIONS AND DECISIONS OF THE MEETINGBULGARIA: STATE OF THE ARTBULGARIA: STATE OF THE ART

Is organised screening present in the past? YES (up to 1989)

Does this program have problems? YES (mortality did not decrease)

Is organised screening present at the moment? NOAt the moment are we in the position to reorganize the

screening program? NOWhat is mainly necessary at the beginning? Which is the

major problem at the moment?a. Political interest

Steps to follow:a. MAJOR PROBLEM: To find groups of pressure (Groups like EuropaDonna, Medical Associations…) within the country and at international levelb. To find practical proposals necessary to start the reorganization and also to solve problems in the pastc. To start with Pilot Program: define the team that could promote and organize the Pilot

TASK FORCE ACTIVITIES (1)TASK FORCE ACTIVITIES (1)

1. Groups of pressures. Ex: ONDA => European Parliament

• Meeting with women of the European Parliament (to organize probably in September 2006)

• Public opinion. Articles on newspapers and women magazines with a local vision

2. Information for local medical associations. EUROCHIP WT Task: Prepare a letter to send to local medical associations

3. Specific recommendations to Health Authorities at national level and at international level. EUROCHIP WT Task: paper for Network of Health Authorities. In the PAPER we will also invite the Health Ministries to inform the EC about the cervical cancer screening programs activated (info on structure, organization, results)

WT: Working Team

4. Participation in the chapter on cancer in the EC Health Book

5. Meeting devoted to the discussion of technical aspectsProbably period: before the end of 2006. Main tasks: Is our work compatible with European guidelines? Study of the possibility to develop a centralized information system (invitation, recall, monitor) in each country

6. To Share information. All information, all presentations will be available at the web-site www.tumori.net/eurochip

7. To change information with EUNICE in order to have standardize collection of data from new screening programs (it is really important to know the activities of the other Europeanprojects on this matter in order to avoid duplications)

TASK FORCE ACTIVITIES (2)TASK FORCE ACTIVITIES (2)

WT: Working Team

The recent decision (from this week) of the Bulgarian Ministry of Health is to form a

National group of experts to develop a new National Screening Program