1. EUROCHIP-2 ACTIVITY ON CERVICAL CANCER SCREENING BULGARIA

3. YearNum of new cases ASR (W) incidence Num of deaths ASR (W) mortality 19705149.81643.0 198054211.61792.8 198574510.12563.7 199071012.32603.9 200098517.13405.2 2003109619.33565.5 Incidence and mortality of cervix uteri cancer in Bulgaria 1970 - 2003

4. HFA-DB, WHO/Europe, June 2005

5. 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

6. 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

7. 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 23 rd of April 2001. That Strategy was not realized in practice. 3.Now, there isn't organized population based screening program in Bulgaria.

8. Two meetings were organized in Sofia, Bulgaria: The first one was on February 17 th 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

9. 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

10. 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

11. 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

12. The second meeting was on 22 nd 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”

13. DISCUSSIONS AND DECISIONS OF THE MEETING

16. 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