Cervical cancer screening in Bulgaria--past and present experience.
BACKGROUND
In Bulgaria the previously (1970-1985) existing population based cervical cancer screening was replaced in the early 1990s with an opportunistic model due to political and socioeconomic reasons. As a result, in the last 20 years, cervical cancer incidence and mortality rates steady increased. The objective of the EUROCHIP project in Bulgaria was to evaluate the readiness of the health system as well as health providers' attitudes to implementation in the country of a population based screening program for cervical cancer.


METHODS
Using a structured questionnaire, a convenience sample of medical specialists representing different actors involved in cervical cancer prevention, treatment, financing and policy were interviewed.


RESULTS
The majority of interviewed practitioners worried that organization and implementation of an effective population-based cervical cancer screening program is not possible in the current unstable health system. A nostalgic attitude to the cervical cancer screening, performed in the past and pessimistic view on the capability of the current health system to cope are strong. As main barriers to implementation of an effective program were pointed financial and organizational ones. Motivation for gynecologists to perform smear test should include better information, organization and payment.


CONCLUSIONS
Medical specialists in Bulgaria are aware of the alarming rates of cervical cancer incidence and mortality in the country. However, due to the insufficient communication and interaction between policy makers and front-line health care staff, they do not have enough information on the ongoing programs. Absence of health policy regarding screening is considered as main barrier for implementation of an effective screening program.
National Oncological Hospital, Sofia, Bulgaria. bncr_zdravka@netbg.com
Zdravka
Z
Valerianova
Yulia
Y
Panayotova
Camilla
C
Amati
Paolo
P
Baili
D000328:Adult; D017677:Age Distribution; D000368:Aged; D002031:Bulgaria / Q000453:epidemiology; D055088:Early Detection of Cancer; D005260:Female; D006176:Gynecology; D006801:Humans; D015994:Incidence; D008403:Mass Screening / Q000191:economics / Q000379:methods / Q000458:organization & administration; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010819:Physician's Role; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*