Screening program for early detection of breast cancer in Bulgaria

Abstract

Breast cancer is a significant public health issue, characterized by high incidence and mortality rates. The primary goal of screening programs is the early detection of the disease to improve treatment effectiveness and reduce mortality. Motivation for participation is influenced by multiple factors, including socio-economic conditions, health literacy, and social norms.

The development of a breast cancer screening program in Bulgaria followed several steps: conducting a literature review to define the program structure and identify the most effective screening methods; analyzing local epidemiological data and identifying high-risk groups; designing the patient pathway from invitation to receipt of results; examining motivational factors for participation; and conducting cost-effectiveness and budget impact analyses.

This study aims to develop a population-based organized screening program for clinical breast cancer in the Bulgarian population, including an assessment of the target population and an analysis of the expected outcomes in terms of cost-effectiveness and budget impact.

 A systematic literature review was conducted, along with analysis of local epidemiological data and calculations of cost-effectiveness and budget impact for two scenarios: one based on the National Cancer Control Plan and one based on the actual age-specific population. Data from the National Statistical Institute, the National Cancer Registry, and expert opinions were used. Economic and budget impact models were developed in MS Excel.

The analysis is presented in two scenarios. The first reflects the perspective of Bulgaria’s National Cancer Control Plan until 2030, using the target population defined in the plan. The second scenario incorporates real-world practice, based on local data on breast cancer risk among women aged 40 to 69. The present analysis also includes age groups beyond the strictly recommended range by ECIBC, in order to assess the impact of an expanded coverage and the associated costs.

The economic evaluation shows that early diagnosis is more cost-effective than late diagnosis—BGN 309.33 per QALY versus BGN 903.08 per QALY.

Implementation costs for the screening program range from BGN 3.86 million in the first year to BGN 15.44 million in the fifth year under the National Plan, and from BGN 48.78 million to BGN 64.94 million in the alternative scenario. Breast cancer mortality is expected to decrease by 25–30%. The estimated indirect contribution to GDP due to improved survival is BGN 379,370.31.