Bulgaria cancer screenings to begin amid probe

SOFIA
Pilot screening for cervical and colorectal cancer is expected to begin in June in three regions of Bulgaria, caretaker Minister of Health Mihail Okoliyski told reporters on Friday. The two programmes were originally due to start last year.
In early March, Okoliyski said the Public Financial Inspection Agency (PFIA) would review public procurement procedures for cervical and colorectal cancer screening tests, with the Prosecutor’s Office to be involved if necessary. “It is unclear how the specific test type was selected, and some details of the procedure remain unclear to us,” he said on Friday.
He added that there were indications similar tests had been offered at lower prices. “We will handle the screening issue with full responsibility.
Both screening programmes are highly justified, as these diseases cause the highest mortality in the European Region of the World Health Organization (WHO),” Okoliyski said. “We have fought for more than 20 years to introduce this kind of screening, and we will do everything in our power not to undermine the idea of population-based screening,” he added.
Tests are already available, but other key elements are still missing, including contracts with the National Health Insurance Fund, doctors and laboratories. Okoliyski said the screening now being organized would use the tests already purchased.
He added that contracts with the NHIF still have to be signed and funding secured, as no money has yet been allocated for them.
The cervical cancer screening programme will cover women aged 25 to 65, while the colorectal cancer programme will target men and women aged 45 to 75.
Participation in both programmes will be open to everyone, regardless of health insurance status, Okoliyski said. Bulgaria has so far received an initial 51,020 diagnostic kits for colorectal cancer and 22,068 kits for cervical cancer.
The Bulgarian Medical Association has already developed protocols for implementing the two screening programmes, but contracts between the NHIF and service providers, doctors and laboratories have yet to be signed.
The logistics of applying those protocols and payment for the services also remain unresolved. Okoliyski said the protocols were based on European best practice, but added that “there are elements and aspects that do not reflect the logic of the state interest or the interest of all medical specialists,” citing the involvement of a private limited company, the Center for European Health Policies, which had been authorized to conduct market research and help shape parts of the procedures set out in the protocols.
He said this needed to be reviewed, as the two screening programmes could not be effectively implemented under the current arrangements.
Test results are meant to be entered in real time, but, to their surprise, they were to be uploaded to a system developed by the Center for European Health Policies rather than the National Health Information System, he said, adding that this would also be reviewed.
An inspection by the Ministry of Health’s Internal Audit Directorate is under way, PFIA inspectors are also on site, and a submission has been prepared for the Prosecutor’s Office so the entire procedure for the two programmes, including the supply of tests and reagents, can be examined, Okoliyski added.
Later on Friday, the Bulgarian Medical Association (BMA) firmly rejected Okoliyski’s claim that the protocols for the two screening programmes required test results to be entered into a system developed by the Center for European Health Policies instead of the National Health Information System.
BMA said its protocols contained no such provision and that all participant data and laboratory results were to be entered exclusively into the NHIS. It added that the Center’s role was purely expert and methodological, and that the publicly available documents were based on European guidelines and recommendations from the World Health Organization and the International Agency for Research on Cancer.
Bulgaria, which has one of the EU’s highest cancer mortality rates, still lacks nationwide population-based cancer screening, and the cervical and colorectal programmes under the National Anti-Cancer Plan have yet to start.
The rollout risks being delayed by disputes over test procurement, limited processing and logistical capacity, and questions about who shaped parts of the implementation framework.
Then-health minister Silvi Kirilov defended the selected tests and protocols as compliant with European, WHO and International Agency for Research on Cancer standards, and said comparisons with pharmacy rapid-test prices were misleading.