Women unite in cancer fight

A new breast cancer screening programme has been launched in Bulgaria as part of a national campaign to raise awareness of the disease among women of all ages.

The initiative was kick-started in September by a march through the streets of Sofia - organised by the cosmetics company, Avon - where around 3,000 people gathered to pledge their support.

Almost 2,000 women nationally will be screened as part of the programme, which is aimed specifically at raising awareness about the early detection and treatment of the disease in women from small rural towns and villages in Bulgaria, including Malko Turnovo, Roudnik and Aitos Karnobat. Around 120 women from each town will receive a free breast examination and mammogram.

Each year, 3,500 women in Bulgaria are diagnosed with breast cancer, and in around 80 per cent of patients the disease is very advanced, typically in stage III/VI, before it is detected and treated.

An estimated 36,000 women in Bulgaria are battling with breast cancer and both the incidence of the disease and the number of deaths from it are rising, while globally these figures are falling.

Knowledge is power
According to campaigning group, the International Women's Club (IWC), women in Bulgaria are very much aware of breast cancer but do not know enough about self-detection or have sufficient access to diagnostic services. A lack of screening and early detection are blamed for the high number of deaths linked to the disease.

However, Mila Nenova, the national representative for the European Breast Cancer Coalition (Europa Donna) in Bulgaria, believes that very few women are aware of breast cancer, and fewer still would consider self-examination. Some women feel uneasy about it and some doctors consider it of little use and dangerous as women are not able to diagnose themselves.

While breast cancer awareness is much greater in urban areas in Bulgaria than in smaller towns and villages, the situation is improving, said Nenova. More equipment is available from the state, as well as private donations. For example, Avon recently donated mobile mammography equipment that visits remote areas.

Lack of funding is a major issue and while many believe broadly there to be sufficient mammography equipment available to provide screening services, staff shortages remain a cause for concern.

There is enough mammography equipment but the funds for personnel and consumables are not enough, so the screening process is not running at full capacity, Nenova added.

Insufficient funding also impacts on the availability of the latest drugs for the disease and although patients in Bulgaria are entitled to free treatment, informed patients often travel abroad to buy the most up-to-date treatment at their own expense.

Concerted effort
Several campaigning groups are fighting hard to highlight the disease - in an attempt to reduce the number of women who reach stage III/VI of the disease before they are diagnosed - by significantly increasing the number who are screened. However, ongoing and radical changes to the health system in Bulgaria are hampering progress. While there are legal grounds for treatment and access to it, said Nenova, due to the healthcare reorganisation process, it is difficult to be treated - some elements need improvement and some are not functioning at all.

The reorganisation of the health service began following the publication of the National Healthcare Strategy 2007-2012, by the Ministry of Health. Under the strategy, the ministry has set out detailed objectives for nine goals it believes should be reached in the five-year period. First on the list is improving the health of the nation, which includes raising public awareness of healthy living and threats to health. Within this, the ministry aims to limit the impact of lifestyle-related diseases, such as Type II diabetes, hepatitis and HIV/AIDS, and support those suffering from mental health problems.

Other plans include the launch of 25 national programmes, worth 18m leva (Ä9.21m), aimed at reducing morbidity and mortality rates from the most widespread infectious diseases and from serious, chronic non-infectious diseases across all social groups.

As part of the Prevention of Non-Infectious Diseases programme, the Health Ministry is mobilising an immunisation campaign for Hepatitis A in Plovdiv, the second largest city in Bulgaria, lying south east of the capital Sofia. The initiative, announced by deputy Health Minister Valeri Tsekov, will see 12,500 children vaccinated against the disease as a preventive measure.

Through the National Healthcare Strategy 2007-2012, the government wants to improve healthcare services in the country and evaluate the level of care provided to both in-patients and outpatients, to ensure better continuity of care. In particular, the strategy aims to define clearly the responsibilities of primary and specialist healthcare professionals, and improve the channels of communication between these two groups.

Funding is crucial to the success of the healthcare strategy and in order to build new hospitals and improve existing infrastructure and services, the government plans to establish public-private partnerships and denationalise parts of the healthcare system, reinvesting the funds from the privatisation process back into services.