Cervical cancer in Bulgaria since EU accession in 2007: a struggle in the face of political instability.

Abstract

BACKGROUND: Bulgaria has one of the highest cervical cancer incidence rates in the EU, driven by persistently low screening uptake and HPV vaccination coverage. Despite the preventable nature of the disease, efforts to implement effective prevention strategies have been undermined by political instability, fragmented governance, and systemic health system weaknesses. REFORM CONTENT: Since EU accession in 2007, Bulgaria has launched several initiatives, including the "Stop and Get Checked" programme and the National Program for Primary Prevention of Cervical Cancer. These efforts were supported by EU policy frameworks and funding. The 2023 National Plan for Combating Cancer aims to align with Europe's Beating Cancer Plan, proposing organised screening, expanded HPV vaccination (including boys), and improved public awareness. A new HPV prevention programme (2025-2030) sets ambitious coverage targets and introduces gender-neutral vaccination. EXPECTED RESULTS: If implemented effectively, these reforms could significantly reduce cervical cancer incidence and mortality. Key expected outcomes include increased screening coverage, higher HPV vaccination rates, improved access for underserved populations, and better data collection and monitoring. The integration of EU-supported strategies offers a pathway to more consistent and sustainable progress. CONCLUSIONS: Bulgaria's experience highlights the challenges of implementing cancer prevention in politically unstable settings. While recent reforms show promise, success depends on sustained political commitment, adequate funding, and coordinated implementation. Lessons from Bulgaria may inform other countries facing similar governance challenges, underscoring the value of external policy frameworks and targeted, system-wide approaches