favourable trend for increasing the proportion of
morphologically confirmed cases, a reduction of cases
registered based only on information from death certificates
as well as those with unspecified stages, and a relatively
constant proportion of cases with unspecified cancer sites.
These indicators are within the range defined for valid data in
international studies.8 This assessment shows that BNCR
yields comparable data that are close-to-complete and
reasonably accurate, especially in recent years, which is a
prerequisite for valid conclusions drawn from them.9
There were 34,864 new cancer cases registered in 2011.18
The most common cancer in males is lung cancer (18.9% of all
cancer cases) and breast cancer in females (27.3% of all
cancer cases). These two are also the most frequent causes of
cancer death in males and females, respectively. Among the
five most common cancers in males, besides lung cancer, are
prostate, colorectal, bladder and stomach cancers. Among
the five most common in females, besides breast cancer, are
cancers of corpus uteri, colon-rectum, cervix uteri and ovary.
About 40% of patients are diagnosed at advanced (III and IV)
stages of the disease. Incidence (all sites) is increasing by 1.5%
annually and mortality does not show any statistically
significant trend. Cancer incidence (all sites, both genders) is
lower, while cancer mortality is higher than the average
European (eco.iarc.fr). Five-year relative survival is 39.7%,
which is lower than the average for European patients
(www.eurocare.it).
According to WHO, cancer control has the following
components: prevention, early detection, treatment and
palliative care.2 The main goal of cancer control is to reduce
incidence, morbidity and mortality and to improve quality of
life of cancer patients with optimal use of available resources.
Even if Bulgaria does not have a national cancer control
plan, some municipalities have initiated regional cancer
control programmes, funded by local resources, and also
there are several projects for specific cancer prevention and
control activities.7 The National Health Insurance Fund pays
for prophylactic examinations of breast, prostate and the
colon-rectum. A smoking ban for closed places was
introduced in June 2012.
A pilot project for screening of breast, cervix uteri and
colon-rectum started in 2013.
The role of BNCR in the planning of cancer control
activities can be the assessment of the scale of cancer
problems in the population in terms of the number of new
cases, computation of incidence rates by gender, residence
and age-groups, frequency distribution by stage at diagnosis,
trend analysis and projections. Such description of cancer
patterns allows the identification of the most frequent
cancers, the most affected age groups or geographic areas,
which is important for allocating resources.
The potential uses of BNCR data
The impact of prevention activities can be monitored using
data from BNCR in the following ways:
‰ analyzing the trends in incidence of cancers associated
with smoking, infections, radiation, occupational
carcinogens, etc;
‰ comparison of trends in other populations and over other
time periods.
The role of BNCR in monitoring the effect of activities
directed at early detection of cancer can be used for:
‰ surveillance of stage distribution of cancers, subject to
early diagnosis by site: breast, cervix, oral cavity, larynx,
colon, rectum and skin;
‰ analysis of trends in incidence and mortality of cancers
that can be screened for - cervical, breast, colorectal.
When monitoring the patterns and effects of treatment in
cancer patients, the data from BNCR can be used for:
‰ surveillance of trends in mortality from curable malignant
diseases (seminoma, acute lymphoblastic leukemia in
children);
‰ analysis of survival by site, age-group, hospital for
Cancer incidence in Bulgaria is lower
than other countries in south-eastern
Europe, but the trends in incidence by
cancer site are similar
REGIONAL INITIATIVES
CANCER CONTROL 2014 135
The most common cancer in males
is lung cancer (18.9% of all cancer
cases) and breast cancer in females
(27.3% of all cancer cases)