Mapping the landscape of breast cancer care in Bulgaria: a scoping review

Breast cancer ranks as one of the most common cancer types in the world, and in Bulgaria, it represents a quarter of all malignant diagnoses in women. Breast cancer screening in Bulgaria is the lowest among all European Union (EU) countries. Existing literature on breast cancer care in Bulgaria is scarce. This study aims to explore the current trends, patterns, and gaps in breast cancer care in Bulgaria.

This study is a scoping review from peer-reviewed databases and grey literature. The results were screened against the SPIDER methodology's inclusion and exclusion criteria. Covidence was used in screening and full-text review. The study included 39 sources.

Breast cancer is the leading cause of cancer mortality in Bulgaria and the incidence remains lower than the European average due to underreporting. Bulgaria lacks a structured breast cancer screening programme, leading to low service use, although essential prophylactic exams are covered by the National Health Insurance Fund. Barriers like the underuse of treatment and significant delays in reimbursement of new cancer therapies exist. with lower survival rates compared to the rest of the EU. While policies focus on increasing screening and improving prevention, practical steps towards achieving this have not yet been taken.

There is low screening and underreporting of breast cancer rates in Bulgaria. The lack of full reimbursement of diagnostic methods, limited adoption of the multidisciplinary approach, and complex market access processes are barriers to developing efficient treatment plans. Efficient screening and prevention are crucial for positive outcomes.