Primary prevention of cervical cancer in Bulgaria

Abstract

Background The incidence and mortality rate of cervical cancer in Bulgaria are higher than in most European Union countries, with an upward trend in the last three decades. Bulgaria is one of the 98 countries that, since 2012, has implemented a nationally funded national program for the primary prevention of cervical cancer. The purpose of this study is to investigate how this program is implemented in Bulgaria and why it is ineffective in our country. Methods A documentary study and a direct individual survey were conducted among 161 GPs from the Pleven region. The questions concern the attitudes of GPs to carry out immunoprophylaxis and the causes of low coverage. Results The immunization coverage with a complete scheme of three intakes in 2013 was 23.83% and in 2014 - 19.6%. In 2015, it switched to a two-dose regimen and its scope dropped sharply below 10% in this and subsequent years. The survey found that 17% of GPs felt that vaccination was unnecessary. 26% have not immunized any of their patients and 32% have covered less than 10%. Only 22% of GPs report that they are actively seeking out patients. The main reasons for the low coverage that respondents include are: rejection by parents (74%) due to fear of complications (41%), do not believe in the benefit of the vaccine (19%), and consider the vaccines to be harmful (10%); poor awareness (43%); negative information on the Internet and media (38%). Conclusions It is too early to take into account the effect of Cervical Cancer Immunoprophylaxis, conducted in Bulgaria, but the low coverage of those subject is alarming. It is necessary to undertake active health education activities among the population and additional training of GPs. Key messages Bulgaria has introduced a national program for primary prevention of cervical cancer, funded by the country. There is a very low coverage of subordinates due to insufficient awareness of the population, negative attitudes and insufficient commitment of GPs to implement the program.