Cancer burden of breast and gynecological cancers in Bulgaria: epidemiology and clinical aspects.

PURPOSE In Bulgaria, there are over 3700 cases diagnosed with breast cancer annually and over 3300 with gynecological cancers. The purpose of this study was to estimate the burden of breast and gynecological cancers in Bulgaria, analyzing trends of incidence, mortality and survival for the past two decades. METHODS Data from the Bulgarian National Cancer Registry for women diagnosed with cancer of breast (C50, ICD10), cervix uteri (C53), corpus uteri (C54) and ovary (C56) during 1993 - 2009 were analyzed. Age-standardized incidence and mortality rates (ASR) per 100,000 persons were calculated using the world standard population. Average annual percent changes (AAPC) for 1993-2009 were estimated by Joinpoint regression. The observed survival was analyzed with the Life Table method for two periods: 1993-1997 and 2005-2009. RESULTS Incidence rates of the most frequent cancers among Bulgarian women are increasing - from 1.7% to 2.6% annually. Mortality rates are decreasing significantly for breast (-0.8% annually) and increasing for corpus uteri cancers (4.9% annually). Survival for all sites increased from 3 to 8% over the study period. We observed greater proportion of cases diagnosed in stage I in 2009 than in 1993, for the 4 sites. CONCLUSION These results indicate some differences in trends in incidence and mortality of the reviewed sites compared with other European countries, highlighting the need for more strict adherence to integrated treatment standards and the necessity of introduction of population screening programs.