Bulgarian National Cancer Registry: the Experience of the Population-Based Cancer Registry in Bulgaria

Key Contextual Factors

• The NCR is one of the oldest population-based cancer registries in Europe and covers the entire territory of the country.
• Every month, data comes from the 13 CRs (maintained by the 13 comprehensive cancer centres) into the centralized NCR, which is maintained by the University Specialized Hospital for Active Treatment in Oncology, Sofia, covering all 28 regions.

Key Components/Steps

• The NCR includes the registration of new cases of malignant neoplasms throughout the country and the capture of the most significant indicators for the spread of the disease among the population.
• The main sources of information in the NCR include patients’ medical records, results from pathoanatomical and other medical diagnostic laboratories tests, cancer case histories, outpatient journals, quick notifications, protocols from oncology committees, reports from hospital information systems and the Regional Health Insurance Fund.
• The NCR periodically receives information from the Directorate General for Civil Registration and Administrative Services and the National Statistical Institute. 
• The information for each case is structured according to the following characteristics: patient data, malignant data, data on the treatment and development of the disease.
• The NCR follows the guidelines of European Network for Cancer Registries and the International Association of Cancer Registries as well as EU and international standards for cancer registration.
• Until 2014 - highest quality and has one of the oldest databases on cancer in the world.

Main Impacts / Added Value

• The database contains over 80 characteristics for each individual case of cancer, which are not only registered, but also monitored dynamically (until 2014).
• The NCR supports close collaboration with European research institutions and programs (e.g., EUROCARE, CONCORD) and data are contributed to relevant international institutions.

Lessons Learned

• Ongoing funding for the NCR is a challenge. Following a strict funding framework and collaboration, the NCR worked efficiently and effectively throughout the country. The NCR was directly financed by the Ministry of Health through an agreement with regional CRs. However, the situation has changed during the last several years. The regional CRs do not receive sufficient funds to maintain their regional CRs, leaving data incomplete.
• The financial situation also impacts on the ability to maintain trained specialists for the cancer registration process
• Despite financial challenges, the Ministry of Health plans to develop and implement at least 35 electronic registries, which is planned in accordance with the Roadmap for Implementation of the Strategy for Development of E-government in the Republic of Bulgaria.

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