BMA: Interests, Not Price, Halted the Screening

Interests, rather than price, have halted screenings for colorectal and cervical cancer. This was stated in a position paper by the Bulgarian Medical Association (BMA) regarding the national screening programs for cervical and colorectal cancer, published by the Ministry of Health for public consultation.

Here is the full text of the position paper:

The Bulgarian Medical Association expresses its categorical indignation at the fact that at the last moment—during the announcement of the new cabinet and the respective new Minister of Health—two key national screening programs for cervical and colorectal cancer were published for public consultation. This is yet another attempt to subvert national screening programs vital to public health through opaque and unsubstantiated arguments.

Nearly three months ago, upon the inauguration of the caretaker cabinet, the colorectal and cervical cancer screening programs for the 2025–2030 period—developed and proposed by the expert council and adopted by the Council of Ministers—were halted under the pretext of “high prices” for the tests. However, instead of seeking opportunities for lower prices, literally hours before the mandate of the Health Ministry’s leadership ended, they proposed new programs with unchanged price parameters. This fact calls into question the declared motive for suspending the implementation of the programs.

The new proposals reconfirm the choice of the quantitative FIT test for colorectal cancer and reject rapid qualitative tests, which in practice refutes the initial claims that the two methods are interchangeable.

In parallel, a significant change is proposed in the methodology for cervical cancer screening by limiting self-sampling to specific cases only. Numerous scientific and validated arguments, including recommendations from the WHO and IARC provided by the BMA, have been ignored. This screening also involves the use of an HPV DNA test with 14 oncogenic genotypes without the condition for risk stratification—contrary to the most cost-effective model proven by European and global guidelines. This creates a real risk of ineffective triaging and opens the possibility for introducing specific market solutions without sufficient medical justification.

The new programs propose that coordination be entrusted to a structure involving NGOs, without clear selection criteria. This raises legitimate concerns regarding the lack of oversight, compromises in quality, and risks in the management of sensitive health data.

It is unacceptable for programs already developed and approved by expert councils and adopted by the Council of Ministers to be halted based on certain arguments, only for solutions to be subsequently proposed that do not address the stated issues.

The delay in screening is not merely an administrative act—it costs human lives. Every missed month means missed opportunities for early diagnosis and more severe consequences for patients. Any deviation from established expert algorithms jeopardizes the quality and effectiveness of medical care.

Therefore, we address the new leadership of the Ministry of Health, represented by Minister Katya Ivkova, and call for the programs and algorithms for colorectal and cervical cancer screening for the 2025–2030 period, already adopted by the Council of Ministers, to be launched as soon as possible, while taking all necessary measures to optimize the financial framework and ensure the effective and transparent expenditure of public funds.