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Fragmented national efforts and limited integration with European standards had left Bulgaria’s cancer outcomes behind EU averages (OECD/European Commission, 2025). There was a lack of structured involvement in EU-level projects and networks, risking isolation from cutting-edge research, training and funding. This led to Bulgarian cancer patients often seeking treatment abroad due to significant gaps in the quality and coordination of care at home, reflecting a broader and persistent distrust in the national healthcare system among citizens.
To improve care quality and patient outcomes, and to align Bulgaria’s approaches with Europe’s Beating Cancer Plan (EBCP), the Bulgarian Joint Cancer Network (BJCN) spearheaded Bulgaria’s involvement in various key European cancer initiatives.
Bulgaria committed to multiple initiatives, such as the Horizon Europe 4P-CAN primary-prevention project, the EU4Health Joint Actions CraNE (and its successor EUnetCCC) on Comprehensive Cancer Centres, CCI4EU and the ECHoS Mission on Cancer hub network. Additionally, Bulgaria joined the European Cancer Organisation (ECO) as an associate member and secured the inclusion of 9 Bulgarian cancer centres in the INTERACT-EUROPE inter-specialty oncology training programme, signalling the country’s commitment to collaborative EU action. Furthermore, the BJCN has been formally designated to coordinate the establishment of a pilot Comprehensive Cancer Infrastructure (CCI) in Bulgaria, leveraging the collaborative capacity of a tri-hospital network. This initiative is being developed with strategic support from the Organisation of European Cancer Institutes (OECI) and the International Agency for Research on Cancer (IARC), as part of a broader alignment with European standards in comprehensive oncology care.
Through these collaborations, Bulgarian experts now contribute to EU policy forums and research consortia, bringing European know-how into the national context. For instance, under EUnetCCC and CCI4EU, Bulgaria working to establish criteria for a National Comprehensive Cancer Centre and Infrastructure of collaboration in line with EU standards, while together with the University of Plovdiv “Paisii Hilendarski”, the 4P-CAN project’s pilot Living Lab in Bulgaria engages communities in cancer prevention based on the European Code Against Cancer. As a result, Bulgaria’s National Cancer Plan 2030 could be updated with real points of action, incorporates EU best practices, and allows Bulgarian oncologists to gain access to EU training and knowledge networks. This active EU engagement is reducing the care gap between Bulgaria and other member states and embedding Bulgaria in the European Cancer Mission’s vision.
Enablers: EU frameworks like the EBCP provided a clear roadmap and funding instruments that Bulgaria could leverage (Governance, Funding). The success of similar networks in other EU countries (and guidance from ECO, OECI and ECHoS) created momentum and provided templates for Bulgaria’s integration. Multi-stakeholder engagement through partners such as the Ministry of Health (leading cancer policy), the Ministry of Innovation & Growth (driving digital health), BJCN, NGOs, universities and patient organizations could enhance advocacy and coordination. NGO leadership and patient advocacy raised domestic urgency. Ultimately, Bulgaria’s multiple stakeholders and political commitment drove adoption, and the BJCN served as a unifying platform, directing Bulgaria’s involvement in different cancer initiatives.
Barriers: Coordination challenges had to be overcome, such as aligning diverse stakeholders (government, NGOs, medical societies) and addressing resource constraints (Governance, Resources). Historically low public investment and bureaucracy hindered initial readiness to join EU programmes. Meeting strict EU criteria (for comprehensive centres or data standards) and overcoming language barriers were also issues. Additionally, trust-building was needed to convince local institutions of the benefits of external collaboration. Furthermore, it is imperative that Bulgarian institutions formally recognize and leverage the expertise and strategic role of the scientific and unified non-governmental sector, such as BJCN, functioning as a cluster organization, in advancing public health objectives and implementing evidence-based cancer care reforms.
Bulgaria’s inclusion in EU projects has expanded expert participation in cross-border networks, enabling adoption of European cancer care standards. By 2027, Bulgaria is expected to be fully embedded in the EU Network of Comprehensive Cancer Centres. BJCN is expected to formalize as the National Cancer Mission Hub under ECHoS by 2026, linking Bulgarian stakeholders with EU peers. Continued participation in EU projects is anticipated. For example, the new Joint Action EUnetCCC (2024–2028) will enable implementation of EU standards, and further Horizon Europe consortia are being pursued. This engagement will help Bulgaria rapidly adopt innovations (such as new screening programmes or digital tools) and contribute to shaping future European cancer policy. Over time, it should translate into improved survival rates and reduced inequalities, in line with EU Mission goals for 2030.
Lessons learned: Bulgaria’s experience highlights that strategic alignment with EU initiatives can catalyse national reform only when supported by strong political will and inclusive stakeholder engagement. Multi-stakeholder platforms such as BJCN proved essential for coordination, advocacy, and credibility. EU frameworks like EBCP offered besides funding, a structure, legitimacy and momentum for reform. However, sustainable transformation requires alignment, systemic readiness, trust-building among domestic institutions, and formal recognition of non-governmental expertise. Effective integration into EU networks must be accompanied by national investment in governance capacity and continuous stakeholder dialogue.
For more information
Bulgarian Joint Cancer Network (BJCN): https://bjcn.bg/en/home
