- Press Release-
Skopje, 07.04.2026
Breast Cancer Screening Coverage Ranges from 0.8% to 5.4% and Cervical Cancer Screening Coverage from 10.3% to 15.5% of the Target Population, Remaining Significantly Below European Recommended Levels for Organized Population Screening
Audit findings indicate that, despite long-standing implementation and progress achieved in the planning and execution of screening programs, under conditions of limited budgetary resources, the programs do not ensure sufficient coverage of the target population nor timely diagnosis at a scale that would allow for a systematic confirmation of their contribution to the early detection of malignant diseases and the reduction of mortality. Data show that in over 80% of female patients with cancer, treatment begins at later stages
The State Audit Office conducted a performance audit on the topic “Programs for Early Detection of Malignant Diseases” to answer the question: “Do the early detection and screening programs ensure adequate coverage of the target population and high-quality and timely diagnosis, and do they result in the early detection of breast and cervical cancer and a reduction in mortality?”
The audit covered activities related to the planning and implementation of screening programs for cervical cancer and breast cancer from 2021 to 2024, including certain issues and events before and after this period.
Cervical cancer screening is conducted through Pap tests in women aged 21 to 59 on a three-year cycle. Between 2022 and 2024, a total of 130.093 Pap test samples were collected by primary care gynecologists.
Breast cancer screening is conducted through mammography examinations in women aged 40 to 69 on a two-year cycle. Between 2021 and 2024, 20.946 screening mammograms were performed in multiple breast screening centers.
Screening programs are adopted annually, without an established long-term strategic framework to ensure continuity and stability in defining the target population, screening coverage, and intervals, and long-term planning of required resources and capacities. During the analysed period, changes were observed in program content, coverage, and priorities. These changes were not consistently based on analyses of available capacities or expected health outcomes, which makes it difficult to assess the justification and effectiveness of the measures taken.
Objectives and performance indicators are not defined consistently and are largely focused on activity volume rather than outcomes.
Financial planning is carried out within limited annual budget resources, without a clear link between resources, planned coverage, and expected outcomes, which makes it difficult to assess the effectiveness of the programs and their contribution to the early detection of malignant diseases.
Screening programs are implemented continuously; however, coverage of the target population remains limited, and they do not produce significant population-level effects. The analysis shows that breast cancer screening coverage ranges from 0.8% to 5.4%. In comparison, cervical cancer screening coverage ranges from 10.3% to 15.5% of the target population, well below European recommended levels for organized population screening. These findings indicate that, at the current level of coverage, a meaningful impact on early disease detection cannot be expected.
The response rate among invited women cannot be fully assessed due to incomplete data on the number of invitations sent and the number of women who attended screening. Information systems do not allow for systematic monitoring in this regard. In addition, promotional activities are not carried out consistently or to a sufficient extent, which affects women’s awareness and motivation to participate in screening programs.
Concerning timeliness and quality of diagnostics, no timeframes have been established between screening and the issuance of results, nor are there protocols for informing women. For mammography screening, results are issued on average after about 25 days, but for many women, the waiting time exceeds 60 days. In cervical cancer screening, some Pap test samples are analysed with significant delays.
Follow-up after breast cancer screening, particularly for women with suspicious or abnormal findings, is primarily linked to the work of Breast Units, which represent an important component of the diagnostic and treatment process. In some public healthcare institutions, limited staffing and organizational capacities affect the scheduling and delivery of additional diagnostic procedures and treatment.
In some cases, the increased volume of screening-related activities affects the availability of routine diagnostic and follow-up examinations in radiology departments, with some public healthcare institutions reporting a reduction in regular appointment slots.
There is no complete traceability of patients from screening through to further diagnostics and treatment. Data on follow-up care is not systematically linked to screening data, with evidence of patients lost to follow-up, particularly when they continue treatment in the private sector, which limits the ability to assess the effectiveness of screening programs. Data from health institutions show that 80% of cancer patients begin treatment at later stages of the disease, indicating that most cases are not detected at an early stage, as would be expected from organized screening.
At the same time, data on the number of cases and deaths is neither complete nor consistent across official institutions. Data from the Cancer Registry show that the number of cases detected through screening is relatively low, particularly for breast cancer, indicating a limited effectiveness of the programs.
A comprehensive regulatory and strategic framework for organized screening, clearly defining the roles and responsibilities of the institutions involved, has not been established, which affects coordination and continuity in the implementation of screening programs. The shortage and uneven distribution of staff, particularly in radiology, cytology, and pathology, pose a risk to the continuity and quality of screening services.
Diagnostic equipment and infrastructure are not evenly distributed, and information systems do not ensure full interoperability and data exchange, which hampers the management of screening and the systematic monitoring of program outcomes.
To address the identified weaknesses, we issued recommendations to eliminate their root causes and create conditions for the implementation of an effective, organized screening system, namely: establishing an appropriate regulatory framework for organized screening, a standard set of objectives and indicators, clear and transparent financial reimbursement models, continuous and systematic promotional activities, and an integrated information system.
Press Contact:
Albiona Mustafa Muhaxhiri +389 72228 203 [email protected]
Mijalche Durgutov +389 70 358 486 [email protected]
Martin Duvnjak +389 75 268 517 [email protected]