Comparative analysis of the Bulgarian national therapeutic guideline on breast cancer treatment with the NCCN, ASCO, and ESMO guidelines using the PICO methodology and its relevance to patient access

Objectives : Patient-centric healthcare ecosystems prioritize personalized diagnostics and treatments based on high-quality evidence regarding health technologies. Pharmacotherapeutic guidelines are essential for providing evidence-based recommendations, enhancing patient safety, and aligning healthcare policies with early detection and rational drug use. Methods : This study compares the Bulgarian pharmacotherapeutic guideline on breast cancer with the National Comprehensive Cancer Network (NCCN), American Society of Clinical Oncology (ASCO), and European Society for Medical Oncology (ESMO) guidelines using the Population, Intervention, Comparison, and Outcome (PICO) methodology, assessing alignment in screening, pharmacotherapy, follow-up, outcomes, and shared decision-making. Results : The results show that Bulgaria has a unified set of guidelines for tumor locations but lacks specific recommendations for screening and shared decision-making. While these guidelines align closely with international standards for breast cancer treatment, they do not offer guidance on follow-up, outcomes, or genomic profiling. Importantly, they incorporate new therapies before these are added to the Positive Drug List, thereby influencing regulatory decisions and patient access to treatments. Conclusion : The Bulgarian pharmacotherapeutic guideline on breast cancer aligns with international standards but could be improved with respect to screening, early detection, therapy adherence, and shared decision-making. A structured classification for levels of evidence would also enhance the guidelines.