SKOPJE – A bottleneck in health-care services is causing dangerous delays in the diagnosis and treatment of breast cancer in North Macedonia, forcing patients to wait months for potentially life-saving scans or obliging them to explore costly private options that are out of reach for many women.
The strain compounds the tragedy of rising breast-cancer death here and around the world, patients and physicians warn, and leaves newly stricken women especially vulnerable in a system that should be dedicated to leaving no patient behind.
Actress Vesna Petrusevska became the public face of the crisis in the former Yugoslav republic in October during Breast Cancer Awareness Month, when she posted a photo of her mastectomy scar alongside glamorous images from her past to encourage women to get checkups.
“We all like to see beautiful food and beautiful lives on social media,” she told RFE/RL’s Balkan Service. “But this is life without a filter. The story is quite raw, and there isn’t enough awareness about this issue among the public.”
Petrusevska recognized that her treatment route -- she found one surgeon through an acquaintance and bypassed the public health system for a second operation -- was closed to many other women in this country of about 2 million people.
“Bureaucracy at the counters kills,” Petrusevska said, adding that she sympathizes deeply with women who can’t afford private health care.
Breast cancer has been the leading cause of cancer deaths for 13 years in North Macedonia, where the cost of a mammogram and comprehensive exam at a private clinic eclipses the average monthly salary of around $730. Treatment escalates quickly from there. At Skopje’s largest private hospital, a mastectomy costs between $1,700 and $4,000, depending on factors including the length of hospitalization. A PET scan costs around $2,700. Basic screenings cost around $100 each, but getting an appointment routinely takes months.
“I could get a visa to America sooner than an appointment for a mammogram and ultrasound at a public hospital,” one woman, who preferred to remain anonymous for privacy reasons, told RFE/RL. “Yet a complete private exam costs more than my monthly salary.”
Macedonian women died of breast cancer at the rate of nearly one per day in the past two years (see chart), with new cases rising rapidly. As with many cancers, early detection saves lives and reduces the cost of treatment.
A shortage of oncologists and radiologists amid a decades-long emigration crisis in the region further complicates problems. Dr. Igor Stojkovski is director of the Oncology Clinic in Skopje, which treats cancer patients from all over the country. Eight breast-cancer specialists, at most, at his clinic treat an astounding 4,700 patients a year.
Incidence increases with an aging population and changing lifestyles and habits, he said, and early detection is heavily reliant on a combination of self-exams, family doctors, and secondary health care.
“By the time they arrive at the Oncology Clinic,” he said, “the patients are [frequently] in an advanced stage of the disease.”
The Health Ministry introduced a digitized screening scheduler for early detection of breast cancer in 2015 focused on women between the ages of 40 and 69 but still does not provide information on waiting times. A year ago, authorities launched a new “My Appointment” system to simplify referrals, but referring physicians say they are then left in the dark, and it’s unclear if waiting times have been reduced.
Elizabeta Ristovska, a 42-year-old from Skopje, said she had taken out three loans in the past three years to cover diagnosis and treatment.
“In the days when you’re fighting to survive, there are no appointments available for CT scans or MRIs, and we wait months for a PET scan.”
She waited four months for a bone scan.
Doctors say scheduling options remain complicated and lack transparency, denying potentially life-saving screenings for many women who couldn’t land any of the 11,676 ultrasounds or 6,693 mammograms performed so far this year.
“The situation exhausts us,” said Dr. Iva Zdravevska-Pandelieva, a family care specialist in Ilinden, outside the capital. “Ultrasound is a basic diagnostic method; if we don’t have that, discussions on self-exams and education are futile. You see changes in the breast, but you can’t help the patient.”
Women wait to be admitted to the University Clinic for Radiotherapy and Oncology in January 2024. Actress Vesna Petrusevska warns that “bureaucracy at the counters kills."
Ana Marjanovic, a cancer survivor and patient advocate at Hema-Onco, said the screening reforms might be easier for existing patients but are “still very complicated for everyone else.” The greatest impact, she said, is on newly diagnosed patients: “Health authorities say the screening program is simpler [now], but reality shows otherwise.”
For many women, the cancer battle becomes a fight against the system itself.
Bozhanka Koseva Karakoleva, a 59-year-old retired accountant from Gevgelija in the country’s southeast, travels to Thessaloniki, Greece, for MRIs and CT scans at a private facility. It’s not only closer, she told RFE/RL, but cheaper. She said she paid around $150 for an abdominal MRI, or about half what it would have cost back home.
“When cancer cells appear in multiple places, you can’t wait two or three months,” she said.
The alarms raised by patient advocates mean little to patients stuck waiting for appointments, uncertain when -- or if -- they’ll ever get them.
“The fight against this illness should be real,” said Ristovska, the Skopje woman slipping into debt to cover her treatment, “not just a pink October filled with empty promises and fake smiles.”