Real-World Data Analysis of Breast Cancer Guidelines Adherence Using Danny Platform

April 16, 2024, the internationally peer-reviewed novel open-access journal, Clinical Surgical Oncology, published the study “Nationwide Analysis of Breast Cancer Guidelines Adherence in Bulgaria,” where Sqilline contributed as a co-author, with the analyses powered by our innovative technology Danny Platform.

Introduction: Breast cancer is a significant health concern globally, with Bulgaria ranking high in both incidence and mortality rates among European countries. Adherence to clinical practice guidelines is crucial for improving patient outcomes. However, there’s a gap in understanding the adherence to these guidelines. This study presents a real-world data (RWD) analysis of breast cancer diagnostic and treatment practices in Bulgaria with health data processed by Danny Platform.

Key Summary Points:


  • Assess adherence to breast cancer diagnostic and treatment guidelines in Bulgaria using RWD processed and analyzed by Danny Platform.
  • Evaluate the utilization rates of core-needle biopsy, frozen section, breast-conserving surgery, and sentinel lymph node biopsy.
  • Identify challenges and opportunities for improving adherence to international guidelines in Bulgaria.


  • Limited implementation of national breast cancer screening programs impacts early detection rates and disease prognosis.
  • Lack of official data for Bulgaria to assess breast cancer patient diagnosis, treatment, follow-up, and outcomes.
  • Insufficient continuous medical education to support new health technologies implementation and assessment.


  • Utilize real-world data from Danny Platform to assess current practices and identify areas for improvement. Data from January 2019 to August 2023 nationwide was analyzed using the platform with access to anonymized medical information from Bulgaria’s leading territorial oncology hospitals. A total of 13,790 patients met the inclusion criteria.
  • Implement targeted interventions to promote adherence to international guidelines, focusing on increasing core-needle biopsy utilization and reducing reliance on frozen sections.
  • Enhance training programs for surgeons, ensure consistent guideline dissemination, and address regulatory barriers to improve diagnostic and treatment practices.


  • The analysis revealed suboptimal adherence to breast cancer diagnostic and treatment guidelines in Bulgaria.
  • Low utilization of core-needle biopsy (CNB), high reliance on frozen sections, and below-average rates of breast-conserving surgery and sentinel lymph node biopsy were observed. The gold standard diagnostic tool, CNB, was done in 5,427 patients (39.35%), an intraoperative frozen section was performed as a method for confirmation of breast cancer in 6,257 patients (45.37%) and the standard technique for lymph node evaluation, sentinel lymph node biopsy, was done in 357 patients (2.99%).
  • These findings highlight the need for targeted interventions to improve guideline adherence and patient outcomes in Bulgaria.


  • Improved adherence to breast cancer diagnostic and treatment guidelines can lead to better patient outcomes, including increased survival rates and enhanced quality of life.
  • Targeted interventions based on real-world evidence can address specific challenges and optimize resource allocation for breast cancer care in Bulgaria.
  • Enhanced guideline adherence can contribute to the development of standardized practices and improve the overall quality of breast cancer care in the country.


Dobromir Dimitrov, Ivelina Petrova, Meri Shoshkova, Martin Karamanliev (Department of surgical oncology, University Hospital “Georgi Stranski”, Department of Propedeutics of surgical diseases, Medical University – Pleven, Pleven, Bulgaria)

Iskra Daskalova (Breast Service Department, European Medical Center, Moscow, Russia)

Tsanko Yotsov (University of Ruse, Department of Health Care, UMHAT Medica Ruse, Ruse, Bulgaria)

Damyan Boychev (Sqilline Health, Sofia, Bulgaria)

Tihomir Andreev (Imagerie Diagnostic Dept, Policlinique du Parc Cholet, France)

Nikolai Ramadanov (Center of Orthopaedics and Traumatology, Brandenburg Medical School, University Hospital Brandenburg/Havel, Brandenburg an der Havel, Germany)

Click here to read the full publication in Clinical Surgical Oncology

Share this article:

More News & Highlights


Sqilline Scientific Research Project Flow

Is there a clinical problem you want to solve? Do you have a hypothesis you want to test? Do you want to clarify your research...



Health data as an infrastructure

Health data can be considered a crucial component of healthcare infrastructure, as it forms the basis for decision-making, research, policy development, and patient care within...



Lung Cancer Real-world Evidence Secondary Use of Data: A Non-Interventional Study

Description of clinical study: Non-Interventional Study for Analysis of Molecular Diagnostics and Treatment Patterns in Metastatic Non-Small Cell Lung Cancer Patients (Newly Diagnosed and Relapses...