When they find out that they have cancer, Jelena and Dragan will not think about the fact that cancer is among the most common diseases of modern times, nor that it will be diagnosed in almost 20 million people worldwide in 2022. They will face a diagnosis that will fundamentally change their lives.
photo: private archiveSandra Bijelac
After learning that they are suffering from cancer, patients go into a state of shock that can last up to three months, explains oncologist Sandra Bijelac for "Vreme". In that period, there is a complete destruction of the previous system of beliefs and attitudes towards oneself, one's own body, obligations and social roles.
While the first shock is still going on, Jelena and Dragan will enter the treatment system which, according to the last available report, has only 0,98 oncologists per 100.000 inhabitants. Even more devastating is the fact that one oncologist in Serbia annually receives as many as 778 new patients - according to the Global Survey on the workforce in the field of clinical oncology, the most in Europe.
THE NUMBER OF PATIENTS AND THE MOST COMMON FORMS OF CANCER IN OUR COUNTRY
According to the latest available report of the Institute for Public Health of Serbia "Dr. Milan Jovanović Batut", during the year 2024, 41.472 new cases of malignant diseases were registered in Serbia - 21.793 in men and 19.679 in women. While Jelena and Dragan try to understand what it means to live with cancer, both will already become part of the official statistics for the year 2026 in Serbia. They won't know it, nor will it matter to them at that moment.
For Dragan, as well as for more than twenty thousand men in Serbia who have been given the same diagnosis, the coming months will be filled with examinations, analyses, therapies and waiting for the results. Dragan does not yet know what his diagnosis will be. Different types of diseases, different prognoses and different methods of treatment are hidden behind the common name "malignant disease".
Statistics show that men in Serbia most often suffer from lung and bronchial cancer, which accounts for almost a fifth of all newly diagnosed cases (19,5 percent). Colon and rectal cancer (15 percent), prostate cancer (12,4 percent), bladder cancer (8,2 percent) and pancreatic cancer (3,4 percent) follow. Lung cancer is the deadliest: more than a quarter of all deaths from malignant diseases among men in Serbia are the result of this diagnosis (27,3 percent). Colon cancer (14,3 percent) and prostate cancer (9,3 percent) follow.
For Jelena, however, one diagnosis will be more likely than others. Statistics show that women in Serbia most often get breast cancer, which accounts for almost a quarter of all newly diagnosed cases of malignant diseases (23,1 percent). They are followed by colon and rectal cancer (10,6 percent), lung cancer (10,1 percent), while cervical cancer and uterine body cancer are in fourth and fifth place, with 5,3 percent each.
What Jelena is still trying to understand, Suzana Đorđević from Kragujevac experienced nine years ago. When she found out that she was suffering from breast cancer at the age of 34, she became part of the official statistics, just one of thousands of newly diagnosed women. Suzana still remembers the journey she went through during the treatment process.
"I didn't go to a state institution because I knew that there was no appointment and that I couldn't get an examination. I did all the examinations before the operation privately. Those who can pay for the examination, maybe they can detect the disease in time. It's difficult for those who don't have money, and there are many who don't," she told "Vreme".
photo: sava radovanović / tanjugSERBIA LEADS BEHIND EUROPE: There are only 2,23 mammograms per 100.000 inhabitants
Suzanne's experience is not an exception, but the standard in Serbia. Months of waiting, private examinations and uncertainty are directly related to the equipment of the health system. According to Eurostat data for the year 2023, Serbia has 1,92 CT scanners per 100.000 inhabitants. For comparison, Greece has 5,06 and Bulgaria 4,93. An even greater difference can be seen when it comes to magnetic resonance imaging - in Serbia, only 0,6 devices are available per 100.000 inhabitants, while Greece has 3,91. The picture is not encouraging when it comes to the equipment used in prevention. In Serbia, there are 2,23 mammograms per 100.000 inhabitants - Greece has almost three and a half times more.
EVERYONE IS TALKING ABOUT PREVENTION, AND THERE IS NO DEADLINE
A smaller number of diagnostic devices does not only mean that the system is less equipped, it leads to long waiting lists for examination and diagnosis of patients.
"The waiting period is much more difficult than just dealing with the diagnosis. When diagnostic procedures are not available or there is a long wait, it puts an additional burden on patients and families, causes fear and leads to some diagnoses being made later than they could be", explains oncopsychologist Sandra Bijelac.
Suzana still remembers how difficult it was to get an examination. "Everybody here talks about prevention, and when you try to schedule an ultrasound, they tell you that there are no appointments. If you have money, you go privately. If you don't, you wait."
source: Swedish Institute for Health Economics, January 2026....
The report of the Swedish Institute for Health Economics from January 2026 also shows that Susan's experience is not alone. In Serbia, only eight percent of women between the ages of 50 and 69 are included in the official program of organized breast cancer screening. By way of comparison, organized screening in Slovenia includes 78 percent of women, in Croatia 62 percent, while the European Union average is 56 percent. Even Bulgaria, according to the available data, is above Serbia with about 36 percent of women included in the examinations.
However, as oncologist Sandra Bijelac says, the number of devices, waiting lists and therapies are only part of the wider story. "What we see in the system are people who come for surgery, chemotherapy or radiation. What we don't see are all the fractures that happen within the four walls and within the family," she says.
The disease, Sandra Bijelac explains, does not end when you leave the hospital - that's when everyday life begins, in which people face their own fears, uncertainty, changes in the family, at work and in relationships with loved ones.
For Suzana, who was receiving chemotherapy after surgery, returning home was an extremely important moment as she did not know what to expect. "I asked the doctor: 'Does this mean that now I should just lie in bed?' She said to me, 'All kinds of things. Why should you lie down? You come to have chemotherapy, rest for a day or two and get on with life as much as you can.' That meant a lot to me", he recalls.
That, says Sandra Bijelac, is one of the biggest misconceptions when it comes to malignant diseases. "Loss of health is one of the most stressful events that a person can experience. However, we often act as if nothing special has happened. People are expected to return very quickly to their old life, work, obligations, the role of parents or partner, even though their world has completely changed in the meantime."
Therefore, she adds, the disease rarely affects only the person who received the diagnosis. "When one family member gets cancer, the whole family goes through a crisis. Everything changes - daily obligations, relationships, plans, finances. Often all attention is focused on the patient, while family members remain completely invisible even though they too go through a great emotional burden."
Suzana says that it was because of her loved ones that she tried to preserve her everyday life. "I didn't want the whole house to revolve around my illness. Of course everyone was worried, but I tried to live as normally as possible. It means a lot when you have the support of the people around you."
THE IMPORTANCE OF SUPPORT AND HOW TO OFFER IT
While Jelena and Dragan will try to understand what awaits them, they will begin to receive advice - that they must think positively, that they must not give up, that they must fight and that they will beat cancer. Such messages have almost become an integral part of the way society talks about malignant diseases. Although they usually come from the best intentions, warns oncopsychologist Sandra Bijelac, they can create an additional burden for people who are already facing one of the most difficult periods in their lives.
"When we tell someone that they have to be strong or that they have to beat cancer, we actually shift the responsibility for the outcome of the treatment onto the patient. As if someone who doesn't recover will be less brave or didn't fight enough. And that's simply not true," says Sandra Bijelac.
Malignancy, she explains, is not a competition won by the most willful, nor is it a psychological test passed only by the most persistent. "People have a right to be scared, to cry, to be angry or to feel powerless. These are all completely normal reactions. There is no one right way to go through cancer."
Suzana says she never thought about whether she was a fighter or not. The only thing she was trying to do was to preserve what gave her a sense of a normal life.
"I told myself that I would think positively as much as I could. That didn't mean that I was going to pretend it wasn't difficult, but that I wasn't going to let the disease consume me." However, she adds, she quickly realized that she would have to change the people around her for her own peace. "I removed from my life everyone who drained my energy. I had no strength for negativity. I needed people with whom I could feel calm."
Bijelac says that this is precisely the difference between psychological support and so-called positive psychology. "The goal is not for a person to be positive at all costs. The goal is to get space to feel what they feel, without pressure to constantly show optimism. Someone will be given strength by humor, someone by conversation, someone by faith, and someone will need time to accept what happened to them."
According to Suzana, there is no universal rule. "It helped me to think that way, but not everyone can do that. Some will be fine, some won't. Some will have the strength to get out of bed one day and not the next. And that's okay."
This reflects the paradox of our health system. Malignant diseases are most often discussed in terms of the number of patients and deaths, and the psychological consequences are almost never mentioned.
This is also confirmed by the Program for the Improvement of Cancer Control in the Republic of Serbia for the period from 2020 to 2022, which states that around 60 percent of cancer patients already in the initial phase of treatment need psycho-oncological support, while between 30 and 40 percent develop more pronounced psychological problems that require professional help. Despite this, psycho-oncology support organized according to the same program is available in only three health centers in Serbia.
For Jelena or Dragan, this means that, in addition to dealing with the diagnosis, therapies and uncertainty, they will most likely have to find a way to deal with the psychological consequences of the disease themselves. Some, like Suzana, will find support in family, friends or their own coping mechanisms, while others will not have that possibility.
"There is no correct way for someone to go through a malignant disease," says Sandra Bjelac. "But every patient should have the opportunity not to go through that process alone."
RELATIONSHIP WITH THE DOCTOR AND AVAILABILITY OF DRUGS
Jelena or Dragan will soon enter the treatment system and will not think about the fact that, according to the Global Survey on the workforce in the field of clinical oncology, there are only 54 oncologists in Serbia. Much more important to them will be what kind of relationship they will be able to establish with the doctor who will guide them through treatment.
Suzana says that she was lucky in that. "It meant a good relationship with my doctor, because we all grew up with the fact that what the doctor says is what it is. I was lucky that the doctors were reasonable and good people. They knew what to say at all times," she explains. She also adds that during the treatment she fully complied with everything the doctors advised her.
Such experiences, however, cannot mask the limitations of the system in which these doctors work. The European Medicines Agency (EMA) approved a total of 56 new oncology drugs between 2020 and 2023, and only eight are available to patients in Serbia. This is about 14 percent of registered therapies, while European Union countries have access to half of new oncology drugs on average.
Neither Jelena nor Dragan will think about how many new therapies are available in Germany or Italy during treatment. They will only think about whether a medicine that could help them exists in Serbia. Even the doctor opposite them will not think about European statistics, but about how to provide the best possible treatment to his patient, despite the limitations of the system.
IT IS NECESSARY TO SPEAK ABOUT CURED FELLOW CITIZENS
Next February 4, on World Cancer Day, or in October, when Breast Cancer Awareness Month is celebrated, Jelena and Dragan, like other patients, will once again listen to statistics in the media - how many people have contracted the disease and how many have died. During the National Cancer Month in March 2026, the Institute for Public Health of Serbia "Dr. Milan Jovanović Batut" announced that cancer, when detected on time, is curable in more than 90 percent of cases and that timely diagnosis saves lives.
However, these percentages do not show people, nor the moment when someone hears the diagnosis of a malignant disease for the first time. You don't see months of waiting, conversations with doctors, families going through treatment together, or the day someone returns to work for the first time or makes a plan for next summer. This is exactly why Suzana believes that cancer should be talked about differently. "As soon as one hears that someone has cancer, people write them off, and that shouldn't be the case." He adds that the public almost always listens to the same numbers.
"We are constantly bombarded with statistics on how many people have fallen ill and how many have died. We have never seen or heard statistics on how many have been cured, and that number is not small. It seems much more optimistic." That is why he believes that the way we talk about malignant diseases should be changed. "We should talk about malignant diseases more often, but on the bright side," she believes.
Jelena and Dragan will become part of the official statistics, but their lives will not fit into the annual reports. Fears and hopes, waiting for results, joy over good news and anxiety over bad news are part of everyday life for people who are being treated for malignant diseases. That is why, along with prevention, diagnosis and treatment, it is equally important that we look at cancer patients not through their diagnosis, but as people who continue to live despite the disease.
