The European Cervical Cancer Prevention Week

Mimosa Day is marked in Croatia every year in January during the European Cervical Cancer Prevention Week, with the aim of raising awareness about cervical cancer and highlighting the importance of prevention, early detection, and timely treatment.

HPV Vaccination

This day serves as a reminder that cervical cancer is one of the few cancers that can be largely prevented through HPV vaccination, regular screening, and responsible care for personal health.

Awareness

In Croatia, nearly 300 women are diagnosed with cervical cancer each year, and around 100 women lose their lives to the disease. Although effective prevention methods are available, cervical cancer continues to affect many women, including younger women.

Mimosa Day reminds us that awareness, prevention, and timely action can save lives. By encouraging vaccination, regular check-ups, and conversations about women’s health, we can help reduce the impact of cervical cancer in Croatia.

One of the Highest Smoking Rates in the EU

Croatia faces a major lung cancer burden, with more than 3,000 new cases and a similar number of deaths each year, alongside one of the highest smoking rates in the EU.

The First National Lung Cancer Screening Program in the EU

In response, the Croatian National Lung Cancer Screening program was launched in 2020 as a nationwide initiative aimed at early detection of lung cancer and reducing disease-related mortality, as the first national lung cancer screening program in the EU.

LDCT

The programme uses low-dose computed tomography (LDCT) to identify small, operable lung tumours before symptoms develop, when treatment is most effective and the chances of successful recovery are significantly higher. Because nearly 90% of lung cancer cases occur in current or former smokers, the programme is intended for high-risk individuals aged 50–75 years who are current smokers or who quit smoking within the past 15 years and have a smoking history of at least 30 pack-years. The screening program is completely digitalized and utilises general practitioners for enrolling participants. Since the start of the program in October 2020, more than 67,000 Croatian citizens have been screened, resulting in over 100,000 LDCT scans.

Organized Population-based Screening

National Cervical Cancer Early Detection Programme in Croatia was launched to reduce the incidence and mortality of cervical cancer through organized population-based screening. The programme aims to detect precancerous lesions and early-stage cancer before symptoms appear, enabling timely treatment and significantly improving health outcomes. It also seeks to increase participation in preventive examinations and strengthen public awareness of cervical cancer prevention.

A Pilot Phase

Originally introduced in 2012 for women aged 25–64, the programme was reorganized in 2019 to improve screening effectiveness and participation rates. Since 2023, a pilot phase of the reorganized programme has been underway in one of Croatia’s counties. The new approach uses Pap testing for women aged 20–29 and combined Pap and HPV testing for women aged 30–64, with the goal of developing an updated national screening model.

HPV Vaccination

In addition to screening, HPV vaccination has been available in Croatia since 2007 and has been included in the national immunization programme for school children since 2016. Together, vaccination and screening form the foundation of cervical cancer prevention, helping to detect precancerous changes early and further reduce the burden of the disease.

A Pilot Initiative

Croatia’s Special Programme for Prostate Cancer Screening and Early Detection is a pilot initiative designed to assess the feasibility of introducing a nationwide organised prostate cancer screening programme. Developed in line with the 2022 Council of the European Union recommendations on cancer screening, the programme aims to improve early detection of prostate cancer, reduce mortality, and identify cancers at a stage when treatment is most effective.

PSA Test

The programme targets men aged 55–69 who have not previously been diagnosed with prostate cancer and have not undergone a PSA (prostate-specific antigen) test within the previous year. Participants are invited by their general practitioners to receive a free PSA test and, where indicated, additional diagnostic examinations at no cost.

A Future National Screening Programme

Implemented in the City of Zagreb, the programme evaluates participation rates, effectiveness, cost-efficiency, and organisational requirements for a future national screening programme. The pilot aims to screen 10,000 men and generate evidence to support the development of an organised, population-based approach to prostate cancer early detection in Croatia.

March as Colorectal Cancer Awareness Month in Croatia

In February 2022, the Croatian Parliament officially declared March as Colorectal Cancer Awareness Month in Croatia, emphasizing the importance of prevention, early detection, and public education about one of the most common cancers worldwide.

In Croatia, colorectal cancer accounts for approximately 14% of all cancer diagnoses and remains the second leading cause of cancer-related deaths.

Precancerous Lesions

Early detection through screening significantly improves treatment outcomes and survival rates, while the removal of precancerous lesions can prevent the disease from developing altogether.

Blue Iris Day

Blue Iris Day is also one of Croatia’s key colorectal cancer awareness initiatives. Through public health campaigns and educational activities, it promotes colorectal cancer prevention, early detection, and the importance of regular screening. The campaign also raises awareness of Croatia’s National Colorectal Cancer Early Detection Programme and encourages people to take proactive steps to protect their health, as colorectal cancer is one of the most common yet highly preventable cancers.

Reducing the Incidence and Mortality

Croatia’s National Colorectal Cancer Early Detection Programme is a population-based screening programme aimed at reducing the incidence and mortality of colorectal cancer through early detection and treatment.

A Stool Test That Detects Hidden Blood

Every two years, all women and men aged 50–74 are invited by mail to complete a stool test that detects hidden blood, which may be an early sign of colorectal cancer or precancerous changes.

The Faecal Immunochemical Test (FIT)

A pilot project introducing a more sensitive screening method, the Faecal Immunochemical Test (FIT), has already been launched in Zagreb and is expected to be expanded to other parts of the country.

High-Quality Endoscopic and Pathological Diagnostics

Individuals with a positive test result are referred for a screening colonoscopy within the programme, ensuring access to high-quality endoscopic and pathological diagnostics. This allows for the detection and removal of precancerous lesions as well as the identification of cancer at an early stage, when treatment is most effective.

Early Diagnosis and Treatment

Colorectal cancer is one of the most common cancers in Croatia, but it is also one of the most preventable. Regular participation in screening can significantly reduce the risk of developing advanced disease and improve survival outcomes through early diagnosis and treatment.

Early Breast Cancer Detection

Daffodil Day Is A Nationwide Public Health Campaign Dedicated To Raising Awareness Of The Importance Of Early Breast Cancer Detection. The initiative brings together healthcare professionals, volunteers, and citizens to promote regular screening and timely treatment.

Free Mammography Screening

The campaign also highlights the achievements of Croatia’s National Breast Cancer Early Detection Programme, which marks its 20th anniversary this year. The programme offers free mammography screening every two years to women aged 49–70, with invitations sent directly to their home addresses.

Reduction in Breast Cancer Mortality

Since its launch in 2006, the programme has detected more than 10,000 breast cancer cases and contributed to earlier diagnosis, improved treatment outcomes, and a 25–30% reduction in breast cancer mortality. Advances in screening, diagnostics, multidisciplinary care, and access to innovative therapies have further strengthened its impact.

 The Croatian Cancer Registry

Breast cancer is the most common cancer among women in Croatia. According to the Croatian Cancer Registry, 3,293 new cases were recorded in 2023, while 697 women died from the disease in 2024.

Regular Screening

Regular screening—including breast self-examination, mammography, and ultrasound—can detect breast cancer at an early stage, when treatment outcomes and survival rates are significantly better. Although it is most common in women over 50, breast cancer can also occur in younger women.

Increase Early Detection Rates

To address this major public health challenge, Croatia launched the National Breast Cancer Early Detection Programme in 2006. The programme aims to reduce breast cancer mortality by 25–30%, increase early detection rates, and improve patients’ quality of life. Women aged 49–70 are invited for a mammography screening every two years. More than 90% of breast cancer cases can be successfully treated when diagnosed early, with a five-year survival rate of 96%.

Eight Screening Cycles

Eight screening cycles have been completed and the ninth is ongoing. Around 150,000 mammograms are performed annually, with participation rates of about 70%. Screening has led to increased detection of early-stage breast cancer and contributed to a decline in breast cancer mortality in Croatia, alongside advances in diagnosis and treatment.

CLARA – Cervical Cancer Control through Equitable Access to Quality Services is Romania’s newest national effort to strengthen its cervical cancer screening programme.

Launched in December 2025 and running for 46 months, until October 2029, CLARA is financed under Romania’s Health Programme 2021–2027 and co-financed by the European Social Fund Plus. By the end of the project, Romania aims to expand equal, timely, and non-discriminatory access to safe, patient-centred cervical cancer prevention and treatment services, while laying the foundations for a sustainable, quality-assured national screening programme.

A national coalition for organised screening

CLARA brings together the main institutions and partners involved in cervical cancer screening in Romania. The project is led by the “Carol Davila” University of Medicine and Pharmacy in Bucharest, in partnership with Romania’s National Institute of Public Health, the three Institutes of Oncology in Bucharest, Cluj-Napoca, and Iași, and five regional hospitals in Târgu Mureș, Constanța, Craiova, Timișoara, and Pitești. Two civil-society organisations, the Coalition of Romania’s Chronic Patients’ Organisations (COPAC-RO) and the Romanian Association of Midwives, strengthen the consortium’s capacity to reach communities and support women along the screening pathway.

Together, these twelve institutions are working on several priorities at once: updating the national screening methodology, training around 700 medical and non-medical professionals, consolidating the cervical cancer screening registry, and establishing five new regional prevention centres. Their shared objective is to make screening more coordinated, accessible, and equitable, regardless of where a woman lives or the barriers, she may face in accessing care.

A key element of this work is the National Scientific Board, led by the Romanian Society of Obstetrics and Gynaecology. The Board brings together gynaecologists, public health experts, laboratory and cytology specialists, oncologists, and academic representatives. It has recently completed the updated methodology for Romania’s cervical cancer screening programme through a consensus process.

The methodology is aligned with European Commission Initiative on Cervical Cancer and includes a dedicated chapter on governance, drawing on the sustainability assessment tool developed under EUCanScreen Work Package 4. This connection is particularly important for EUCanScreen, whose work supports countries in strengthening governance, quality, monitoring, and sustainability across cancer screening programmes.

The Scientific Board is also supporting the development of a comprehensive screening registry. The registry will collect data across the full screening pathway, from invitations and test results to colposcopy, pathology, and treatment of precancerous lesions. It will also provide many of the indicators required for the Third EU Cancer Screening Report and will be interconnected with the national cancer registry.

In parallel, the Board has developed the training curriculum for the professionals involved in the programme, with 700 healthcare and community-level workers expected to be trained over the next two years.

The courses will employ the knowledge and skills of the Romanian specialists who will be trained through WP 11 of the EUCanScreen Project.

Reaching women who are too often left out

CLARA’s equity ambition is most visible in its outreach component. The project aims to reach more than 217,000 women from vulnerable or socio-economically disadvantaged communities  women for whom a screening invitation letter, however carefully designed, is rarely enough. Reaching them requires trusted people from within or close to the community, communicating in ways that are familiar, respectful, and accessible.

The Romanian Association of Midwives plays a central role in this outreach. The midwives go directly into communities, delivering face-to-face education sessions in local centres and rural settlements on female reproductive health, HPV infection, HPV vaccination, cervical cancer screening, and children’s immunisation. Sessions are delivered in culturally appropriate language and, where needed, in Romanian, Hungarian, and other ethnic minorities languages, helping ensure that information is not only provided but understood.

This work builds the health literacy and trust that must exist before women who have limited contact with the health system can feel confident coming forward for screening. Midwives are particularly well placed to support this process, drawing on three decades of professional association work and long-standing engagement with vulnerable and underserved women across Romania.

From community conversations to screening pathways

CLARA does not stop at information. Women reached through community activities will receive long-term support, case management, and guidance in accessing healthcare services available within the project. From prevention and screening to medical follow-up, the initiative aims to create a continuous pathway of care adapted to the realities of each community. In doing so, Romania’s cervical cancer screening efforts reflect EUCanScreen’s broader mission: to support sustainable, high-quality, and equitable cancer screening across Europe.

By 2029, CLARA aims to leave behind more than increased screening participation. Its longer-term contribution will be a stronger national screening system, better data, trained professionals, regional prevention capacity, and community partnerships capable of continuing to reach women who need these services most.

CLARA’s nationwide partnership, built on strong clinical and academic infrastructure paired with genuine, community-level trust-building is now matched by a close collaboration with EUCanScreen. For Romania, a country that has long carried one of Europe’s highest cervical cancer burdens, this convergence could not have come at a better time, it is exactly what allows a national screening programme to be built the way it will last, steadily and surely.

Building a Network of Early Detection

Cancer remains one of Romania’s most significant public health challenges. Around 300,000 people are currently living with a cancer diagnosis, while the risk of dying from cancer before the age of 75 is approximately 14%. In response, Romania has made the development of organized, population-based, quality-assured cancer screening programmes a national priority, aiming to ensure equitable access for all citizens.

Here is where that work stands today, programme by programme, followed by a look at the wider European collaboration that has helped shape it.

From Opportunistic Testing to National Programmes

Until 2012, Romania had no organized national cancer screening programme. That year, building on a successful regional pilot in the country’s North-West, the Ministry of Health introduced the first nationally funded early detection initiative through opportunistic cervical cancer screening with Pap smear testing.

A major milestone followed in 2016 with the first draft of Romania’s National Cancer Control Plan, developed through the country’s participation in the European Joint Actions EPAAC and CanCon. Since then, Romania has steadily expanded from a single screening initiative into a growing network of organized programmes supported by European collaboration, quality assurance systems, and national monitoring frameworks coordinated by the National Institute of Public Health (INSP) together with universities, oncology institutes, and professional societies.

CLARA: Transforming Cervical Cancer Screening

Romania has long recorded the highest cervical cancer mortality rate in the European Union, largely due to decades of opportunistic rather than organized screening.

The CLARA programme, funded through the European Social Fund Plus and led by Carol Davila University of Medicine and Pharmacy with INSP as a core partner, is establishing Romania’s first fully organized population-based cervical cancer screening programme.

The programme introduces HPV testing as the primary screening method, complemented by self-sampling options to reach women facing barriers to healthcare access. It also includes standardized follow-up pathways, comprehensive quality assurance, patient communication materials, regional prevention centres, mobile screening units, a unified electronic patient registry, and training for approximately 700 healthcare professionals. More than 200,000 vulnerable women are expected to benefit from the programme.

ROCCAS: Expanding Colorectal Cancer Screening

Romania’s colorectal cancer screening programme, ROCCAS, began as regional pilots between 2019 and 2020 across four development regions.

Adults aged 50–74 were invited to complete a fecal immunochemical test (FIT), followed by colonoscopy for positive cases. Acceptance rates ranged from 89% to 99%, demonstrating strong public participation.

Following the successful pilots, ROCCAS is now progressing towards nationwide implementation, with INSP coordinating monitoring systems, reporting mechanisms, and quality assurance procedures.

DARIA: Romania’s First Organized Breast Cancer Screening Programme

Until recently, access to breast cancer screening in Romania depended largely on opportunistic mammography, often paid for by patients themselves.

The DARIA programme, led by the Prof. Dr. Ion Chiricuță Oncology Institute in Cluj-Napoca, is changing this landscape by establishing Romania’s first organized national breast cancer screening programme.

Through 2029, DARIA will provide free mammography to more than 119,000 women aged 50–69, focusing particularly on underserved populations, including uninsured, unemployed, and marginalized communities. The programme will also establish regional prevention centres, mobile screening units, an electronic patient registry, and train approximately 600 healthcare professionals. Screening is expected to begin in August 2026.

Launching Lung Cancer Screening

Lung cancer remains the leading cause of cancer-related death among Romanian men.

Following the European Council’s 2022 recommendation on low-dose CT (LDCT) screening for high-risk smokers, Romania has launched a national pilot coordinated by the Marius Nasta National Institute of Pneumology, with INSP as a core partner.

The pilot is developing screening methodologies, public awareness materials, and monitoring indicators that will support the future implementation of an organized national lung cancer screening programme.

European Collaboration Driving Progress

Romania’s progress has been strengthened through extensive collaboration with European initiatives that provide shared expertise, methodologies, quality standards, and practical experience.

Among these initiatives, EUCanScreen plays a central role by supporting Romania in developing sustainable governance structures, quality assurance systems, and organized screening programmes for breast, cervical, and colorectal cancers, while helping prepare future programmes for lung, prostate, and gastric cancers.

Romania also participates in several complementary European projects:

• CBIG-SCREEN, focusing on increasing cervical screening participation among underserved populations through innovative approaches such as self-sampling.
• SOLACE, supporting equitable implementation of lung cancer screening using low-dose CT.
• PRAISE-U, whose risk-based prostate cancer screening research provides valuable evidence that Romania is following closely while preparing for future implementation.

Alongside these projects, Romania is adapting European quality assurance guidelines, strengthening health information systems, and building the professional capacity required to sustain organized screening programmes.

Building Capacity Through Academic and Professional Leadership

Romanian universities and professional societies play a crucial role in translating scientific evidence into national clinical practice.

Institutions including Carol Davila University of Medicine and Pharmacy and the Universities of Medicine and Pharmacy in Cluj-Napoca, Craiova, and Iași work alongside professional organizations such as the Romanian Society of Obstetrics and Gynecology, the Romanian Society of Gastroenterology and Hepatology, the Society of Family Doctors, and the College of Physicians of Romania to develop clinical guidelines, training curricula, and quality standards.

These collaborations ensure that screening programmes are not only designed according to international recommendations but are also effectively implemented by well-trained healthcare professionals across the country.

A Coordinated National Effort

Together, Romania’s screening programmes form the foundation of the National Cancer Control Plan (2023–2030) and contribute to the objectives of Europe’s Beating Cancer Plan.

Supported by funding from the European Social Fund Plus, the European Regional Development Fund, and EU4Health, each programme is progressing at its own pace—from well-established cervical screening to emerging lung cancer pilots—but all share the same ambition: detecting cancer earlier, improving survival, and ensuring that high-quality screening becomes accessible to every eligible citizen across Romania.