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.

The BCR works closely with hospitals and laboratories in the context of cancer registration. 
In the context of screening, collaboration with other partners deserves to be highlighted :

• the Intermutualistic Agency[1]
• and regional screening organizations and the regional authorities:
• BRUPREV | Vivalis (Brussels)
• CCRef | AVIQ (Wallonia)
• Centre for Cancer Detection (CvKO) | Departement Zorg (Flanders)

All data are centralised at BCR:

Through regular and structured data exchanges, these partnerships help to:

strengthen data completeness
improve the quality and accuracy of collected information
support more effective screening strategies
assess the performance of the existing programs.

One of the missions of the BCR is to evaluate the screening programs through the calculation of indicators. The analyses concern participation, coverage and overdiagnosis, quality indicators related to cancer diagnosis, follow-up and treatment among the target population…

Monitoring and Evaluation

Annual reports with results of regional cancer screening programmes are published or can be assessed through our website:

Breast: Publications | Belgian Cancer Registry

Colo-rectum: Publications | Belgian Cancer Registry

Cervix: Publications | Belgian Cancer Registry

The BCR has a central position within this ecosystem and collaborates with Belgian partners for a better organization of cancer screening in Belgium, benefiting patients and public health.

The BCR and the screening organizations also collaborate at the international level and have an active contribution in WP5 of the Joint Action EUCanScreen,

• for the collection and reporting of aggregated data (tasks 5.2-5.3)
• for the planned pilot data collection based on individual data (tasks 5.4-5.5)
  • within Belgium, some preparatory work and discussions has been initiated
  • a collaborative effort will allow maximally participating to the pilot data collection

The Belgian partners also actively contributed to the previous CanScreen-ECIS project:

• selection of a set of indicators describing the different phases of the screening process
• pilot data collection: active contribution for all existing organized screenings in Belgium
  • qualitative surveys
  • quantitative surveys

A strong example of how collaboration turns data into meaningful impact for prevention and data excellence!

[1] The InterMutualistic Agency (IMA) brings together patient data from the seven Belgian mutual insurance organizations and prepares them for analytical purposes. The IMA databases contain, in addition to demographic and socio-economic data relating to all residents affiliated with the compulsory health insurance in Belgium, billing data for reimbursed healthcare services.

Strengthening Collaboration for Data Quality in Belgium

High-quality screening programmes depend on robust data systems that enable continuous monitoring, evaluation and quality improvement. In Belgium, collaboration between the Belgian Cancer Registry and the regional screening organisations is being further strengthened to

strengthen data completeness
improve the quality and accuracy of collected information
support more effective screening strategies
assess the performance of the existing programmes.

Contributing to Harmonised Screening Standards Across Europe

Building on previous European initiatives and ongoing activities within EUCanScreen (WP5 and WP7), Belgian partners contribute to the development of harmonised indicators, standardised data models, implementation of quality assurance schemes and innovative approaches for secure data sharing and performance monitoring.

Exploring New Pathways

Cancer screening programmes offer an important opportunity to engage citizens in broader cancer prevention efforts. Through activities within EUCanScreen, Sciensano as leads of task 9.6, with our co-leads at UNICANCER and Centre Léon Bérard in Lyon, France, are exploring ways to strengthen the links between screening and prevention by integrating health promotion and risk-reduction messages into screening pathways. The initial outcomes of a scoping review on how screening is used to strengthen the link between primary prevention and prevention after a cancer was presented at IARC’s 60th anniversary conference in May.

Preliminary Findings

Preliminary findings showed that most initiatives linked primary prevention to screening through lifestyle counselling, risk communication, or prevention information provision and counselling during screening encounters (“teachable moments”). Few programmes integrated tertiary prevention, highlighting a gap in supporting cancer survivors through continued screening and prevention of second primary cancers. Examples were most prevalent in breast cancer screening programmes. Evidence on sustainability, equity, and implementation within routine healthcare systems remains limited.

The COMET Project

High participation is essential for cancer screening programmes to achieve their full public health impact. However, we know that some groups are at a disadvantage and their participation remains low. A new research initiative, the COMET project, implemented as part of the Flemish population-based cervical cancer screening programme, will examine whether HPV self-sampling can help improve cervical cancer screening participation among women with mild to moderate intellectual disabilities, one of the most underserved groups in current screening programmes.

Addressing Inequalities

Earlier findings from the Centre for Cancer Detection showed that women with intellectual disabilities in Flanders are significantly less likely to attend screening, with participation rates dropping further as the severity of disability increases. The gap underline ongoing inequalities in access to preventive healthcare, that exist in Belgium as well as the EU. The COMET project aims to address this by testing more accessible screening approaches, in line with Belgium’s commitment to equal healthcare access under the UN Convention on the Rights of Persons with Disabilities.

The CUPID Project

Relatedly, CvKO was also co-author in: “Cancer screening for people with intellectual disabilities: Evidence from a global scoping review within the EUCansScreen Joint Action” onwhich an oral presentation will be given by the WP 6.5 leader, the German Cancer Society in the CUPID (Cancer Understanding Prevention in Intellectual Disabilities) at the Cupid Project’s final conference taking place in Brussels at the end of June.

The first paper published in the Joint Action underlines Belgium’s expertise in new opportunities for cancer screening, particularly lung cancer screening. This narrative review, published by colleagues at Antwerp University Hospital, outlined the emerging best practices on integrating smoking cessation with lung cancer screening, highlighting both opportunities and challenges for future developments.

As such evidence evolves, several cancer sites, including lung, prostate and gastric cancer, are being considered for organised screening. However, introducing new screening programmes requires careful evaluation of benefits, harms, feasibility and resource requirements. Within EUCanScreen, Belgian partners Sciensano & UZA, with Sciensano as co-lead of WP8, recently published a report providing an overview of the database discussions and the current status of lung, gastric, and prostate cancer screening programmes and pilot studies across Europe (Milestone 42).  A substantial contribution was made to the White Book by inclusion of 2 chapters, with a lead author from Antwerp University Hospital and review by a collaborator from Sciensano.

It was found that lung cancer screening is the most advanced, with national programmes in Croatia and the Czech Republic and widespread pilots using low-dose CT for high-risk individuals. Gastric cancer screening has not yet been a fully implemented programme in EU countries, though pilots are testing approaches such as H. pylori screen-and-treat. PSA-based prostate cancer screening programmes exist in Lithuania, Sweden, and the Czech Republic, while other countries are piloting risk-based models. Across all three areas, efforts are focused on quality assurance, harmonized data collection, and shared KPIs to support future population-based screening programmes.

Population-based Screening Programmes

Belgium has three organised population-based screening programmes for breast, cervical and colorectal cancer. Due to the country’s federal structure, screening programmes are organised at the regional level by three screening organisations: BruPrev in the Brussels-Capital Region, the Centre Communautaire de Référence pour le dépistage des cancers (CCRef) in Wallonia, and the Centrum voor Kankeropsporing (CvKO) in Flanders.

Working Closely

These organisations work closely with the Belgian Cancer Registry (BCR), Sciensano (the Belgian national public health institute) and regional health authorities to monitor programme performance, ensure quality assurance and support evidence-based improvements. Whitin the Joint Action EUCanScreen, academic partners are also involved, such as the Antwerp University Hospital (UZA), which provides expertise in lung cancer screening.

European Screening Community

Together, these collaborations within the Joint Action help strengthen screening programmes nationally, while also contributing knowledge and experience to the wider European screening community.

Latvia Reaches a Milestone in Digital Oncology Care

On 31 May this year, a major milestone in the digital transformation of oncology care in Latvia is set be reached with the conclusion of the project “Development of Clinical University Hospital Oncology Patient Data Exchange Platform”. Launched on 6 December 2023, the project aims to create a platform for optimally coordinated exchange of oncology patient data within the clinical university hospitals – Riga East Clinical University Hospital (RAKUS), Pauls Stradins Clinical University Hospital (PSKUS), and Children’s Clinical University Hospital (BKUS) – as well as to ensure the digitalised exchange of oncology patient treatment and care data between these institutions.

A Unified Platform for Oncology Data Exchange

The results and benefits of the project are further explained by Aija Lagzdina, Director of Digital Transformation at RAKUS. A. Lagzdina notes that the data exchange platform for oncology patients has been implemented and is being further developed within clinical university hospitals, providing a unified, digitalised and standardised flow of patient data, thereby improving coordination of the treatment process and data quality.

Cooperation Between Institutions

Both objectives – the creation of a digital data exchange platform and the establishment of effective mutual data exchange between hospitals – are being achieved. The platform has already been developed and implemented, while the adaptation of related systems for data digitalisation and user training is currently ongoing in order to ensure even broader practical data exchange and cooperation between the involved institutions.

Supporting Collaborative Cancer Care

During the project, the university hospitals have jointly developed solutions for both paediatric and adult treatment and care needs, including the exchange of multidisciplinary oncology board decisions, transfer of surgical and diagnostic reports, as well as mutual access to medical images and videos between hospitals.

The platform will provide healthcare institutions with several key functionalities – organisation and decision-making support for inter-hospital councils, mutual exchange of diagnostic and results data, as well as real-time information exchange with the Centre for Disease Prevention and Control in Latvia regarding the epidemiological situation and methodological guidelines. At the same time, it will foster centralised, secure and timely access to patient data and cooperation between clinical university hospitals.

Benefits for Patients

Patients will experience the project’s results with a faster, more coordinated and higher-quality care. Unified and up-to-date information will help ensure timely initiation of appropriate treatment, improve patient safety and care quality, and promote consistent, evidence-based clinical decision-making throughout the treatment process.

Timely access to essential diagnostic results across clinical university hospitals will be ensured, together with the possibility to rapidly organise inter-hospital councils for complex cases, as well as improved continuity of care. For patients, this will mean shorter waiting times, more accurate decisions, and a reduced need to repeat examinations or attend additional consultations at different healthcare institutions, as the necessary information will be available digitally to clinicians.

Future Expansion and Integration

Following the completion of the project, further expansion and integration of the platform within the wider health sector is planned – by enhancing functionality, connecting additional healthcare institutions and integrating the solution with other health information systems.

In the future, the platform is expected to be integrated into the unified health sector information system architecture, including linkage with the planned Unified Hospital Information System (VIPS), to ensure even broader availability and interoperability of medical data across healthcare providers. At the same time, it is essential to ensure long-term maintenance, data quality monitoring, and user training.

A Foundation for Future Healthcare Innovation

One of the most significant benefits is that, for the first time, a practically usable mechanism for real-time inter-hospital data exchange in oncology patient care has been created, laying the foundation for the development of similar solutions in other areas of healthcare in the future.

Project Funding and Timeline

The development and implementation of the oncology patient data exchange platform is being carried out under the European Union Recovery and Resilience Facility plan 2.1.3.1.i investment project “Development of Clinical University Hospital Oncology Patient Data Exchange Platform” (project No. 2.1.3.1.i.0/2/23/I/CFLA/003).

The implementation of the main project results is planned to be completed by 31 May 2026, followed by a gradual expansion of use and user training.

A Significant Step Forward In Strengthening Cervical Cancer Screening

On 31 October 2025, Riga hosted an international colposcopy trainer course, marking a Significant Step Forward In Strengthening Cervical Cancer Screening and education across the region.

This training was organised under the umbrella of the EU-supported Joint Action project EUCanScreen, which focuses on implementing sustainable, high-quality screening programmes for breast, cervical, and colorectal cancer across Europe.

Shifting Focus: Training the Trainers

Unlike standard clinical courses, the primary objective of this international course was “training the trainers.” Rather than focusing solely on the medical methodology itself, the curriculum was dedicated to enhancing the pedagogical, teaching, and feedback skills of existing experts. The goal was to master both the theoretical and practical aspects of delivering structured, high-quality colposcopy training to the next generation of medical professionals.

This initiative is part of a dedicated work package aimed at training cervical cancer screening specialists and establishing robust regional training centres. The work package is coordinated by the Norwegian Cervical Cancer Screening Centre under the leadership of Ameli Trope.

By preparing colposcopy training practitioners, the project ensures that these specialists can return to their respective countries and successfully implement structured, standardised colposcopy training programmes within their regions.

Led by International Experts

The course featured a prestigious lineup of instructors, bringing together internationally recognised European colposcopy specialists:

·         Assoc. Prof. Jana Zodzika – Secretary General of the European Federation for Colposcopy (EFC) and Associate Professor at Riga Stradins University (Latvia).

·         Ameli Trope – Head of the Norwegian Cervical Cancer Screening Centre.

·         Cecilia Karrberg – Specialist at Sahlgrenska University Hospital (Sweden) and Chair of the Colposcopy Society.

A Strong Regional Impact

The course saw active participation from dedicated specialists across the Baltic region and beyond, welcoming attendees from Latvia, Lithuania, Estonia, and Ukraine.

By equipping these regional practitioners with advanced teaching tools, the EUCanScreen project continues to foster international collaboration and elevate the standards of cancer prevention and women’s healthcare across Europe.