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.

ECHoS Holds Final Meeting in St Julian’s, Malta

On 23–24 June, the European project ECHoS (Establishing Cancer Mission Hubs: Networks and Synergies) held its final meeting in St Julian’s, Malta, bringing together project partners, representatives of European initiatives, and experts from across Europe. The event showcased the achievements of the past three years, including progress in establishing National Cancer Mission Hubs and strengthening collaboration with other European initiatives, while also marking the transition to the project’s next phase.

Establishing National Cancer Mission Hubs Across Europe

The main objective of ECHoS is to advance cancer research, innovation and healthcare by establishing National Cancer Mission Hubs. These hubs will serve as collaborative platforms bringing together government institutions, hospitals, universities, researchers, patient organisations and other stakeholders to support evidence-based cancer policies and facilitate the implementation of European initiatives at national level. The project involved 30 countries, resulting in the establishment of 17 National Cancer Mission Hubs across Europe, including in Poland, Greece, Malta, the Netherlands, Croatia, Sweden, Italy and Finland.

A Key Project Under the EU Cancer Mission

ECHoS is one of the projects contributing to the European Union’s Cancer Mission, which aims to improve the understanding of cancer, cancer prevention and early detection, treatment and quality of life, while reducing inequalities in cancer care across Europe. Achieving these goals requires close collaboration between healthcare professionals, researchers, policymakers, patient organisations and other stakeholders – an approach that lies at the heart of the ECHoS project.

Key Achievements and the Transition to ECHoS 2

The final meeting highlighted several key achievements, including the organisation of 14 policy dialogues, successfully organised two Cancer Mission Fairs, established synergies with 17 European initiatives, including EUCanScreen, EUnetCCC and JANE-2. Partners also presented a Business Continuity Model aimed at ensuring the long-term sustainability of the National Cancer Mission Hubs and supporting the establishment of a European network, which will form the foundation for the next phase of the project, ECHoS 2, launching in July. The new phase will focus on strengthening the capacity of the hubs and ensuring their continued development.

EUCanScreen at the ECHoS Final Meeting

EUCanScreen was represented at the event by Sindija Kiršteine from the University of Latvia, the project’s coordinating institution.

Primary Health Care at the Heart of Prevention and Early Risk Detection

During his presentation at the 3rd Synergies Forum on Cancer Policy, Research & Funding Strategies, held in Athens from 29 June to 1 July 2026, Prof. Apostolos Vantarakis highlighted the pivotal role of Primary Health Care (PHC) in the transition from treatment-oriented care to prevention, emphasising that modern PHC is evolving into a cornerstone of public health by focusing on early risk detection, equitable access, and effectively linking citizens to organised community-based prevention programmes.

Primary Health Care: From Treatment to Prevention

As Prof. Apostolos Vantarakis noted, Primary Health Care is no longer simply the first point of contact with the health system when illness occurs. Instead, it is becoming a proactive mechanism for predicting and preventing disease, leveraging the long-term relationship between family physicians, community nurses, Primary Health Care teams (TOMYs), and citizens. This continuity of care enables the early identification of risk factors for chronic diseases such as diabetes, cardiovascular disease, and cancer through an increasingly organised, digitally supported, and holistic approach that also considers the social determinants of health.

Connecting Citizens with Prevention Programmes

Particular emphasis was placed on the importance of connecting Primary Health Care with community-based prevention programmes. According to Mr. Vantarakis, early risk detection has little value unless it is followed by effective referral, follow-up, and support. The personal and family physician is called upon to act as a “navigator” within the healthcare system, encouraging participation in prevention programmes while ensuring continuity of care, particularly for citizens facing social or geographical barriers to accessing health services.

Greece’s National Prevention Programme: PROLAMVANO

Referring to the current situation in Greece, Mr. Vantarakis described the implementation of the National Prevention Programme “PROLAMVANO” as a historic milestone, marking the country’s first comprehensive and systematic nationwide prevention initiative. The programme includes organized screening for breast cancer, cervical cancer, colorectal cancer, and cardiovascular risk assessment, supported by modern digital infrastructure such as electronic prescribing, the use of the national social security number (AMKA), and electronic invitations sent directly to eligible citizens.

Challenges to Achieving Equitable Participation

Despite this significant progress, he stressed that major challenges remain. Participation rates in prevention programmes continue to fall below national targets, while digital invitation systems alone are insufficient to effectively reach older adults, residents of remote areas, and other vulnerable population groups. Furthermore, shortages and uneven geographical distribution of personal and family physicians, incomplete enrolment in the Personal Physician system, and the longstanding fragmentation between primary and hospital care continue to hinder equitable access to preventive services.

The Contribution of EUCanScreen

At the European level, Mr. Vantarakis highlighted the importance of the EUCanScreen Joint Action, implemented under the EU4Health Programme and Europe’s Beating Cancer Plan. The initiative aims to strengthen quality assurance, governance, and equitable access to cancer screening programmes while promoting the exchange of expertise, methodologies, and best practices among European countries. Greece’s active participation, he noted, offers a valuable opportunity to further enhance national prevention policies and improve the effectiveness of organised screening programmes.

Looking Ahead

Concluding his address, Mr. Vantarakis emphasized that the future success of Primary Health Care will not be measured solely by its ability to treat disease, but increasingly by its capacity to identify health risks early, effectively connect citizens with preventive services, and ensure that no one is left behind. As he underlined, Greece has taken the essential first step; the next—and most critical—challenge is to transform invitations into meaningful and equitable participation through a strong, well-staffed, and fully integrated Primary Health Care system.

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.

WP6 Toolkit

Recently, an enthusiastic group of EUCanScreen partners were gathered in Tallinn with a special focus on exploring and developing the toolkit that will become one of the main deliveries of WP6.

The toolkit will serve as a plattform for sharing experiences and best practices from the different countries and partners on how to overcome systemic and individual barriers for participation in screening. 

Dedication and Contributions from WP6 Partners

Piret Veerus, Hilde Underthun and WP6 lead Mari Nygård arranged the meeting, and they express their gratitude for all the dedication and contributions from the WP6 partners. 

Interest Βeyond WP6 — Final Stage Ahead

We also experience that our way of thinking about a toolkit to share findings from EUCanScreen has appeal far beyond WP6. We contribute to the discussion on the possible extension of the toolkit to other work packages; however, this remains a commitment within the coordinator team. To maintain momentum and ensure timely delivery, WP6 is now entering the final stage of deciding which tools can be included in the toolkit. Any new suggestions should therefore be submitted within the next two weeks, says Mari Nygård.