Introducing Colorectal Cancer Screening in Romania - Preliminary Results from the Regional Pilot Programs (ROCCAS).

BACKGROUND AND AIMS: Colorectal cancer (CRC) is the third cause of cancer-related death worldwide. Screening programs can reduce CRC mortality rates by up to 60%. In line with the European Union recommendations, Romania started the first four regional pilot screening programs in 2020 (the ROCCAS II projects). This study reports the interim screening performance indicators. METHODS: People aged 50 to 74 years were invited to the screening program. General practitioners (GPs) evaluated CRC risk based on a survey. High-risk or symptomatic individuals were referred directly to colonoscopy. The average risk participants received a fecal immunochemical test (FIT). Positive cases were invited to colonoscopy. Three regions were screened using the OC-SENSOR® (South-Muntenia, Bucharest-Ilfov, South-East) and one region (South-West) used the FOB GOLD®. The data was collected in the ROCCAS screening electronic registry. The following FIT parameters were evaluated: rates of return, invalidity, positivity, and colonoscopy acceptance rate according to age group, gender, region of provenience, and vulnerability status. RESULTS: We included all cases screened between January 1, 2022 and September 30, 2023. In total, 168,958 people received the FIT test within the projects. The global FIT return rate was 90%. Factors associated with a higher return rate were female gender (90.77% vs 88.83%, p<0.0001), vulnerable status (91.23% vs 88.83%; p<0.00001), and rural residence (91.84% vs 88.42%, p<0.00001). The overall positivity rate was 5.75%. It was higher in males (7.64% vs 4.57% in females, p<0.00001) and progressively increased with the age group. The total invalid FIT rate was 5.87%, significantly lower for OC-SENSOR® (2.24%) than for the FOB GOLD® (13.6%). The overall acceptability rate for colonoscopy was 51.3%. CONCLUSIONS: According to our preliminary data, GP's participation in the pilot programs ensured adequate adherence to screening through FIT. The rate for FIT return and positivity were acceptable for both tests, while the invalid rate was much higher in FOB GOLD® compared to the OC-SENSOR®. Moreover, colonoscopy acceptance needs to be improved. Our preliminary analysis revealed the screening performance indicators meet the EU recommendations and fulfill the premises for national-level expansion of the program starting in 2024.

Assessment of the health information system in Czech Republic / by Pavla Lexova and Jana Brozova

This assessment of the National Health Information System (NHIS) in the Czech Republic was conducted as part of a project of the WHO Regional Office for Europe. Its goal is to enable a better use of information in decision-making, while holding into account the other factors influencing decisions. The methodology was developed in Romania in June 2003, and then tested in the Czech Republic, Denmark, Hungary and Poland. This report is the result of the Czech experience. Semi-structured interviews of key-informants at the highest possible level, both decision-makers and professionals working in the field of health information, were performed by a Czech team, with the support of WHO. The project aims at identifying gaps and problems in health information system and serving as a basis for reviewing and strengthening NHIS; as a result, this system could be a better instrument for good governance, responsive to the needs of modern Public Health Care system

Description of the national health information system in Romania : results of a participative evaluation conducted in June 2003 / by Irma Eva Csiki, Aurelia Marcu and Carmen Ungurean

This assessment of the National Health Information System (NHIS) in Romania was conducted as part of a project of the WHO Regional Office for Europe. Its goal is to enable a better use of information in decision-making, while holding into account the other factors influencing decisions. The methodology was developed with the authors in June 2003 and is currently being tested in the Czech Republic, Denmark, Hungary and Poland. Semi-structured interviews of key-informants at the highest level, both decision-makers and professionals working in the field of health information, were performed by a Romanian team, with the support of WHO. Special attention was given to the processes taking place at sub-national level. The project aims at building capacities in health information at country level, and serving as a basis for reviewing and strengthening NHIS; as a result, this system could be a better instrument for good governance, responsive to the needs of modern Public Health as expressed by different audiences and initiatives