Basic project information

Project title: Strengthening at National Level the Capacity of the Romanian Health Sector to Implement Organized Screening for Cancers Amenable To Cost-Effective Early Detection Interventions

Programme area: PA 6 European Public Health Challenges

Project promoter:  The Oncology Institute “Prof. Dr. Ion Chiricuță” Cluj-Napoca (IOCN), Republicii str., No. 34-36, RO-400015, Cluj-Napoca, Romania

Main contact: Dr. Florian Nicula, Project Director, Mobile: +40744569898, E-mail: nicula@iocn.ro

Back-up contact: Andreea Itu, E-mail: itu.andreea@yahoo.com, Mobile: +40756 601 901

Donor project partner: Oslo UNIVERSITETSSYKEHUS HF / KREFTREGISTERET, PB 5313 Majorstuen, N-0304 Oslo, Norway, Dr. Mari Nygård, , e-mail: mary.nygard@kreftregisteret.no

Project budget:  1.999.889 €

Project duration: 24 months

2. Project Summary

The overall objective:

Improving quality assurance of integrated preventive and curative medical services related to cervical cancer prevention among disadvantaged population at risk living in communities from remote areas.

In order to decrease Romanians incidence and mortality rates of cervical cancer is it clearly not enough to detect barriers and offer women, living in rural area, screening-tests by mobile units. On the contrary, in order for a cancer-screening programme to be in active existence, several entities of different kinds must be assembled and act together. At the core of this assemblage is women in a certain age range, appropriate testing equipment (screening tests), and professionals performing the testing. This collective must be associated with yet more entities including: a transport medium for the test to be stored safely before analysis, a service carrying specimens, a laboratory able to assess specimens, a feedback mechanism that will inform women about pathological test results, a cancer Registry keeping track of women’s screening history for insuring adequate and correct treatment, and finally a follow-up service that allow appropriate medical action to be taken when precancerous changes are detected. Taken together, one could with Latour (2007) refer to this constellation as an ‘actor-network’ consisting of associated human and non-human actors. Moreover, this is an actor-network that to a large degree is performativity constituted. The actors must continuously act and inter-act in order to keep the screening programme ‘alive’.

Specific Objective 1 (SO1): Improving quality assurance of screening intensity

In order to overcome detected barriers of access to cervical cancer prevention toward groups of women at risk in rural remote areas, CEDICROM 2 will offer information followed by vaccination and   screening-tests performed by mobile units.

CEDICROM 2 aims to roll-out HPV related preventive and curative medical services in 7 determined counties* (not included in POCU project – European Structural Funds for 2014-2020). CEDICOM 2 will mainly target the disadvantaged groups (including Roma population and other ethnical groups) of the population at risk, piloting the use of 20 local community experts (mediators and nurses). The project will be carried out in order to ensure access of disadvantaged population to information on prevention and free tests (including taking smears and self-sampling proposal) – finally the objective is to analyze the personalized risk of developing cervical cancer in disadvantaged communities.


*The counties targeted are Arad, Constanța Dolj, Gorj, Timis, Tulcea, Hunedoara (these counties have been chosen, not to be duplicated with the POCU project (EU Structural Funds), but to come into the complementarity of the project, for a larger coverage)


Specific Objective 2 (SO2): Improving quality assurance of follow-up of lesions found within cervical cancer screening programme.

In CEDICROM 1, women living in rural and remote areas were tested with cervical cytology and HPV test and some of them were detected with precancerous lesions. These women were in need of follow-up according to insurance house rules. There are however, no records of what happened with these women after screening results indication abnormalities. CEDICROM 2 aims to follow-up and treat women detected within CEDICROM 1 who still are being untreated. All women taking part in CEDICROM 2 with abnormal screening test results will be follow-up within the projects time frame according to European Guidelines. 

The Norwegian partner will conduct a study, aiming to identify and make feasible proposals for how Romania’s health care system can offer follow-up and treatment of all women attending the national cervical cancer-screening programme. The Norwegian partner will have a special focus on the women found positive in CEDICROM 1 with a poor record on follow-up.

Expected results for SO 1: Vaccination and HPV and Babes – Papanicolaou tests in disadvantaged communities

CEDICROM 2 is rolled-out of CEDICROM 1 being a previous project including disadvantaged groups of the population at risk for HPV infections and /or cervical cancer.  CEDICROM 2 will include 7 determined counties, in 100 communities, in the form of integrated community primary medical assistance, piloting “door to door” information campaign using 20 local community experts (mediators and nurses). There will also be a media campaign for target awareness and mobilization. (The project promoter will contract a media agency to prepare and implement an information campaign and a media campaign, highlighting the importance of cancer prevention activities.)

The information campaign will use printed leaflets (approx. 30.000 units) and other promotional materials (shirts – 30 units, cancer prevention pins-10.000 units, pens -300 units, notebooks – 50 units). This will be distributed to promote the project among stakeholders, decision makers and to the target group population.

The general objectives of the information campaign strategy are achieved through continuous dialogue and participation default and are the recognition, efficiency of human and financial resources optimization and effective implementation of the lessons learned during the previous project, and participation, through cooperation and human and financial support.

In order to reach a wider audience at the regional level, dissemination of information will target the following groups:

  1. General population and disadvantaged groups from Roma and other ethnical groups
  2. Local community experts (nurses, mediators)
  3. Doctors and specialists in the field of oncology
  4. Health Ministry – as part of the national interest;
  5. General Audience;
  6. The scientific community

For the media campaign a specialized provider will be contracted to conduct an audio-video national media campaign in order to raise the awareness of the importance of cancer prevention activities through the screening. The purpose of this campaign is to highlight the importance of cancer prevention.

The CEDICROM 2 success and reaching the proposed indicators depends to a significant extent on the effectiveness of information, education and communication. Success and good results of a project are due to well informed and mobilized makers and beneficiaries.

In the project, improved access to preventive and curative medical services related to cervical cancer prevention, at communities levels, will be achieved. Performing smears with community nurses and mediators will be piloted as well as self-sampling.

HPV vaccination for young girls and catch-up for girls aged 12 – 24 years old. As well as both HPV self-sampling and screening test performed by mobile unit for women aged 25-64 years old women will be integrated in community packages of preventive services. This will include family doctors, medical preventive and curative services. As CEDICROM 1 information campaign evidenced raised screening intensity in terms of coverage and improved access to quality assured and controlled screening tests, CEDICROM 2 should provide new evidence on screening intensity rise. In the project as much as 7.000 women in the age range 25-64 years old will be tested with mobile units, community nurse and by self-sampling.

Expected results for SO 2: CEDICROM 2 follow-up component for treatment of cervical lesions found in CEDICROM 1 and CEDICROM 2 projects

In CEDICROM 2 women detected in CEDICOM 1 being at risk for cervical cancer will be detected and offered adequate follow-up and treatment. The project will have a focus especially on the uninsured women with no access to free-of-charge treatment  from disadvantaged groups from Roma communities, other ethnical minorities and isolated rural communities from remote areas in mountains, country borders, Danube Delta, etc. The project aims to make a suggested proposal for how the programme can be carried out in order to embrace all women in the targeted age-range, irresponsible of health insurance status.

CEDICROM 2 follow-up component for treatment (including “see and treat” strategy after CareHPV test and mobile colposcopy, followed by cold coagulation in the same visit) of cervical lesions found in CEDICROM 1 project at women with risk of cervical cancer. Women are from disadvantaged groups (Roma population and other ethnical groups) in suburban and rural areas, ethnical minorities and women living in isolated rural communities. The project will focus on uninsured women with no access to treatment and women who are referred for evaluation (colposcopy/biopsy) and follow-up for confirmation of diagnosis and treatment in public or private medical services providers. However, as follow-up was not provided within CEDICROM services, is currently unknown. CEDICROM 2 will therefore reevaluate all women with an abnormal screening test result in CEDICROM 1, and will complete follow-up of all women found untreated. CEDICOM 2 will have a special focus for uninsured women. All CEDICROM 1 data and follow-up information will be recovered, and added to CEDICROM 2. Data, on women with abnormal screening results, and all follow-up for diagnostic confirmation and treatment, will be registered.  This new completed screening database will be connected to cancer regional population-based registry and future vaccination registry.

The follow-up activity will be done based on CEDICROM 1 and CEDICROM 2 cervical cancer screening database for all women tested HC2 HPV positive, according to the protocols of European Guidelines in use.

Follow-up protocol will include Care HPV field testing on mobile units, performing “see and treat” for all women remained untreated after CEDICROM 1 and women requesting immediate follow-up from CEDICROM 2, women from 7 determined counties, from disadvantaged groups (Roma and other ethnical groups).

Mobile units will therefore be equipped with follow-up resources for pre-cancerous lesions: Care HPV, mobile colposcopy and cold coagulator.

Medical services included in CEDICROM 2 follow-up protocol, will be: information and mobilisation of 25-64 years of age eligible women at risk, Babes-Papanicolaou tests for 25-30 years old women, Care HPV tests for 30-64 years old women, with liquid based cytology taken for following Babes Papanicolaou triage/confirmation of positives, onsite colposcopy evaluation of Care HC2 HPV positives and finally cold coagulation of positive colposcopies.

Produced evidences, on predictive rates and “see and treat”| feasibility and cost effectiveness as alternative follow-up strategies, will be subject for a Policy paper submitted to MoH including proposals of new screening methodologies for further  MoH decided screening strategies focusing Roma and other disadvantaged groups of women at risk.