Equitable colorectal cancer screening implementation framework via a modified Delphi Consensus for Romanian healthcare
Negoi I. Zubayraeva A. Verras G.I. van Ramshorst G. Ungureanu A.-C. Ungureanu A. Tudorascu S.I. Tudor A.-V. Toma E.A. Toma C. Tantau M. Stojkovski K. Stoica B. Silviu M. Shalaby M. Seretis C. Seppälä T. Saïd H. Sartelli M. Sandru V. Munteanu L.E.R. Rodrigo L. Gabriel L.R. Pucheanu X. Popescu S.S. Pellino G. Patel T. Pata F. Otabekov A. Obaid O.R. Negoi R. Natalia V. Musina A.-M. Mulita F. Morar A. Moldoveanu A. Mirica R.M. Marin I. Maeda Y. Lupu R.G. Lunca S. Kok K.Y.Y. Jan H. Ionescu V.S. Tănase I. Herteliu C. Grama F. Ginghina O. Garoufalia Z. Garofil D. Ganescu R. Frasson M. Fakhradiyev I. Ewnte B. Efetov S. Doran H. Dinu F. Dina C. Dimofte G. Dimitriu C. Diaconescu I.B. Constantinescu G. Cirstea G.O. Cabel T. Botezatu M. Bonci E.-A. Baral S. Boromiz A.
December 2025Nature Research
Scientific Reports
2025#15Issue 1
Colorectal cancer (CRC) continues to be a predominant cause of cancer-related mortality on a global scale. Screening for early detection plays a crucial role in significantly reducing both incidence and mortality rates. However, screening uptake varies widely across regions due to disparities in healthcare resources and implementation of screening programs. The aim of this study was to evaluate various potential strategies for implementing an effective colorectal cancer screening program that enhances adherence. This program should be feasible and appropriate, considering the demographic characteristics, geographical distribution, and logistical factors, including human and material resources, of medical facilities at the national level in Romania. A multidisciplinary panel was convened using a modified Delphi process (two survey rounds and a consensus meeting in early 2022) to develop a harmonized CRC screening framework tailored to diverse healthcare settings. Clinicians and allied professionals from 19 countries (Europe, Asia, and Africa) contributed to the consensus recommendations for average-risk individuals. The panel advised that primary care physicians should play a central role in CRC risk assessment and patient engagement and endorsed initiating screening at age 45 and continuing to 75, with selective extension up to 85 for healthy, willing individuals. To improve participation, we recommended region-specific screening strategies that accommodate local resources and demographics and emphasized a patient-centered approach offering multiple modalities (colonoscopy, fecal immunochemical testing, CT colonography), emphasizing that the most effective test is one that patients are willing to complete. Finally, the study group deemed implementing a centralized system for screening invitations, result tracking, and patient recall essential. This consensus guideline provides a scalable model to enhance screening adherence and reduce CRC mortality through early detection and prevention. This framework is developed for the Romanian healthcare context, informed by international professional input but tailored to local healthcare infrastructure and estimated population needs.
Colorectal cancer , Delphi consensus , Early detection , Guidance , Healthcare disparities , Radical resection , Screening , Screening adherence
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Carol Davila University of Medicine and Pharmacy Bucharest, Clinical Emergency Hospital of Bucharest, No 8 Floreasca Street, Sector 1, Bucharest, 014461, Romania
Carol Davila University of Medicine and Pharmacy Bucharest, Bucharest, Romania
Dirghayu Pokhara Hospital, Pokhara, Nepal
Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
Clinical Emergency Hospital of Bucharest, Bucharest, Romania
Alexandria County Emergency Hospital, Alexandria, Romania
Jersey General Hospital, Jersey, United Kingdom
Regional Institute of Oncology, University of Medicine and Phramacy Grigore T. Popa, Iasi, Romania
Ovidius University, Constanta, Romania
Public Involvement, Bucharest, Romania
IM Sechenov First Moscow State Medical University, Moscow, Russian Federation
Debre Tabor University, Debre Tabor, Ethiopia
Kazak National Medical University, Almaty, Kazakhstan
University Hospital La Fe, Valencia, Spain
KKH Prignitz, Perleberg, Germany
Cleveland Clinic Florida, Cleveland, Greece
Saint John Emergency Clinical Hospital, Bucharest, Romania
Coltea Clinical Hospital, Bucharest, Romania
Bucharest University of Economic Studies, Bucharest, Romania
Khyber Medical College, Khyber, Pakistan
Pengiran Anak Puteri Rashidah Saadatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Darussalam, Brunei Darussalam
Regional Institute of Oncology Iasi, Iasi, Romania
Gheorghe Asachi Technical University of Iasi, Iasi, Romania
Queen Elizabeth University Hospital, Glasgow, United Kingdom
University Politehnica of Bucharest, Bucharest, Romania
Saint John Emergency Hospital Bucharest, Bucharest, Romania
Department of Surgery, General University Hospital of Patras, Patras, Greece
University of Medicine and Pharmacy Grigore T. Popa/Regional Institute of Oncology Iasi, Iasi, Romania
Department of Surgery, Nicola Giannettasio Hospital, Corigliano-Rossano, Corigliano-Rossano, Italy
Baroda Medical College and SSG Hospital, Baroda, India
Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
Zarnesti Hospital, Zarnesti, Romania
HUCA, Oviedo, Spain
Macerata Hospital, Macerata, Italy
Central Hospital of the Army, Lucknow, Algeria
University of Tampere/Helsinki, Tampere, Finland
St Andreas General Hospital of Patras, Patras, Greece
Mansoura University, Mansoura, Egypt
Regina Maria Brasov, Brasov, Romania
PSI-CRO, Skopje, North Macedonia
University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
Ghent University Hospital, Ghent, Belgium
General University Hospital of Patras, Patras, Greece
Carol Davila University of Medicine and Pharmacy Bucharest
Carol Davila University of Medicine and Pharmacy Bucharest
Dirghayu Pokhara Hospital
Iuliu Hatieganu University of Medicine and Pharmacy
Clinical Emergency Hospital of Bucharest
Alexandria County Emergency Hospital
Jersey General Hospital
Regional Institute of Oncology
Ovidius University
Public Involvement
IM Sechenov First Moscow State Medical University
Debre Tabor University
Kazak National Medical University
University Hospital La Fe
KKH Prignitz
Cleveland Clinic Florida
Saint John Emergency Clinical Hospital
Coltea Clinical Hospital
Bucharest University of Economic Studies
Khyber Medical College
Pengiran Anak Puteri Rashidah Saadatul Bolkiah Institute of Health Sciences
Regional Institute of Oncology Iasi
Gheorghe Asachi Technical University of Iasi
Queen Elizabeth University Hospital
University Politehnica of Bucharest
Saint John Emergency Hospital Bucharest
Department of Surgery
University of Medicine and Pharmacy Grigore T. Popa/Regional Institute of Oncology Iasi
Department of Surgery
Baroda Medical College and SSG Hospital
Department of Advanced Medical and Surgical Sciences
Zarnesti Hospital
HUCA
Macerata Hospital
Central Hospital of the Army
University of Tampere/Helsinki
St Andreas General Hospital of Patras
Mansoura University
Regina Maria Brasov
PSI-CRO
University of Medicine and Pharmacy Cluj-Napoca
Ghent University Hospital
General University Hospital of Patras
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