Equitable colorectal cancer screening implementation framework via a modified Delphi Consensus for Romanian healthcare

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.