Key learnings: Colorectal cancer survival outcomes can be significantly improved by well-established screening programmes and timely removal of early-stage cancers. However, the implementation of these large-scale initiatives requires:
Operational and logistical constraints, human resource and capacity gaps, as well as fragmented service integration hinder access to timely diagnostics. Furthermore, digital and legal barriers impair data sharing and slow implementation. Slow or insufficient evaluation mechanisms limited the ability to assess programme performance and adapt strategies in a timely manner. |
Colorectal cancer (CRC) remains one of the leading causes of cancer-related deaths worldwide (Filho et al., 2025). However, it offers considerable opportunities for prevention by addressing modifiable risk factors such as obesity, low physical activity, smoking and alcohol consumption. Most CRCs develop over a span of 10–15 years (Dekker, 2019), allowing for early detection and timely removal of precancerous lesions or early-stage cancers, significantly improving survival outcomes. While colonoscopy remains the most effective method for CRC prevention, stool-based tests detecting blood or molecular markers also play a vital role in early detection. These screening tools have shown the potential to substantially reduce CRC incidence and mortality in Europe (Cardoso et al., 2021).
As CRC survival rates are key indicators of a healthcare system’s effectiveness in cancer management, the European Commission’s Europe’s Beating Cancer Plan (EBCP) aims to ensure that 90% of eligible EU populations receive screening for CRC (as well as breast and cervical cancer) by 2025. To support this goal, the commission is providing funding and launching targeted initiatives to assist member states in implementing evidence-based screening strategies (European Commission, 2025). In response to specific national challenges, e.g., high colorectal cancer burden (e.g., Slovakia), regional disparities in cancer care (e.g., Slovenia), and low screening participation rates (e.g., Belgium, Cyprus, Slovakia), the countries Belgium, Cyprus, Slovakia and Slovenia have implemented different measures to increase early detection, enhance screening efficiency, improving cancer care and reduce CRC-related mortality (Box 1).
Box 1. Summary of the CRC initiatives from four countries Belgium: In Flanders, the Centre for Cancer Detection (Centrum voor Kankeropsporing – CvKO) collaborated with the regional government and the Belgian Cancer Registry to enhance CRC screening. By using data such as screening history, general practitioner (GP) affiliations and follow-up results, the CvKO ensured that screening invitations were precisely targeted and enabled better-informed health practitioners on their patients’ needs. This data-driven model now covers all GP practices in Flanders. Additionally, the collected data is (anonymously) shared with local stakeholders through annual reports and press briefings to inform and optimize regional screening programmes. Cyprus: Despite initiating screening efforts in 2007, critical gaps in organization and coverage remain. Consequently, Cyprus strengthened its cancer prevention efforts through launching several initiatives and expanding screening programmes for the key cancers cervical, prostate, breast and colorectal cancer. Regarding colorectal cancer, a new population-based CRC screening programme is set to begin in spring 2025, targeting individuals aged 50–74 to facilitate earlier diagnosis and intervention. Slovakia: With some of the highest CRC incidence and mortality rates in Europe, Slovakia introduced a population-based screening programme in 2019. However, participation remains low and long-term effectiveness has not been systematically assessed. To address this, a cost-effectiveness study was conducted, comparing biennial and annual faecal immunochemical test (FIT) screening for individuals aged 50–75. The study used the MISCAN-Colon microsimulation model, drew on national and external epidemiological data, and also accounted for real-world implementation barriers, such as healthcare resource constraints and adherence rates. The analysis confirmed that both biennial and annual FIT screenings are cost-effective compared to no screening and highlighted the critical need to boost participation. Slovenia: To address persistent inequalities in cancer care across hospitals, Slovenia’s National Cancer Control Program (NCCP) established a network of specialized clinical registries for the country’s five most common cancers; malignant melanoma, breast, colorectal, prostate and lung cancer. Multidisciplinary expert groups for each cancer type were formed, tasked with developing quality indicators and providing evidence-based recommendations. The colorectal cancer registry began data collection in 2023. These efforts aim to standardize care and address disparities related to geography, literacy and socio-economic status. |
These four countries demonstrate good examples how to improve colorectal cancer outcomes through the entire care continuum, starting from early detection, to better care.
Belgium, Cyprus and Slovakia’s initiatives aim to improve early detection and prevention by either implementing new screening programmes (e.g., Cyprus), optimizing existing ones (e.g., Belgium), or evaluating their efficiency (e.g., Slovakia). In contrast, Slovenia’s efforts are intended to improve care quality and reduce inequalities in cancer care.
Cyprus’ CRC initiative is still in the starting blocks. However, previous cancer interventions for other major cancers in Cyprus, such as large-scale HPV vaccination against cervical cancer, have already been successful. Building on the previous experiences may facilitate the successful roll-out of the CRC initiative.
Data collection and cancer registries help improve efficiency, participation and equity
That colorectal cancer screenings are not only clinically effective but also economically worthwhile is clearly demonstrated by Slovakia’s microsimulation model, showing that screenings are more cost-effective compared to no screenings. Due to limitations in available data however, the study required reliance on external sources, thus highlighting the urgent need for comprehensive cancer registries, an area where Slovenia and Belgium are making significant strides.
Incorporating cancer registries into screening programmes, as seen in Belgium’s initiative, made it possible to avoid unnecessary invitations to screening tests, to enhance patients’ compliance, and to inform different levels of the health system from individual health practitioners to regional screening programmes. Similarly, Slovenia’s specific cancer registries are important measures to improve care quality and reducing inequalities. Though the CRC registry is still under construction, Slovenia’s first registry (Clinical Registry of Skin Melanoma – KrMel) proved to collect more comprehensive data and ensured a richer dataset for monitoring and improving care quality. Similar positive effects could be achieved by the CRC registry and are being addressed by experts.
Strong stakeholder engagement and resource allocation underpin successful implementation of colorectal cancer strategies
Effective stakeholder collaboration was a cornerstone of success across all four countries (Governance). Clear policy direction, combined with active involvement from key actors, including Ministries of Health, national cancer committees (e.g., Cyprus), national oncology institutions (e.g., Slovakia), health insurers, general practitioners, public health agencies and awareness campaigns, proved essential for effective screening programmes. Early involvement of stakeholders, particularly GPs, was highlighted as critical for ensuring coordination and buy-in. Belgium underscored the value of having detailed, timely data, which proved to be a key enabler for informed decision-making and efficient implementation. However, reaching national consensus among all stakeholders required substantial time, negotiation and dedicated resource development.
Adequate financial investment and resource availability were equally important. In Slovakia, for example, the FIT screening programme was fully financed through public health insurance, making it accessible to the target population (Financing). The development of national-scale screening programmes and cancer registries also required dedicated human resources and tailored IT infrastructure (Resources).
Operational and resource constraints limit the scalability and effectiveness of CRC screening programmes
Implementing large-scale, nationwide colorectal cancer screening programmes presented significant logistical and operational challenges. Slovakia, in particular, faced uncertainties around participation rates, screening costs and the absence of stable funding, all of which hindered scalability (Financing). Both Slovakia and Cyprus struggled with limited resources for outreach and awareness efforts, as well as a lack of incentives to encourage participation. A shortage of trained healthcare professionals and inconsistent engagement of general practitioners further constrained access to essential gastroenterological services in Slovakia, Cyprus and Slovenia (Resources). In Slovakia, pronounced geographic disparities in the distribution of specialists contributed to uneven participation and diagnostic access. Additionally, weak integration between primary and specialist care services led to delays in follow-up diagnostics, undermining the overall effectiveness of screening programmes (Service delivery).
Digital Infrastructure and legal barriers hinder efficient data use and coordination in cancer care
All countries highlighted the critical role of a robust digital infrastructure in supporting effective cancer screening and care, while also acknowledging significant challenges when such systems were lacking. In Slovakia, the absence of comprehensive cancer registry data necessitated reliance on external sources. Belgium and Cyprus faced legal and regulatory obstacles related to data protection, leading to complex, time-consuming IT procedures for accessing and sharing data. In Cyprus, outdated software delayed the implementation of upgraded systems, while Slovenia encountered difficulties with data system interoperability between hospitals and national registries. Additionally, both Slovakia and Slovenia reported slow or insufficient mechanisms for monitoring and evaluation.
Lesson learned
The experiences of Belgium, Cyprus, Slovakia and Slovenia highlight diverse and effective strategies for strengthening CRC screening, diagnosis and care. Collectively, these countries showcase how digitalization can be meaningfully integrated into healthcare systems, especially through the use of cancer registries and data-driven screening models.
A central insight across all four countries is that successful improvement of CRC outcomes depends on strong stakeholder engagement, sustained investment, robust digital infrastructure and reliable data systems. These foundational elements enable targeted interventions, informed decision-making and better coordination across care levels.
However, these enablers must be supported by long-term planning, stable financing mechanisms, legal and regulatory clarity and continuous monitoring. Additionally, many of the initiatives, particularly newly launched or scaled-up programmes, require ongoing evaluation and adaptability to remain effective in dynamic healthcare environments. Flexibility to revise implementation strategies in response to barriers such as workforce shortages, participation gaps or service delivery fragmentation is essential for sustained impact.
These lessons provide a practical roadmap for other countries aiming to advance their CRC strategies as part of broader cancer control efforts and health system strengthening. They underline the importance of not only initiating programmes, but about embedding them into a learning health system. This means investing in ongoing monitoring and evaluation, engaging stakeholders across levels of care and building the flexibility to adapt strategies as new data or challenges emerge.
References
Cardoso, R., Guo, F., Heisser, T., Hackl, M., Ihle, P., De Schutter, H., ... & Brenner, H. (2021). Colorectal cancer incidence, mortality, and stage distribution in European countries in the colorectal cancer screening era: An international population-based study. The Lancet Oncology, 22(7), 1002–1013.
Dekker, E., Tanis, P. J., Vleugels, J. L. A., Kasi, P. M., & Wallace, M. B. (2019). Colorectal cancer. Lancet (London, England), 394(10207), 1467–1480. https://doi.org/10.1016/S0140-6736(19)32319-0
European Commission. (2025). Commission Staff Working Document: Review of Europe’s Beating Cancer Plan.
European Commission. (2021). Europe’s Beating Cancer Plan – Communication from the Commission to the European Parliament and the Council.
Filho, A. M., Laversanne, M., Ferlay, J., Colombet, M., Piñeros, M., Znaor, A., ... & Bray, F. (2025). The GLOBOCAN 2022 cancer estimates: Data sources, methods, and a snapshot of the cancer burden worldwide. International Journal of Cancer, 156(7), 1336–1346.
