Cervical Cancer in Romania: Updated Statistics, Screening Gaps and Policy Outlook (2025 Report)

Romania continues to record some of the highest cervical cancer incidence and mortality rates in Europe, despite sustained public health efforts over the past decade. This report was developed by Medic24 to provide an updated, evidence-based overview of the national situation, focusing on epidemiological trends, screening coverage, HPV vaccination progress, and the current legislative and administrative framework.

The aim is to help clinicians, policymakers, and health professionals better understand the structural challenges affecting cervical cancer prevention and control in Romania. The publication also aligns with World Cervical Cancer Elimination Day, marked globally on 17 November, underscoring the importance of timely, data-driven action to reduce preventable deaths.

Cervical cancer in Romania – key numbers

Cervical cancer remains a major public health challenge in Romania, with one of the highest burdens in Europe. Annual incidence is about 3,380 new cases and 1,805 deaths (Globocan 2020). Cervical cancer is the third most common cancer in Romanian women (after breast and colorectal) and the fourth leading cause of female cancer death. Romania’s age-standardized incidence (around 33 per 100,000) is almost three times the EU average (~12/100,000), and mortality (around 12–18 per 100,000, depending on year) is about three times the EU average (OECD, 2025). This rate is the highest in the European Union and comparable to rates seen in some lower-income countries. The burden has modestly declined over the past decade – for example, cervical cancer mortality fell ~25% from 2011 to 2021 – but remains far above European norms. Most cases are diagnosed at advanced stages, reflecting gaps in prevention. The disease exacts a heavy toll in premature mortality: the years of life lost (YLL) rate peaks in mid-life (55–59) and varies by region, with some counties experiencing 1.5-fold higher YLL rates than others, highlighting geographic and socio-economic disparities.

Screening participation in Romania is very low, undermining early detection efforts. A national Cervical Cancer Screening Programme was launched in 2012, offering free Pap smear (Pap test) screening every 5 years to women aged ~25–64. The programme is organized in theory – with county-level screening networks and Ministry of Health funding – but in practice it has faced serious implementation issues. Coverage has remained under 20% even by the second five-year round of the programme. Only ~612,000 Pap tests were done in 2012–2017 (~11% of the eligible population).

Survey data indicate that less than 15% of Romanian women aged 20–74 reported having a Pap test in the last 5 years as of late 2010s – by far the lowest uptake in the EU (by comparison, only ~13% of women in the EU have never been screened). More recent estimates show around 38–39% of women 25–69 had a Pap in the past 5 years as of 2019, still well below the EU average (~65%). The programme has been opportunistic rather than truly population-based – there are no systematic invitation/reminder systems, and many women who get screened do so on their own initiative or physician recommendation. Key barriers have included limited public awareness, low provider engagement, insufficient infrastructure (especially in rural areas), and fragmented administration. For example, many family doctors and gynecologists did not actively recruit women (only about 48% of doctors participated fully by recommending tests). The lack of a unified call-recall registry and inconsistent funding further impeded the programme’s effectiveness. As a result, Romania’s screening rate remains a fraction of the 70% target recommended by EU/WHO for effective prevention.

Romania is now taking steps to strengthen screening, albeit belatedly. In 2018–2021, regional pilot projects introduced HPV testing (with Pap triage) for women 25–64 in certain regions (Center, North-East, North-West, South Muntenia), covering ~200,000 women (with over 50% from vulnerable groups). These pilots, co-funded by EU Social Fund, showed improved participation (~51% in the pilot) and informed a new strategy. In 2023–2024, Romania adopted plans to transition to primary HPV-based screening nationally. Under the updated policy (approved in 2024), all women 25–65 will be offered an HPV DNA test every 5 years (with cytology for those who test positive), regardless of insurance status.

This aligns with EU guidelines and the WHO goal of 70% of women screened with a high-performance test by age 35 and 45. Quality assurance indicators for cervical screening were introduced in 2024, and screening registries are being established to support follow-up. However, these reforms are at an early stage. The COVID-19 pandemic also disrupted screening services in 2020–2021, causing a slow recovery. As of mid-2025, the organised screening programme is not yet achieving its desired coverage, and most cervical cancers in Romania are still detected in unscreened or underscreened women.

Recent policy changes

HPV vaccination in Romania has historically been limited, but recent policy shifts aim to improve uptake. Romania launched an HPV vaccination campaign in 2008 – one of the first in Europe – targeting 10–14 year-old girls, but it was a notorious failure, with under 3% of eligible girls vaccinated. Widespread public mistrust, insufficient community education, and vaccine hesitancy led to the program’s suspension by 2010. For nearly a decade, HPV vaccines were available only through private purchase, and no routine school-based programme existed. The Ministry of Health cautiously resumed HPV vaccination in 2017–2020 by allowing parents to request the vaccine through family doctors.

A formal national HPV vaccination program was reintroduced in 2021, offering free Gardasil-9 vaccines to girls 11–14, later extending eligibility to girls up to 18 years old (on a request-and-consent basis through GPs). Coverage remained very low under this opt-in system. As of 2020/2021, preliminary data suggested only ~50,000 girls had been vaccinated – a national average coverage of ~2%, with no region exceeding 5% of its target cohort. By 2022, it’s estimated only 12–13% of eligible adolescent girls had received HPV vaccination, the lowest level in the EU. The main barriers identified include lack of parental information, fears and misconceptions about vaccine safety or impact on sexual behavior, and the cumbersome process requiring active requests and parental consent.

Notably, Romania did not initially include HPV vaccination in its routine child immunization schedule, and until recently did not offer the vaccine to boys, missing the opportunity for a gender-neutral approach.

Significant improvements to HPV vaccination policy have been enacted since 2023. In line with Europe’s Beating Cancer Plan, the government moved to expand access. Effective December 2023, Romania began funding HPV vaccines for both girls and boys aged 11–18, providing them free of charge through the National Immunisation Programme. Simultaneously, partial reimbursement (50% of cost) was introduced for women aged 19–45 who wish to be vaccinated.

This represented a major policy shift toward gender-neutral vaccination. Building on that, in August 2025 the government approved an emergency ordinance to further extend free HPV vaccination up to age 26 for both females and males (effective 1 October 2025). Under the new scheme, adolescents and young adults (11–26) can obtain the HPV vaccine at no cost via community pharmacies on family doctors’ prescriptions, and receive the shots from their family physician or other authorized vaccinators. Women 27–45 are still eligible for the 50%-compensated vaccine. These changes aim to rapidly increase cohort coverage in line with the WHO target of 90% of girls vaccinated by age 15. Implementation of the expanded programme is ongoing – success will depend on robust communication campaigns and addressing vaccine hesitancy. As of mid-2025, HPV vaccine uptake in Romania remains far below EU peers (many Western countries exceed 70–80% coverage in adolescent girls, versus an estimated ~15% or less in Romania), but the policy infrastructure is now being put in place to catch up.

National policies and governance around cervical cancer prevention in Romania have evolved, especially in the last 2–3 years, but gaps remain between strategy and implementation. In 2022, Romania adopted an overarching National Cancer Control Plan (2023–2030), which for the first time was enacted into law (Law No. 293/2022). This Plan includes specific objectives for cervical cancer, aligning with EU and WHO initiatives. It mandates improving screening (e.g. integrating HPV testing, increasing coverage) and HPV vaccination (including for boys), development of regional networks, and patient navigation for timely diagnosis and treatment. The Plan explicitly labels the current screening programme as “inefficient” and calls for its overhaul. It also guarantees every resident’s right to preventive and treatment services for cancer, funded by public sources.

Following the Plan’s passage, several laws and regulations have been issued: e.g. a Government Ordinance in 2023 (OG 26/2023) to adjust legal frameworks and clarify responsibilities for Plan implementation, and Government Decisions in 2023 to establish a National Cancer Registry and incorporate new services into health programs. The National Cancer Registry (RNC) was formally created in August 2023 (Government Decision No. 663/2023), under the National Institute of Public Health. This will for the first time enable nominal, population-based recording of all cancer cases, addressing a long-standing data gap. A Ministerial Order in Sept 2023 set out the registry’s minimum dataset and reporting procedures, and designated 8 regional cancer registry coordination centers (reinvigorating an earlier regional registry structure from 2007). These steps aim to improve data quality for incidence, survival, and screening follow-up, and to link Romania with the European Network of Cancer Registries.

Roles and responsibilities in cervical cancer prevention are shared by multiple institutions, which has sometimes led to fragmentation. The Ministry of Health is the lead agency for policy, planning and overall coordination (as reaffirmed in the 2022 Cancer Plan law). It finances and oversees the National Screening Program (as a public health programme) and the vaccination campaigns (through the National Immunisation Programme and special allocations). The National Institute of Public Health (INSP), through its regional public health centers, is responsible for implementing screening in the field – e.g. organizing county screening networks, training, data collection – and now hosts the Cancer Registry and screening registries. District Public Health Authorities (DSP) coordinate local recruitment and education campaigns. The National Health Insurance House (CNAS) plays a role in that some cervical cancer prevention services are covered in the basic benefits package – for instance, Pap smears or HPV tests can be reimbursed as part of outpatient specialist care, and family doctors can issue referrals for gynecologic exams.

CNAS and its regional insurance funds finance diagnostic and treatment services and have started to include preventive services in contracts (e.g. a 2023 framework agreement expanded reimbursement for certain screening tests and HPV genotyping). However, screening has largely been funded via the Ministry’s national programme rather than insurance, which caused some discontinuities. Professional medical societies (obstetrics-gynecology, oncology, family medicine) provide clinical guidelines and have advocated for improvements – for example, guidelines for HPV testing and management of screen positives, or training of more cytology and colposcopy providers. Civil society and patient organizations have become increasingly active: groups like the Romanian Cancer Society and the Renașterea Foundation have run awareness campaigns, mobile screening units in rural areas, and lobby for policy changes (such as the “HPV Action Romania” campaign launched in 2023).

Nonetheless, coordination among stakeholders has been a challenge. Until recently, Romania lacked an integrated governance mechanism for cancer prevention – responsibilities were split and accountability was weak, contributing to low coverage. The Cancer Plan now attempts to bring these actors together under a unified strategy, but effective coordination and consistent funding remain critical issues.

Equity and access disparities

Equity and access disparities are pronounced in Romania’s cervical cancer landscape. The burden of disease and the reach of prevention services vary by socio-economic status and geography. Rural women face significant barriers – rural counties tend to have higher cervical cancer mortality, reflecting lower screening uptake and later diagnosis. Gynecology services and laboratories are concentrated in cities, and many rural areas lack female physicians or transport to screening sites. In surveys, women cite lack of time, distance, and cost (e.g. travel or unofficial payments) as reasons for not getting screened. Poor and low-education populations have much lower participation: for instance, one study found 43% of low-income women had never had a Pap test, versus 13% of higher-income women. Roma communities, who comprise an estimated 3% (or more) of the population, are especially underserved – cultural barriers, discrimination, and poverty result in very low screening rates among Roma women. A qualitative study noted that many Roma women lack trust in the health system and have limited awareness of screening benefits. The government has recognized these gaps; the screening pilot projects explicitly targeted vulnerable groups (over half of participants were vulnerable, as noted).

There have been some outreach initiatives, such as mobile screening caravans visiting rural and Roma communities (often led by NGOs like Renașterea). For HPV vaccination, disparities are also evident – urban, higher-educated families have been more likely to request the vaccine, whereas uptake in rural areas was almost negligible under the request-based system. The new pharmacy-based distribution from 2025 may improve rural access (since previously parents had to sign up far in advance). No formal studies on regional vaccination coverage are published, but anecdotal data suggest wide variation. To address equity, the Cancer Plan guarantees free screening and vaccination even for uninsured individuals, and calls for community education campaigns. However, practical support (e.g. patient navigators, reminders, transportation aid) for disadvantaged women is still limited. Romania’s experience shows that structural determinants – education, health literacy, poverty – heavily influence cervical cancer outcomes. Without tailored interventions (such as involving community health workers or adapting communication to different cultural contexts), national averages will mask these internal inequalities.

European and international context

Romania stands out as an outlier in the EU for cervical cancer. Its incidence and mortality rates are roughly 2–4 times higher than EU averages. For example, a Romanian woman’s lifetime risk of developing cervical cancer is estimated at ~2.3%, which is 2.5 times the risk for the average EU woman. Mortality differences are even more stark; a Romanian woman’s risk of dying from cervical cancer is about 3.2 times higher than in the EU as a whole.

Within Central-Eastern Europe, Romania and Bulgaria historically had the highest rates, though Romania now slightly exceeds even its neighbors in the EU. (In the broader WHO European region, only some Balkan countries like Montenegro have comparable or higher rates.) These disparities underscore gaps in prevention – most Western and Northern European countries achieved large declines in cervical cancer through organised Pap screening in past decades, and more recently through HPV vaccination. By contrast, Romania is now essentially catching up 30+ years of prevention progress. EU agencies have put a spotlight on this issue: the European Commission’s Country Cancer Profile (2023) singled out Romania’s cervical cancer incidence (32.3 per 100k) and mortality (16.9 per 100k) as the highest in the EU, calling for urgent improvements in screening and vaccination. Romania is also not yet fully aligned with the latest EU Council Recommendation on cancer screening (December 2022), which urges Member States to implement organised HPV-based screening for women 30–65 and to achieve at least 90% HPV vaccination coverage of girls (and significantly increase boys’ coverage) by 2030. Romania’s new policies are a step toward alignment – e.g. introducing primary HPV testing and expanding vaccine coverage – but actual performance remains well below EU targets. At the global level, Romania has endorsed the WHO Cervical Cancer Elimination strategy (90-70-90 goals), yet current coverage (approx. 15% HPV vaccination, <40% screening) is a fraction of the 90% and 70% goals. WHO models suggest that Eastern Europe, including Romania, may not reach the elimination threshold (<4 cases per 100k) by 2030 without dramatic acceleration. International agencies (WHO, IARC, ECDC) have provided technical support; for instance, IARC’s HPV Information Centre tracks Romania’s indicators and confirms the high burden. Romania has been participating in EU-funded projects – such as the ReThink HPV Vaccination project in 2023–2025 – aimed at sharing best practices to reduce inequalities in HPV prevention.

There are successful models Romania can draw on: e.g. Slovenia built an effective screening registry and achieved over 70% screening coverage; England and Sweden have demonstrated how switching to HPV testing and using self-sampling kits can reach women who never screened. Scandinavian countries and the UK also integrated school-based HPV immunization with strong public education, attaining 80%+ vaccine uptake and now observing sharp drops in cervical cancer (the UK reported a 90% reduction in cervical cancer in vaccinated cohorts).

These examples are frequently cited in Romanian policy discussions as evidence that comprehensive approaches work. In summary, Romania’s situation is increasingly viewed not in isolation but as a European equity concern, given the EU’s commitment to eliminate cervical cancer. Achieving that will require Romania to implement and sustain the reforms now underway, learning from international best practices.

Recent developments (2020–2025) and ongoing challenges

In the past 3–5 years, Romania has made notable policy commitments to tackle cervical cancer. The National Cancer Plan 2023–2030 (legislated in 2022) is a cornerstone, bringing political priority and setting measurable objectives (e.g. reducing cervical cancer mortality by at least 5% by 2030). This period also saw alignment with EU initiatives: Romania joined Europe’s Beating Cancer Plan efforts and the updated EU screening recommendations. As noted, HPV vaccination policy was relaunched (2021) and significantly expanded (2023–25) after a decade of stagnation. Organised screening pilots were completed (2018–2023) and, despite delays from COVID-19, have led to plans for nationwide rollout of HPV-based screening starting 2024. The National Cancer Registry was established (2023) to address data deficiencies. These are positive developments, but many open issues remain. A frequent concern is implementation lag: new laws and strategies are in place, but on-the-ground impact is pending. For example, although the law guarantees free screening for all women, as of 2025 there is still no fully operational call–recall system; it will take time to build the IT infrastructure and public awareness needed to actually bring 70% of women to screening. Funding, while allocated on paper, needs to be disbursed consistently – the Cancer Plan mandates at least 20% of the national health program budget to be spent on cancer control, but observers note that budget execution and absorption of EU funds have historically been weak in Romania’s health sector. Some promised measures have faced delays: e.g. the rollout of self-sampling for HPV (mentioned in expert recommendations) has not yet begun; a plan to accredit and equip regional cancer centers for cervical pathology (for precancer treatment and oncology) is in progress but not complete. Human resource constraints are an open issue – Romania has shortages of cytotechnologists, pathologists, and gynecologic oncologists in certain regions.

Integration of services is another challenge: ensuring that women who test positive in screening swiftly get colposcopy, biopsy and treatment. The patient “care pathway” for cervical abnormalities is being defined in guidelines, but in practice it can be fragmented (with potential loss to follow-up). Civil society groups and professional bodies have been vocal recently about the need for transparency and speed. For instance, the Romanian Health Observatory has criticized the slow pace of implementing the Cancer Plan’s actions in 2023, and cancer charities have called for more community engagement to combat vaccine myths. The Ministry of Health has responded with periodic public reports on Cancer Plan implementation, and by launching information campaigns (e.g. around European Cervical Cancer Prevention Week each January).

Nonetheless, mistrust and misinformation remain hurdles – vaccine hesitancy is still fueled by conspiracy narratives on social media, and screening can be hampered by fatalistic attitudes or fear. Another pressing issue is data gap on outcomes: until the new registry produces results, Romania lacks precise statistics on stage-at-diagnosis, survival rates by region, etc. This makes it hard to evaluate progress in real-time. Finally, the COVID-19 pandemic and other crises (e.g. the influx of refugees from Ukraine, who also may need screening services) have strained the public health infrastructure in recent years, potentially diverting attention and resources. In summary, while Romania has entered a new phase of policy commitment to eliminate cervical cancer, it faces a critical implementation phase in the coming years. Success will depend on converting plans into action on the ground, maintaining stable funding, and overcoming deep-rooted barriers in the population.

Key Policy Challenges:

• Increasing Coverage: Rapidly scaling up HPV vaccination and organised screening coverage to reach rural and vulnerable populations. This requires strengthening primary care involvement, outreach programs, and possibly school-based delivery for vaccines.
• Health Education and Misinformation: Countering vaccine hesitancy and low screening awareness through sustained, evidence-based public education campaigns. Improving health literacy, especially among youth and disadvantaged groups, is essential to increase acceptance of HPV vaccination and Pap/HPV testing.
• Infrastructure and Workforce: Expanding the capacity of laboratories and specialists for HPV testing, cytology, and follow-up treatment. Training more professionals (e.g. cytotechnologists, colposcopists) and deploying adequate equipment across all regions so that the new screening protocols can be executed with high quality.
• Integrated Information Systems: Fully implementing the National Cancer Registry and dedicated screening registries to enable proper invitation, recall, and monitoring. Data integration will also support evaluation of program performance (e.g. tracking how many screen-positive women receive treatment within recommended time).
• Sustainable Financing: Ensuring consistent funding for prevention programs. While new laws allocate funds, the challenge is to maintain these allocations during government and budgetary changes, and to effectively use EU funds (e.g. for equipment, training) allocated for cancer control.
• Multi-sector Coordination: Enhancing coordination between the Ministry of Health, INSP, CNAS, local public health authorities, and NGOs. Clear governance is needed to avoid fragmentation – for instance, defining who is accountable for reaching screening targets in each county, and how family doctors are incentivized to participate.
• Equity Strategies: Developing targeted interventions for high-risk groups (e.g. Roma women, those in remote rural areas). This could include mobile clinics, involvement of community mediators or NGOs to facilitate access, and culturally sensitive communication to build trust in services.
• Monitoring and Accountability: Regularly reviewing progress towards the 2030 goals (90% vaccination, 70% screening, etc.) with independent evaluations. Publishing annual reports on cervical cancer incidence/mortality and program indicators would keep attention on the issue. If mid-course corrections are needed (for example, if screening uptake remains low, considering making use of self-sampling kits or adjusting age ranges), policies should be agile to adapt.

Open Questions for Further Inquiry

• Will the new strategies deliver results? How effectively is the transition to HPV-based screening being implemented, and is it improving detection of precancerous lesions in Romania? Early data (in the next 1–2 years) on screening uptake and outcomes will be crucial to assess if Romania is on track or if additional measures (like mandatory invitations or self-sampling) are needed.
• Vaccine Uptake Trajectory: After the expansion of free HPV vaccination to age 26 and inclusion of boys, is Romania seeing a significant rise in vaccination rates? What are the regional variations in uptake, and which strategies seem to work best in overcoming hesitancy (e.g. GP recommendations, school campaigns, social media outreach)?
• Resource Allocation and Use: Is the funding earmarked by the Cancer Plan (20% of national health programme funds) truly reaching cervical cancer control initiatives? A detailed look at budgets and expenditures could reveal whether programs are under-resourced or if existing funds are not utilized efficiently (e.g. delays in procurement of tests or vaccines).
• Healthcare Provider Engagement: How engaged are Romania’s healthcare providers in prevention? For instance, are family doctors now proactively recommending HPV vaccination and screening to their patients, and are they being supported (financially or through training) to do so? If provider participation remains low, further incentives or mandates might be considered.
• Data Quality and Transparency: With the new National Cancer Registry coming online, will Romania finally have reliable, timely cancer statistics? Investigating the registry’s early operation (Are hospitals and clinics reporting as required? How complete is the data?) will be important. Reliable data will also allow analysis of stage at diagnosis and treatment delays – indicators of system performance.
• Impact of Health System Issues: Romania’s broader health system challenges (workforce migration, hospital infrastructure, primary care strength) inevitably affect cancer outcomes. How are these factors specifically impacting cervical cancer care? For example, do women in certain areas face long waits for colposcopy or cancer treatment due to specialist shortages? Identifying such bottlenecks can inform targeted investments (like telemedicine for pathology or centralized treatment referral).
• Reaching the Uninsured and Marginalized: Although legally all women have access to free screening and treatment, in practice uninsured or marginalized women often fall through the cracks. An important question is how many women outside the formal system are getting screened or treated, and what mechanisms (mobile units, community health workers, etc.) could be strengthened to reach them.
• Public Perception and Trust: What are the current attitudes of Romanian women (and men) toward cervical cancer prevention? A follow-up to earlier perception surveys (such as the 2018 “Attitudes and perceptions on cancer” survey) could reveal whether awareness has improved by 2025 and what misconceptions persist. Such insight would guide more effective communication strategies.
• Role of EU and International Support: Romania is benefiting from EU-funded projects and guidance; a question is how well these external supports translate into sustained local capacity. For example, after the EU pilot funds end, will the government continue to finance the expanded screening in all regions? Similarly, is there scope for more cross-country collaboration (perhaps learning from neighbors like Moldova or Hungary) in areas like training cytologists or sharing best practices on engaging hard-to-reach communities?
• Long-term Outlook:  Ultimately, is Romania on the path to meet the WHO “90-70-90 by 2030” targets? If not, what additional extraordinary measures might need to be considered (for instance, making HPV vaccination opt-out in schools, or instituting reminder sanctions for screening)? Continual appraisal of progress versus targets will determine whether Romania can reverse its high cervical cancer burden in the coming decade or if cervical cancer will remain a preventable tragedy for many Romanian women.

Methodology

This report was compiled in mid-2025 through an extensive review of both national and international sources, including laws, government strategies, and official statistics from the Ministry of Health, National Institute of Public Health (INSP), and legislative archives. The National Cancer Control Plan (Legea 293/2022) and its annex provided detailed insights into Romania’s current situation and planned measures.

We consulted the Globocan 2020 cancer database and the IARC/WHO HPV Information Centre for epidemiological indicators, and cross-referenced these with the European Cancer Information System (ECIS) and OECD/EU Country Cancer Profile 2023/2025 for EU comparisons.

Policy developments were verified via official gazettes and press releases. We reviewed peer-reviewed studies (including 2023–2025 articles) analyzing Romania’s screening and vaccination programs, which provided context on barriers and historical failures. International guidelines and WHO/EU reports were used to benchmark Romania’s alignment with recommended practices. Where precise data were unavailable (for instance, recent vaccination coverage), we relied on the latest estimates from health authorities or surveys as cited in credible sources.

A limitation is that very recent on-the-ground data (e.g. 2024–2025 screening uptake or vaccination counts after policy changes) are not yet published, so this report uses the most recent available figures (generally up to 2023). Some government targets and claims (e.g. projected funding levels) could not be independently verified in implementation. Nonetheless, by triangulating multiple sources – official reports, academic studies, and international datasets – we aimed to ensure an accurate and current picture.

All information is evidence-based and referenced; any interpretative comments (such as likely causes of program underperformance) are grounded in the cited analyses and comparative experience. The cut-off for literature and data inclusion was June 2025.

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