{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:49:08Z","timestamp":1760147348312,"version":"build-2065373602"},"reference-count":38,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,31]],"date-time":"2023-01-31T00:00:00Z","timestamp":1675123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Craiova, Romania"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The objective of this study is to investigate the feasibility of colorectal cancer (CRC) screening in the absence of a national screening program using the resources provided by the Romanian healthcare system. Study participants were recruited from adult patients (over 18 years old) registered with a general practitioner from an urban area over a period of 3 years (October 2019 to September 2022). Patients were recruited when they came for a consult at their family physician\u2019s office. The study excluded patients with a medical history of colorectal cancer. Written consent was obtained from the patients who agreed to participate. Patients who agreed to participate were recommended to undergo a fecal occult blood test (FOBT). For those with a positive FOBT result, a colonoscopy was recommended. The study identified a need and willingness of patients to participate in CRC screening when they were informed about it, especially when it involved a noninvasive test such as FOB. We did not anticipate the refusal to perform FOBT in the public healthcare system because the recommendation was made by a GP. We identified a deficit of specialists that can perform colonoscopies in the public healthcare system, insufficient health education, and a lack of dedicated pathways for screening.<\/jats:p>","DOI":"10.3390\/ijerph20032531","type":"journal-article","created":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T02:29:03Z","timestamp":1675218543000},"page":"2531","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A Pilot Colorectal Cancer Study Using Fecal Occult Blood Tests and Colonoscopy to Identify the Weaknesses of the Romanian Public Healthcare System before Implementing National Screening"],"prefix":"10.3390","volume":"20","author":[{"given":"Linda-Nicoleta","family":"B\u0103rbulescu","sequence":"first","affiliation":[{"name":"Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Cabinet Medical Dr Profir I Mirela SRL, 200145 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stelian-\u0218tef\u0103ni\u021b\u0103","family":"Mogoant\u0103","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"},{"name":"Department III of Surgery, University Emergency County Hospital, 200642 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5419-3977","authenticated-orcid":false,"given":"Lucian-Florentin","family":"B\u0103rbulescu","sequence":"additional","affiliation":[{"name":"Department of Computers and Information Technology, University of Craiova, 200585 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Constantin","family":"Kamal","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Didi-Liliana","family":"Popa","sequence":"additional","affiliation":[{"name":"Department of Computers and Information Technology, University of Craiova, 200585 Craiova, Romania"},{"name":"Doctoral School \u201cConstantin Belea\u201d, University of Craiova, 200585 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Radu-Teodoru","family":"Popa","sequence":"additional","affiliation":[{"name":"Department of Computers and Information Technology, University of Craiova, 200585 Craiova, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","unstructured":"(2022, December 28). International Agency for Research on Cancer, Press Release No. 292, 15 December 2020, Available online: https:\/\/www.iarc.who.int\/wp-content\/uploads\/2020\/12\/pr292_E.pdf."},{"key":"ref_3","unstructured":"(2022, November 28). Globocan 2020. Available online: https:\/\/gco.iarc.fr\/today\/data\/factsheets\/populations\/642-romania-fact-sheets.pdf."},{"key":"ref_4","unstructured":"(2022, December 28). Romanian National Institute of Public Health, Cancer Analysis, May 2022, (In Romanian)."},{"key":"ref_5","unstructured":"(2022, December 28). Romanian National Institute of Public Health, General Mortality, (In Romanian)."},{"key":"ref_6","unstructured":"(2022, December 28). European Commission, State of Health in the EU, Romania, 2021 Country Profile in Terms of Health, (In Romanian)."},{"key":"ref_7","unstructured":"(2022, December 28). World Cancer Research Fund International, Colorectal Cancer Statistics. Available online: https:\/\/www.wcrf.org\/cancer-trends\/colorectal-cancer-statistics\/."},{"key":"ref_8","unstructured":"(2022, December 28). United European Gastroenterology, Colorectal Screening Across Europe. March 2019, Available online: https:\/\/ueg.eu\/files\/779\/67d96d458abdef21792e6d8e590244e7.pdf."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Cardoso, R., Guo, F., Heisser, T., Hoffmeister, M., and Brenner, H. (2020). Utilisation of Colorectal Cancer Screening Tests in European Countries by Type of Screening Offer: Results from the European Health Interview Survey. Cancers, 12.","DOI":"10.3390\/cancers12061409"},{"key":"ref_10","first-page":"89","article-title":"Epidemiology of colorectal cancer: Incidence, mortality, survival, and risk factors","volume":"14","author":"Rawla","year":"2019","journal-title":"Przegl\u0105d Gastroenterol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Ansa, B.E., Lewis, N., Hoffman, Z., Datta, B., and Johnson, J.A. (2021). Evaluation of Blood Stool Test Utilization for Colorectal Cancer Screening in Georgia, USA. Healthcare, 9.","DOI":"10.3390\/healthcare9050569"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"124","DOI":"10.3748\/wjg.v24.i1.124","article-title":"Systematic review of colorectal cancer screening guidelines for average-risk adults: Summarizing the current global recommendations","volume":"24","author":"Barkun","year":"2018","journal-title":"World J. Gastroenterol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1016\/j.cgh.2018.08.023","article-title":"Lowering the Starting Age for Colorectal Cancer Screening to 45 Years: Who Will Come and Should They?","volume":"16","author":"Imperiale","year":"2018","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"250","DOI":"10.3322\/caac.21457","article-title":"Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society","volume":"68","author":"Wolf","year":"2018","journal-title":"CA Cancer J. Clin."},{"key":"ref_15","unstructured":"(2022, November 28). Colorectal Cancer: Screening. Available online: https:\/\/www.uspreventiveservicestaskforce.org\/uspstf\/recommendation\/colorectal-cancer-screening#bootstrap-panel--6."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1053\/j.gastro.2018.07.017","article-title":"Effects of Organized Colorectal Cancer Screening on Cancer Incidence and Mortality in a Large Community-Based Population","volume":"155","author":"Levin","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"677","DOI":"10.3109\/00365528709011142","article-title":"Initial mass screening for colorectal cancer with fecal occult blood test. A prospective randomized study at Funen in Denmark","volume":"22","author":"Kronborg","year":"1987","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1136\/gutjnl-2011-300774","article-title":"Nottingham trial of faecal occult blood testing for colorectal cancer: A 20-year follow-up","volume":"61","author":"Scholefield","year":"2012","journal-title":"Gut"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1002\/1097-0142(19880801)62:3<645::AID-CNCR2820620333>3.0.CO;2-#","article-title":"Screening and rescreening for colorectal cancer. A controlled trial of fecal occult blood testing in 27,700 subjects","volume":"62","author":"Kewenter","year":"1988","journal-title":"Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1365","DOI":"10.1056\/NEJM199305133281901","article-title":"Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study","volume":"328","author":"Mandel","year":"1993","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1016\/j.canep.2013.07.008","article-title":"Colorectal cancer screening by guaiac faecal occult blood test in France: Evaluation of the programme two years after launching","volume":"37","author":"Leuraud","year":"2013","journal-title":"Cancer Epidemiol."},{"key":"ref_22","unstructured":"\u0218tef\u0103ni\u021b\u0103, S. (2019). Actualit\u0103\u021bi \u00een Cancerul Colorectal (in Romanian), Craiova, 2019, SITECH."},{"key":"ref_23","unstructured":"(2022, November 28). Plan National de Combatere a Cancerului. (In Romanian)."},{"key":"ref_24","unstructured":"(2022, December 28). Romanian Law No. 293\/3 November 2022, Published in MO No.1077\/8 November 2022. (In Romanian)."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Lee, J. (2022). Analyzing Factors Associated with the Behavior-Change Stage of Colorectal Cancer Screening. Healthcare, 10.","DOI":"10.3390\/healthcare10081492"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e017186","DOI":"10.1136\/bmjopen-2017-017186","article-title":"Cost-effectiveness of the faecal immunochemical test at a range of positivity thresholds compared with the guaiac faecal occult blood test in the NHS Bowel Cancer Screening Programme in England","volume":"7","author":"Murphy","year":"2017","journal-title":"BMJ Open"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"37","DOI":"10.5946\/ce.2017.141","article-title":"Colorectal Cancer Screening-Who, How, and When?","volume":"51","author":"Bevan","year":"2018","journal-title":"Clin. Endosc."},{"key":"ref_28","first-page":"658","article-title":"Colorectal Cancer Screening and Prevention","volume":"97","author":"Wilkins","year":"2018","journal-title":"Am. Fam. Physician"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2156","DOI":"10.1038\/bjc.2014.480","article-title":"Optimising faecal occult blood screening: Retrospective analysis of NHS Bowel Cancer Screening data to improve the screening algorithm","volume":"111","author":"Geraghty","year":"2014","journal-title":"Br. J. Cancer"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Kelkar, A.H., Zhao, J., Wang, S., and Cogle, C.R. (2022). Impact of the COVID-19 Pandemic on Colorectal and Prostate Cancer Screening in a Large U.S. Health System. Healthcare, 10.","DOI":"10.3390\/healthcare10020264"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Di Martino, G., Cedrone, F., Di Giovanni, P., Romano, F., and Staniscia, T. (2022). Impact of COVID-19 Pandemic on Oncological Surgery Activities: A Retrospective Study from a Southern Italian Region. Healthcare, 10.","DOI":"10.3390\/healthcare10112329"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1439","DOI":"10.1136\/gutjnl-2011-300843","article-title":"Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests","volume":"61","author":"Logan","year":"2012","journal-title":"Gut"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"17562848211009716","DOI":"10.1177\/17562848211009716","article-title":"Colorectal cancer screening programme: Is the French faecal immunological test (FIT) threshold optimal?","volume":"14","author":"Pellat","year":"2021","journal-title":"Therap. Adv. Gastroenterol."},{"key":"ref_34","unstructured":"(2022, November 28). Colorectal Cancer, Zentrum f\u00fcr Krebsregisterdaten. Available online: https:\/\/www.krebsdaten.de\/Krebs\/EN\/Content\/Cancer_sites\/Colorectal_cancer\/colorectal_cancer_node.html."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2423","DOI":"10.1002\/ijc.32566","article-title":"Changes in colorectal cancer screening use after introduction of alternative screening offer in Germany: Prospective cohort study","volume":"146","author":"Guo","year":"2020","journal-title":"Int. J. Cancer"},{"key":"ref_36","unstructured":"(2022, December 28). Slovenian National Colorectal Cancer Screening Programme\u2014Svit. Available online: https:\/\/www.program-svit.si\/en\/about-the-programme\/about-svit-programme\/."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1159\/000516978","article-title":"Quality Control in the Slovenian National Colorectal Cancer Screening Program","volume":"40","author":"Tepes","year":"2022","journal-title":"Dig. Dis."},{"key":"ref_38","unstructured":"(2022, November 28). Colonoscopy Lowers CRC Risk and Death, but Not by Much: NordICC. Medscape. 10 October 2022. Available online: https:\/\/www.medscape.com\/viewarticle\/982143."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/3\/2531\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:19:43Z","timestamp":1760120383000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/3\/2531"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,31]]},"references-count":38,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["ijerph20032531"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20032531","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2023,1,31]]}}}