Population-based Colorectal cancer (CRC) screening using faecal immunochemical testing (FIT) followed by colonoscopy is recommended across the EU. Romania initiated the ROCCAS program in 2019, with pilot implementation in four administrative regions. Our aim was to evaluate the quality metrics and key performance indicators (KPIs) of the ROCCAS pilot program in the South Muntenia region.

A cohort of 50,000 average-risk individuals aged 50–74 years was invited between January 2021–December 2023. Screening was based on biennial FIT (positivity ≥20 µg/g). FIT-positive participants were invited for colonoscopy at the regional screening centre. Prospectively collected registry data were analysed. Multivariable logistic regression was used to identify predictors of adenoma, advanced adenoma (AA), sessile serrated lesion (SSL), and CRC detection.

: FIT completion rate was 89%, with 6% positivity (n=2576). Colonoscopy uptake was 40% (n=1038). Caecal intubation (96%) and adenoma detection (55%) exceeded international benchmarks. Advanced adenomas and CRC together represented 38% of detected lesions. Multivariable analysis showed male sex predicted adenoma (OR 2.72, 95%CI 2.11–3.51) and AA detection (OR 1.85, 95%CI 1.41–2.44), while female sex was associated with right-sided SSLs (OR 0.34, 95%CI 0.14–0.81). FIT values correlated with lesion severity and independently predicted CRC (aOR 1.53 per 100 µg/g, p<.001). CRC was diagnosed in 11% (n=114) of scoped individuals. Colonoscopy waiting time was above recommended limits, and uptake was lower than expected.

The ROCCAS pilot demonstrated high-quality colonoscopy performance and clinically relevant detection rates. However, colonoscopy participation requires significant improvement before national roll-out. Awareness campaigns, and tailored communication strategies could optimize program effectiveness.