Blood cancers, which often show no symptoms in their early stages, are underdiagnosed in Romania even though they can be detected through simple blood tests. There are also explanations for the fact that most cases are in urban areas.
FABC’s “I didn’t do enough” caravan has been running for 12 years PHOTO: DeciSePoate
More than one million people with blood cancers are diagnosed annually in the world. In Romania, new cases of chronic lymphocytic leukemia (CLL) reach 900 per year, but specialists estimate that the real number would be between 2,000 and 10,000. Underdiagnosis has its explanation in the fact that we do not have a culture of prevention, drew the attention of Prof. Dr. Daniel Coriu, hematologist, Fundeni Clinical Institute, during the event “Improving the patient’s course in oncology and hematology in Romania”, organized by the Federation of Associations of Cancer Patients, Be One and Swixx Group and hosted online by the Pacientul2.0 platform.
Blood cancers are often silent with no symptoms in the early stages. However, a simple blood test – the complete blood count – can make the difference between a timely diagnosis and a late one. “Blood cancer is not a doom, if caught early. A regular blood count can save lives. We need a culture of prevention, not just intervention,” attracted the attention of Prof. Dr. Daniel Coriu.
The doctor explained that in Romania, patients from vulnerable categories do not get tests, which is why caravans like the one organized by the Federation of Cancer Patient Associations – the “I didn’t do enough” Caravan – actually have a screening role, although the investigations carried out could be considered “trivial”. When we talk about the diagnosis of blood cancers, the detection of more cases in the urban environment, compared to the rural, has its explanation precisely in the limited access to investigations of people in many rural areas.
Complete blood count and electrophoresis – two handy, life-saving tests
Screening for malignant hematological diseases involves carrying out simple blood tests, aimed at evaluating the health of the blood and detecting certain diseases early, explained Dr. Coriu. Most of these diseases have an insidious onset, without obvious clinical signs in the early stages.
But they can be highlighted with the help of usual blood tests, which can suggest an anomaly and sometimes even a diagnosis can be made or become the starting point for more thorough investigations. Early detection is important because it can increase the chances of effective treatment.
Periodic tests include complete blood count and electrophoresis, which can be done with a referral from your family doctor. Even against the cost, these are affordable (together they do not exceed 150 lei) compared to other types of investigations.
The complete blood count, the hematologist explained, measures the number of white blood cells, red blood cells, platelets, hemoglobin, hematocrit and RDW. Here is what the values below or above the limits of these parameters indicate:
Changes in the number of red blood cells (RBC), Hb, Ht, VEM, HEM
=> growth: polyglobulia, Polycythemia vera
=> decrease: anemias
Change in the number of leukocytes:
=> growth: acute leukemia, chronic myeloid leukemia, chronic lymphatic leukemia, some lymphomas
=> decrease: leukopenia
Change in platelet count:
=> increase: thrombocytosis (reactive, essential thrombocythemia…)
=> decrease: thrombocytopenia
Protein electrophoresis (separates proteins from blood or urine) is the analysis that detects:
– immunodeficiencies (decrease of immunoglobulins);
– abnormal proteins – monoclonal proteins.
Based on this analysis, the following can be highlighted: Monoclonal gammopathy (MGUS), amyloidosis, multiple myeloma and Waldenström macroglobulinemia.
Chronic lymphocytic leukemia (CLL) is a disease in which mature B lymphocytes accumulate abnormally. The incidence is about 4-5 cases per 100,000 people per year.
Symptoms include: fatigue, enlarged lymph nodes and frequent infections.
Useful tests: complete blood count, flow cytometry and genetic tests.
Waldenström macroglobulinemia (WM) – involves the proliferation of IgM-producing plasma cells. The incidence is approximately 1 case per 100,000 persons/year.
Symptoms include: fatigue, bleeding and peripheral neuropathy.
Recommended tests: serum or urine protein electrophoresis, immunofixation, complete blood count and bone marrow examination
Marginal zone lymphoma (MZL) – is a non-Hodgkin’s lymphoma that affects B lymphocytes. The incidence is approximately 2-3 cases per 100,000 persons/year.
Symptoms include: enlarged lymph nodes and fatigue.
Recommended tests: complete blood count, imaging and lymph node biopsy.
Refractory or relapsed follicular lymphoma (FLR/R) – it is an indolent lymphoma that can return after treatment (20-30% of cases become refractory or relapse). The incidence is 3-4 cases per 100,000 people/year.
Symptoms include: enlarged lymph nodes, fatigue, fever and weight loss.
Recommended tests: complete blood count, imaging, lymph node biopsy and molecular tests.
A former patient affected by acute lymphoblastic leukemia told his experience PHOTO: DeciSePoate
An annual medical consultation is recommended for screening purposes. It is also recommended to consult whenever suggestive symptoms (adenopathy – enlarged lymph nodes), persistent fatigue, fever or unexplained weight loss occur.
Prevention still remains difficult because, on the one hand, certain population categories have limited access to medical services, and on the other hand, because Romanians are hard to convince to come for routine tests, in good health. “The healthy man must let himself be pricked”insisted Dr. Daniel Coriu.
Cancer incidence in Romania, below the European average
The incidence of cancer in Romania remained slightly below the European Union average, according to the data from the “Country profile on cancer: Romania”. The news is not necessarily good, because a good part of cancer detection in Europe is achieved thanks to screening programs, but in Romania they are not as well represented.
However, cancer mortality in our country is significantly above the EU average among men, with a modest decrease in the last decade.
Patient access to innovative medicines, according to the EFPIA WAIT (2024) indicator, in Romania is still difficult. Romanian patients have access to only 19% of innovative medicines approved at European level between 2020–2023, less than half of the EU average (EU average: 46%). Out of 173 new medicines approved in the EU in the last 5 years, only 33 were included in the list to be reimbursed in Romania at the beginning of 2025.
A patient in Romania has to wait, on average, 828 days for access to a new treatment, compared to the EU average of 578 days.
Regarding the treatment of cancer, only 20% of the new oncological drugs approved in the EU between 2020–2023 are available for Romanian patients. Only 11 of the 56 recently approved oncological therapies were accessible in Romania at the beginning of this year, i.e. 50% of the EU average.
$30,000 for free rural testing
The Federation of Associations of Cancer Patients (FABC) received, during the said event, the news that it will benefit from a $30,000 grant from the BeOne Foundation to continue free testing for people in rural areas. The funding will support the expansion of the “I haven’t done enough” caravan, a free cancer screening campaign in rural areas, offering blood tests, consultations and hematological assessments to people with limited access to health services. The results of the campaign that is taking place during this period will be presented in December.
Specialists recommend performing a complete blood count at least once a year, and for people at high risk – every six months.
