Capacity Building for Population-Based Cancer Registration in an LMIC: The Moldova Experience
ARNAUT O. 1,2, NEGARA I. 1,2, GRIZA N. 1, CULAXIZOV A. 1, BALTAGA R. 1,2
1 Oncological Institute, Chisinau, Moldova (Republic of); 2 USMF 'Nicolae Testemitanu', Chisinau, Moldova (Republic of)
Background.
Population-based cancer registries (PBCRs) are essential for evidence-based cancer control. In the Republic of Moldova, a lower-middle income country, the National Cancer Registry (NCR) is in an early phase of transformation toward a modern PBCR. Following the adoption of new national legislation, major structural improvements have been initiated, introducing mandatory cancer case reporting for all medical institutions and laboratories. An IARC/ENCR/JRC-supported external assessment was conducted to evaluate the current progress and guide further capacity building of the Moldovan NCR.
Objectives.
To document Moldova’s PBCR development and propose a practical capacity-building strategy to improve data collection, coding, validation, linkage, analysis and dissemination in line with international standards.
Methods.
A structured external review (ENCR/JRC and IARC-supported mission, March 2025) assessed the Moldovan NCR governance and legal framework, staffing and training, case ascertainment and data sources, coding and staging practices, IT infrastructure, quality assurance procedures, and reporting outputs. Findings were translated into practical recommendations with defined short- and medium-term priorities.
Results.
The Moldovan NCR covers approximately 2.5 million residents (excluding Transnistria) and remains in transition toward population-based completeness. The registry collects all mandatory variables recommended in the European dataset and applies ICD-O-3 and TNM-8. Compared with the 2016 evaluation, data validity improved: morphologically verified cases increased from 84.7% to 87.2% and unknown stage decreased from 13.9% to 5.6%. Death certificate only (DCO) cases were identified and incorporated (5% at assessment). Linkage with the national health insurance claims database identified approximately 1,200 additional cancer cases in 2024 beyond standard notifications. Operational strengthening was evident through expanded staffing (including full-time physicians, operators, and IT support) and increased international engagement (ENCR membership; participation in Cancer Watch JA, eCAN+, EUnetCCC). Persistent gaps include underreporting from private providers and pathology laboratories, interruption of individual-level mortality data exchange since October 2024, a lack of an SOP manual, insufficient analytical workforce, and reliance on in-house software, with fragmented national clinical information systems precluding automated linkage. Following the mission, technical requirements for a new interoperable software platform were submitted to the Ministry of Health.
Conclusions.
Moldova’s NCR is at a pivotal capacity-building stage. Legislative reform, restructuring and linkage activities produced measurable improvements in data validity and completeness and a feasible development roadmap. Achieving a fully functional PBCR will require sustained investment in trained personnel (including epidemiology/biostatistics expertise), strengthening multi-source reporting compliance, restored mortality linkage for follow-up and DCO trace-back, SOP implementation, development of interoperable digital infrastructure, and secure long-term financing. Moldova’s experience illustrates how coordinated legal, technical and workforce actions, supported by international partnerships, can accelerate PBCR strengthening in LMICs and improve the evidence base for cancer control policy.