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ECPC Cancer Summit 2010, 13-14 October 2010
The importance of
cancer data & registries
to understand
the cancer burden
(EUROCHIP)
Dr. Andrea Micheli
Director
Descriptive Studies and Health Planning Unit
Fondazione IRCCS “Istituto Nazionale dei Tumori”
Milan
LIFE EXPECTANCY IN EU-27, Ice, N, Ch
2005-2009
Source: United Nations
Population Division
GDP per capita (PPP$) in EU-27, Ice, N, Ch
2005-2009
Source: International
Monetary Fund
GDP and life expectancy at birth
Life expectancy at birth
$Purchasing Power Parity
yrs (average)
I) GDP < = 20,000
73.3
79.1
79.6
80.0
II) 20,000 < GDP < = 30,000
III) 30,000 < GDP < = 36,000
IV) GDP > 36,000
I, Bulgaria, Romania, Latvia, Poland, Lithuania, Hungary, Estonia, Slovakia
II, Portugal, Malta, Czech Republic, Slovenia, Cyprus, Greece, Spain, Italy
III, France, Germany, Finland, United Kingdom, Belgium, Sweden, Denmark
IV, Austria, Iceland, The Netherlands, Switzerland, Ireland, Norway, Luxembourg
Sources: United Nations Population Division. For GDP International Monetary Fund
LIFE
EXPECTANCY
TRENDS IN
EUROPE
Inequalities
in health
increased
Source: United Nations
Population Division
INFORMATION IS THE KEY
• We know LE because population level current
statistics are made available
• LE in Europe are improving as disparities do
• Wealth appears related to these phenomena
AND CANCER ?….
GROSS DOMESTIC PRODUCT (GDP) AND
CANCER INCIDENCE
Age-standardized incidence rates, World Standard Population per 100,000, GDP: at current prices US $, 2006.
Source: GLOBOCAN 2002, IARC & United Nations (UN)
GROSS DOMESTIC PRODUCT (GDP) AND
CANCER MORTALITY
Age-Standardized incidence rates, World Standard Population per 100,000, GDP: at current prices US $, 2006.
Source: GLOBOCAN 2002, IARC & United Nations (UN)
GDP and age-standardized mortality rates for all cancers. Men
Disks are proportional to the public health expenditure ($ PPP)
Sources: Human Development Report 2009; Ferlay et al. 2008
GDP and age-standardized incidence rates for all cancers. Men
Sources: Human Development Report 2009; Ferlay et al. 2008
GDP AND EPIDEMIOLOGICAL CANCER DATA
All cancers M & F
COUNTRIES BY QUARTILE of
GDP per capita ($PPP)
Incidence
Mortality
per 100,000
per 100,000
5-yr
Survival
%
GDP < 20,000
336
209
-
363
172
50
411
171
49
405
176
53
(BUL, ROM, LAT, PL, LIT, HUN, EST, SK)
20,000 < GDP < = 30,000
(PT, MT, CZK, SLO, CY, HEL, S, I)
30,000 < GDP < = 36,000
(F, D, FIN, UK, B, SW, DK)
GDP > 36,000
(A, ICE, NL, CH, IRE, N, LUX)
Sources: Ferlay et al. EJC, 2010. EUROCARE-4. For GDP International Monetary Fund
Age standardised -prevalence (P), -incidence (I), and -survival,
all cancers combined, m + w, 1992
The area of the disk is proportional to the 5-year relative survival
TREATMENT
ACTS
TO INCREASE
PREVALENCE
PREVENTION AIMS TO REDUCE INCIDENCE
Source:
Micheli et al
Annals of
Oncology,
2002
Scientific contributions in cancer domain
and cancer burden in 2002
English language
Number of cancer publications per year
Number of new cancer cases per year
United States
Japan
Germany
UK
France
China
Italy
Canada
Spain
Mexico
Korea
Brazil
India
Netherland
Australia
United States
Japan
Germany
UK
France
China
Italy
Canada
Spain
Mexico
Korea
Brazil
India
Netherland
Australia
0
1,000
2,000 3,000 4,000 5,000
6,000 7,000
0
500,000 1,000,000 1,500,000 2,000,000 2,500,000
"the 15 most wealthy countries are ordered by decreasing gross domestic product level"
EUROCARE-4
5-year relative survival, all cancers
countries are orded by Total Expenditure on Healh
Europe
Berrino F. et al, The Lancet Oncology, 2007
5 YEARS RELATIVE SURVIVAL FOR ALL CANCERS
Ranked by 1995 TNEH
Source: Verdecchia A. et al. European Journal of Public Health, 2008
EUROCHIP-1 2002-04
EUROCHIP-2 2005-07
EUROCHIP-3 2008-11
1. development of a list of cancer health indicators
2. using indicators to promote actions for cancer control
3. promoting common view of cancer plan: collaborative
actions
By consensus conferences involving cancer experts of EU
institutes, organisations and cancer networks
EUROCHIP INDICATORS
1.
Outcome
Stage at diagnosis Incidence Survival
Prevalence
Mortality & PYLL
2. Health determinants
Prevention
Socio-economic indicators
Tobacco
Alcohol
Fruit and vegetables
Sun radiation
Occupational carcinogens
BMI & Physical activity
GDP
Total Health expenditure
Public health expenditure
Anti-tobacco regulations
Screening
3. Health system indicators
Care & Treatment
Organised screening coverage
% with mammography
% with cervical cytology exam
% with colorectal cancer screening test
Radiation equipments
CTS
Palliative radiotherapy
Delay of cancer treatment
Compliance with guidelines
The burden of Cancer in Europe
• According estimates for 2006, there were about 2.3
million new cases of cancer and over 1 million cancer
deaths in the EU25 (Cancers of the breast (in women),
prostate, colorectum (colon and rectum combined, or
large bowel) and lung accounted for over half the total
cancer incidence burden
• Female breast cancer (320,000 new cases) was the
most frequent cancer, closely followed by both
prostate and colorectal cancer (300,000 new cases)
• Lung cancer ranked fourth, with an estimated 265,000
new cases
Source: Responding to the challenge of cancer in Europ,Fealy et al,2007.
EU AGAINST CANCER
IMPROVE INFORMATION
Activate, expand, improve
cancer registration
Health
Strategies
Europe.
Health Strategies in Europe. Lisbon,
12-13
July 2006. in
Coleman
M. Lisbon, 12-13 July 2006. Coleman M.
CANCER REGISTRY: RECOMMENDATIONS
1. Cancer Registries should inform the evaluation of
programmes for: prevention (incidence), screening,
treatment (survival). And, on long term follow-up for
cure, care, social support, rehabilitation plans
2. Update the EU Directive (1995) to enable populationbased registries
3. EU should recommend that all MS make cancer
registration statutory, with special coverage by low in
collecting data to avoid conflicts with the rights of
confidentiality
4. Set EU standards for registration in countries with no
cancer registry. Greece and Luxembourg and ..
Health Strategies in Europe. Lisbon, 12-13 July 2006. Coleman M.
Cancer is an element of our societies
• To reduce risks: smoking&alcohol habits, bad diet,
insufficient physical activity, remove carcinogens
• To improve the cure,
• To support those who experienced the disease
To promote actions for cancer control
Cancer registry population based
information
is the key