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EUROCHIP-2 - The action
FROM EUROCHIP-1
TO EUROCHIP-2
Public Health Program
EUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL
www.tumori.net/eurochip
EUROCHIP-1
Consensus Conferences involving cancer experts of EU
institutes, organisations and cancer networks
Development of a list of health indicators
describing cancer in Europe:
a) to help the development of the
European Health Information System
b) to promote actions in cancer control
Europe is characterised by unacceptable
inequalities in cancer control
PREVENTION
• Consumption of fruit and vegetables
• Consumption of alcohol
• Body Mass Index
• Physical activity
• Tobacco survey
• Exposure to sun radiation
• Prevalence of occupational exposure to
carcinogens (CAREX)
CANCER REGISTRATION &
EPIDEMIOLOGY
• Population covered by cancer registry
• Cancer incidence rates, trends and projections
• Cancer survival rates, trends and projections
• Cancer prevalence prop., trends and projections
• Cancer mortality rates, trends, projections and
person-years life lost due to cancer
• Stage at diagnosis: % of cases with
early diagnosis and % underwent a metastatic test
SCREENING
• Organised screening coverage
• % of women underwent a mammography
• % of women underwent a cervical cytology exam
• % of persons underwent a colorectal cancer
screening test
CARE & TREATMENT
• % of radiation equipments on population
• % of diagnostic Computed Axial Tomography
(CTS) in the population
• % of patients receiving palliative radiotherapy
• Delay of cancer treatment: pilot studies
• Compliance with best oncology practice
Gross Domestic Product
and cancer outcomes (All cancers, M+F)
5-year
Relative
Survival
Mortality
Rate x
100000
(world st)
%
Rate x
100000
(world st)
I) GDP < 15611
216
31
146
II) 15611 < GDP < 17538
244
43
133
III) GDP > 17538
253
45
135
Incidence
$PPP
I, Estonia, Poland, Slovenia, Slovakia, and Spain;
II, UK, Finland, Netherland, Sweden, Italy, and Austria;
III, Iceland, Denmark, France, Germany, and Switzerland
Gross Domestic Product (1997) and
5-year- age- and cancer site- adjusted relative survival (women)
The area of the disk is proportional to the Total National Health Expenditure ($ PPP) in the country
$ PPP: Parity Purchasing Power per capita (US $) Sources: OECD 2002 for GDP and TNEH; EUROCARE-3 for survival
Total Prevalence, All Cancer
m+f, 1992
3047
Swedish registry
2778
German registry
2597
Italian registries
2565
Swiss registries
2427
Austrian registry
2388
Denmark
2356
French registries
2098
Scotland
Iceland
2018
English registries
2012
Dutch registry
1867
Finland
1867
Spanish registries
1862
1759
Slovakia
1442
Slovenia
1339
Estonia
1169
Polish registries
2239
European registries
0
500
1000
1500
2000
2500
Prevalence per 100 000
3000
3500
GDP and cancer prevalence
Cancer prevalence (world standard)
$PPP
I) GDP<15611
II) 15611<GDP<17538
III) GDP>17538
I, Estonia, Poland, Slovenia, Slovakia, and Spain;
II, UK, Finland, Netherland, Sweden, Italy, and Austria;
III, Iceland, Denmark, France, Germany, and Switzerland
prop. per 100,000
996
1355
1560
Public expenditure on health (PEH)
and cancer survival
5-year- age- and cancer site- adjusted relative survival
Men - Median values per tertile - 1997 (from Annals, modified, 2003)
$PPP
Males %
Females %
I) PEH < 920
27.3
41.7
II) 920 < PEH < 1492
42.0
53.0
III) PEH > 1492
44.8
54.2
I, Estonia, Poland, Slovakia, Slovenia, Czech Republic, and Spain
II, Finland, UK, Italy, Netherlands, Austria, and Sweden
III, France, Switzerland, Iceland, Denmark, Norway, and Germany
CTS and 5-year relative survival for all cancers
MALES
FEMALES
Sources: OECD 2000, EUROCARE-3.
ASSR: 5-year Age and cancer sites adjusted relative survival
CTS: Computed Tomography scanners x 1000000 pop
THE HISTORY IN WEALTHY AREAS
Improvement in CVD
and cancer treatment
Life expectancy
increased
Number of cancer
cases is increasing
Inflation of prevalent cases
NEEDS: Actions in
primary prevention
Short term:
assistance, palliative
care, and hospices
Long term: reduction of cases
Main Public Health Strategies in
Europe for cancer
• Wealthy areas (highest prevalence):
Primary Prevention, management of
queues
• Less wealthy areas (lowest survival):
Treatment and investment
• All: focus on the elderly
JOINT WORK
is essential
to create action
and to build a bridge
between research and
health plans
EUROCHIP indicators
Epidemiology / Outcome
Incidence
Prevalence
Survival
Prevention
Fruit and vegetables
Alcohol
BMI & Physical activity
Tobacco
Sun radiation
Occupational carcinogens
Screening
Organised screening coverage
% mammography
% cervical cytology exam
% colorectal cancer screening test
Mortality & PYLL
Stage
Socio-economic
indicators
Anti-tobacco regulations
TNEH
GDP
PEH
Care & Treatment
Radiation equipments
CTS
Palliative radiotherapy
Delay of cancer treatment
Compliance with guidelines
Study on the EUROCHIP indicators (today available)
Incidence
Prevalence
Survival
Fruit and vegetables
Alcohol
BMI & Physical activity
Tobacco
Sun radiation
Occupational carcinogens
Organised screening coverage
% mammography
% cervical cytology exam
% colorectal cancer screening test
Mortality & PYLL
Stage
Anti-tobacco regulations
TNEH
GDP
PEH
Radiation equipments
CTS
Palliative radiotherapy
Delay of cancer treatment
Compliance with guidelines
Correlations among indicators
GDP
TNEH
PEH
CTS
($PPP)
($PPP)
($PPP)
($PPP)
.768 **
.819 **
.773 **
.823 **
.716 **
.785 **
.746 **
.805 **
.804 **
.808 **
.768 **
.822 **
.838 **
.854 **
.836 **
.847 **
GDP
-
.956 **
.947 **
.794 **
TNEH
-
-
.976 **
.840 **
PEH
-
-
-
.822 **
r
ASSR 1M
(%)
ASSR 1F
(%)
ASSR 5M
(%)
ASSR 5F
(%)
GDP: Gross Domestic Product TNEH: Total Expenditure on Health PEH: Public Expenditure on Health
CTS: Computed Tomography Scanners x 1000000 pop. $PPP: Purchasing Power Parity ** <0.01 (2 tails)
ASSR: 1-year and 5-year age-cancer sites adjusted relative survival for all cancers for males (M) and females (F)
Analysis on 18 countries: regression coefficients
Risks [ln(-ln(ASSR))]
1 year M
1 year F
5 years M
5 years F
CTS
-
-
-0.747
-
GDP
-
-
-
-
% Smokers
-
-
-
-
PEH
-
-
-
-
TNEH
-
-
-
-
Unemployed
-
-
-
-
GDP x PEH
-
-
-
-
GDP x TNEH
-
-
-
-
GDP x CTS
-
-
-
-0.849
TNEH x PEH
-
-
-
-
TNEH x CTS
-0.867
-0.869
-
-
-
-
-
-
73.6 %
74.0 %
53.1 %
70.3 %
PEH x CTS
R2 corrected
Analysis on 13 countries (without Eastern countries): regression coefficients
Risks [ln(-ln(ASSR))]
1 year M
1 year F
5 years M
5 years F
CTS
-0.824
-0.850
-0.702
-0.883
GDP
-
-
-
-
-0.300
-
-
-
PEH
-
-
-
-
TNEH
-
-
-
-
Unemployed
-
-
-
-
GDP x PEH
-
-
-
-
GDP x TNEH
-
-
-
-
GDP x CTS
-
-
-
-
TNEH x PEH
-
-
-
-
TNEH x CTS
-
-
-
-
PEH x CTS
-
-
-
-
78.6 %
72.3 %
67.4 %
76.0 %
% Smokers
R2 corrected