Cancer inequalities Cancer inequalities in Europein Europe

UKACR & NCIN Conference, 17/18 June 2010 UKACR & NCIN Conference, 17/18 June 2010

Dr. Andrea MicheliDirector

Descriptive Study and Health Planning UnitFondazione IRCCS “Istituto Nazionale dei Tumori”

Milan

• Macro-economic approach

• European vision

By

• a) background

• b) correlations

• c) programs

Cancer - inequalities - EuropeCancer - inequalities - Europe

LIFE EXPECTANCY IN EU-27, Ice, N, ChLIFE EXPECTANCY IN EU-27, Ice, N, Ch2005-20092005-2009

Source: United Nations Population Division

GDP per capita (PPP$) inGDP per capita (PPP$) in EU-27, Ice, N, Ch EU-27, Ice, N, Ch2005-20092005-2009

Source: International Monetary Fund

Life expectancy at birthLife expectancy at birth

$P$Purchasingurchasing P Powerower P Parityarity yrs

I) GDPI) GDP << = 20,000 = 20,000 73.373.3 II) II) 20,000 20,000 << GDPGDP << = 30,000 = 30,000 79.179.1III) III) 30,000 30,000 << GDPGDP << = 336,0006,000 79.679.6IV) GDPIV) GDP >> 336,0006,000 8080.0.0

GDP and life expectancy at birthGDP and life expectancy at birth

I, Bulgaria, Romania, Latvia, Poland, Lithuania, Hungary, Estonia, SlovakiaI, Bulgaria, Romania, Latvia, Poland, Lithuania, Hungary, Estonia, Slovakia

II, Portugal, Malta, Czech Republic, Slovenia, Cyprus, Greece, Spain, ItalyII, Portugal, Malta, Czech Republic, Slovenia, Cyprus, Greece, Spain, Italy

III, France, Germany, Finland, III, France, Germany, Finland, United KingdomUnited Kingdom, Belgium, Sweden, Denmark, Belgium, Sweden, Denmark

IV, Austria, Iceland, The Netherlands, Switzerland, Ireland, Norway, LuxembourgIV, Austria, Iceland, The Netherlands, Switzerland, Ireland, Norway, Luxembourg

Sources: United Nations Population Division. For GDP International Monetary Fund Sources: United Nations Population Division. For GDP International Monetary Fund

LIFE LIFE EXPECTANCY EXPECTANCY

TRENDS IN TRENDS IN EUROPEEUROPE

InequalitiesInequalitiesin healthin health

increasedincreased

Source: United Nations Population Division

• Inequalities in LE do not depend on geographic pattern

• LE in Europe are improving as disparities do

• Wealth appears related to these phenomena

Background

GROSS DOMESTIC PRODUCT (GDP) ANDGROSS DOMESTIC PRODUCT (GDP) ANDCANCER INCIDENCECANCER INCIDENCE

Source: GLOBOCAN 2002, IARC & United Nations (UN)

Age-standardized incidence rates, World Standard Population per 100,000, GDP: at current prices US $, 2006.

GROSS DOMESTIC PRODUCT (GDP) ANDGROSS DOMESTIC PRODUCT (GDP) ANDCANCER MORTALITYCANCER 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 age-standardized mortality rates for all cancers. Women

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. Women

Sources: Human Development Report 2009; Ferlay et al. 2008

GDP AND EPIDEMIOLOGICAL CANCER DATA GDP AND EPIDEMIOLOGICAL CANCER DATA

All cancers M & FAll cancers M & FCOUNTRIES BY QUARTILE of GDP per capita ($PPP)

Incidenceper 100,000

Mortalityper 100,000

Survival%

GDP < 20,000(BUL, ROM, LAT, PL, LIT, HUN, EST, SK)

336 209 -

20,000 < GDP < = 30,000(PT,MT,CZK,SLO,CY,HEL,S,I) 363 172 5030,000 < GDP < = 36,000(F, D, FIN, UK, B, SW, DK) 411 171 49GDP > 36,000(A,ICE,NL,CH,IRE,N,LUX) 405 176 53

Sources: Ferlay et al. EJC, 2010. EUROCARE-4. For GDP International Monetary Fund 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

PREVENTION AIMS TO REDUCE INCIDENCE

TREATMENT ACTS

TO INCREASE PREVALENCE

Source: Micheli et alAnnals of Oncology, 2002

0 1,000 2,000 3,000 4,000 5,000 6,000 7,000

AustraliaNetherland

IndiaBrazilKorea

MexicoSpain

CanadaItaly

ChinaFrance

UKGermany

JapanUnited States

Number of cancer publications per year

0 500,000 1,000,000 1,500,000 2,000,000 2,500,000

AustraliaNetherland

KoreaMexico

SpainCanada

Italy

FranceUK

GermanyJapan

United States

Number of new cancer cases per year

0 500,000 1,000,000 1,500,000 2,000,000 2,500,000

AustraliaNetherland

IndiaBrazilKorea

MexicoSpain

CanadaItaly

ChinaFrance

UKGermany

JapanUnited States

Scientific contributions in cancer domain Scientific contributions in cancer domain and cancer burden in 2002and cancer burden in 2002

English languageEnglish language

"the 15 most wealthy countries are ordered by decreasing gross domestic product level"

5 YEARS RELATIVE SURVIVAL FOR ALL CANCERS5 YEARS RELATIVE SURVIVAL FOR ALL CANCERS

Ranked by 1995 TNEHRanked by 1995 TNEH

Source: Verdecchia A. et al. European Journal of Public Health, 2008

EUROCARE-45-year relative survival, all cancers

countries are orded by Total Expenditure on Healh

Italy

Europe

Berrino F. et al, The Lancet Oncology, 2007

• Macro-economic approach

• European vision

By

• a) background

• b) correlations

• c) programs

Cancer - inequalities - EuropeCancer - inequalities - Europe

EUROCHIP-1..3EUROCHIP-1..3Cancer is an element of our societies Cancer is an element of our societies

Why?Why? ToTo fight inequalities fight inequalities What?What? Translational research projectTranslational research project

How?How? Economy of scale: EUEconomy of scale: EU

From actions to common actions: From actions to common actions: the EU pillars of EU cancer controlthe EU pillars of EU cancer control

1.1. development of development of a list of cancer health indicators a list of cancer health indicators

2.2. using indicators to using indicators to promote actionpromote actionss for cancer control for cancer control

3.3. promoting common view of cancer plan: promoting common view of cancer plan: collaborative collaborative actionsactions

4.4. to help the development of the European Health to help the development of the European Health Information System Information System

By consensus conferences involving cancer experts of By consensus conferences involving cancer experts of EU institutes, organisations and cancer networks EU institutes, organisations and cancer networks

EUROCHIP-1 EUROCHIP-1 2002-042002-04

EUROCHIP-2 EUROCHIP-2 2005-072005-07

EUROCHIP-3 EUROCHIP-3 2008-112008-11

Estimated new cases and deaths in EU-25Estimated new cases and deaths in EU-2520062006

Source: Ferlay et al, 2004

EUROPE in THE WORLDEUROPE in THE WORLDAGE-STANDARDIZED INCIDENCE RATES

Source: GLOBOCAN 2002, IARC. Age-Standardised (World) rates, per 100,000

EUROPE in THE WORLDEUROPE in THE WORLDAGE-STANDARDIZED MORTALITY RATES

Source: GLOBOCAN 2002, IARC. Age-Standardised (World) rates, per 100,000

• According estimates for 2006, there were about 2.3 million new cases of cancer and over 1 million cancer deaths in the EU25. (Ferlay et al., 2007)

• In the continent of Europe as a whole, there were almost 3.2 million new cancer diagnoses and 1.7 million cancer deaths.

• 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 in 2006.

• With an estimated female breast cancer (320 000 new cases) was the most frequently diagnosed cancer in the former EU25, closely followed by both prostate and colorectal cancer (300 000 new cases)

• Lung cancer ranked fourth in the EU25, with an estimated 265.000 new cases in 2006

Source: Responding to the challenge of cancer in Europe.

The burden of Cancer in EuropeThe burden of Cancer in Europe

• Lung cancer was by far the most frequent cause of cancer death in the EU25 in 2006, with an estimated 236 000 deaths – one in five of all deaths from cancer

• Colorectal cancer ranked second with 140 000 deaths (12% of total cancer mortality), followed by breast cancer in women (7.3%) and prostate cancer (5.8%).

The burden of Cancer in EuropeThe burden of Cancer in Europe

Source: Responding to the challenge of cancer in Europe.

Source: Verdecchia A. et al. (Submitted)

EUROPE

Gross Domestic Product (GDP), Total National Health Expenditure (TNHE) and Public Health Expenditure (PHE)

GDP ($PPP)

0 10000 20000 30000

EstoniaPoland

SlovakiaCzech Rep

SloveniaScotland

SpainWales

FinlandEngland

ItalyFrance

SwedenGermany

NetherlandsDenmark

AustriaNorway

Switzerland

TNEH ($PPP)

0 1000 2000 3000

EstoniaPoland

SlovakiaCzech Rep

SloveniaScotland

SpainWales

FinlandEngland

ItalyFrance

SwedenGermany

NetherlandsDenmark

AustriaNorway

Switzerland

PHE ($PPP)

0 500 1000 1500 2000

EstoniaPoland

SlovakiaCzech Rep

SloveniaScotland

SpainWales

FinlandEngland

ItalyFrance

SwedenGermany

NetherlandsDenmark

AustriaNorway

Switzerland

Countries are ranked by GDP