The importance of The importance of cancer data & registries cancer data & registries

to understand to understand the cancer burden the cancer burden

(EUROCHIP)(EUROCHIP)

ECPC Cancer Summit 2010, 13-14 October 2010 ECPC Cancer Summit 2010, 13-14 October 2010

Dr. Andrea MicheliDirector

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

Milan

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 (average)

I) GDPI) GDP << = 20,000 = 20,000 73.373.3 II) II) 20,000 20,000 << GDPGDP << = 30,000 = 30,000 79.179.1 IIII) II) 30,000 30,000 << GDPGDP << = 336,0006,000 79.679.6 IV) IV) GDPGDP >> 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, United Kingdom, Belgium, Sweden, DenmarkIII, France, Germany, Finland, United Kingdom, 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

• 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 ?….

INFORMATION IS THE KEY

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 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

5-yr

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"

EUROCARE-45-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 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

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

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

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

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

TobaccoAlcohol Fruit and vegetablesSun radiationOccupational carcinogens BMI & Physical activity

Stage at diagnosis Incidence Survival Prevalence Mortality & PYLL

Organised screening coverage % with mammography % with cervical cytology exam % with colorectal cancer screening test

Radiation equipmentsCTSPalliative radiotherapyDelay of cancer treatmentCompliance with guidelines

GDP Total Health expenditurePublic health expenditureAnti-tobacco regulations

EUROCHIP INDICATORS

PreventionPrevention Socio-economic indicatorsSocio-economic indicators

Care & TreatmentCare & TreatmentScreeningScreening

1. Outcome1. Outcome

2. Health determinants 2. Health determinants

3. Health system indicators3. Health system indicators

• 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.

The burden of Cancer in EuropeThe burden of Cancer in Europe

EU AGAINST CANCER

IMPROVE INFORMATION

Activate, expand, improve

cancer registration

Health Strategies in Europe. Lisbon, 12-13 July 2006. Coleman M. Health Strategies in Europe. Lisbon, 12-13 July 2006. Coleman M.

CANCER REGISTRY: RECOMMENDATIONS

Health Strategies in Europe. Lisbon, 12-13 July 2006. Coleman M.

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 population-based 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 ..

Cancer is an element of our societies Cancer is an element of our societies

• To reduce risks: smoking&alcohol habits, bad diet, To reduce risks: smoking&alcohol habits, bad diet, insufficient physical activity, remove carcinogens insufficient physical activity, remove carcinogens • To improve the cure,To improve the cure,• To support those who experienced the diseaseTo support those who experienced the disease

To promote actions for cancer control To promote actions for cancer control

Cancer registry population based Cancer registry population based information information

is the keyis the key