the importance of cancer data & registries to understand the cancer burden (eurochip) ecpc...
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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