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