Transcript Diapositiva 1

UKACR & NCIN Conference, 17/18 June 2010
Cancer inequalities
in Europe
Dr. Andrea Micheli
Director
Descriptive Study and Health Planning Unit
Fondazione IRCCS “Istituto Nazionale dei Tumori”
Milan
Cancer - inequalities - Europe
• Macro-economic approach
• European vision
By
• a) background
• b) correlations
• c) programs
LIFE EXPECTANCY IN EU-27, Ice, N, Ch
2005-2009
Source: United Nations
Population Division
GDP per capita (PPP$) in EU-27, Ice, N, Ch
2005-2009
Source: International
Monetary Fund
GDP and life expectancy at birth
Life expectancy at birth
$Purchasing Power Parity
I) GDP < = 20,000
II) 20,000 < GDP < = 30,000
III) 30,000 < GDP < = 36,000
IV) GDP > 36,000
yrs
73.3
79.1
79.6
80.0
I, Bulgaria, Romania, Latvia, Poland, Lithuania, Hungary, Estonia, Slovakia
II, Portugal, Malta, Czech Republic, Slovenia, Cyprus, Greece, Spain, Italy
III, France, Germany, Finland, United Kingdom, Belgium, Sweden, Denmark
IV, Austria, Iceland, The Netherlands, Switzerland, Ireland, Norway, Luxembourg
Sources: United Nations Population Division. For GDP International Monetary Fund
LIFE
EXPECTANCY
TRENDS IN
EUROPE
Inequalities
in health
increased
Source: United Nations
Population Division
Background
• Inequalities in LE do not depend on
geographic pattern
• LE in Europe are improving as
disparities do
• Wealth appears related to these
phenomena
GROSS DOMESTIC PRODUCT (GDP) AND
CANCER INCIDENCE
Age-standardized incidence rates, World Standard Population per 100,000, GDP: at current prices US $, 2006.
Source: GLOBOCAN 2002, IARC & United Nations (UN)
GROSS DOMESTIC PRODUCT (GDP) AND
CANCER 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
All cancers M & F
COUNTRIES BY QUARTILE of
GDP per capita ($PPP)
GDP < 20,000
Incidence
Mortality
Survival
per 100,000
per 100,000
%
336
209
-
363
172
50
411
171
49
405
176
53
(BUL, ROM, LAT, PL, LIT, HUN, EST, SK)
20,000 < GDP < = 30,000
(PT,MT,CZK,SLO,CY,HEL,S,I)
30,000 < GDP < = 36,000
(F, D, FIN, UK, B, SW, DK)
GDP > 36,000
(A,ICE,NL,CH,IRE,N,LUX)
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
TREATMENT
ACTS
TO INCREASE
PREVALENCE
PREVENTION AIMS TO REDUCE INCIDENCE
Source:
Micheli et al
Annals of
Oncology,
2002
Scientific contributions in cancer domain
and cancer burden in 2002
English language
Number of cancer publications per year
Number of new cancer cases per year
United States
Japan
Germany
UK
France
China
Italy
Canada
Spain
Mexico
Korea
Brazil
India
Netherland
Australia
United States
Japan
Germany
UK
France
China
Italy
Canada
Spain
Mexico
Korea
Brazil
India
Netherland
Australia
0
1,000
2,000 3,000 4,000 5,000
6,000 7,000
0
500,000 1,000,000 1,500,000 2,000,000 2,500,000
"the 15 most wealthy countries are ordered by decreasing gross domestic product level"
5 YEARS RELATIVE SURVIVAL FOR ALL CANCERS
Ranked by 1995 TNEH
Source: Verdecchia A. et al. European Journal of Public Health, 2008
EUROCARE-4
5-year relative survival, all cancers
countries are orded by Total Expenditure on Healh
Italy
Europe
Berrino F. et al, The Lancet Oncology, 2007
Cancer - inequalities - Europe
• Macro-economic approach
• European vision
By
• a) background
• b) correlations
• c) programs
EUROCHIP-1..3
Cancer is an element of our societies
Why? To fight inequalities
What? Translational research project
How? Economy of scale: EU
From actions to common actions:
the EU pillars of EU cancer control
EUROCHIP-1 2002-04
EUROCHIP-2 2005-07
EUROCHIP-3 2008-11
1. development of a list of cancer health indicators
2. using indicators to promote actions for cancer control
3. promoting common view of cancer plan: collaborative
actions
4. to help the development of the European Health
Information System
By consensus conferences involving cancer experts of EU
institutes, organisations and cancer networks
Estimated new cases and deaths in EU-25
2006
Source: Ferlay et al, 2004
EUROPE in THE WORLD
AGE-STANDARDIZED INCIDENCE RATES
Source: GLOBOCAN 2002, IARC. Age-Standardised (World) rates, per 100,000
EUROPE in THE WORLD
AGE-STANDARDIZED MORTALITY RATES
Source: GLOBOCAN 2002, IARC. Age-Standardised (World) rates, per 100,000
The burden of Cancer in Europe
• 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 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%).
Source: Responding to the challenge of cancer in Europe.
EUROPE
Gross Domestic Product (GDP), Total National Health Expenditure
(TNHE) and Public Health Expenditure (PHE)
GDP
TNEH
($PPP)
PHE ($PPP)
($PPP)
Switzerland
Norway
Austria
Denmark
Netherlands
Germany
Sweden
France
Italy
England
Finland
Wales
Spain
Scotland
Slovenia
Czech Rep
Slovakia
Poland
Estonia
Switzerland
Norway
Austria
Denmark
Netherlands
Germany
Sweden
France
Italy
England
Finland
Wales
Spain
Scotland
Slovenia
Czech Rep
Slovakia
Poland
Estonia
Switzerland
Norway
Austria
Denmark
Netherlands
Germany
Sweden
France
Italy
England
Finland
Wales
Spain
Scotland
Slovenia
Czech Rep
Slovakia
Poland
Estonia
0
10000
20000
30000
0
1000
2000
3000
0
500
1000
1500
2000
Countries are ranked by GDP
Source: Verdecchia A. et al. (Submitted)