FROM EUROCHIP-1 TO EUROCHIP-2 EUROCHIP-2 - The action Public Health Program EUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL

Consensus Conferences involving cancer experts of EU institutes, organisations and cancer networks Development of a list of health indicators describing cancer in Europe: a) to help the development of the European Health Information System European Health Information System b) to promote actions in cancer control EUROCHIP-1 Europe is characterised by unacceptable inequalities in cancer control

PREVENTION Consumption of fruit and vegetables Consumption of alcohol Body Mass Index Physical activity Tobacco survey Exposure to sun radiation Prevalence of occupational exposure to carcinogens (CAREX)

Population covered by cancer registry Cancer incidence rates, trends and projections Cancer survival rates, trends and projections Cancer prevalence prop., trends and projections Cancer mortality rates, trends, projections and person-years life lost due to cancer Stage at diagnosis: % of cases with early diagnosis and % underwent a metastatic test CANCER REGISTRATION & EPIDEMIOLOGY

SCREENING Organised screening coverage % of women underwent a mammography % of women underwent a cervical cytology exam % of persons underwent a colorectal cancer screening test

% of radiation equipments on population % of diagnostic Computed Axial Tomography (CTS) in the population % of patients receiving palliative radiotherapy Delay of cancer treatment: pilot studies Compliance with best oncology practice CARE & TREATMENT

Gross Domestic Product and cancer outcomes (All cancers, M+F) and cancer outcomes (All cancers, M+F) I, Estonia, Poland, Slovenia, Slovakia, and Spain; II, UK, Finland, Netherland, Sweden, Italy, and Austria; III, Iceland, Denmark, France, Germany, and Switzerland Incidence 5-year Relative Survival Mortality $PPP Rate x (world st) % Rate x (world st) I) GDP < II) < GDP < III) GDP >

The area of the disk is proportional to the Total National Health Expenditure ($ PPP) in the country $ PPP: Parity Purchasing Power per capita (US $) Sources: OECD 2002 for GDP and TNEH; EUROCARE-3 for survival Gross Domestic Product (1997) and 5-year- age- and cancer site- adjusted relative survival (women)

Total Prevalence, All Cancer m+f, 1992 Prevalence per

Cancer prevalence (world standard) $PPP prop. per 100,000 I) GDP< II) 15611<GDP< II) 15611<GDP< III) GDP> GDP and cancer prevalence I, Estonia, Poland, Slovenia, Slovakia, and Spain; II, UK, Finland, Netherland, Sweden, Italy, and Austria; III, Iceland, Denmark, France, Germany, and Switzerland

5-year- age- and cancer site- adjusted relative survival Men - Median values per tertile (from Annals, modified, 2003) $PPP Males % Females % I) PEH < II) 920 < PEH< II) 920 < PEH < III) PEH> III) PEH > Public expenditure on health (PEH) and cancer survival I, Estonia, Poland, Slovakia, Slovenia, Czech Republic, and Spain II, Finland, UK, Italy, Netherlands, Austria, and Sweden III, France, Switzerland, Iceland, Denmark, Norway, and Germany

CTS and 5-year relative survival for all cancers Sources Sources: OECD 2000, EUROCARE-3. ASSR ASSR: 5-year Age and cancer sites adjusted relative survival CTS CTS: Computed Tomography scanners x pop MALESFEMALES

Improvement in CVD and cancer treatment Life expectancy increased Number of cancer cases is increasing Inflation of prevalent cases NEEDS NEEDS: Actions in primary prevention Long term: reduction of cases Short term Short term: assistance, palliative care, and hospices THE HISTORY IN WEALTHY AREAS

Main Public Health Strategies in Europe for cancer Wealthy areas (highest prevalence): Primary Prevention, management of queues Less wealthy areas (lowest survival): Treatment and investment All: focus on the elderly

JOINT WORK is essential to create action and to build a bridge between research and health plans

Fruit and vegetables Alcohol BMI & Physical activity Tobacco Sun radiation Occupational carcinogens IncidencePrevalence Survival Mortality & PYLL Stage Organised screening coverage % mammography % cervical cytology exam % colorectal cancer screening test Radiation equipments CTS Palliative radiotherapy Delay of cancer treatment Compliance with guidelines Anti-tobacco regulations TNEH GDP PEH EUROCHIP indicators Prevention Socio-economic indicators Care & Treatment Screening Epidemiology / Outcome

Fruit and vegetables Alcohol BMI & Physical activity Tobacco Sun radiation Occupational carcinogens IncidencePrevalence Survival Mortality & PYLL Stage Organised screening coverage % mammography % cervical cytology exam % colorectal cancer screening test Radiation equipments CTS Palliative radiotherapy Delay of cancer treatment Compliance with guidelines Anti-tobacco regulations TNEH GDP PEH Study on the EUROCHIP indicators (today available)

Correlations among indicators rGDP ($PPP)TNEH PEH CTS ASSR 1M (%).768 **.819 **.773 **.823 ** ASSR 1F (%).716 **.785 **.746 **.805 ** ASSR 5M (%).804 **.808 **.768 **.822 ** ASSR 5F (%).838 **.854 **.836 **.847 ** GDP-.956 **.947 **.794 ** TNEH **.840 ** PEH ** GDPTNEHPEH GDP: Gross Domestic Product TNEH: Total Expenditure on Health PEH: Public Expenditure on Health CTS$PPP** CTS: Computed Tomography Scanners x pop. $PPP: Purchasing Power Parity ** <0.01 (2 tails) ASSR ASSR: 1-year and 5-year age-cancer sites adjusted relative survival for all cancers for males (M) and females (F)

Risks Risks [ln(-ln(ASSR))] 1 year M 1 year F 5 years M 5 years F CTS GDP---- % Smokers ---- PEH---- TNEH---- Unemployed---- GDP x PEH ---- GDP x TNEH ---- GDP x CTS TNEH x PEH ---- TNEH x CTS PEH x CTS ---- Analysis on 18 countries: regression coefficients R2 corrected 73.6 %74.0 %53.1 %70.3 %

Risks Risks [ln(-ln(ASSR))] 1 year M 1 year F 5 years M 5 years F CTS GDP---- % Smokers PEH---- TNEH---- Unemployed---- GDP x PEH ---- GDP x TNEH ---- GDP x CTS ---- TNEH x PEH ---- TNEH x CTS ---- PEH x CTS ---- Analysis on 13 countries (without Eastern countries) : regression coefficients R2 corrected 78.6 %72.3 %67.4 %76.0 %