Cancer inequalities in Europe UKACR & NCIN Conference, 17/18 June 2010 Dr. Andrea Micheli Director Descriptive Study and Health Planning Unit Fondazione IRCCS “Istituto Nazionale dei Tumori” Milan

Macro-economic approach European vision By a) background b) correlations c) programs Cancer - inequalities - Europe

LIFE EXPECTANCY IN EU-27, Ice, N, Ch Source: United Nations Population Division

GDP per capita (PPP$) in EU-27, Ice, N, Ch Source: International Monetary Fund

Life expectancy at birth $P urchasing P ower P arity $P urchasing P ower P arity yrs I) GDP < = 20, II) 20,000 < GDP < = 30, II) 20,000 < GDP < = 30, III) 30,000 <GDP <36, III) 30,000 < GDP < = 36, IV) GDP > 36, GDP and life expectancy at birth 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 increased 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) AND CANCER 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) AND CANCER MORTALITY Age-Standardized incidence rates, World Standard Population per 100,000, GDP: at current prices US $, 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) Incidence per 100,000 Mortality per 100,000 Survival % GDP < 20,000 (BUL, ROM, LAT, PL, LIT, HUN, EST, SK) ,000 < GDP < = 30,000 (PT,MT,CZK,SLO,CY,HEL,S,I) ,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, 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 al Annals of Oncology, 2002

Number of cancer publications per yearNumber of new cancer cases per year Scientific contributions in cancer domain and cancer burden in 2002 English language "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

Macro-economic approach European vision By a) background b) correlations c) programs Cancer - inequalities - Europe

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

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 EUROCHIP EUROCHIP EUROCHIP

Estimated new cases and deaths in EU 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

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 With an estimated female breast cancer ( new cases) was the most frequently diagnosed cancer in the former EU25, closely followed by both prostate and colorectal cancer ( new cases) Lung cancer ranked fourth in the EU25, with an estimated 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 deaths – one in five of all deaths from cancer Colorectal cancer ranked second with deaths (12% of total cancer mortality), followed by breast cancer in women (7.3%) and prostate cancer (5.8%). The 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) Countries are ranked by GDP