1. 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

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

3. LIFE EXPECTANCY IN EU-27, Ice, N, Ch 2005-2009 Source: United Nations Population Division

4. GDP per capita (PPP$) in EU-27, Ice, N, Ch 2005-2009 Source: International Monetary Fund

5. Life expectancy at birth $P urchasing P ower P arity $P urchasing P ower P arity yrs I) GDP < = 20,000 73.3 II) 20,000 < GDP < = 30,000 79.1 II) 20,000 < GDP < = 30,000 79.1 III) 30,000 <GDP <36,000 79.6 III) 30,000 < GDP < = 36,000 79.6 IV) GDP > 36,000 80.0 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

6. LIFE EXPECTANCY TRENDS IN EUROPE Inequalities in health increased increased Source: United Nations Population Division

7. Inequalities in LE do not depend on geographic pattern LE in Europe are improving as disparities do Wealth appears related to these phenomena Background

8. 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.

9. 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)

10. 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

11. GDP and age-standardized incidence rates for all cancers. Men Sources: Human Development Report 2009; Ferlay et al. 2008

12. 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

13. GDP and age-standardized incidence rates for all cancers. Women Sources: Human Development Report 2009; Ferlay et al. 2008

14. 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) 336209- 20,000 < GDP < = 30,000 (PT,MT,CZK,SLO,CY,HEL,S,I) 36317250 30,000 < GDP < = 36,000 (F, D, FIN, UK, B, SW, DK) 41117149 GDP > 36,000 (A,ICE,NL,CH,IRE,N,LUX) 40517653 Sources: Ferlay et al. EJC, 2010. EUROCARE-4. For GDP International Monetary Fund

15. 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

16. 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"

17. 5 YEARS RELATIVE SURVIVAL FOR ALL CANCERS Ranked by 1995 TNEH Source: Verdecchia A. et al. European Journal of Public Health, 2008

18. 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

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

20. 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

21. 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-1 2002-04 EUROCHIP-2 2005-07 EUROCHIP-3 2008-11

22. Estimated new cases and deaths in EU-25 2006 Source: Ferlay et al, 2004

23. EUROPE in THE WORLD AGE-STANDARDIZED INCIDENCE RATES Source: GLOBOCAN 2002, IARC. Age-Standardised (World) rates, per 100,000

24. EUROPE in THE WORLD AGE-STANDARDIZED MORTALITY RATES Source: GLOBOCAN 2002, IARC. Age-Standardised (World) rates, per 100,000

25. 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

26. 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 Europe Source: Responding to the challenge of cancer in Europe.

27. 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