1. Algeria Croatia EgyptFranceGreece ItalyJordanLebanonLybiaMorocco PortugalSyriaSloveniaSpainTunisiaTurkeyPalestine Albania Cyprus MacedoniaMalta Mediterranean Task Force for Cancer Control (MTCC) AIMS: To unify efforts to eliminate suffering and reduce mortality of cancer through decreasing incidence of adv. disease

2. Massimo Crespi, MD on behalf of the MOS Epidemiology Group M Barchana, AS Ibrahim, N Mikhail, S Eser, M Strnad, V Ramazzotti www.mosepi.org

3. Introduction Mediterranean coastal populations share a common historical heritage and cultural roots B U T genetic background and lifestyle habits diverged in the centuries, mostly in the last 200 years, as a consequence of industrialization R E S U L T great difference in cancer incidence Mediterranean coastal populations share a common historical heritage and cultural roots B U T genetic background and lifestyle habits diverged in the centuries, mostly in the last 200 years, as a consequence of industrialization R E S U L T great difference in cancer incidence

4. Cancer – All sites

6. Aims coastal Perform a comprehensive analysis based on solid (not extrapolated) data for Mediterranean coastal populations and intended as a baseline for future, more analytical studies Data at National levelSelected coastal areas

7. GLOBOCAN methodology GLOBOCAN methodology Sources of GLOBOCAN data Reports of National and Regional Registries (when available) Relative Frequency data. Data of neighboring countries Mathematical modeling Extrapolation Sources of GLOBOCAN data Reports of National and Regional Registries (when available) Relative Frequency data. Data of neighboring countries Mathematical modeling Extrapolation

9. MOS methodology The most frequent cancer sites were examined for 20 countries, standardized to ASR world as crude, age specific and age-adjusted (x 100,000y) by the most recently data available (2003-2004) from National/Regional Cancer Registries The cancer sites considered are : All Cancer-sites combined Breast (F)Prostate (M) ColorectalUrinary bladder Non Hodgkin Lymphoma Lung The most frequent cancer sites were examined for 20 countries, standardized to ASR world as crude, age specific and age-adjusted (x 100,000y) by the most recently data available (2003-2004) from National/Regional Cancer Registries The cancer sites considered are : All Cancer-sites combined Breast (F)Prostate (M) ColorectalUrinary bladder Non Hodgkin Lymphoma Lung

10. Why Incidence ? Cancer Incidence rates are the net effect of internal (genetic) and external (environmental) causal and preventive factors and provide the clearest measure of exposure to the above factors at the population level

11. What we achieved A description of cancer incidence in populations sharing a common past history but with significant differences arising in the modern context in respect to ethnicity, religion, socio- economic status, level of industrialization and GDP All data are available at www.mosepi.org

15. Cancer Incidence Globocan 2002 BREAST 29.0 % 27.1 % Southern Europe Northern Africa

17. Lung Cancer

18. Colorectal Cancers

20. Cancer Incidence Globocan 2002 COLON 4.7% 13.3 % Southern Europe Northern Africa Southern Europe Northern Africa

21. The ultimate efficiency indicator of preventive diagnostic therapeutic strategies and the frame for evaluation of Health Systems and the frame for evaluation of Health Systems The ultimate efficiency indicator of preventive diagnostic therapeutic strategies and the frame for evaluation of Health Systems and the frame for evaluation of Health Systems Survival of Cancer Patients

22. EPICENTRO.ISS.IT EUROCARE.IT Eurocare-3 study Annals of Oncology 2003 (Suppl. 5) vol. 14 (Not EU) England Scotland Wales 5y survival of CRC from Cancer Registries

23. Economics are always a significant determinant of outcomes…

24. Disks area is proportional to National Health Expenditure ($ PPP) del paese $ PPP: Parity Purchasing Power per capita (US $) - From: OECD 2002 for GIP and NHE; EUROCARE-3 for survival Gross Internal Product (1997) and all cancer 5y-Survival (adj. for age and site) (%) - Males

25. Total expenditure on health as percentage of GDP (WHO data)

26. Conclusions In comparison, GLOBOCAN data differs substantially from the ones of MOS, either in over- or under-estimation. The MOS data are on coastal population and based on Cancer Registries data. We propose them as a baseline information to clinicians, researchers and Health authorities for proper actions In comparison, GLOBOCAN data differs substantially from the ones of MOS, either in over- or under-estimation. The MOS data are on coastal population and based on Cancer Registries data. We propose them as a baseline information to clinicians, researchers and Health authorities for proper actions www.mosepi.org

27. Final message Eat better Smoke less Decrease infections Decrease pollution Increase Health Budgets !!

28. Causal factors Preventive factors Which are the priority actions?