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

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

4. 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

5. 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.

6. 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)

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

8. 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

9. 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

10. 5 YEARS RELATIVE SURVIVAL FOR ALL CANCERS Ranked by 1995 TNEH Source: Verdecchia A. et al. European Journal of Public Health, 2008

11. 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"

12. 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

13. EUROCHIP-1..3 Cancer is an element of our societies Why EUROCHIP? To fight inequalities What it is? Translational research project How? Economy of scale: EU From local actions to common actions: the EU pillars of EU cancer control

14. 1.development of a list of cancer health indicators 2.use of indicators to promote actions for cancer control 3.promoting a 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

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

16. 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

17. 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