1. Dr Andrea Micheli Descriptive Epidemiology and Health Planning Unit Istituto Nazionale Tumori Milan WP-10 - CANCER EXCHANGE OF INFORMATION ON THE PROJECT PROPOSAL

2. ABOUT THE PRESENT TALK 1. Major health determinants and cancer sites Suggestion for cancer data to be considered in DYNAMO-HIA Suggestion for cancer data to be considered in DYNAMO-HIA 2. Exposure and cancer occurrence Suggestion for model Suggestion for model 3. Cancer outcome Suggestion for indicator Suggestion for indicator 4. Public health actions Suggestion for actions Suggestion for actions ECOLOGICAL STUDIES ON PRIMARY PREVENTION INITIATIVES ECOLOGICAL STUDIES ON PRIMARY PREVENTION INITIATIVES AND CANCER

3. HEALTH DETERMINANTS AND CANCERS HEALTH DETERMINANTS AND CANCERS Tobacco smoking: cancer of: oral cavity, pharynx, oesophagus, stomach, liver, pancreas, larynx, lung, bladder, kidney, cervixTobacco smoking: cancer of: oral cavity, pharynx, oesophagus, stomach, liver, pancreas, larynx, lung, bladder, kidney, cervix Alcohol: cancer of:oral cavity, oesophagus, liver, larynx, colo-rectum, breastAlcohol: cancer of: oral cavity, oesophagus, liver, larynx, colo-rectum, breast Obesity and overweight (DIET): cancer of: oesophagus, Colon-rectum, Kidney, Corpus uteri, Breast Over 49 yearsObesity and overweight (DIET): cancer of: oesophagus, Colon-rectum, Kidney, Corpus uteri, Breast Over 49 years Physical activity: cancer ofColon, BreastPhysical activity: cancer of Colon, Breast SOURCE: EUROCADET project Suggestion 1: to study few major cancer sites

4. EXPOSURE AND CANCER OCCURENCE For a given person, interval between health determinant exposure and cancer occurrence is often higher than 15-20 yearsFor a given person, interval between health determinant exposure and cancer occurrence is often higher than 15-20 years Mind: a) cumulative exposure (dose by time), b) cohort approach The risk of cancer occurrence – for most cancer sites – increases as age increasesThe risk of cancer occurrence – for most cancer sites – increases as age increases Mind: c) in period analyses the prevention outcome affects incidence differently by age Suggestion 2: to develop a cohort approach model in few countries as example

5. Age and site adj 5 year relative survival Countries are ordered by Total Health Expenditure ($ US PPP) Source: Berrino F. et al. Survival for eight major cancers and all cancers combined for European adults diagnosed in 1995-99: results of the EUROCARE-4 study. Lancet Oncology, Volume 8, 2007.

6. Primary prevention first affects incidencePrimary prevention first affects incidence Sparse evidences suggest that primary prevention affects survivalSparse evidences suggest that primary prevention affects survival Primary prevention indirectly affects prevalence (40% by incidence modifications)Primary prevention indirectly affects prevalence (40% by incidence modifications) Primary prevention finally affects mortalityPrimary prevention finally affects mortality CANCER OUTCOME CANCER OUTCOME Suggestion 3: consider incidence, as outcome indicator

7. AGE STANDARDISED - TOTAL PREVALENCE, -INCIDENCE, 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

8. Dr Andrea Micheli Descriptive Epidemiology and Health Planning Unit Istituto Nazionale Tumori Milan WP-10 CANCER AVAILABLE DATA AVAILABLE DATA

9. CANCER INCIDENCE SOURCE:SOURCE: CANCER INCIDENCE IN V CONTINENTSCANCER INCIDENCE IN V CONTINENTS vol. VII: 75 CRs, 24 countries, 1988-92vol. VII: 75 CRs, 24 countries, 1988-92 vol. VIII: 88 CRs, 28 countries, 1993-1997vol. VIII: 88 CRs, 28 countries, 1993-1997 vol. IX: in publication by IARCvol. IX: in publication by IARC NATIONAL ESTIMATES IN GLOBOCAN (1998, 2000, 2002). Recent article on estimates in 2006NATIONAL ESTIMATES IN GLOBOCAN (1998, 2000, 2002). Recent article on estimates in 2006 Italian Estimated data, from 1970-2010, for cohort study approachItalian Estimated data, from 1970-2010, for cohort study approach BY CANCER SITE: YESBY CANCER SITE: YES BY AGE: YESBY AGE: YES BY COUNTRY: YESBY COUNTRY: YES

10. CANCER MORTALITY SOURCE: WHOSOURCE: WHO LAST UPDATE: MARCH 2007LAST UPDATE: MARCH 2007 BY CANCER SITE: YESBY CANCER SITE: YES BY AGE: YES (5-yr age classes)BY AGE: YES (5-yr age classes) BY COUNTRY: YESBY COUNTRY: YES AVAILABILITY-1: http://www-dep.iarc.fr FROM 1987 TO 2003AVAILABILITY-1: http://www-dep.iarc.fr FROM 1987 TO 2003 AVAILABILITY-2: http://epicancer.iss.it FROM 1955 TO 2001AVAILABILITY-2: http://epicancer.iss.it FROM 1955 TO 2001

11. Summary of indications for providing data Suggestion 1: to study few major cancer sites Suggestion 2: to develop a cohort approach model Suggestion 3: to consider incidence