1. The importance of cancer data & registries to understand the cancer burden (EUROCHIP) ECPC Cancer Summit 2010, 13-14 October 2010 Dr. Andrea Micheli Director Descriptive Studies 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. GDP per capita (PPP$) in EU-27, Ice, N, Ch 2005-2009 Source: International Monetary Fund

4. Life expectancy at birth $P urchasing P ower P arity $P urchasing P ower P arity yrs (average) 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 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. LIFE EXPECTANCY TRENDS IN EUROPE Inequalities in health increased increased Source: United Nations Population Division

6. We know LE because population level current statistics are made available LE in Europe are improving as disparities do Wealth appears related to these phenomena AND CANCER ?…. INFORMATION IS THE KEY

7. 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.

8. 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)

9. 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

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

11. 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 5-yr 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

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. 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"

14. EUROCARE-4 5-year relative survival, all cancers countries are orded by Total Expenditure on Healh Europe Berrino F. et al, The Lancet Oncology, 2007

15. 5 YEARS RELATIVE SURVIVAL FOR ALL CANCERS Ranked by 1995 TNEH Source: Verdecchia A. et al. European Journal of Public Health, 2008

16. 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 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

17. Tobacco Alcohol Fruit and vegetables Sun radiation Occupational carcinogens BMI & Physical activity Stage at diagnosis Incidence Survival Prevalence Mortality & PYLL Organised screening coverage % with mammography % with cervical cytology exam % with colorectal cancer screening test Radiation equipments CTS Palliative radiotherapy Delay of cancer treatment Compliance with guidelines GDP Total Health expenditure Public health expenditure Anti-tobacco regulations EUROCHIP INDICATORS Prevention Socio-economic indicators Care & Treatment Screening 1. Outcome 2. Health determinants 3. Health system indicators

18. According estimates for 2006, there were about 2.3 million new cases of cancer and over 1 million cancer deaths in the EU25 (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 Female breast cancer (320,000 new cases) was the most frequent cancer, closely followed by both prostate and colorectal cancer (300,000 new cases) Lung cancer ranked fourth, with an estimated 265,000 new cases Source: Responding to the challenge of cancer in Europ,Fealy et al,2007. The burden of Cancer in Europe

19. EU AGAINST CANCER IMPROVE INFORMATION Activate, expand, improve cancer registration

20. Health Strategies in Europe. Lisbon, 12-13 July 2006. Coleman M.

21. CANCER REGISTRY: RECOMMENDATIONS Health Strategies in Europe. Lisbon, 12-13 July 2006. Coleman M. 1.Cancer Registries should inform the evaluation of programmes for: prevention (incidence), screening, treatment (survival). And, on long term follow-up for cure, care, social support, rehabilitation plans 2.Update the EU Directive (1995) to enable population- based registries 3.EU should recommend that all MS make cancer registration statutory, with special coverage by low in collecting data to avoid conflicts with the rights of confidentiality 4.Set EU standards for registration in countries with no cancer registry. Greece and Luxembourg and..

22. Cancer is an element of our societies To reduce risks: smoking&alcohol habits, bad diet, To reduce risks: smoking&alcohol habits, bad diet, insufficient physical activity, remove carcinogens insufficient physical activity, remove carcinogens To improve the cure, To improve the cure, To support those who experienced the disease To support those who experienced the disease To promote actions for cancer control Cancer registry population based information is the key