FROM EUROCHIP-1 TO EUROCHIP-2

1. EUROCHIP-2 - The action FROM EUROCHIP-1 TO EUROCHIP-2 Public Health Program EUROPEAN COMMISSION: HEALTH & CONSUMER PROTECTION DIRECTORATE-GENERAL www.tumori.net/eurochip

2. EUROCHIP-1 • Consensus Conferences involving cancer experts of EU institutes, organisations and cancer networks • Development of a list of health indicators describing cancer in Europe: • a) to help the development of the • European Health Information System • b) to promote actions in cancer control Europe is characterised by unacceptable inequalities in cancer control

3. INDICATORS AT HIGH PRIORITY PREVENTION • Consumption of fruit and vegetables • Consumption of alcohol • Body Mass Index • Physical activity • Tobacco survey • Exposure to sun radiation • Prevalence of occupational exposure to • carcinogens (CAREX)

4. INDICATORS AT HIGH PRIORITY CANCER REGISTRATION & EPIDEMIOLOGY • Population covered by cancer registry • Cancer incidence rates, trends and projections • Cancer survival rates, trends and projections • Cancer prevalence prop., trends and projections • Cancer mortality rates, trends, projections and • person-years life lost due to cancer • Stage at diagnosis: % of cases with • early diagnosis and % underwent a metastatic test

5. INDICATORS AT HIGH PRIORITY SCREENING • Organised screening coverage • % of women underwent a mammography • % of women underwent a cervical cytology exam • % of persons underwent a colorectal cancer • screening test

6. INDICATORS AT HIGH PRIORITY CARE & TREATMENT • % of radiation equipments on population • % of diagnostic Computed Axial Tomography • (CTS) in the population • % of patients receiving palliative radiotherapy • Delay of cancer treatment: pilot studies • Compliance with best oncology practice

7. Gross Domestic Product and cancer outcomes (All cancers, M+F) I, Estonia, Poland, Slovenia, Slovakia, and Spain; II, UK, Finland, Netherland, Sweden, Italy, and Austria; III, Iceland, Denmark, France, Germany, and Switzerland

8. Gross Domestic Product (1997) and 5-year- age- and cancer site- adjusted relative survival (women) The area of the disk is proportional to the Total National Health Expenditure ($ PPP) in the country $ PPP: Parity Purchasing Power per capita (US $) Sources: OECD 2002 for GDP and TNEH; EUROCARE-3 for survival

10. Total Prevalence, All Cancer m+f, 1992 Prevalence per 100 000

11. GDP and cancer prevalence Cancer prevalence (world standard) $PPP prop. per 100,000 I) GDP<15611 996 II) 15611<GDP<17538 1355 III) GDP>17538 1560 I, Estonia, Poland, Slovenia, Slovakia, and Spain; II, UK, Finland, Netherland, Sweden, Italy, and Austria; III, Iceland, Denmark, France, Germany, and Switzerland

12. Public expenditure on health (PEH) and cancer survival 5-year- age- and cancer site- adjusted relative survival Men - Median values per tertile - 1997 (from Annals, modified, 2003) $PPP Males % Females % I) PEH < 920 27.3 41.7 II) 920 < PEH< 1492 42.0 53.0 III) PEH> 1492 44.8 54.2 I, Estonia, Poland, Slovakia, Slovenia, Czech Republic, and Spain II, Finland, UK, Italy, Netherlands, Austria, and Sweden III, France, Switzerland, Iceland, Denmark, Norway, and Germany

13. CTS and 5-year relative survival for all cancers MALES FEMALES Sources: OECD 2000, EUROCARE-3. ASSR: 5-year Age and cancer sites adjusted relative survival CTS: Computed Tomography scanners x 1000000 pop

14. THE HISTORY IN WEALTHY AREAS Last 30 yrs Improvement in CVD and cancer treatment Life expectancy increased Number of cancer cases is increasing Present Inflation of prevalent cases Next future NEEDS: Actions in primary prevention Short term: assistance, palliative care, and hospices In 10 yrs Long term: reduction of cases

15. Main Public Health Strategies in Europe for cancer • Wealthy areas (highest prevalence): Primary Prevention, management of queues • Less wealthy areas (lowest survival): Treatment and investment • All: focus on the elderly

16. JOINT WORK is essential to create action and to build a bridge between research and health plans

17. EUROCHIP indicators Epidemiology / Outcome Incidence Prevalence Survival Mortality & PYLL Stage Socio-economic indicators Prevention Fruit and vegetables Alcohol BMI & Physical activity Tobacco Sun radiation Occupational carcinogens Anti-tobacco regulations TNEH GDP PEH Care & Treatment Screening Radiation equipments CTS Palliative radiotherapy Delay of cancer treatment Compliance with guidelines Organised screening coverage % mammography % cervical cytologyexam % colorectal cancer screening test

18. Study on the EUROCHIP indicators (today available) Incidence Prevalence Survival Mortality & PYLL Stage Fruit and vegetables Alcohol BMI & Physical activity Tobacco Sun radiation Occupational carcinogens Anti-tobacco regulations TNEH GDP PEH Radiation equipments CTS Palliative radiotherapy Delay of cancer treatment Compliance with guidelines Organised screening coverage % mammography % cervical cytologyexam % colorectal cancer screening test

19. Correlations among indicators GDP: Gross Domestic Product TNEH: Total Expenditure on Health PEH: Public Expenditure on Health CTS: Computed Tomography Scanners x 1000000 pop. $PPP: Purchasing Power Parity ** <0.01 (2 tails) ASSR: 1-year and 5-year age-cancer sites adjusted relative survival for all cancers for males (M) and females (F)

20. Analysis on 18 countries: regression coefficients

21. Analysis on 13 countries(without Eastern countries): regression coefficients