Improving cancer control in the European Union: Conclusions from the Lisbon round-table under the Portuguese EU Presidency, 2007

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Abstract

Cancer is a major cause of morbidity and mortality in the European Union (EU), and a public health burden. Improving cancer control in the EU will require implementation of efficient strategies within Member States and better policy coordination between them. In cooperation between the rotating EU Presidencies of Germany (2007), Portugal (2007) and Slovenia (2008), special attention was devoted to an integrated approach to cancer control in EU policies and programmes. A round-table focussed on national cancer plans, population-based cancer registries and cancer screening programmes was held during the Health Strategies in Europe meeting in Lisbon in July 2007, under the Portuguese Presidency. These three topics were selected as critical for improving cancer control at both national and European levels. The round-table was designed to produce a set of recommendations to inform EU cancer policy. This paper provides a résumé of the conclusions and recommendations, to stimulate wider discussion and policy development.

The conclusions of the meeting were presented at the Employment, Social Policy, Health and Consumer Affairs Council in December 2007 and cancer was included in the Council Conclusions for the new European Health Strategy. Success in cancer control will require consistent attention from future EU Presidencies, such as the initiative of the Slovenian EU Presidency in early 2008.

Introduction

Germany, Portugal and Slovenia have collaborated on an 18-month health policy programme during their consecutive 6-month Presidencies of the European Union (January 2007–June 2008). Special attention has been given to improving EU policies and activities on cancer control. A round-table on cancer was included in the Health Strategies in Europe meeting in Lisbon in July 2007, under the Portuguese Presidency.

The Lisbon round-table was designed to advance European policy for improving cancer control, treatment and care in all EU member states. Cancer will be the main health topic of the Slovenian Presidency, in the first half of 2008. It was considered important to establish continuity with future EU Presidencies, in order (a) to ensure that progress in cancer control in the European Union comes under active surveillance, (b) to develop cancer control strategy in the EU, and (c) to make cancer control strategy a standing item on the EU health agenda.

The main conclusions of the round-table were that cancer must be recognised as a European public health priority, and integrated into wider European public health strategy. Improving cancer control in Europe will require sharing of expertise and best practice, continuous dialogue among all involved parties and better coordination of health policies between Member States.

We present the background, conclusions and recommendations of the Lisbon meeting, and its outcome in the Employment, Social Policy, Health and Consumer Affairs (EPSCO) Council in December 2007, to stimulate further discussion and policy development.

Section snippets

Background

Cancer is one of the major causes of disease and death in Europe. An estimated 3.2 million people were diagnosed with cancer in 2006, and there were 1.7 million cancer deaths.1 The annual number of new cases has increased by 300,000 since 2004. Ageing of the European population will cause these numbers to increase still further over the next few decades, even if the chances of being diagnosed with cancer at each age do not continue to rise.

European institutions have collaborated in many cancer

Cancer plans

The cancer burden can be influenced by interventions of all kinds, from primary prevention to end-of-life care. It is an extremely complex social undertaking to organise and deliver public health programmes that are designed both to reduce cancer incidence, with preventive services, and to improve cancer outcomes and reduce cancer mortality, with clinical services. It involves a wide range of professional expertise, and input from organisations at all levels within the health system.6 Relevant

Cancer registration

Population-based cancer registries collect data on all new cases of cancer occurring in a well-defined population, with the goal of improving cancer control. By 1955, cancer registries were operational in England, Germany, all five Nordic countries and Slovenia. Elsewhere in Europe, cancer registration started in the 1970s or later, with regional registries covering usually about 30% of the national population, though less in Eastern European countries.19 Today, 15 of the EU-27 Member States

Cancer screening

The ultimate purpose of cancer screening is to reduce cancer mortality, and to reduce the incidence of disease that is too advanced for curative treatment, thus improving the quality of life. The basic approach is early detection of disease that is not yet clinically detectable.

Screening has been shown to reduce cancer mortality in regional comparisons for cervical cancer (with the cervical smear or Pap test),30 and in randomised controlled trials for breast cancer (mammography)31 and

Summary and conclusions

Not all EU Member States have a national cancer plan, or a population-based cancer registry, or mass screening for cancers of the breast, cervix and large bowel. Member States that do have one or more such programmes still need to improve them in a number of areas.

All populations need an effective, integrated cancer plan for prevention, screening, early diagnosis and treatment of cancer, as well as cancer research. These activities are vital if we are to achieve long-term reductions in cancer

Conflict of interest statement

None declared.

Acknowledgements

On behalf of the EU Portuguese Presidency, the National Coordinator of Oncological Diseases would like to express his gratitude to all those who contributed to the Lisbon cancer conference and its outcome. We are also grateful to the European Society of Medical Oncology (ESMO) Foundation for their support.

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