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Home » Breast Cancer, EU Health, Health, Healthcare Policy

How should the EU act differently in tackling the burden of breast cancer?

Submitted by on 14 Jul 2017 – 09:15

There is no better time than now to reflect on what individual member states could change in diagnosis and treatment of breast cancer. Francesca Colombo, Head of the OECD’s Health Division, and Rie Fujisawa, OECD Health Statistician present four major objectives for change

Breast cancer imposes a large health and financial burden on individuals and societies in Europe. It is the most common form of cancer among women in all European countries and on average, one in nine women will develop breast cancer at some point in their life. It is also the leading cause of death from cancer among women, followed by lung cancer and colorectal cancer, and one in thirty will die from the disease. Spending on breast cancer care accounts for up to 1% of total expenditure on health while the economic impact of the disease in terms of premature deaths and lost earnings is much higher.

The burden of breast cancer varies across European countries. In 2013, incidence rates were highest in Belgium, Denmark and France, with rates 40% or more than the EU average, while Greece has the lowest rate, followed by Lithuania and Romania. But countries with high incidence rates do not necessarily have high mortality rates and mortality from breast cancer was highest in Croatia, Ireland and the SlovakRepublic, and lowest in Spain, Portugal and Estonia.

These cross-country variations can be partly explained by the differences in how well countries deal with preventing, diagnosing and treating breast cancer. Although average screening rates for women aged 50-69 across the European Union has risen and the gap in screening rates has narrowed across countries in the past decade, breast cancer screening rates still range widely from 23% in the SlovakRepublic to over 80% in Portugal, Denmark, Finland and Slovenia in 2014.

There is also significant international variation in when and how breast cancer is treated. The waiting time between diagnosis and initial treatment for breast cancer varies from a few days in Iceland and Luxembourg to a few months in countries such as Poland and Slovenia. Conservative, breast-sparing surgery is the norm in most countries, but in a few countries, such as Finland, Luxembourg and Poland, more aggressive treatment of mastectomy is more common than other countries.

Even after taking into account differences in the nature of the disease, this may suggest cross-country differences in the application of evidence-based cancer care.

Across countries, survival after the diagnosis of breast cancer, which reflects quality of care based on early diagnosis and timely and adequate treatment, still varies, although it is improving over time. While five-year relative breast cancer survival is above 80% in most EU countries, it is lower than 75% in Estonia and Poland. Poland also shows the lowest relative survival for other cancers such as cervical and colorectal cancers and these low rates appear to be related with limited care access and relatively fewer numbers of cancer care centres and radiotherapy facilities.

However, over the last decade, breast cancer survival has improved across all EU countries, and this increase has been particularly noticeable in Estonia, the Czech Republic and Latvia. This reflects advances in improved treatments as well as public health interventions to detect the disease early and greater awareness of the disease.

Nonetheless, countries can do more in the ongoing fight against breast cancer by pursuing the following four objectives:

• Put adequate resources into breast cancer care – Expensive healthcare is not necessarily the best care: countries need the right policies in place to use resources such as workforce or equipment to diagnose and treat breast cancer effectively and fairly.

• Ensure that breast cancer care is both rapidly accessible and high quality – early diagnosis and treatment is key in the fight against breast cancer. Patients should be able to access evidence-based, high-quality care quickly, with minimal waiting times to see specialists. Ensuring that care is multidisciplinary and delivered in specialist cancer units while putting patients at the centre of care is increasingly being used to improve the quality of cancer care.

• Continuously improve services by strengthening the governance of cancer care – the bedrock of governance is an effective national cancer control plan. These help focus political and public attention on the performance of cancer care systems, attract new resources, and drive debate on difficult topics such as resource allocation. They also offer opportunities to reinforce the common goals and approaches shared by patients, health care providers, researchers and other stakeholders.

• Monitor and benchmark performance through better data – countries need to build rich information systems to monitor outcomes, costs and quality of cancer care. Public dissemination and benchmarking of performance, as well as incentives set adequately around quality improvement can help to reduce variations in breast cancer care and ensure continuously improving quality.

A pre-requisite, however, is a rich and detailed information system which can track patients’ diagnoses, treatment and outcomes of breast cancer care.

References:

1. OECD/EU (2016), Health at a Glance: Europe 2016 – State of Health in the EU Cycle, OECD Publishing, Paris; http://dx.doi.org/10.1787/9789264265592-en

2. OECD (2016), Health Statistics, OECD Publishing, Paris.

3. OECD (2014), OECD Reviews of Health Care Quality: Czech Republic 2014 – Raising Standards, OECD Publishing, Paris, http://dx.doi.org/10.1787/9789264208605-en

4. OECD (2013) Cancer Care: Assuring Quality to Improve Survival, OECD Health Policy Studies

5. OECD Publishing, Paris, http://dx.doi.org/10.1787/9789264181052-en