Tackling the Impact of Cancer on Health, the Economy and Society

This Special Focus chapter explores the potential impact of aligning cancer risk factor prevalence rates and cancer survival rates to the best rates observed across the 27 European Union (EU) Member States (MS), plus Norway and Iceland (EU27+2), for each age and sex group. Rather than predetermined international policy targets, which may or may not be achievable, this approach shows what some countries have achieved and could therefore be a realistic goal for others.

Achieving the best risk factor rates observed across age and sex groups in the EU27+2 (or across urban, commuting and rural areas for air pollution) has an impact on the average risk factor prevalence in all countries (Table 7.1). This is because no country has the best rates across all age and sex groups (or across urban/commuting/rural areas), leaving room for improvement in all countries. On average, achieving the best risk factor rates in the EU27+2 would reduce obesity prevalence by 4.6 percentage points, tobacco smoking by 12.2 percentage points, average alcohol consumption by 43%, reduce the prevalence of physical inactivity by 15.9 percentage points and PM2.5 air pollution levels by 45%.

Aligning the risk factor prevalence in all EU27+2 countries to the best performing country would prevent around 14% of all cancer cases, avert around 19% of premature deaths due to cancer, and save around 19% of healthcare expenditure on cancer (Figure 7.1). While diet has most impact on cancer cases and healthcare expenditure, the strong link between tobacco and lung cancer (Figure 7.2), combined with the high case fatality rate of lung cancer, mean that tobacco has the greatest impact on premature mortality. Overall, aligning cancer risk factors to the best rates observed across the EU27+2 primarily prevents colorectal and lung cancer cases.

Looking at country-specific results, in most countries diet and tobacco are the two risk factors where most impact can be achieved. When it comes to preventing cancer cases (Figure 7.3) and reducing healthcare expenditure on cancer (Figure 7.5), countries with high smoking rates (e.g. Bulgaria, Croatia, Greece, Latvia) see the greatest impact from addressing tobacco, while in other countries diet has a greater impact. However, in almost all countries reducing tobacco smoking has the greatest impact on premature mortality (Figure 7.4).

To understand the potential impact of improving cancer screening, diagnosis, and treatment, it is useful to look at the cancer survival rates achieved by other countries. Similar to the scenario presented in Chapter 4, where cancer survival rates were aligned to the best performer across the OECD and EU, here cancer survival rates (by age, sex and cancer type) were aligned to the best performer in the EU27+2 alone. Note that this scenario does not assume any change in risk factors, and thus no change in cancer incidence other than through demographic changes.

All countries in the EU27+2 can make improvements to their cancer survival rates (Table 7.2). This is because no country has the best survival rates across all cancer types, sex and age groups. On average across the EU27+2, cancer survival rates would improve by 12.2 percentage points if all countries achieved the best rates seen in Europe. This means that an additional 12.2% of cancer patients would survive their diagnosis.

It is estimated that, if all countries improved their screening, diagnosis and treatment of cancer, to the point at which they achieved the best possible 5‑year survival rates observed in the EU27+2, this would save a total of 70 000 premature deaths – one‑fifth (21%) of all premature deaths due to cancer (Figure 7.6). Countries with a high baseline cancer premature mortality rate, including Central and Eastern EU MS, would see the greatest improvement in premature mortality rates as well as in the percentage of deaths prevented.

For mouth and throat cancer, around four in ten premature deaths (42%) could be avoided if the highest survival rates were to be attained across the EU27+2 countries (Figure 7.7). Improved survival rates would also prevent nearly one in three premature deaths due to prostate cancer (31%). In absolute terms the impact on lung cancer is the largest, with nearly 18 000 premature deaths avoided every year – 25% of the total impact – followed by more than 14 000 premature deaths due to colorectal cancer.

As premature mortality decreases, the average life expectancy is estimated to increase in all countries, and by 5 months in the EU27+2 on average (0.41 years) (Figure 7.8). Central and Eastern MS, who see the greatest improvement in premature mortality rates, also see the greatest impact on life expectancy.

Improved cancer survival would increase the size and output of the workforce. In the EU27+2, it is estimated that the equivalent of 87 000 additional full-time workers would be available due to increased employment. However, improved cancer survival also means that the workforce would include more people living with cancer and older people who are more likely to have other non-communicable diseases (NCDs). As a result, there would be a reduction in workforce output due to increased absenteeism, presenteeism, and early retirement. However, these impacts do not outweigh the increased employment. Based on annual wages, per capita output would increase by EUR PPP 8.5 in the EU27+2 on average – including an increase of EUR PPP 13.0 due to employment (Figure 7.9). In total, improved cancer survival rates would increase the workforce output by EUR PPP 2.2 billion in the EU27+2.

As more people survive their cancer diagnosis, healthcare cost will go up: people will live for longer with cancer, they can get cancer again and they can incur cost for other diseases. If all countries improve cancer care to attain the best possible survival rates observed within the EU27+2, per capita health expenditure will increase by EUR PPP 29.1 per year on average in the EU27+2, even without additional per case costs (Figure 7.10). This includes EUR PPP 19.6 per capita in costs related to cancer treatment, as well as EUR PPP 9.5 for the treatment of other diseases. This is a 1.0% increase in overall health expenditure on average in the EU27+2, or a total of EUR PPP 13 billion – equivalent to the total annual health budget of the Slovak Republic and Slovenia combined.