I Jornada Técnica de la ESTRATEGIA EN CÁNCER DEL SISTEMA NACIONAL DE SALUD

Madrid, MSC, 25 y 26 de Junio de 2007.

PROYECTO DE LA UNIÓN EUROPEA: GRUPO EUROPEO CONTRA EL

CÁNCER

Alfredo Carrato Catedrático y Jefe de Servicio Oncología Médica

Hospital Universitario de Elche, Univ. Miguel Hernández

CANCER CHARACTERISTICS

Cancer Incidence Rates*, All Sites Combined, All Races, 1975-2000

*Age-adjusted to the 2000 US standard population.Source: Surveillance, Epidemiology, and End Results Program, 1973-1999, Division of Cancer Control and Population Sciences, National Cancer Institute, 2003.

0

100

200

300

400

500

600

70019

75

1976

1977

1978

1979

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

Both Sexes

Men

Women

Rate Per 100,000

SITUACIÓN DEL CÁNCER EN ESPAÑA 2003

• 162.000 nuevos casos y 95.000 defunciones.• El cáncer es la primera causa de fallecimiento por delante de las

enfermedades cardiovasculares.• Uno de cada 3 hombres y una de cada 5 mujeres se diagnosticarán

de cáncer en algún momento de su vida.• El cáncer colorrectal es el más frecuente con 25.600 casos nuevos

anuales• Los más frecuentes:

– en hombres son el de pulmón (16.600 nuevos casos/año), el colorrectal (14.204) y próstata (13.212).

– En mujeres el de mama (15.979), colorrectal (11.461) y útero (7.164).

• Supervivencia a 5 años (57%): 64% en mujeres y 50% en hombres

Gene-Environment Interaction and Likelihood of Developing Cancer

A cancer gene could be expressed without any environmental influence oronly when activated by environmental factors. Lichtenstein P. N Engl J Med 2000; 343:78-85

FRENTES EN LA LUCHA CONTRA EL CÁNCER

• Aumento de conocimientos sobre la biología del cáncer (Incremento de la investigación básica, traslacional y clínica)

• Prevención primaria (Hábitos saludables, fármacos, cirugía, etc.)

• Prevención Secundaria (Diagnóstico precoz)• Mejorando el diagnóstico (Innovación tecnológica)• Mejorando el tratamiento (Fomento de la investigación

traslacional y clínica. Nuevos fármacos y estrategias. Tratamientos individualizados, administrados por profesionales bien entrenados)

Tobacco Use in the US, 1900-2000

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

1900

1905

1910

1915

1920

1925

1930

1935

1940

1945

1950

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

Year

Per

Cap

ita C

igar

ette

Con

sum

ptio

n

0

10

20

30

40

50

60

70

80

90

100

Age

-Adj

uste

d Lu

ng C

ance

r Dea

th

Rate

s*

*Age-adjusted to 2000 US standard population. Source: Death rates: US Mortality Public Use Tapes, 1960-2000, US Mortality Volumes, 1930-1959, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002. Cigarette consumption: US Department of Agriculture, 1900-2000.

Per capita cigarette consumption

Male lung cancer death rate

Female lung cancer death rate

Trends in Obesity* Prevalence (%), By Gender, Adults Aged 20 to 74, US, 1960-2000

*Obesity is defined as a body mass index of 30 kg/m2 or greater. Source: National Health Examination Survey 1960-1962, National Health and Nutrition Examination Survey, 1971-1974, 1976-1980, 1988-1994, 1999-2000, National Center for Health Statistics, Centers for Disease Control and Prevention, 2002.

1311

161512

1715

13

17

2321

26

3128

34

0

5

10

15

20

25

30

35

40

45

Both sexes Men Women

Prev

alen

ce (%

)

NHES I (1960-62) NHANES I (1971-74) NHANES II (1976-80)NHANES III (1988-94) NHANES 1999-2000

Supervivencia a 5 años en cáncer en la UE

• Justified by the challenge that cancer represents for Europe on the human, scientific and political fronts.

• The Alliance had come about as a result of a proposal made by European Ministers of Health in April 2005.

• Twenty-three representatives from European Member States were present at the first meeting in Paris, December 13, 2005

• There was a presentation by each country of their national organisation in the area of cancer, key challenge, innovative area of working and expectations from the Alliance.

• Policies, programmes and projects implemented by the European Commission were also presented.

European Alliance Against Cancer

Mission Statement

• "Cancer is a major health challenge for Europe. It is the secondcause of mortality and more than two million new cases are recorded each year.

• The European Alliance against Cancer aims:

• To define, promote and offer joint actions through voluntary cooperation to strengthen national measures and to ensure equal access to prevention and treatment for all European citizens, and to improve outcomes including patients’ overall experience of care.

• To explore ways of supporting research efforts and their implementation into practice."

Discussion on suggested areas of collaboration

• Clinical guidelines - Teresa Moss, UK • Tumour Banks* - Marcella Mottolese, Italy (E de Álava)• High throughput technologies* – François Amalric, France

(X Bustelo)• Education and Training* – Miklós Kásler and Maria Godeny ,

Hungary (A Carrato)• Clinical trials database – Thierry Le Chevalier, France• Primary prevention -Harald Zur Hausen, Germany• Secondary prevention. Sergio Pecorelli, Italy

Regina Elena Cancer Institute, Rome, Steering Committee Meeting, 27 April 2006

• 11 members of the steering committee were present at the meeting, representing 10 countries.

• In Europe, there are major differences in the level of health care between and within countries.

• EAAC was set up as an Alliance focused on political issues in cancer and therefore one of its objectives is to set the minimumservice which should be available in Europe

• Patients can move in Europe to get treatment with E112 documents which allow patients to be treated in another country because the ‘best treatment” is not available in their own country.

Educational Working Group MeetingNational Institute of Oncology, Budapest, 17th July, 2006

• Discussion about the educational systems of the present representatives (3) of the participant countries (9).

– Christine Lepage (EAAC member, France)– Alfredo Carrato (Spain) – Maria Gődény (Hungary) – Breborowicz (Poland)

• Minimum Recommendations have to be pointed for– Undergraduate programs (medical faculties, universities) – Graduate programs (resident’s training)– CME

Tumor Bank Working Group MeetingRegina Elena Cancer Institute Rome, 7th December, 2006

Distribución de tareas entre los miembros del equipo:

• preparar un documento para los Ministros de Sanidad de cada nacioón acerca de las condiciones mínimas que deben tener los bancos de tumores europeos,

• Una guía para la promoción de bancos nuevos, como para la acreditación de bancos ya existentes, allá donde aún no se hayan puesto en marcha sistemas de acreditación de biobancos (cualquier lugar excepto UK).

Budget

• France would finance the work of the Alliance and host the secretariat during the first year of its activities.

• It was agreed that each country should be asked to make a contribution to an initial budget for the next three years of the EAAC's activity and that individual working groups could also look for further funding from other sources such as the EC.

• It was agreed that industry funding for meetings was not acceptable.

• France, Germany, Italy, Portugal and Spain all thought that theywould be able to secure funding. Representatives from Hungary, Ireland and Luxembourg were not able to commit without further consultation and the Teresa Moss, for the UK, was sure that she would not be able to secure funding.

FACTORES CRÍTICOS PARA EL ÉXITO EN EL PROGRESO DE LA ONCOLOGÍA

Impulsar la colaboración entre todos los sectores y centrarla alrededor del paciente

Gobiernos Nacionales

Unión Europea

Agencias Reguladoras

InstitucionesAcadémicas

y otros ...

IndustriaFarmacéutica

Paciente

InstitucionesClínicas

Sociedades Científicas

Centros de Investigación

Incremento inversiones en prev formac asist e investig cáncer

¡¡Gracias!Gracias!