Title: Estimating survival gain for cost-effectiveness analysis: The example of early hormonal treatment in locally advanced prostate cancer
1European Federation for Colposcopy French
Society for Colposcopy and Cervical Pathology
3rd European Congress for Colposcopy and
Cervical Pathology Paris, January 23-24, 2004
- An overview of
- cervical cancer screening systems
- in Europe
M. ARBYN 1,2 1European Network for Cervical
Cancer Screening 2Scientific Institute of Public
Health, Brussels
2Cancer Screening policy in the EU(Council
recommendation)
3Conference on Screening and Early Detection of
CancerNovember 18-19th, 1999, Vienna
- Development of a European Strategy
- Organised by
- Europe Against Cancer
- Wiener Krebshilfe
- International Union for Cancer Control (IUCC)
- Consensus reached Advisory Commitee on Cancer
Prevention Eur J Cancer 2000 36 1473-8.
4Vienna Conference, 1999
- Evidence organised screening can reduce
cause-specific mortality from - Breast cancer
- mammography, women 50-69 years, 2-year interval
- Cervical cancer
- Pap smear, women from ?20 ? 30 to ?60 years, 3-5
year interval - Colo-rectal cancer
- FOBT, men women 50-74 years, 1-2 year interval
5Council recommendation on cancer screening(a
long way )
- Delay in translation of consensus into regulating
texts. - European consensus should be applied urgently by
health ministers. Arbyn M, Lynge E, Micksche M,
BMJ 2001 323 396. - Publication of the Proposal for a Council
Recommendation by the EU Commission, Brussels,
5th May 2003 (Ref 2003/0093 (CNS). - Consultation of member states and EU Parliament
(May-Nov 2003). - 2nd December 2003 endorsement of the Council
Recommendation. - Meanwhile 3th Update European Code Against
Cancer - Boyle P et al, Ann Oncol 2003 14 973-1005.
6Summary of the Council recommendation
- Based on the Vienna consensus
- Argumentation updated
- Screening policy less detailed
- Mammography for women 50-69 years
- Pap test for women starting at 20-30 years
- Colo-rectal cancer screening for man women
50-74 years - Screening only offered in organised programmes
- Monitoring QA at all levels invitation,
participation, screen test, follow-up of screen,
treatment, after-care, registration, data-linkage
(privacy!)
7Summary of the Council recommendation (2)
- Screening in accordance with evidence-based
guidelines - Research on new screening methods (RCT, public
health relevant outcomes mortality or
established surrogate endpoints) - Assessment of level of evidence concerning
effects of new methods by pooling results of
trials - Note European guidelines
- Breast Network 4th update in 2004 (funding ?)
- Cervix Network 2nd update in 2004 (funding ?)
- No guideline for colo-rectal cancer screening
- Note industrial lobbying!
- Question screening in new MS of the EU?
8Council recommendation but
- European Cancer Networks (EBCSN, ECCSN, ECSN) not
supported anymore in 2004 - Only marginal attention for cancer in the 2004
call for proposals - Nevertheless last article of the recommendation
- to encourage co-operation between MS in research
exchange of best practices evaluating new
methods
9References
- Advisory Committee on Cancer Prevention.
Recommendations on cancer screening in the
European Union. Eur J Cancer 2000 36 1473-78. -
- Arbyn M, Van Oyen H, Lynge E, Mickshe M. European
consensus on cancer screening should be applied
urgently by health ministers. BMJ 2001 323 396.
-
- Arbyn M, Van Oyen H, Lynge E, Micksche M, Faivre
J, Jordan J. European Commission's proposal for
a Council recommendation on cancer screening.
BMJ 2003 327 289-290. -
- Boyle P, Autier P, Bartelink H et al. European
Code Against Cancer and scientific justification
third version (2003). Ann Oncol 2003 14
973-1005. - Council of the European Union. Council
Recommendation of 2 December 2003 on cancer
screening (2003/878/EC). Official J Eur Union
2003 L327 34-38. -
- Coleman D, Day N, Douglas G, Farmery E, Lynge E,
Philip J, Segnan N. European Guidelines for
Quality Assurance in Cervical Cancer Screening.
Europe against cancer programme. Eur J Cancer
1993 29A Suppl 4 1-S38. -
- Commission of the European Communities. Proposal
for a Council Recommendation on Cancer Screening.
2003/0093 (CNS). Brussels, 5th of May, 2003. -
- Perry N, Broeders M, de Wolf C, Törnberg S,
Schouten J. European Guidelines for Quality
Assurance in Mammographic Screening, 3rd edition.
Office for Official Publications of the European
Communities, Luxembourg, 2001. -
10Burden of Cervical Cancer
11W-Age standardised mortality from and incidence
of cervical cancer European Union, 2000
Ferlay J, et al. GLOBOCAN 2000 Cancer incidence,
mortality and prevalence worldwide, Version 1.0.
IARC CancerBases No. 5. Lyon, IARC, 2001.
12W-Age standardised mortality from and incidence
of cervical cancer Acceding EU member states,
2000
Ferlay J, et al. GLOBOCAN 2000 Cancer incidence,
mortality and prevalence worldwide, Version 1.0.
IARC CancerBases No. 5. Lyon, IARC, 2001.
13Burden of cervical cancerEuropean Continent, 2000
- Estimated number of cases 66,000
- Number of deaths 29,000
14Cervical cancer mortality in Europe
Source Globocan 2000, IARC Map
produced by M. Arbyn
15IARC\iarc.do
16IARC\iarc.do
17IARC\iarc.do
18Number of deaths by cancer of the uterus
(Belgium 1954-94)
Arbyn M, Int J Cancer 2002
19Estimated number of deaths by cancer of cervix
and corpus uteri (Belgium 1954-94)
Arbyn M, Int J Cancer 2002
20Standarised mortality rate for cervical cancer
(Belgium 1954-94, European reference population)
24
22
Cervix uteri (certified)
20
18
16
14
deaths/100 000 women/y
12
Start screening
10
8
6
4
2
0
1955
1960
1965
1970
1975
1980
1985
1990
Year
Arbyn M, Int J Cancer 2002
21Cervical cancer screening systems
22Screening systems
- Organised screening
- more effective cost-effective
- Finland, UK gt1990, Denmark, Sweden, Iceland, The
Netherlands - Opportunistic screening
- overscreening
- heterogenous quality
- in most other European countries
Miscan.xls
23Effectiveness opportunistic versus organised
screening
- Case-control study Finland (Nieminen, Int J
Cancer, 1999) - History of previous Pap smears in 156 cancer
cases, 1139 controls - OR for no screening (ref) 1
- OR if organised screening 0.25 (.13-.48)
- OR if opport. screening 0.57 (.30-1.06)
- OR if org. opp. screening 0.27 (.15-.49)
Miscan.xls
24National cervical cancer policies in EU countries
Miscan.xls
Van Ballegooijen M et al, Eur J Cancer 2000
25Screening coverage in EU countries (Having had at
least 1Pap since screening interval)
European Network Cervical Cancer Screening, Eur J
Cancer, 2000 Rousseau A, Bull épid hebd, 2002.
26Study current status CC screening in Europe
- Update of the descriptive studies in 15 EU
countries (Eur Network for CC screening Eu J
Cancer, 2000) - Extension towards other countries of the European
continent - In collaboration with
Miscan.xls
27Questionnaire
- In collaboration with
- Eur Federation of Colposcopy
- WHO programme for Cancer Control in Europe
- European Cervical Cancer Association
- Developed by
- M. Arbyn, J. Jordan, P. Nieminen, JJ. Baldauf, S.
Thornberg
Miscan.xls
28Questionnaire
- Sent beginning January 2004
- Answers received from UK, France, Slovenia,,
Serbia, Hungary, Croatia, Germany, Czech
Republic, The Netherlands, Belgium - Contacts with Greece, Poland, Sweden, Finland,
Norway, Denmark, Iceland, Latvia, Lithuania,
Roumania - March (Tirana) Albania, Macedonia, Moldavia,
Russian Fed, Moldavia, Georgia, Azerbedjan,
Armenia - Q available m.arbyn_at_iph.fgov.be
Miscan.xls
29Q1 National screening policy
- Existing poliy
- Yes UK, France, Hungary, Slovenia, Belgium,
Netherlands, Germany - No Serbia, Czech R (pilot Pilsen Karvina,
Croatia - (planned in all countries)
-
Miscan.xls
30Q2-3 target age groups frequency (2004)
- UK
- 20-64 since Oct 2003? 25-64
- In 25-49 every 3y in 50-64 every 5y
- France, Belgium, Hungary
- 25-64/5 every 3y
- The Netherlands
- 30-60y every 5 y
- Germany
- 20 every year
- Slovenia
- 20-64y, starting yearly, after 2-tests every 3y
Miscan.xls
31Q5 Screening test
- LBC UK gradual introduction over 5y
- Pap smear /or colposcopy Serbia, Hungary
- Papsmear other countries
- HPV cytology in Croatia (?)
Miscan.xls
32Q6 organised national programme
- Yes UK, The Netherlands, Slovenia
- Regional France (4), Belgium (1), Czech R (2)
- Q9 who invited
- All (call) UK, The Netherlands
- Not recently screened women (call-recall)
Hungary, Slovenia
Miscan.xls
33Q17 Cytological report form
- Yes
- UK BSCC
- The Netherlands KOPAC/Pap
- Bethesda 2001 France, Belgium, Hungary,
Slovenia, Czech R, Croatia (Zagreb 2002) - No Germany, Serbia
Miscan.xls
34Q19 informed consent for data registration
- No, opportunity is given to refuse UK, France
- No Hungary
- Yes Belgium (1), Germany (mammography screening)
- Other countries no anwer
-
Miscan.xls
35Q 21 screening coverage UKEngland, 2003, 5-year
coverage for Pap smear screening
Paris2003Coverage.xls
36Q 21 screening coverage The Netherlands, 2001,
5-year coverage
Paris2003Coverage.xls
37Q 21 screening coverage France 1995-2000, of
women with Pap lt 3y ago
Paris2003Coverage.xls
38Screening status in Belgium(Health Interview
Survey, 1996 2000)
- Women 25-64 years, Pap smear lt 3 years ago
- Flemish Region 74.0 (70.6-77.4 )
- Walloon Region 64.0 (60.9-67.1 )
- Capital Region Brussels 64.1 (60.7-67.5 )
- HIS 2000 2-3 higher
39Belgium screened lt 3 years ago (Flemish
Region, 1996, telephone interview)
40Other questions
- Health education, promotion
- Data registration linkage procedures
- Result communicaton
- Prevalence of cytological lesions
- Guidelines for management
- Publication, documents
- For the details questionnaire suggestions
m.arbyn_at_iph.fgov.be - Work will be continued throughout 2004
- Feedback with country representatives
- Summary spread sheet on web side of collaborating
partners - Joint publication
41To conclude
- Large heterogeneity in cervical cancer screening
systems in Europe - Aim of the current study to document this over
all countries of the continent, share information
will all concerned partners - Hope that European guidelines will invite health
authorities decision makers, stakeholders,
member of the European Federation of Colposcopy
to more evidence cost-effective approaches to
offer the best available quality to as much as
women as possible
42To conclude (2)
- To hope
- European Commission will accept to set up again
Networks for Cancer screening - In order to realise the principles of the
European Council Recommendation on Cancer
Screening - A fortiori useful for the 10 acceding member
states