Innovations in health care and mortality trends from 5 cancers in 7 European countries

Although the contribution of health care to survival from cancer has been studied extensively, much less is known about its contribution to population health. In a recently published study at the International Journal of Public Health, the authors sought to determine whether the introduction of selected health care innovations coincided with a favourable change in the trend of mortality in five cancers in seven European countries.

The cancers studies were breast, cervical and testicular cancer, Hodgkin’s disease and leukaemia. Data came from Estonia, France, West Germany, Netherlands, Spain, Sweden and UK, which have different health care systems. The innovations found to be most successful from literature searches were mammography and tamoxifen (breast cancer), the introduction of cervical screening (cervical cancer), cisplatin (testicular cancer), high dose therapy and peripheral blood stem cell transplantation (Hodkin’s disease) and improved treatment (leukaemia). Data concerned cause-specific mortality in the whole population from 1970 to up to 2007.

The authors could not find sufficient evidence for an association between innovations and favourable changes in mortality for any of the five cancers studied. The highest association found was that between the introduction of tamoxifen and breast cancer mortality.

The authors conclude that the lack of evidence of health care effectiveness may be due to gradual improvements in treatment, to effects limited to certain age groups or cancer subtypes, and to contemporaneous changes in cancer incidence. Research is limited by unreliable data on their introduction.


This study was conducted by Rasmus Hoffmann, Iris Plug, Martin McKee, Bernadette Khoshaba, Ragnar Westerling, Caspar Looman, Gregoire Rey, Eric Jougla, Katrin Lang, Kersti Pärna and Johan P. Mackenbach


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