Where do OECD countries stand in the “war against cancer”?

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Gaétan Lafortune, Senior Economist and Principal Administrator, OECD Health Division

In his State of the Union address in 1971, President Richard Nixon declared a “war on cancer”. World Cancer Day provides a timely opportunity to reflect on how much progress has been achieved over the past 45 years in the United States and other OECD countries in winning this war.

The good news is that after a poor initial start in the 1970s and 1980s, the mortality rates from cancer (age-standardised to remove the effect of population ageing) have come down in most OECD countries since the mid-1990s, thanks to a reduction in important risk factors such as smoking and improvements in survival related to earlier diagnoses and better treatments. But still, all countries could do better in their fight against cancer to reduce the number of new cases through public health and prevention efforts, and by detecting cancer earlier and treating it adequately.

Large reduction in cancer mortality rates on average across OECD countries since early 1990s

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Source: OECD Health Statistics 2015, http://dx.doi.org/10.1787/health-data-en (extracted from WHO).

There were nearly 5.8 million new cancer cases in OECD countries in 2012 (up from 4.6 million a decade earlier) and 2.6 million deaths (up from 2.3 million a decade earlier), according to GLOBOCAN. Cancer incidence is higher in men than in women in all OECD countries, with average age-standardised incidence rates of 310 and 242 per 100,000, respectively.

Data recently reported in Health at a Glance 2015 show that cancer accounted for 25% of all deaths in 2013, up from 15% in 1960, mainly because there has been a much sharper reduction in deaths from cardiovascular diseases over the past 50 years. In several OECD countries, mortality rates from cancer among men are at least two times greater than among women, because of greater prevalence of risk factors (e.g., smoking and harmful alcohol consumption) and later detection.

Cancer Mortality, 2013 (or latest year)

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Source: OECD Health Statistics 2015, http://dx.doi.org/10.1787/health-data-en (extracted from WHO).

Information on data for Israel: http://oe.cd/israel-disclaimer

Lung cancer continues to be by far the main cause of cancer mortality among men, accounting for 26% of all male cancer-related deaths on average in OECD countries in 2013, but it is also the main cause of cancer mortality among women, accounting for 17% of all deaths. Breast cancer is the second most common cause of cancer mortality among women in OECD countries (15% on average).

Main causes of cancer deaths among men and women in OECD countries, 2013

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Source: OECD Health Statistics 2015, http://dx.doi.org/10.1787/health-data-en (extracted from WHO).                

The cost of cancer goes far beyond health care

Beyond the costs in terms of human lives, the economic costs of cancer are also considerable. Cancer consumes around 5% of all health care costs, and growth in spending on cancer is outstripping growth in total health expenditure. But the cost of cancer is not only borne by health systems. There are also opportunity costs related to the loss of productivity and working days.

In a population-based cost analysis in the Lancet, the economic burden of cancer across the European Union was estimated at €126 billion in 2009. Health care costs accounted for €51 billion, equivalent to €102 per citizen. Productivity losses because of early death cost €43 billion and lost working days €9 billion. Informal care costs – the cost of work and leisure time carers forgo to provide unpaid care for relatives or friends with cancer – amounted to €23 billion. Lung cancer had the highest economic cost of €18.8 billion.

Much more can be done to improve cancer care, but at what cost?

OECD research indicates that countries can do more to reduce the social and economic costs of cancer, and save lives. Survival after diagnosis of various types of cancer, such as breast cancer, cervical cancer and colorectal cancer, have generally increased over the past decade, thanks to earlier diagnosis and better treatments.

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Further progress is possible. It has been estimated that about one-third of cases could be cured if they are detected on time and adequately treated. Systematic screening of at-risk populations should be implemented where it is proven to reduce mortality, where cost-effectiveness is acceptable, where high quality is assured and the public is educated about the benefits and potential harms of screening.

Making cancer care rapidly accessible and of high quality, continuously improving services with strong governance such as a national cancer control plan, and monitoring and benchmarking performance through better data are also important in improving patients’ outcomes.

But the progress in cancer survival has come with a cost. New types of surgery, radiation therapy and chemotherapy (including the introduction of new high-cost drugs which in some cases prolong the lives of patients by only a few weeks) have contributed to increased survival, but at increasing cost. And it is likely that these costs will continue to grow, with population ageing and improved sensitivity of diagnostic tools leading to the detection of more cases. This will all add up to higher costs.

An important challenge in cancer care that many OECD countries have already started to face is balancing what may be doable given the growing range of possible treatment options and what may be sensible to pay for publicly. Economists can provide some guidance in making difficult decisions about resource allocation through cost-effectiveness analysis. But at the end of the day, it will require hard policy decisions to manage these fiscal challenges responsibly and sensitively.

Useful links

OECD Health Statistics 2015 The OECD Health Database offers the most comprehensive source of comparable statistics on health and health systems across OECD countries. It is an essential tool to carry out comparative analyses and draw lessons from international comparisons of diverse health systems.

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