Periodic Reporting for period 5 - VENUSCANCER (Women’s cancers: do variations in patterns of care explain the world-wide inequalities in survival and avoidable premature deaths?)
Reporting period: 2024-05-01 to 2025-04-30
VENUSCANCER is a world-wide study designed to explain the global inequalities in survival from breast, cervical and ovarian cancers, three of the most common cancers in women. The goal is to provide levers for health policy to reduce or eliminate avoidable differences in survival from these cancers.
Opening the World Cancer Congress in Paris (2016), President François Hollande insisted that women should be at the heart of cancer control, “because they are victims of inequality in access to prevention, treatment and screening in every country in the world.”
Cancers of the breast, ovary and cervix are a major public health problem world-wide. Each year, some 2.5 million women are diagnosed with one of these cancers, and they account for over 900,000 deaths. Many of these deaths are avoidable, even in low- and middle-income countries (LMIC), where cancers in women represent a major economic burden, both to families and to the national economy. Reducing the number of cancer deaths in women requires improvements in prevention, but also more effective health systems, to improve cancer survival. Yet access to safe surgery varies widely between the richest and poorest countries, and in more than 30 of the poorest countries, radiotherapy services are not available.
Differences in survival from these cancers between high-income (HIC) and LMIC are striking. Inequalities in survival also exist between HIC, and even between regions within those countries. The problem has been succinctly summarised: “political toleration of unfairness in access to affordable cancer treatment is unacceptable”. In 2015, the CONCORD programme established world-wide surveillance of trends in 5-year survival over the period 1995-2009, documenting for the first time the wide global differences in survival trends for most common cancers. In 2018, CONCORD-3 updated world-wide trends in survival for patients diagnosed up to 2014.
VENUSCANCER, embedded in the CONCORD programme, examines in greater depth why these enormous differences in 5-year survival still persist in the most recent years (2015-2018). It aims to explore how much of the differences in survival between HIC and LMIC can be explained by differences in biological characteristics of the cancers, or the health care women receive, or their socio-economic status.
The overall aim of VENUSCANCER is to provide actionable evidence for health policies to reduce the burden of women’s cancers world-wide. The key questions are:
• Why in the 21st century does survival from women’s cancers depend so much on where they live?
• How can population-based data be used to improve our understanding of the effectiveness of health systems in dealing with cancer?
• To what extent do stage at diagnosis and access to the main types of treatment explain inequalities in survival from women’s cancers?
• How many premature deaths that are attributable to inequalities in 5-year survival between and within countries can be avoided?
Opening the World Cancer Congress in Paris (2016), President François Hollande insisted that women should be at the heart of cancer control, “because they are victims of inequality in access to prevention, treatment and screening in every country in the world.”
Cancers of the breast, ovary and cervix are a major public health problem world-wide. Each year, some 2.5 million women are diagnosed with one of these cancers, and they account for over 900,000 deaths. Many of these deaths are avoidable, even in low- and middle-income countries (LMIC), where cancers in women represent a major economic burden, both to families and to the national economy. Reducing the number of cancer deaths in women requires improvements in prevention, but also more effective health systems, to improve cancer survival. Yet access to safe surgery varies widely between the richest and poorest countries, and in more than 30 of the poorest countries, radiotherapy services are not available.
Differences in survival from these cancers between high-income (HIC) and LMIC are striking. Inequalities in survival also exist between HIC, and even between regions within those countries. The problem has been succinctly summarised: “political toleration of unfairness in access to affordable cancer treatment is unacceptable”. In 2015, the CONCORD programme established world-wide surveillance of trends in 5-year survival over the period 1995-2009, documenting for the first time the wide global differences in survival trends for most common cancers. In 2018, CONCORD-3 updated world-wide trends in survival for patients diagnosed up to 2014.
VENUSCANCER, embedded in the CONCORD programme, examines in greater depth why these enormous differences in 5-year survival still persist in the most recent years (2015-2018). It aims to explore how much of the differences in survival between HIC and LMIC can be explained by differences in biological characteristics of the cancers, or the health care women receive, or their socio-economic status.
The overall aim of VENUSCANCER is to provide actionable evidence for health policies to reduce the burden of women’s cancers world-wide. The key questions are:
• Why in the 21st century does survival from women’s cancers depend so much on where they live?
• How can population-based data be used to improve our understanding of the effectiveness of health systems in dealing with cancer?
• To what extent do stage at diagnosis and access to the main types of treatment explain inequalities in survival from women’s cancers?
• How many premature deaths that are attributable to inequalities in 5-year survival between and within countries can be avoided?
Since May 2018, we have spent considerable time developing the protocol, and collecting “high-resolution” data (stage, staging procedures, bio-markers, treatment) for breast, cervical and ovarian cancers, in as many countries as possible. This is a major undertaking.
We held three VENUSCANCER Working Group meetings to discuss the protocol during international conferences. In February 2019, we invited over 300 cancer registries to complete online questionnaires to identify which registries have data at the required level of completeness, or are willing to improve their data. We presented a report in Lisbon, Portugal (2019), in Vancouver, Canada (2019) and in Moscow, Russia (2019). By September 2019, 123 cancer registries in 42 countries (4 LMIC, 14 UMIC, 24 HIC) had submitted at least one questionnaire, but 80% submitted all three. We included cancer registries with the highest availability and completeness of the required data.
Despite the difficulties posed by the COVID-19 pandemic and by Brexit, we finalised the legal contracts to permit the transfer of funds for data collection to selected cancer registries in LMIC, and data-sharing agreements with cancer registries in the 27 EU Member States, to enable transmission of sensitive personal data in compliance with the EU GDPR.
We have created the largest population-based high-resolution database for breast, cervical and ovarian cancers.
VENUSCANCER has produced the first real-world picture of the patterns of care and consistency with clinical guidelines for three of the most common cancers in women, using population-based data on a global scale. The first article is now in press with The Lancet.
Consistency of initial treatment with the main international clinical guidelines (ESMO, ASCO, NCCN) was very variable, particularly for surgery in early-stage breast cancer; for chemotherapy in advanced cervical cancer, and for surgery plus chemotherapy in metastatic ovarian cancer. Prompt access to optimal treatment for these three cancers is available for early-stage tumours in most countries, where some type of surgery is offered to most women. This means that if women in LMIC are diagnosed early, they can receive the same guideline-consistent treatment as in HIC. Unfortunately, the proportion of women who are diagnosed at an early stage in LMIC is still far too low. Lack of radiotherapy is still a major issue in LMIC, where mastectomy represents the only available option for women with breast cancer. Chemotherapy was a very frequent option, even in LMIC. The median time to treatment for early-stage cancer was generally less than one month in several HIC, but as long as four months to a year in some LMIC, leading to more advanced stage and sub-optimal treatment. Several cancer-specific articles will follow.
We have finalised the analysis on world-wide trends in avoidable premature deaths. These are the deaths that could be avoided if 5-year net survival in a given country were as high as in a comparator country with higher survival. We have produced results on avoidable premature deaths for breast and ovarian cancer for HIC and for LMIC, also by racial/ethnic minorities in selected countries. These articles will be submitted to high-impact journals shortly.
We held three VENUSCANCER Working Group meetings to discuss the protocol during international conferences. In February 2019, we invited over 300 cancer registries to complete online questionnaires to identify which registries have data at the required level of completeness, or are willing to improve their data. We presented a report in Lisbon, Portugal (2019), in Vancouver, Canada (2019) and in Moscow, Russia (2019). By September 2019, 123 cancer registries in 42 countries (4 LMIC, 14 UMIC, 24 HIC) had submitted at least one questionnaire, but 80% submitted all three. We included cancer registries with the highest availability and completeness of the required data.
Despite the difficulties posed by the COVID-19 pandemic and by Brexit, we finalised the legal contracts to permit the transfer of funds for data collection to selected cancer registries in LMIC, and data-sharing agreements with cancer registries in the 27 EU Member States, to enable transmission of sensitive personal data in compliance with the EU GDPR.
We have created the largest population-based high-resolution database for breast, cervical and ovarian cancers.
VENUSCANCER has produced the first real-world picture of the patterns of care and consistency with clinical guidelines for three of the most common cancers in women, using population-based data on a global scale. The first article is now in press with The Lancet.
Consistency of initial treatment with the main international clinical guidelines (ESMO, ASCO, NCCN) was very variable, particularly for surgery in early-stage breast cancer; for chemotherapy in advanced cervical cancer, and for surgery plus chemotherapy in metastatic ovarian cancer. Prompt access to optimal treatment for these three cancers is available for early-stage tumours in most countries, where some type of surgery is offered to most women. This means that if women in LMIC are diagnosed early, they can receive the same guideline-consistent treatment as in HIC. Unfortunately, the proportion of women who are diagnosed at an early stage in LMIC is still far too low. Lack of radiotherapy is still a major issue in LMIC, where mastectomy represents the only available option for women with breast cancer. Chemotherapy was a very frequent option, even in LMIC. The median time to treatment for early-stage cancer was generally less than one month in several HIC, but as long as four months to a year in some LMIC, leading to more advanced stage and sub-optimal treatment. Several cancer-specific articles will follow.
We have finalised the analysis on world-wide trends in avoidable premature deaths. These are the deaths that could be avoided if 5-year net survival in a given country were as high as in a comparator country with higher survival. We have produced results on avoidable premature deaths for breast and ovarian cancer for HIC and for LMIC, also by racial/ethnic minorities in selected countries. These articles will be submitted to high-impact journals shortly.
Health policy-makers need good evidence on the reasons for international disparities in cancer survival. Such evidence can come from “high-resolution” studies, which aim to identify the key drivers of inequalities in cancer survival. Analysis of detailed data on stage at diagnosis, investigations and treatment can show the extent to which international differences in survival are due to factors such as late stage or under-treatment in the elderly.
VENUSCANCER is an extremely important high-resolution study, because it is population-based, covering 39 countries world-wide. We analysed global consistency with clinical treatment guidelines for women diagnosed with breast, cervical or ovarian cancer, highlighting the effectiveness of each country’s health system in providing care. The first set of results, in press, will help drive policy to reduce inequalities in survival from these cancers in women. We also expect it to have an impact in the clinical domain.
Trends in the number of avoidable deaths within 5 years of diagnosis offer a powerful contrast with better-performing health systems in neighbouring countries. They stimulate policy-makers to plan more appropriate cancer control strategies.
VENUSCANCER is an extremely important high-resolution study, because it is population-based, covering 39 countries world-wide. We analysed global consistency with clinical treatment guidelines for women diagnosed with breast, cervical or ovarian cancer, highlighting the effectiveness of each country’s health system in providing care. The first set of results, in press, will help drive policy to reduce inequalities in survival from these cancers in women. We also expect it to have an impact in the clinical domain.
Trends in the number of avoidable deaths within 5 years of diagnosis offer a powerful contrast with better-performing health systems in neighbouring countries. They stimulate policy-makers to plan more appropriate cancer control strategies.