# Form

Gen_defin:
Number of patients who have recieved palliative radiotherapy

Rationale:
Quality of life for uncurable cancer patients

Utility:
Indication on diffusion of palliative care activity

Est_Numerator:
Number of patients who have received palliative radiotherapy

Databank:
Comparable data has not yet been produced

Name_ind:
Proportion of patients treated with palliative radiotherapy

NAME:
Proportion of patients treated with palliative radiotherapy


Gen_defin:
Use of morphine units per cancer patients and morphine ordered per phisicians

Est_Numerator:
Use of morphine units per cancer patients and morphine ordered per phisicians

Inf_Numerator:
International association of palliative care


Gen_defin:
Number of PET (Positron Emission Tomography) systems per 1 000 000 population

Rationale:
Level of availability of diagnostic facilities

Unit__meas:
Number of systems per 1 000 000 population

Est_Numerator:
Number of PET (Positron Emission Tomography) systems

Name_ind:
Percentage of Positron Emission Tomographies (PETs) on population

NAME:
Percentage of Positron Emission Tomographies (PETs) on population


Gen_defin:
Proportion of colorectal cancer cases receiving a liver ultrasound (or CT and chest x-ray) as a detection test for metastasis

Est_Numerator:
Number of male (or female) colorectal cancer cases at age x with presence of liver ultrasound (or CT and chest x-ray)

Est_Denominator:
Number of male (or female) colorectal cancer cases at age x classified as "advanced" cases or "metastatic" cases with condensed-TNM

Inf_Numerator:
Special studies organised in cancer registration areas

Inf_Denominator:
Special studies organised in cancer registration areas

Databank:
The availability data refer to the following reference regarding colorectal cancers in a limited number of European Cancer Registries. Greece and Luxembourg have not got Cancer Registries on their territory.

References:
Gatta G et al. Understanding variations in survival for colorectal cancer in Europe: a EUROCARE high resolution study. GUT 47-4: 533-538 (2000)

Notes:
The collection of this indicator should be extended in all European Cancer Registries

Name_ind:
Stage at diagnosis: percentage of cases with a metastatic test

NAME:
Stage at diagnosis: % of cases with a metastatic test - COLORECTAL CANCER


Gen_defin:
Distribution of the population by daily portion of all fruits and vegetables (excluding potato)

Rationale:
Fruit & Vegetables are a major dietary protective factor for tobacco related and several other cancers. The consumption of a variety of Fruit & Vegetables is a good proxy for a healthy diet

Utility:
Monitoring and promoting healthy lifestyles

Caveat:
Lack of accuracy in referring to and estimating consumption

Modalities:
By portion and, possibly, seperating fruit and vegetables

Est_Numerator:
Number of males (or females) at age x consuming Y daily portions of fruit & vegetables

Inf_Numerator:
Representative survey (covering all ages)

Inf_Denominator:
Representative survey (covering all ages)

References:
EFCOSUM underlines the possibility of having guidelines in order to collect dietary data that can be comparable among the European countries

Notes:
Cutting point would be reviewed on the basis of the results of scientific progress


Rationale:
Alcohol consumption is the major determinant of head & neck, aesophagus, liver and, possibly, breast cancer

Caveat:
The method of converting alcoholic drinks to pure alcohol may differ between countries. Generally beer is valued at 4-5%, wine at 11-16% and spirits at 40% of pure alcohol.

Unit__meas:
Mg per person (aged 15 and over) per day

Est_Numerator:
Number of males (or females) at age x consuming Y daily quantitities per day

References:
ECAS suggests having an indicator on "Total alcohol consumption" but also underlines the difficulty to have comparable data up to now

Cancer:
Upper airo-digestive cancers, liver, maybe breast


Gen_defin:
Percentage of obese and overweight population by BMI (Body Mass Index)

Rationale:
Obesity is associated with increased risk of breast, colon, kidney, endometrium cancers and esophageal adenocarcinoma

Utility:
To implement preventive actions and predict future risk for children

Caveat:
Under estimation of the individual values and under reporting

Modalities:
By BMI values (25-30 Kg/m2: Overweight; 30+ Kg/m2: Obesity)

Est_Numerator:
Number of males (or females) at age x with a BMI between 25 and 30 Kg/m2 (or 30+)

Est_Denominator:
Number of males (or females) at age x interviewed

Inf_Numerator:
EHRM survey. Specific survey for children

Inf_Denominator:
EHRM survey. Specific survey for children

Name_ind:
Body Mass Index distribution in the population

NAME:
Body Mass Index distribution in the population


Gen_defin:
Proportion of cervical cancer cases receiving a chest X-ray and pelvic image as a detection test for metastasis

Est_Numerator:
Number of cervical cancer cases at age x with presence of chest X-ray and pelvic image

Est_Denominator:
Number of cervical cancer cases at age x classified as "advanced" cases or "metastatic" cases with condensed-TNM

NAME:
Stage at diagnosis: % of cases with a metastatic test - CERVICAL CANCER


Gen_defin:
Proportion of the national population that is covered by general population-based Cancer Registries present in the "Cancer Incidence in 5 Continents" in a given year

Utility:
To estimate, from cancer registry data, national cancer indicators

Caveat:
Population coverage may not be representive of national population. The definition of population may be different in different countries (immigrants, refugees)

Modalities:
By registration span. For a given calendar year, the indicator shows the percentage of cancer registration coverage of 5, 10 and 20 years at least

Est_Numerator:
Sum of the populations covered by general population-based Cancer Registries present in the "Cancer Incidence in 5 Continents"

Inf_Numerator:
Cancer registries, IARC, ENCR, National CR Associations and National Statistics offices

Databank:
Cancer Incidence in 5 Continents. Greece and Luxembourg have not got Cancer Registries on their territory.

References:
Parkin DM et al. Cancer Incidence in 5 Continents Vol. VII. IARC Scientific Publications No.143

Notes:
Cancer Registries present in the "Cancer Incidence in 5 Continents" are only those satisfying particular registration quality controls

Name_ind:
Population Covered by high quality Cancer Registries

NAME:
Population Covered by high quality Cancer Registries


Gen_defin:
Number of new cases diagnosed in a time interval / Person years at risk in the same time interval

Rationale:
Main epidemiologial measurement of cancer occurence

Utility:
Basic epidemiological measure of cancer burden

Caveat:
Affected by screening activities and quality of Cancer Registries

Modalities:
By broad age classes (0-49, 50-64, 65+), cumulative risk, stage.

Databank:
EUROCIM. The subnational areas are the areas covered by Cancer Registries. Greece and Luxembourg have not got Cancer Registries on their territory.

References:
EUROCIM: The European Cancer Incidence and Mortality Database v 4.0. CD-ROM. European Network of Cancer Registries (ENCR)

Name_ind:
Cancer incidence rates, trends and projections

NAME:
Cancer incidence rates, trends and projections


Gen_defin:
Proportion of subjects that have attained a given level by ISCED level

Rationale:
Indicator of ability to use health facilities

Caveat:
There are no standardised educational levels in the different countries (ISCED classification)

Databank:
OECD Health Data. The data is available for different years


Gen_defin:
Total domestic expenditure plus exports minus imports of goods and services

Rationale:
Indicator of ability to provide health facilities

Unit__meas:
$ PPP (Purchasing Power Parity per Person)

References:
National Accounts of OECD Countries, Main Aggregates, Volume 1, 1988-1998, 2000 Edition.


Gen_defin:
Financial contributions and provision (by public and private institutions) of benefits to individuals in order to provide support during circumstances that adversely affect their welfare


Gen_defin:
A country's expenditure on health per person (public+private)


Gen_defin:
Government expenditure on health (public only) per person


Rationale:
Demographic determinant of cancer incidence

Est_Numerator:
Number of male (or female) population at age x in 2010 (or 2020 or 2030)

Est_Denominator:
Number of male (or female) population in 2010 (or 2020 or 2030)

Inf_Numerator:
Projections of the national statistic offices

Inf_Denominator:
Projections of the national statistic offices


Rationale:
To have information on general mortality


Gen_defin:
Percentage of women aged between 40-49, 50-69 and 70-74 examined by mammography by year span

Rationale:
Mammographic screening is generally accepted as a means of reducing breast cancer mortality and it is being implemented in all EU countries as at present

Utility:
Monitoring organised and "opportunistic" screening coverage

Est_Numerator:
Number of females at age 40-49 or 50-69 or 70-74 who had a mammography by the time of the last examination

Est_Denominator:
Total interviewed females at age 40-49 or 50-69 or 70-74

Name_ind:
Percentage of women that have undergone a mammography

NAME:
Percentage of women that have undergone a mammography


Gen_defin:
Total expenditure devoted to supporting population-based cancer registration

Utility:
To study relation between expenditure and outcome

Caveat:
It is not a full picture: this is a proxy

Modalities:
Per population covered by Cancer Registry and per national population

Unit__meas:
Euro's per million population (Considering all 25 European countries: Euro PPP)

Est_Numerator:
Public expenditures devoted to supporting population-based Cancer Registry

Est_Denominator:
Population covered by the Cancer Registry

Inf_Denominator:
Cancer Registries and National popoulation

Name_ind:
Total expenditure for population-based cancer registries

NAME:
Total expenditure for population-based cancer registries


Gen_defin:
Total expenditure on cancer organised mass screening programs by cancer site

Rationale:
Measurement of the effort against cancer

Utility:
To study the relationship between expenditure and outcome

Inf_Numerator:
European Breast and Cervix Cancer Screening Networks

Name_ind:
Total expenditure on organised cancer screening programmes

NAME:
Total expenditure on organised cancer screening programmes


Gen_defin:
Number of magnetic resonance systems per 1 000 000 population

Name_ind:
Percentage of magnetic resonance systems on population

NAME:
Percentage of magnetic resonance systems on population


Gen_defin:
List of specific anti-tobacco regulations in: school, work place, transport, public areas, sales to children/teenagers, hospital, taxes, advertising, sponsorship

Rationale:
Regulation has an effect on the smoking prevalence

Utility:
Comparison among countries in relation to smoking prevalence

Databank:
Tobacco country profiles. Appendix B: Legislation (Pagg. 443-508)

References:
Corrao MA et al. Tobacco Control Country Profiles. American Cancer Society, Atlanta, GA, (2000)


Gen_defin:
'Gini's index' is a commonly-used summary indicator of income inequality in a population.  It is presented as a 'coefficient' ranging from 0 to 1

References:
OECD Labour Market and Social Policy Occasional Paper "Trends and driving factors in income distribution and poverty in the OECD area", DEELSA/ELSA/WD (2000) 3.

Notes:
A gini level which is increasing towards 1 means that the distribution of income is becoming more unequal, while a gini coefficient that is declining towards 0 describes a more equal income distribution


Gen_defin:
Proxy for cancer treatment expenditure: public expenditure on cancer chemotherapy drugs, for some adjuvant therapies specific to cancer (to list) and for pain relief drugs

Inf_Numerator:
Macro estimations of the Health Ministry


Gen_defin:
It is based on a division of households into deciles. The data provides the percentage of the total disposable income (including all incomes, taxes, and benefits) in each decile on the total national income

Databank:
OECD Health Data. The data is available for different years and for different deciles

Notes:
A household is defined as a collection of individuals, who are sharing the same housing unit.  Each household is weighted by the number of individuals who belong to this household


Gen_defin:
Percentage of the population aged 15+, reporting to be current smokers

Rationale:
Major cause of lung and several other cancers

Utility:
To predict the future risk. Monitoring of and suggesting preventive initiatives

Caveat:
Under reporting. Definition of daily smokers

Est_Numerator:
Number of males (or females) with age x reporting to be current smokers

Est_Denominator:
Number of males (or females) with age x interviewed

Databank:
WHO Tobacco country profiles. Comparable data are not yet produced

Notes:
Current smoker: someone who smoked on average at least 1 gram of tobacco per day in the year before the survey

Name_ind:
Prevalence of current tobacco smokers among adults

NAME:
Prevalence of current tobacco smokers among adults


Gen_defin:
Percentage of people who have been invited to diagnostic work-up after screening by screening round

Databank:
The national evaluation of the organised screening programme indicators is not yet implemented. The data is only available for countries with national programmes.

References:
Data management in screening programmes. Project title: Vocational training and educational tool development for data managers in screening programmes.

Notes:
Organised screening programme: population-based system with a structure for quality control and assurance including quantitative information on screening performance indicators


Gen_defin:
Number of screen-detected cancers / examined population by screening round


Gen_defin:
Proportion of localised cancers on total screen-detected cancers

Unit__meas:
Proportion of localised cancers on total screen-detected cancers


Gen_defin:
True positive / (true positive + false positive) by screening round


Gen_defin:
Screening benign biopsies / screening malignant biopsies by screening round

Unit__meas:
Number of benign biopsies per 100 malignant


Gen_defin:
Number of cancer deaths in a given period / Person-years at risk during the same period

Utility:
Epidemiological measure for cancer description

Name_ind:
Cancer mortality rates, trends and projections

NAME:
Cancer mortality rates, trends and projections


Gen_defin:
Proportion of cases receiving a CT thorax examination as a detection test for metastasis

Est_Numerator:
Number of male (or female) lung cancer cases at age x with presence of CT Thorax examination

Est_Denominator:
Number of male (or female) lung cancer cases at age x classified as "advanced" cases or "metastatic" cases with condensed-TNM

NAME:
Stage at diagnosis: % of cases with a metastatic test - LUNG CANCER


Gen_defin:
Years lost due to cancer using general life expectancy as reference

Rationale:
Synthesize in a single measure the effects of cancer in a given population compared with competitive disease

Utility:
Particularly useful for countries which do not have cancer registration. Single measure able to express the impact of cancer in premature mortality

Est_Numerator:
Specific formula. See methodological form

Inf_Numerator:
Age-specific death statistics provided by the World Health Organisation

Databank:
Age-specific death statistics provided by the World Health Organisation. The indicator is easily collectable from these statistics.


Gen_defin:
Proportion of prostatic cancer cases receiving a bone-scan as a detection test for metastasis

Est_Numerator:
Number of prostate cancer cases at age x with presence of bone-scan examination

Est_Denominator:
Number of prostate cancer cases at age x classified as "advanced" cases or "metastatic" cases with condensed-TNM

NAME:
Stage at diagnosis: % of cases with a metastatic test - PROSTATIC CANCER


Gen_defin:
Average time between date of diagnosis and date of first treatment

Utility:
Indicator of health education and/or screening

Caveat:
The time intervals are very short (months or fraction of months) so uncertainty about dates is a problem.

Est_Numerator:
Sum of individual interval between first diagnosis date and first treatment date for site cancer cases at age x

Notes:
We recommend to organise pilot studies to define the dates of diagnosis and treatment


Gen_defin:
Proportion of cases classified as "localised" with the condensed-TNM

Caveat:
Some Cancer Registries do not collect data on insitu cancers

Est_Numerator:
Number of males (or females) site cancer cases at age x classified as "localised" with the condensed-TNM

Est_Denominator:
Number of males (or females) site cancer cases at age x

Inf_Numerator:
Routinary activity in the cancer registration areas

Inf_Denominator:
Routinary activity in the cancer registration areas

Cancer:
Breast, cervix, lung, prostate, colo-rectal cancers

Name_ind:
Stage at diagnosis: percentage of cases with early diagnosis

NAME:
Stage at diagnosis: percentage of cases with early diagnosis


Unit__meas:
Euro per million population (Considering all 25 European countries: Euro PPP)


Gen_defin:
Number of cancers detected in persons screened negative at the previous screening round (as % of expected incident cases)

Rationale:
Major indicator of screening sensitivity


Gen_defin:
True negative / (true negative + false positive)


Gen_defin:
Proxy for cancer prevention expenditure: public expenditure for campaigns, initiatives, facilities and so on against tobacco smoking

Rationale:
Preventative smoking actions should be an important Governmental issue because they are proven to have the largest effect in cancer risk reduction

Utility:
To monitor anti-tobacco actions in relation to smoking prevalence. Proxy for expenditure for cancer

Caveat:
Boundaries of expenses that are to be added to the indicator must be defined exactly; regional/local expenditures and charity interventions must also be taken into consideration

Inf_Numerator:
Governments and/or local administrations, Leagues against cancers

Name_ind:
Public expenditure for cancer prevention on anti-tobacco activity

NAME:
Public expenditure for cancer prevention on anti-tobacco activity


Gen_defin:
Total expenditure on cancer related clinical trials not supported by pharmaceutical companies, fundamental research and contributions from International Organisations


Gen_defin:
Percentage of the population aged from 10 to 14, reporting to be a daily or weekly smoker

Rationale:
Major cause of lung and several other cancers. Monitoring the future nicotine dependence

Utility:
To predict future risk. Monitoring of and suggesting preventive initiatives specifically addressed to the young population

Caveat:
Under reporting. Definition of daily or weekly smokers

Est_Numerator:
Number of males (or females) with age x reporting to be a daily (or weekly) smoker

Databank:
WHO Tobacco country profiles. The available data are from the following reference and refer to ages 11-15 and year 1998

References:
Currie, C. et al. (2000). Health behaviour in school-aged children: a WHO cross-national study. Health Policy for Children and Adolescent Series No. 1. Copenhaghen: WHO Regional Office for Europe

Notes:
"By age class" means "by individual year of age". No restrictions on definition of amount and duration of daily or weekly smokers

Name_ind:
Prevalence of tobacco smokers among 10-14 year olds

NAME:
Prevalence of tobacco smokers among 10-14 year olds


Gen_defin:
Proportion of colon cancer cases with Dukes B (or TNM Stage 2) not receiving adjuvant chemotherapy

Rationale:
To reflect the compliance with best practice in oncology

Est_Numerator:
Number of male (or female) colon cancer cases at age x with Dukes B (or TNM Stage 2) not receiving adjuvant chemotherapy

Est_Denominator:
Total number of male (or female) colon cancer cases with Dukes B (or TNM Stage 2) at age x

NAME:
Compliance with best oncology practice - COLON CANCER


Gen_defin:
Incidence variations for Pleureal cancer and/or Perithoneal cancer and/or Mesothelioma by period and by administrative unit

Rationale:
The occurence of mesothelioma largely reflects previous exposure to asbestos. Asbestos explains the majority of cases of mesothelioma and a sizeable proportion of lung cancer

Utility:
Monitoring reflects past exposure. Prompting actions intended to identify still present sources of asbestos exposure.

Caveat:
Reflects only past exposure. Diagnosis of mesothelioma is not yet well standardise

Unit__meas:
Temporal and geographical differences in incidence rates

Est_Numerator:
Number of males (or females) pleural, perithoneal cancers or mesothelioma incidence cases in a given administrative area at age x

Est_Denominator:
Male (or female) population in a given administrative area at age x

Inf_Numerator:
Cancer registries and Mesothelioma Cancer Registries

Inf_Denominator:
National statistics, Cancer registries and Mesothelioma Cancer Registries

Databank:
EUROCIM. The subnational areas are the areas covered by Cancer Registries.

Notes:
Even very few cases in a limited area should be followed by a public action in order to find the asbestos source

Cancer:
Mesothelioma, pleural and perithoneal cancers

Name_ind:
Exposure to Asbestos: mesothelioma incidence trends

NAME:
Exposure to Asbestos: mesothelioma incidence trends


Gen_defin:
Number of linear accelerators per 1 000 000 population

Modalities:
By all linear accelerators, linear accelerators with multi-leaf collimator and linear accelerators installed within the last 10 years

Unit__meas:
Number of linear accelerators per 1 000 000 population

Est_Numerator:
Number of linear accelerator equipments (or with multi-leaf collimator or installed within the last 10 years)

Name_ind:
Percentage of radiation systems on population

NAME:
Percentage of radiation systems on population


Gen_defin:
Number of diagnostic CT (Computed Axial Tomography or computed tomography scanners) systems per 1 000 000 population

Name_ind:
Percentage of diagnostic Computed Axial Tomographies (CTs) on population

NAME:
Percentage of diagnostic Computed Axial Tomographies (CTs) on population


Gen_defin:
Proportion of breast cancer cases receiving post-operative breast radiotherapy after breast conserving surgery

Est_Numerator:
Number of breast cancer cases at age x receiving post-operative breast radiotherapy after breast conserving surgery

Est_Denominator:
Total number of breast cancer cases at age x

NAME:
Compliance with best oncology practice - BREAST CANCER


Gen_defin:
Proportion of breast conservation surgery in pT1 cases (multiple cancers excluded)

Est_Numerator:
Number of pT1 breast cancer cases (multiple cancers excluded) at age x  receiving breast conservation surgery

Est_Denominator:
Total number of pT1 breast cancer cases at age x


Gen_defin:
Proportion of cervical cancer cases with FIGO-stage III/IV receiving combined chemo-radiotherapy

Est_Numerator:
Number of cervical cancer cases at age x with FIGO-stage III/IV receiving combined chemo-radiotherapy

Est_Denominator:
Total number of cervical cancer cases with FIGO-stage III/IV at age x

NAME:
Compliance with best oncology practice - CERVICAL CANCER


Gen_defin:
Proportion of cervical cancer cases with FIGO-stage "Ia2" and "Ib" undergoing hysterectomy with pelvic lymphonodatectomy (WERTHEIM-MEIGS hysterectomy)

Est_Numerator:
Number of cervical cancer cases at age x with FIGO-stage "Ia2" and "Ib" in cervical cancer undergoing hysterectomy with pelvic lymphonodatectomy (WERTHEIM-MEIGS hysterectomy)

Est_Denominator:
Total number of cervical cancer cases with FIGO-stage "Ia2" and "Ib" at age x

NAME:
Compliance with best oncology practice - CERIVICAL CANCER


Gen_defin:
Proportion of colon cancer cases with Dukes C (or TNM Stage 3) receiving adjuvant chemotherapy

Est_Numerator:
Number of male (or female) colon cancer cases at age x with Dukes C (or TNM Stage 3) receiving adjuvant chemotherapy

Est_Denominator:
Total number of male (or female) colon cancer cases with Dukes C (or TNM Stage 3) at age x


Gen_defin:
Proportion of lung cancer cases with non small cell undergoing radical surgery

Est_Numerator:
Number of male (or female) lung cancer cases at age x with non small cell undergoing radical surgery

Est_Denominator:
Total number of male (or female) lung cancer cases with non small cell at age x

NAME:
Compliance with best oncology practice - LUNG CANCER


Gen_defin:
Proportion of lung cancer cases undergoing staging with thoracic CT scanning

Est_Numerator:
Number of male (or female) lung cancer cases at age x undergoing staging with thoracic CT scanning

Est_Denominator:
Total number of male (or female) lung cancer cases at age x


Gen_defin:
Proportion of rectal cancer cases receiving pre-operative radiotherapy

Est_Numerator:
Number of male (or female) rectal cancer cases at age x receiving pre-operative radiotherapy

Est_Denominator:
Total number of male (or female) rectal cancer cases at age x

NAME:
Compliance with best oncology practice - RECTAL CANCER


Gen_defin:
Current prevalence of occupational exposure to a given carcinogen

Rationale:
Describing trends in exposure to identified carcinogens

Utility:
Monitoring of occupational exposure. To identify priorities for intervention and regulation

Caveat:
Limited accuracy of the assignment of exposures to job titles at country level

Modalities:
By carcinogens as defined in the IARC classification (1, 2A, some 2B).

Est_Numerator:
Number of males (or females) occupationally exposed to one or more carcinogens. We need to collect the number of exposed individuals and the number of exposures

Inf_Numerator:
Updating and expanding the present CAREX database

References:
Kauppinen et al. 2000 - Occupation Environment Medicine 57: 10-18

Notes:
Previous experience in CAREX should be repeated pooling and harmonising information from control groups in European community based case control and cohort studies

Name_ind:
Prevalence of occupational exposure to carcinogens

NAME:
Prevalence of occupational exposure to carcinogens


Gen_defin:
Percentage of the population aged 15+ reporting to have stopped smoking in the last 10 years

Rationale:
Monitoring the effectiveness of anti-tobacco prevention actions

Est_Numerator:
Number of males (or females) with age x reporting to have stopped smoking 1-4 (5-9) years ago

Est_Denominator:
Number of males (or females) with age x reporting to be current smokers and to have stopped smoking in the last 10 years


Gen_defin:
Percentage of the population reporting to be exposed to ETS by place

Rationale:
Passive smoking is recognized as a cause of lung cancer. Monitoring the effectiveness of the anti-tobacco prevention actions

Utility:
To predict future risk. Monitoring of and suggesting prevention initiatives

Caveat:
Over reporting. Definition of passive smoker

Modalities:
By exposition at work (including school), public places and at home

Est_Numerator:
Number of males (or females) with age x reporting to be exposed to ETS by place

Name_ind:
Prevalence of exposure to environmental tobacco smoke (ETS)

NAME:
Prevalence of exposure to environmental tobacco smoke (ETS)


Gen_defin:
Proportion of people carrying out physical activity (moderate and strenuous activities) by number of hours per working day or holiday

Rationale:
As colon cancer is related to sedentariness, physical activity can be proposed as a major preventive factor for colon cancer

Utility:
To promote compaigns encouraging physical activity

Modalities:
By number of hours per working days or holidays

Est_Numerator:
Number of males (or females) at age x carring out physical activity y hours per working days (or holidays)

References:
EUPASS recommends a European survey on physical activity (IPAQ)

Notes:
Organisation of validation studies is recommended. Also improvement of the examples in question A2 of the IPAQ survey is suggested


Gen_defin:
Proportion of persons reporting to be exposed to the suns radiation at work and during leisure time

Rationale:
Skin cancer incidences are increasing. Exposure of UV radiation is the major cause of skin cancers and it is a behavioural trait

Modalities:
By differentiation between "at work" and in the "leisure time"

Est_Numerator:
Number of males (or females) at age x reporting to be exposed to the suns radiation at work (or in the leisure time)


Gen_defin:
Mortality variations for Pleureal cancer and/or Perithoneal cancer and/or Mesothelioma by period and by administrative unit

Unit__meas:
Temporal and geographical differences in mortality rates

Est_Numerator:
Number of males (or females) pleural, perithoneal cancers or mesothelioma death cases in a given administrative area at age x

Name_ind:
Exposure to Asbestos: mesothelioma mortality trends

NAME:
Exposure to Asbestos: mesothelioma mortality trends


Gen_defin:
Ratio of the x-year observed survival rate expected in the group of patients to the 1-year survival rate expected in a demographically comparable subset of the general population

Rationale:
It reflects the survival experience of cancer patients, after removing the effects of non cancer causes of death. Recommended for geographical and temporal comparisons.

Modalities:
By year (1, 5, 10) and for all cancer and by proportion of cured patients

Databank:
EUROCARE. The subnational areas are the areas covered by Cancer Registries. Greece and Luxembourg have not got Cancer Registries on their territory. Some national data are estimations.

References:
Berrino F et al. Survival of Cancer Patients in Europe: the EUROCARE-2 Study. Lyon: International Agency for Research on Cancer; 1999 IARC Scientific Publications No. 151

Name_ind:
Cancer relative survival rates, trends and projections

NAME:
Cancer relative survival rates, trends and projections


Gen_defin:
Proportion of subjects living in the population at a given date with past diagnosis of cancer

Rationale:
Indicates how many people show potential medical, physical, psychological or social problems as a consequence of their cancer. Political interests

Utility:
Epidemiological measure for cancer burden description

Caveat:
It is a pessimistic measure, as it includes a (generally unestimable) number of subjects that are completely recovered and do not suffer from any other kind of inconvenience due to their cancer.

Modalities:
By total, 5-years, 2-years, morbid, pre-morbid

Databank:
EUROPREVAL. The subnational areas are the areas covered by Cancer Registries. Greece and Luxembourg have not got Cancer Registries on their territory. Some national data is estimation

References:
Micheli A et al. Cancer prevalence in European registry areas. Annals of Oncology 2002;132(6):840-865

Name_ind:
Cancer prevalence proportions, trends and projections

NAME:
Cancer prevalence proportions, trends and projections


Gen_defin:
Percentage of women aged 20-29, 30-59 and 60+ examined by cervical citology (or pap-smear) by year span

Rationale:
Pap smear is generally accepted as a means of reducing cervical cancer mortality and it is being implemented in all EU countries as at present

Est_Numerator:
Number of females at age 20-29, 30-59 and 60+ who had cervical citology (or pap-smear) by the time of the last examination

Est_Denominator:
Total interviewed females at age 20-29, 30-59 and 60+

Name_ind:
Percentage of women that have undergone a cervical citology examination

NAME:
Percentage of women that have undergone a cervical citology examination


Gen_defin:
Percentage of persons aged 50-74 who have had a colo-rectal cancer screening test by year span

Rationale:
Fecal occult blood screening is accepted as a means of reducing colo-rectal cancer mortality and is being recommended by the European Commission

Utility:
Monitoring organised (and "opportunistic") screening coverage

Est_Numerator:
Number of males (or females) at age 50-74 who had a colo-rectal cancer screening test by the time of the last examination

Est_Denominator:
Total population of males (or females) at age 50-74

Name_ind:
Percentage of persons that have undergone a colo-rectal cancer screening test

NAME:
Percentage of persons that have undergone a colo-rectal cancer screening test


Gen_defin:
Percentage of people living in houses by radon gas concentration

Rationale:
In some regions radon is a major cause of lung cancer

Utility:
To promote control measures aimed at reducing radon concentration. To identify high risk areas

Caveat:
Concentration of radon gas may not properly reflect the exposure to radon progenies, i.e. the actual risk factor.

Modalities:
By radon gas concentration (< 200 Bq/m3, 200-400 Bq/m3, >400 Bq/m3)

Est_Numerator:
Number of persons living in houses by radon gas concentration (< 200 Bq/m3, 200-400 Bq/m3, >400 Bq/m3)

Est_Denominator:
Total population for a given administrative unit

Databank:
Air quality guidelines-Chapter 8.3. The available data refer to different calendar years and different surveys.

References:
Bochicchio F et al. Radon in indoor air. Luxembourg, Office for Official Publications of the European Communities, 1995 (European Collaborative Action: Indoor air quality and its impact on man, No. 15)

Notes:
200 Bq/m3 is an administrative limit commonly used in different European countries


Gen_defin:
Percentage of population living in areas by PM10 (particulate matter <= µ³) daily average concentration (measured in microgrammes per air cubic metre)

Rationale:
Respiratory cancer risk is related to air pollution. PM10 is a good indicator of particulate air pollution

Utility:
Prevention of risk factors. Indications for actions

Caveat:
PM10 is not spelling a predominant risk factor. Air pollution is difficult to define. Coverage of monitoring networks. Definitions of sources and methods of measurement may differ from country to country

Modalities:
By PM10 (particulate matter <= µ³) daily average concentration (measured in microgrammes per air cubic metre)

Est_Numerator:
Number of persons living in areas by PM10 (particulate matter <= µ³) daily average concentration (measured in microgrammes per air cubic metre)

Est_Denominator:
Population covered by the monitoring networks

Inf_Numerator:
"Environmental health indicators for WHO European Regions". National monitoring networks

Inf_Denominator:
"Environmental health indicators for WHO European Regions". National monitoring networks

References:
The "Environmental health indicators for WHO European Regions" group includes in its list the indicator "% of population living in urban areas with a PM10 daily average above 50 microgrammes per air m3"

Notes:
It is strongly recommended to integrate this exercise with the collection of reports from European Countries related to air pollution

Name_ind:
PM10 (particulate matter <= µ³) emissions

NAME:
PM10 (particulate matter <= µ³) emissions


Gen_defin:
Hormonal Replacement Treatment drug use in the female population from 50 to 69

Unit__meas:
Number of HRT drug prescriptions per 100 000 women 50-69

Est_Numerator:
Number of Hormonal Replacement Treatment drug prescriptions

References:
EURO MED Project underlines the possibility to collect data on the HRT prescriptions

Cancer:
Breast and other hormone related cancers

Name_ind:
Prevalence of use of Hormonal Replacement Treatment Drugs

NAME:
Prevalence of use of Hormonal Replacement Treatment Drugs


Gen_defin:
Proportion of the national population that is covered by an organised screening programme in a given period by site

Rationale:
"Organised" screening is recognised as more effective than spontaneous "opportunistic" screening

Est_Numerator:
Population covered by an organised screening programmes who accepted (or not) to participate


