Health expert: Cancer control plans must be implemented

Dr Tit Albreht is a Senior Health Services and Heath Systems researcher at the National Institute of Public Health of Slovenia. [Photo by Sarantis Michalopoulos]

This article is part of our special report How Europe can better tackle rising cancer incidence.

Governments should take full responsibility for implementing national cancer plans, which are a commitment toward people and not just a piece of paper, health expert Dr Tit Albreht told in an interview.

Dr Tit Albreht is a Senior Health Services and Health Systems researcher at the National Institute of Public Health of Slovenia.

He spoke to EURACTIV Editor Sarantis Michalopoulos on the sidelines of the ECCO 2019 European Cancer Summit on 12-14 September 2019 in Brussels.

Smoking and alcohol

Dr Albreht said the risk factors in the region, mainly tobacco and alcohol consumption, remain insufficiently dealt with.

He said there is too much freedom of smoking as well as exposure to passive smoking for a large part of the population.

“In many countries, almost half of the adult population is still smoking. When you go to these countries, the restrictions to smoking in public places are sometimes either not introduced, or they’re not implemented. Some of them have not even joined the framework convention of tobacco control. This had been for many years a problem in Bosnia, for example,” he said.

He said for some countries it is a sort of a trade-off, considering that they also grow tobacco. “Especially the tobacco industry was pressuring, even the European Commission, that supposedly the incomes from excise tax, and from taxation are bigger than the costs of losing, basically productivity and lives. Which is not true, we know that, and it’s just the bias that the industry has always had.”

Referring to alcohol, he said it is common knowledge that 12 cancers are related to excessive consumption of alcohol. Apart from digestive cancers, he also said there is a link between breast cancer and excessive drinking.

“It’s surprising, because, in this area, the European Commission did act in the past. And it’s one of their missions, considering that in the field of public health the EU Commission has much more space to act than in the field care itself.”

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Cancer control plans, just on paper

Dr Albreht, who is also coordinating a joint action on cancer control, said when the EU Commission called on member states to produce National Cancer Control Plans by 2013, a guide and a structure on what the plan should include were provided.

“But we still see that people skip evaluation, that there are no targets in the plan. The biggest problem is the implementation and the classical political game.

“We produce the document and now our job is done. So now it’s up to actors in the society to implement it. Well, it’s not, because of course, the cancer plan is a policy, political document, which is a commitment. So the ministry cannot delegate the responsibility to someone else. It can of course if they appointed an institution. But generally, it is still in the hands of the ministry,” he said.

Referring to cancer registries, he noted that many governments view them as additional red tape because they do not understand the capacity that the data can have.

“I was asked to provide my advice for Serbia’s national cancer plan. And the main problem there with the registry is that it does not catch the whole incidence.”

“The second problem is that the linkages to the registry of the diseased persons, so that you would calculate the mortality and survival rate, does not exist, although it’s just a bureaucratic matter. So, that could be resolved if they could do it. And they don’t do it. And the ministry doesn’t understand the meaning of that. Survival is a very important piece of information,” he added.

Referring to the EU member states in the region, he said on paper all of them have national cancer plans except Slovakia, which has not formally adopted it yet. The Czech Republic, Slovenia and Hungary have implemented them.

But he insisted that in many countries, implementation remains an issue. He cited as an example Romania, where the plan was technically prepared in 2016 but since then nothing has happened.

“The plan is sitting there. And we even asked the government or the ministry to provide us with a copy. And they said they could give us pieces of it. What do you mean pieces?” he wondered.

Asked if, in Slovenia, his home nation, the national cancer plan has brought results, he replied: “We reduce the incidence of colorectal cancer because of the screening or program. It took us eight years. But we now have 25% less incidence than before.”

The importance of screening

Dr Albreht emphasised the role of screening programmes, which in the beginning indeed increase the incidence because more cancers are detected. But in the long run, it saves lives.

However, he said some countries have to reconsider their stance toward screening programmes, as they view them as an additional cost.

“In Slovenia, introducing the colorectal cancer screening program meant that apart from the tests, people who are positive have to go for colonoscopy and you have to pay for treatment for all these people that you detect earlier than before.”

“And this is all technically additional costs. It’s hard to say additional as it’s a cost that would appear sometime in the future. And now it appears sooner. More people have chances of survival. So it’s cost-effective for sure,” he added.

“But, you know, in healthcare, it’s often like this. First, you have the cost, and then you have the gains. And for accounting, first, you have to pay and then you will probably see benefits in the future,” he concluded.

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