Better Health For All

Dr Claudia Allemani

• by Dr Claudia Allemani, PhD FHEA MFPH
• Senior Lecturer in Cancer Epidemiology, Cancer Survival Group, London School of Hygiene & Tropical Medicine

In March 2016 I was delighted to receive a letter from Professor John Ashton, President of the UK’s prestigious Faculty of Public Health (FPH), congratulating me on being awarded FPH’s inaugural Global Public Health Award.

I was really happy. In a period during which finding support for public health research is becoming more and more challenging, this award gives me one more reason to pursue my professional goals.

My interest is in international comparisons of population-based cancer survival – much cheaper but far less sexy than clinical trials or molecular biology studies. Clinical trials are the gold standard for testing the efficacy of new treatments by randomised assignment of eligible patients, but they recruit patients selected on criteria of age, stage, co-morbidity, etc.

Population-based cancer survival is the gold standard for public health. It reflects the survival achieved for all cancer patients, regardless of their age, health status, stage of disease and access to care, and after eliminating the risk of death from causes other than cancer. It is a key measure of the overall effectiveness of health systems in the delivery of cancer care.

This award is a great professional honour for me personally as a public health scientist, but it is also an authoritative recognition of the global public health contribution made by the CONCORD programme, the 67-country collaboration that established world-wide surveillance of cancer survival in 2015 (The Lancet).

It also gives me a great opportunity to inform the UK public health community about this unprecedented enterprise, which I have the privilege to lead.

CONCORD: 67-country collaboration

The CONCORD-2 study provided estimates of 5-year net survival for patients diagnosed during 1995-2009 with one of 10 common cancers. We analysed data on 25.7 million individual cancer patients, contributed by 279 population-based cancer registries in 67 countries, 40 of which with 100% national population coverage. The CONCORD Working Group included 496 collaborators.

The Lancet article on CONCORD-2 was covered by 170 TV, radio, press and wire outlets world-wide, with intensive social media attention (Altmetric 770, above 99.98% of 4.8 million articles). Results have now been included in the American Cancer Society’s Cancer Atlas and the Global Lung Cancer Coalition atlas. The article has been downloaded over 43,000 times and cited over 270 times in the first 12 months.

Population-based cancer survival is used by policy makers to plan future cancer control strategies. The US Center for Disease Control and Prevention described CONCORD-2 as the start of global surveillance of cancer survival, with survival estimates “that can be compared, so scientists can begin to determine why survival differs among countries. This could lead to improvements in cancer control programs.”

This has already started. In July 2015, CONCORD-2 results were used to inform England’s new cancer strategy, Achieving world-class cancer outcomes: a strategy for England 2015-2020. In September 2015, the International Atomic Energy Agency’s Programme for Action on Cancer Therapy (PACT) used the results to drive an ambitious world-wide campaign to highlight the global divide in cancer survival, and to raise awareness of persistent inequalities in access to life-saving cancer services.

These unprecedented results still seem insufficient to convince some local charities to support this kind of scientific research, even if is instantly recognised as important by cancer patient bodies such as the European Cancer Patient Coalition, the European Cancer Leagues and national cancer patient associations from Argentina to Poland, Switzerland, Japan and the UK.

FPH’s independent judgement in giving this award for my work on the CONCORD programme may help to persuade these charities that to support global research also means supporting global research in their own country!

I am particularly delighted that this award has been made to an Italian cancer epidemiologist during the run-up to the European referendum – it gives me great pleasure to recognise the open-minded vision of public health professionals in the UK.

We have now issued the data call for CONCORD-3!