With nearly 100,000 women lose their life to breast cancer every year in the European Union it is the most lethal cancer diagnosis for women in the EU.

And while health systems of the 28 different Member States have made progresses in providing better care, chances of early diagnosis and state of the art treatment depends heavily on where a patient lives.

The recently launched Breast Cancer Index illustrates very well on disparities in breast cancer care across the continent. While Northern European countries rank usually in the top 20% of this index, Eastern and Southern Europe’s health systems seem to provide less advanced care in the field of breast cancer.

All of the three Benelux countries can be found in the top six of this index including all 28 EU Member States. Sweden, Austria, and Germany are the other three countries in the top six. These are followed by the other two northern EU Members Finland and Denmark.

And Italy’s very heterogeneous health system lands a 9th rank in this new index, treatment outcomes vary a lot depending on which part of Italy a patient seeks care. Traditionally the health system of for instance the region of Lombardia is worlds apart from care infrastructure in the south of Italy. And while France’s health system is often ranked best globally by the World Health Organization it merely makes it on the 10th spot in this EU ranking.

Greece, Croatia, Latvia, and Hungary mark the last five ranks of the index and illustrate the strong North/West to South/East divide of breast cancer care in the EU. The index’ methodology focuses on indicators such access to screening, preventive measures, palliative care offers, medical specialists, outcomes like survival rates, the quality of cancer registries, and the populations’ lifestyle.

Looking at the top-ranked countries one can conclude that health systems which allow competition between providers both inpatient and outpatient seem to have a higher standard of breast cancer care.

• Breast Cancer Index 2018

Sweden’s successful tobacco harm reduction strategies have not only lead to by far the lowest smoking rates in the EU but also helped to get to the top of this ranking. And while the UK’s (acknowledging that is has several regional systems) centralized NHS is successful in maintaining high quality registries it falls short in focusing on individual cases and offering speedy treatments. 

Most Central & Eastern European countries saw economic growth over 3% in the last couple of years and while this also resulted in higher absolute healthcare spending it did not necessarily outpace the general GDP growth which would be necessary in order to bridge the gap in care compared to the ranking’s front runners.

The access to innovative medicine and government’s willingness to cover innovative medicine or at least allow private funding mechanism is not looked at by this index. If one would look at the time lags between the introduction and reimbursement of lifesaving innovative medicines in some of the index’ front runners and its poorest performers it is likely to assume that these results would correlate with most of what the index already shows.

This should put policymakers in the second half of the index’ ranks into a position to ask themselves how to tackle this massive problem of deficiencies in breast cancer care. At times of government austerity and debt crises in the Mediterranean one proven policy option would be to allow public private partnerships or fully private solutions that enable patients to purchase a top up coverage closing the gap between their home country’s level of care and what’s recommended by European guidelines.

Portugal has been experimenting with such new models that allow a better access to innovative medicines in care care. And while the country ranks 23rd on the overall index it is at a respectable 6th place when solely looking at outcomes and survival rates.

Policy innovations and more involvement of the private sector in improving care and funding of care are needed in order to successfully combat the notion that cancer equals a death diagnosis.

Originally published here