RESEARCH AND DEVELOPMENT
37 CANCER CONTROL 2021
their policy initiatives.
Such evidence can come from "high-resolution" studies,
in which detailed clinical data that are not systematically
captured at cancer registration are obtained directly from
the medical records, such as the stage of disease at diagnosis,
the investigations carried out to identify the stage of disease,
and the types of treatment provided for each patient. Analysis
of these data can show the extent to which international
differences in survival are likely to be due to differences in
stage at diagnosis or, for example, to under-treatment in the
elderly.
High-resolution studies can thus identify the key drivers of
inequalities in cancer survival.
VENUSCANCER will be a particularly important highresolution study,
because it is both population-based and
worldwide. It will provide details of the biological and
molecular characteristics of tumours in all women diagnosed
with cancer of the breast, ovary or cervix in a given country or
region, and on patterns of care, as well as short- and mediumterm survival, in over
40 countries.
Analysis of the VENUSCANCER data will highlight the
strengths and weaknesses of the health system in providing
care for all women diagnosed with one of these three common
cancers in each country.
Trends over time in the number of avoidable premature
deaths among cancer patients will offer a powerful contrast
with outcomes in better-performing health systems in
neighbouring countries. They stimulate policymakers to
plan more appropriate cancer control strategies. Avoidable
premature deaths are a powerful
way to express inequalities in
survival as a single number that
is suitable for policymakers:
"Politicians do not like to do things
that are too difficult. Simple,
clear messages are important"
(Baroness Delyth Morgan, Breast
Cancer Now).
Even in the twenty-first century,
safe and effective surgery is not
yet available in many countries
in the world. In some countries,
radiotherapy may be considered
a luxury, or may simply be
unavailable (4). Examination of
recent trends in cancer survival,
and in the number of avoidable
premature deaths, in the light of
the distribution of patterns of care,
will contribute key evidence for
widest possible geographic scope (option 1). Nevertheless,
we will also perform parallel analyses by tumour sub-type for
those registries that can provide data on biomarkers (option 2),
and analyses by socioeconomic status for the small proportion
of registries that aim to submit this information (option 3).
Over 100 registries submitted questionnaires for each
cancer; incidence for 2015-2017 was complete in over 90 of
these registries. Data completeness was high for stage, staging
procedures and treatment, only moderate for molecular
biomarkers, and low for comorbidities and socioeconomic
status.
Most cancer registries were willing to improve their data
completeness before submitting their data to VENUSCANCER.
Results for breast cancer are shown in Figures 3-5. Similar
results are available for cervical and ovarian cancers (data not
shown).
The call for data was issued on 21 December 2019. The
original deadline for data submission was 30 June 2020. Due
to the COVID-19 pandemic, this deadline was postponed to
September 2020. Since the pandemic has been affecting the
various areas of the world at different times, data collection
is still ongoing. By mid-September 2021, we had received data
sets from 49 cancer registries: 44 data sets for breast cancer,
42 for cervical cancer and 27 for ovarian cancer (Figure 2). We
expect to receive more data sets in the coming months.
Expected results
Health policymakers need good evidence on the reasons for
international disparities in cancer survival, in order to focus
BREAST CERVIX OVARY
§ Morocco
§ Nigeria
§ Algeria
§ South Africa
§† Mali
Mauritius *
Martinique *
Costa Rica *
Argentina
Puerto Rico *
§ Algeria
§ Nigeria
§ South Africa
Mauritius *
§ Costa Rica *
Cuba *
Puerto Rico *
Brazil
Martinique *
§† South Africa
§ Algeria
§ Nigeria
Mauritius *
Costa Rica *
§ Cuba *
Argentina
Ecuador
§ Uruguay *
0
20
40
60
80
100
Less
2Percentage of registries
0
20
40
60
80
100
Percentage of registries
Less
2
100ries
Data completeness
Percentage of registries
20 20
60
43
57
20
10
70
4
17
79
5
13 13
68
4
88
79
0
20
40
60
80
100
Less than 25% 25-49% 50-74% 75-100%
Percentage of registries
Data completeness
2012 (5 registries)
2013 (7 registries)
2014 (10 registries)
2015 (24 registries)
2016 (38 registries)
2017 (24 registries)
0
20
40
60
80
100
Less than 25% 25-49% 50-74% 75-100%
2012 (5 registries)
2013 (7 registries)
2014 (10 registries)
2015 (24 registries)
2016 (38 registries)
2017 (24 registries)
20 20
60
43
57
20
10
70
4
17
79
5
13 13
68
4
8 8
79
Figure 3: Breast cancer - stage availability by year of diagnosis (from questionnaires