International Journal of Public Health

, Volume 59, Issue 2, pp 341–350 | Cite as

Innovations in health care and mortality trends from five cancers in seven European countries between 1970 and 2005

  • Rasmus HoffmannEmail author
  • Iris Plug
  • Martin McKee
  • Bernadette Khoshaba
  • Ragnar Westerling
  • Caspar Looman
  • Gregoire Rey
  • Eric Jougla
  • Katrin Lang
  • Kersti Pärna
  • Johan P. Mackenbach
Original Article



Although the contribution of health care to survival from cancer has been studied extensively, much less is known about its contribution to population health. We examine how medical innovations have influenced trends in cause-specific mortality at the national level.


Based on literature reviews, we selected six innovations with proven effectiveness against cervical cancer, Hodgkin’s disease, breast cancer, testicular cancer, and leukaemia. With data on the timing of innovations and cause-specific mortality (1970–2005) from seven European countries we identified associations between innovations and favourable changes in mortality.


For none of the five specific cancers, sufficient evidence for an association between introduction of innovations and a positive change in mortality could be found. The highest association was found between the introduction of Tamoxifen and breast cancer mortality.


The lack of evidence of health care effectiveness may be due to gradual improvements in treatment, to effects limited to certain age groups or cancer subtypes, and to contemporaneous changes in cancer incidence. Research on the impact of health care innovations on population health is limited by unreliable data on their introduction.


Cancer Mortality Health care innovation Outcome assessment (health care) Amenable mortality 



We thank Walter Holland for his input and valuable advices throughout the project, Esther de Vries for important comments on an earlier version of this paper and Janina Knuth for her help with layout and editing.

Conflict of interest

None declared.

Supplementary material

38_2013_507_MOESM1_ESM.doc (69 kb)
Supplementary material 1 (DOC 69 kb)


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Copyright information

© Swiss School of Public Health 2013

Authors and Affiliations

  • Rasmus Hoffmann
    • 1
    Email author
  • Iris Plug
    • 1
  • Martin McKee
    • 2
  • Bernadette Khoshaba
    • 2
  • Ragnar Westerling
    • 3
  • Caspar Looman
    • 1
  • Gregoire Rey
    • 4
  • Eric Jougla
    • 4
  • Katrin Lang
    • 5
  • Kersti Pärna
    • 5
  • Johan P. Mackenbach
    • 1
  1. 1.Department of Public HealthErasmus Medical CenterRotterdamThe Netherlands
  2. 2.Department of Health Services Research and PolicyLondon School of Hygiene and Tropical MedicineLondonUK
  3. 3.Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
  4. 4.CépiDc INSERMLe Kremlin-BicêtreFrance
  5. 5.Department of Public HealthUniversity of TartuTartuEstonia

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