Greece

Summary: Greece does not have a population-based cancer registry whilst the screening for cancer is opportunistic. 
A new National Action Plan against Cancer was presented in December 2008, along with other national action plans in the field of public health. Regarding the country’s GDP and comparing with other EU countries, cancer research funding and output are substantial.

Last update: 21 January 2009

Read sections A., B. and C. bellow:

A. Some information concerning Greece and cancer registration (5 headings)

1. Facts and considerations on cancer registration in Greece – notes by A.A. Terpos:

This document concerns information and data regarding the two previous efforts for cancer registration in Greece (period 1967-1986 and period 1990-2005) and contains a short history and a description of data sources, methods etc. supplemented with the relevant material (cancer registration forms, hospital in-patient discharge forms, death certification forms, lists of variables, summary tables extracted from the National Statistical Service of Greece etc.). Click to download the document (1.7MB, MS-Word file, 49 pages)

Please note that this document is part of a volume work which is to be published in due time. Therefore, this material has been transferred to the “Greece-II -Protected” section (requires a password).

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2. Cancer morbidity data (1990-1991):

Greek Cancer Registry: “Cancer Morbidity in Greece 1990-1991“, Central Health Council of the Greek Ministry of Health & Welfare, 1997, 135 pages in both languages Greek and English (click to download 6.9 MB).

This is a scanned version of the official publication of the Greek Cancer Registry. It concerns the official data of the 1st year of the 2nd effort for cancer registration (note that these data are the only official data published since the registry’s operation in 1990).

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3. The Greek Health Services

a) Abel-Smith et al. Report (1994):

Previous acquaintance and knowledge of the structure and function of the Greek Health Services as well as of the existing problems are necessary for the understanding of the causes of failure of cancer registration in Greece.

The following report is a key document that outlines the various aspects and problems of the Greek Health Services in 1994 and proposes a framework of actions for a new Healthcare system (note that most of the problems, described in 1994, are still present):

B. Abel-Smith, J. Calltorp, M. Dixon, Ad. Dunning, R. Evans, W. Holland, B. Jarman, E. Mossialos: “Report on the Greek Health Services“, June 1994, Ministry of Health and Social Welfare of Greece, Pharmetrica S.A., Athens 1994, 149 pages (click to download the English version 3.9 MB or click here to download the Greek version 5.5MB).

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b) Other sources on the Greek Health Services:

– WHO country profiles: Greece 

– National Statistical Service of Greece: NSSG , NSSG new site – requires subscription (click on English tab and follow instructions). Please note, Health Statistical data are poor.

– Literature references 1991-2007: click to download an MS-Word file (~36kB)

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4. Current situation on cancer registration in Greece

In June 2005, a new legislation (law 3370/2005) provided that the Hellenic Center for Disease Control & Prevention (KEELPNO) would take responsibility of the Cancer Registry and that it would elaborate b) the organisation and coordination of the national cancer network.

In November 2005, a scientific Advisory Committee for Cancer Registration in Greece (ACCR) was set up at the KEELPNO (decision 12 of 7 Nov. 2005). This committee submitted its proposal to the Board of Directors of KEELPNO in June 2006 (protocol No. 5212 of 29 June 2006). According to this proposal, the ACCR committee suggested two main actions: a) that a, appropriately staffed, Cancer Registry Department within the KEELPNO should be organised and established as soon as possible and b) that a preliminary feasibility study, followed by a full study in due time, should start as soon as possible. After a small delay, the proposal was forwarded to the Ministry of Health & Social Solidarity (press release of 10 Nov. 2006, NAFTEMPORIKI newspaper) while it was officially presented to the Board of Directors of KEELPNO in December 19, 2006.

A collaboration between KEELPNO and EUROCHIP Project started in December 18, 2006 and in May 31, 2007, a joint meeting between representatives from EUROCHIP, ENCR and members from the ACCR committee took place at the KEELPNO offices. The presentation of the material of each side was followed by a thorough discussion on the cancer registration problem in Greece.

In August 2007, the KEELPNO applied for the funding of a preliminary study on cancer registration in Greece.

UPDATE (21 Jan 2009): During July-August 2008, a project regarding the setting-up of the specifications of cancer registration in Greece was undertaken by an independent company, following a call for proposals issued by KEELPNO-HCDCP (this company was the sole participant of this contest). This study should have been finished by 30 August 2008 but, nevertheless, it has not been published yet.

Moreover, the National Action Plan against Cancer (see above), which comprises the creation of a Cancer Registry, is accompanied by a financial study and time-schedule for funding the cancer registration. The total budget, allocated for 2008-2012, amounts € 2,514,611. However, this financial study has to be evaluated (download the financial study – in Greek only).

OLD TEXT: However, to the best of my knowledge (last information December 2007), the fate of both a) the ACCR proposal (18 months after submission) and b) the application for funding the preliminary study is unknown.

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5. Some more data presented at the Ljubljana ENCR meeting (21 Sept 2007).

These data are comprised in the work entitled: “Raising funds for cancer registration: A proposal for and from Greece” by Asterios A. TERPOS. It is noteworthy that data on Tobacco Taxes as compared to the Government Health Expenditures at European level are included in this work.

      a) Abstract (click to download, PDF 75kB)

      b) Presentation (click to download, PDF 975kB)

Please note that the content of the presentation document is part of a volume work which is to be published in due time. Therefore, this material has been transferred to the “Greece-II -Protected” section (requires a password).

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B. National Cancer Control Strategy # Screening for Cancer # “HPV vaccine”

 

1. National Cancer Control Strategy:

UPDATE (21 Jan 2009): In December 17, 2009, the Ministry of Health & Social Solidarity announced a new National Public Health Plan for the period 2008-2012 which comprised 15 National Action Plans. Four of those action plans concern or relate to cancer control:

a) a National Action Plan against Cancer 2008-2012 (download ~2.1 MB, in Greek only)

b) a National Action Plan against Smoking 2008-2012 (download ~1.6 MB, in Greek only) which is accompanied by new legislation “for the Protection of Youths from Tobacco and Alcohol”; law 3730/2008 published in the official journal of the Greek Government FEK A’ 262/23.12.2008, to take effect from 1st July 2009 (link, in Greek only). [8 Jan 2010 update: Details of smoking restrictions in Greece including some old mandate regulations -the first in 1856, link in Greek only]

c) a National Action Plan to Reduce the Harmful Effects of Alcohol Consumption on Health 2008-2012 (download ~1.4 MB, in Greek only)

d) a National Action Plan for Proper Nutrition and Nutritional Disorders 2008-2012 (download ~1.8 MB, in Greek only)

Old text: Greece does not have a thorough National Cancer Control Strategy and only segmental measures exist concerning mainly tobacco use (about 40% of the adult population are smokers) as well as several recommendations on other issues. A draft plan was presented in February 2008 by the Ministry of Health.
Click here to download the current state (Feb. 2008) of Tobacco Restrictions in Greece (MS-Word file 36kB). In April (9th, 2008) The Ministry of Health announced a new Tobacco Control Strategy. This strategy shall be implemented after a forthcoming legislation will pass the Parliament.
A few years ago, the elaboration of a national cancer control plan was proposed and some documents were submitted to the Ministry of Health but no action was taken. Last February (2008), a draft was presented by the Ministry of Health & Social Solidarity but it is still very premature.

2. Cancer Screening: Regarding cancer screening, two large scale pilot efforts were organized in the past (in the framework of “Europe Against Cancer” Programme in the 1990’s) to screen women for BREAST and CERVICAL CANCER in the rural areas of Greece. However it is questionable whether they were true population-based screening programmes. Other smaller efforts exist at municipal level but in fact, cancer screening in Greece (both in urban and in rural areas) is opportunistic. This is the case for all three cancers (Breast, Cervix and Colon).

Some references
“Breast cancer screening programmes in 22 countries: current policies, administration and guidelines”	(link)
Quality Assurance for Mammography Screening in Halkidiki (1992-1999)	(link)
Quality Assurance programme for cervical cancer screening in Halkidiki (1992-1999)	(link)
Screening programmes in Peloponese-Greece: International Breast Cancer Screening Network, Council Meeting May 30-31, 2002 Montpellier, France, ABSTRACTS p.14 and p.17	(link)

3. HPV vaccination: In September 2007, the Government announced that the HPV vaccine was included in the national immunisation programme.

In February 5, 2008, a common announcement from the Ministries a) of “Employment & Social Protection” and b) of “Health & Social Solidarity” stated that all schoolgirls between 12-15 years old should get the vaccine (mandate) and that all females between 15-26 years old would be offered the vaccine optionally. It was decided that the cost of the HPV vaccination of both target groups shall be covered by the Social Insurance System since it is very expensive for the people to get it privately (€ 500 485 to 550 495 for the 3 shots plus the vaccine administration costs). Note that each age cohort consists of about 60,000 girls.

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C. Research on Cancer

There isn’t any single authority for the organisation and coordination of cancer research in Greece.  Most institutions, involved in cancer research, receive grants from the General Secretariat of Research and Technology (a government agency).

According to the “European Cancer Research Managers Forum – ECRMF” (2nd report) the funding of cancer research in Greece in 2004 was substantial (about € 40 million).  When compared with the other EU countries in terms of GDP, the cancer research funding in Greece was among the highest in the European Union. Most of this funding is public while charitable funding is almost absent.

Certainly though, according to several witnesses and other evidence, there are other private funding sources for cancer research that come from the pharmaceutical industry. It is said that the private resources are substantial but in fact unknown. An explanation is that, although the legal framework for research is rigid, there is no essential audit of the procedures while manpower and case recruitment are relatively easy and cheap as compared with other countries. 

The following table summarises the cancer research funding in Greece in 2004 (source: ECRMF –2nd report plus addition #).

Name of Institution	Type	2004 spend (m €)
General Secretariat of Research and Technology	Government Agency	38.70
National Hellenic Research Foundation	Government Agency	0.80
Ministry of Health and Welfare	Government Agency	Unknown – not responded
Hellenic Cancer Society	Charity	0.165
Pharmaceutical industry (#)	Private	Unknown but substantial

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