title: Innovations in health care and mortality trends from five cancers in seven European countries between 1970 and 2005.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Public Health, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands, r.hoffmann@erasmusmc.nl.
authors.forename: Rasmus
authors.initials: R
authors.lastname: Hoffmann
authors.forename: Iris
authors.initials: I
authors.lastname: Plug
authors.forename: Martin
authors.initials: M
authors.lastname: McKee
authors.forename: Bernadette
authors.initials: B
authors.lastname: Khoshaba
authors.forename: Ragnar
authors.initials: R
authors.lastname: Westerling
authors.forename: Caspar
authors.initials: C
authors.lastname: Looman
authors.forename: Gregoire
authors.initials: G
authors.lastname: Rey
authors.forename: Eric
authors.initials: E
authors.lastname: Jougla
authors.forename: Katrin
authors.initials: K
authors.lastname: Lang
authors.forename: Kersti
authors.initials: K
authors.lastname: Pärna
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care; D004059:Diffusion of Innovation; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D009369:Neoplasms / Q000401:mortality*; D017063:Outcome Assessment, Health Care; D055815:Young Adult