Switzerland weak in prevention and aftercare, says expertOf the forty countries in Europe, Switzerland currently has the highest rate of melanoma, the fifth highest rate of breast cancer (the second place for the French-speaking cantons), and the eighth highest rate of prostate cancer. We sat down with the head of the Geneva Cancer Registry, Professor Christine Bouchardy, to discuss the causes of some of these alarming figures, as well as the factors bedeviling cancer care in one of Europe’s healthiest nations.
Each year 35,000 people are diagnosed with cancer in Switzerland. 16,000 people—foreigner and expat alike—will die from it, with over 3,000 succumbing to lung cancer alone. Untold hundreds of thousands more will be forced to alter their daily routine to better take care of a sick friend, relative or spouse. Simple arithmetic means that by the time you go to bed this evening, 95 Swiss residents will have been diagnosed with cancer, and 43 will have died from the disease.
Indeed despite its reputation for healthy living, Switzerland is at the center of what some leading healthcare analysts such as Prof. Christine Bouchardy, have called a cancer epidemic. Prof. Bouchardy, the Chief Medical Officer of the Geneva Cancer Registry (a cantonal public health organization focused on the collation and analysis of cancer-related statistics), not only integrates these figures into her work as a scientist, but also uses them to analyze Geneva’s record on prevention, treatment and aftercare. Cancer survival in Switzerland is also one of the highest in the world. These patterns of high incidence and low mortality reflect that most of resources in our country are devoted to high quality of care, acquisition of new, expensive and attractive technology for cancer diagnosis and treatment. However Switzerland, she says, while strong in treatment, is remarkably weak in prevention, screening strategies and after-care. These weaknesses, she argues, hamper efforts to understand not only the root causes of cancer, but also the side effects of both treatment and disease alike.
Why do some cancers seem to be more prevalent than others? Prof. Bouchardy lays the blame on environmental and behavioral factors. Certain lifestyle choices, she argues, seem to be triggers for the appearance of certain forms of cancer, as well as their prevalence in Swiss society. She rattles off a few sources, and their levels of risk for society at large. Smoking, she mentions, a vice in which 27% of the Swiss population indulges, is a major cause of lung and other cancers. Eating red meat, she explains, appears to also be a potential trigger for colon cancer, and a diet high in smoked, pickled or salted foods is also strongly linked to stomach cancer. Moreover, as Prof. Bouchardy argues, some factors are endemic to Swiss life: Switzerland’s high altitude and a (natural) propensity among its citizenry to indulge in activities taking advantage of the world’s sunny holiday destinations, she claims, are partially responsible for a spike in melanoma rates in young women, as is a recourse to unregulated tanning beds keep a healthy-looking tan during the winter.
Lack of Swiss political priority for cancer prevention and screening Switzerland is one of the richest OECD countries, but puts little efforts in public health.
Of the total health expenditure, Switzerland spends less than 2.7%, average of all OECD countries, in disease prevention and promotion. For example, it was only in 2010, way later than other OECD countries that Switzerland established a law on smoking bans. She also singles out the case of menopausal hormone replacement therapy, which at one point was used by nearly half postmenopausal women in Switzerland, and was later found to cause up to 30% higher risk of breast cancer, a mindboggling figure. Yet even on the scientific level, Prof. Bouchardy notes that there is a lack of comprehensive attention on the part of Swiss authorities to further research for the causes of cancer, and a misdirected effort towards specialization rather than cheaper and potentially more effective holistic preventive healthcare. In fact, Switzerland’s investment in prevention, health promotion and epidemiology (the study of diseases among the population) is a very small fraction of what is invested in curative care. Part of the problem is systemic: Swiss health authorities, she notes, prefer to disproportionally invest in training specialist physicians, ideal for treatment, and neglect prevention efforts.
On a more fundamental level, Prof. Bouchardy also notes the lack of attention given to public health in Switzerland’s public school system, especially when compared to the systems of countries in Northern Europe and North America. Despite the fantastic job of Swiss schools of turning out well educated students, she says that these same schools have done a dismal job for ensuring that their students follow through with basic instructions regarding healthy eating, physical fitness, smoking, and sexual hygiene. Nor, she notes, have the schools done a particularly good job of integrating public health into their other activities; the relatively lax engagement of Swiss schools is a far cry from programs such as the Terry Fox run in Canada or the various ribbon campaigns hosted by schools across the United Kingdom and the United States.
Preferential investment on top quality of care
In Switzerland most resources are invested in diagnosis and treatment to improve survival of cancer patients, and the results show that we have indeed higher survival rates than in other European countries. However, much more could be done, in particular for those cancers for which early detection and screening could be possible, such as breast cancer, cervical cancer, colon cancer and melanoma, but there are no national programs established for these cancers in Switzerland yet. As to date, most of the decisions about preventive measures are taken at a cantonal level, which is why there are great disparities in cancer screening program offers. The implementation of a nationwide breast cancer screening program to follow the OECD/WHO 2006 recommendations is still in progress due to uncoordinated cantonal and federal policies and capacities.
Breast cancer screening programs, in fact, started much later than in other European countries, and at the beginning only in the French speaking cantons around 1998. As a result, the breast cancer mortality rates decreased significantly in these cantons, while in German speaking cantons, where the screening programs are not yet introduced everywhere, the decrease is much less marked. Even worse, for a cancer for which the benefit of screening is today well proven such as for the colon cancer, no national recommendations in this direction are taken, nor do the insurances reimburse screening tests such as fecal occult blood test or colonoscopy. Also, compared to the United Kingdom, which allows non-medical scientists to specialize in public health, and non-specialists to conduct medical screening exams, Prof. Bouchardy argues that Switzerland has rigorous- some might say too rigorous- official educational and professional requirements for basic procedures. By way of example, she notes that only professionals have right to conduct Pap tests in Switzerland, something for which trained nurses could replace gynecologists, saving time, money and effort.
Marginalization of quality of life
With progress in cancer treatment, survival increases and long term quality of care become very important. However, the quality of life is not yet considered a priority in the Swiss health care policy, and despite the large investment on treatment technologies, not all the citizens benefit equally from them. One reason for that Prof. Bouchardy says is the overreliance on specialists unsuited for providing holistic care. While useful in the treatment of cancer she says, specialization can also work to narrow the range of post-care treatment options available to survivors, reducing their overall quality of life. The issue is fundamental. A system that relies on specialists trained to excel in certain areas Prof. Bouchardy says is not ideal for the provision of the kind of holistic aftercare, which she notes, is what cancer survivors are often in need of. The end result of a reliance on specialists is that patients are often left to own devices- hardly an ideal situation for anyone recovering from a devastating illness.
The Swiss weakness carries through to aftercare, and is exacerbated, Prof. Bouchardy argues, by an overly atomized society that neglects the public component to individual illness. She says that not only is there a lack of cooperation among different cantonal health organizations, but that cantons do not provide their citizens with information on cancer. Prof. Bouchardy notes that francophone Swiss are often directed to sites hosted in Quebec or France for further information relating to cancer and other diseases. On a non-governmental basis, the plethora of Swiss-based patient support groups, she says, are marginalized when it comes to listening to patients’ real problems in order to incorporate possible improvements in medical care. She mentions that other organizations, such as health insurance firms and government also focus minimal attention on professional reinsertion of patients, or any kind of childcare and academic assistance to children with affected parents. A major exception comes from the work of some associations such as the English Speaking Cancer Support Group, the Association Savoir Patient (see sidebar), and PROSCA, but this is still not enough, she says, to make a nation-wide difference in effective aftercare and support treatments.
Social inequalities are strong
In fact, social inequalities in cancer in Switzerland are important and poorly documented. They exist all along the disease from exposure to risk factors as tobacco, alcohol, obesity and high fat diet, to disparities in screening access and optimal care. These differences are even more evident in some profile groups such as migrants, elderly or disabled people. Lack of research, social support, training of professionals and target actions at a cantonal and national level, contribute to maintain these socio-economic disparities in our country. The problem is circular and urgent. Rising rates of cancer in certain demographics, demand concerted action in both prevention and aftercare. It remains to be seen whether Prof. Bouchardy’s recommendations will be listened, or if, in this, as in so many other elements, the Swiss educational and medical establishments will carry on as usual.
Take home message
Cancer is an important public health issue in Switzerland. Although we do have a very high level of quality of care and treatment, we need to put much more emphasis and efforts in prevention and health promotion programs in order to control the cancer epidemic, to reduce health inequalities and to focus on the patient’s quality of life.
Cancer Support Groups in Switzerland
The Association Savoir Patient is an organization dedicated to promoting dialogue between patient, researcher and doctor. Formed in 2002, the association specializes in the care of breast cancer victims, and is a well-known lobby group in what concerns efforts to improve patient standard of care and quality of life.
English speakers afflicted by cancer may also speak to the English Speaking Cancer Association, a not-for-profit organization that provides, in their words “a welcoming, supportive and confidential environment where people can share and express their experiences and feelings in English.”
The Association Savoir Patient may be reached at:
55, bd de la Cluse
Tel. 022 379 49 76/78
They may also be reached at
The English Speaking Cancer Association hosts a drop-in session every Tuesday from 10am to 2pm at:
150, rte de Ferney
1211 Geneva 2
Tel. 022 791 63 05
Helpline: 079 531 55 11
They may also be emailed at
Article by Robert Dunloe