For years, they have remained off the radar: women living with cancer, but also women who care for, support and provide for cancer patients — a double invisibility that Europe can no longer afford to ignore. A new international index paints a stark picture of Europe’s healthcare systems, exposing deep cracks and inequalities that can cost lives. Belgium is one of the top-scoring countries on the index. But is excellence just a step away?
On 17 March, at the European Parliament, the launch of the Women and Cancer Policy Index by the European Cancer Organisation (ECO) set out in black and white what doctors and patients have long been saying: the problem is not a lack of knowledge, but a failure to apply it. “For too long, women with cancer have been the invisible women of our health systems. The evidence is there; now it is time to act. The index gives us the metrics to make those invisible gaps visible and ensure that no woman is left behind,” said Isabel Rubio, President of ECO.
As Norbert Couespel, head of policy research and EU projects at the European Cancer Organisation, explains, the analysis spans the entire care pathway — from prevention, including screening programmes, HPV vaccination and risk-factor policies, through early diagnosis, to access to treatment and quality of care. Drawing on the most recent data, it combines expert input with official sources such as national health plans, legislation and clinical guidelines. The result is a composite score from 0 to 100, designed to compare how effectively countries address women’s cancer. “The scoring thresholds,” Couespel adds, “provide a guide to interpretation: results above 70% point to strong, well-implemented policies; scores between 50% and 69% indicate partial or uneven implementation; anything below 50% highlights significant structural gaps.”
The result is a map of a divided Europe. On one side are the high performers. Finland (80%) and Sweden (76%) top the ranking, with robust systems, widespread screening, and rapid access to treatment. On the other side is a Europe under strain: Romania, Hungary, Poland, and Bulgaria sit at the bottom, with scores dipping below 30%. In these countries, diagnoses come later, treatments are less accessible, and prevention remains fragile. In between lies a broad middle, from Spain (63%) and Portugal (59%) to the Netherlands (58%), Italy (55%), and Slovenia (55%).
Mapping cancer care disparities
Belgium ranks among the top-performing countries. It scores 68% overall, placing it third in Europe. Take primary prevention policy. This is the slow machinery of public health, rarely dramatic, but decisive over decades. Here, Belgium’s score of 66% reflects relatively comprehensive policy frameworks. Tobacco and overweight control measures are in place, as is HPV vaccination policy. For girls, coverage is very high (88%). These are not trivial achievements.
Yet on screening programmes, Belgium records a score of 55%. While breast cancer screening implementation is high (95%), uptake is less strong (58%). Similarly, cervical cancer screening shows robust programme implementation (76%), but participation rates (56%) again point to room for improvement.
In terms of outcomes and quality of life, Belgium scores 64% — not at the very top, but comfortably within Europe’s higher-performing group. The country performs particularly well in supporting fertility preservation for women undergoing treatments such as chemotherapy, radiotherapy, or surgery that may affect reproductive capacity. Survival rates and post-treatment indicators are broadly comparable to those of countries ranked higher on the index, suggesting Belgium is a nation of consistent competence rather than an outlier in excellence. Certainly, where Belgium stands out more clearly is in patient support. Its 89% score in informal care is among the strongest in Europe and appears to reflect a system that extends beyond clinical treatment into the social realities of cancer.
This is the key to understanding Belgium’s position. Unlike some Nordic countries, such as Finland and Sweden, it does not dominate specific categories; yet, unlike lower-performing states, it avoids systemic gaps. Instead, it delivers across all pillars at a consistently solid level. That consistency, however, comes with a trade-off. Screening must connect seamlessly to treatment, treatment to survivorship, and survivorship to long-term wellbeing. Belgium has many of the pieces in place. So is the challenge less about fixing weaknesses than about breaking into the top tier?
