Summary
Cancer data in Spain has long been fragmented across the autonomous communities, with noted gaps in timeliness, completeness and comparability. Under Royal Decree 568/2024, which established Spain’s State Public Health Surveillance Network, the Ministry of Health set the legal foundation for a comprehensive, integrated Cancer Surveillance System, including the future National Cancer Registry that will be used to coordinate cancer surveillance nationally. The policy aims to harmonize currently available cancer information across all autonomous communities, provide quality data to support research, and improve the evaluation of cancer control and prevention programmes. It is connected to the National Health System Cancer Strategy and to Europe’s Beating Cancer Plan.
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Cancer data collection in Spain was managed at the regional level, with some of the 17 autonomous communities and 2 autonomous cities maintaining their own cancer registries or surveillance systems. This fragmented landscape was limiting Spain’s ability to monitor cancer trends, evaluate public health policies, and plan effective prevention and control strategies across regions. Growing political attention to integrated, real-time public health systems, reinforced by the experience of the COVID-19 pandemic, supported the prioritization of a coordinated national approach.
Hence, the Ministry of Health of Spain, through the Directorate-General for Public Health and Equity in Health, initiated the Royal Decree 568/2024 establishing the State Public Health Surveillance Network. Article 13.2 explicitly includes non-communicable disease surveillance within this network, encompassing the forthcoming Cancer Surveillance System. The policy is informed by Europe’s Beating Cancer Plan, the Joint Action CancerWatch, and the standards of the European Network of Cancer Registries (ENCR), aligning Spain’s national cancer data infrastructure with EU and international frameworks.
A clear legal mandate under Royal Decree 568/2024 establishes a structured, time-bound obligation for the government to regulate the Cancer Surveillance System and the National Cancer Registry within three years of its entry into force, ensuring prioritization and coordinated action across national and regional levels. Initial preparatory steps included coordination between the Ministry of Health and the Autonomous Communities to assess existing regional surveillance capacities, as well as methodological alignment with ENCR and IARC standards and preliminary proposals for national data architecture. Planned next steps include the development of national standards for data collection, reporting timeliness, digital interoperability and quality assurance, alongside the progressive integration of regional registries into a unified national platform.
Enablers: A key driver of progress appears to have been the early and continuous involvement of the Autonomous Communities, which are responsible for existing cancer registries and whose participation is central to ensuring data availability, comparability, and quality (governance). The clear legal mandate established through Royal Decree 568/2024, requiring regulation of the Cancer Surveillance System within three years, supported structured national and regional prioritization of the work (governance). Alignment with international methodological frameworks, particularly ENCR, IARC and EU surveillance principles, provided solid guidance and accelerated agreement on minimum datasets and quality criteria (resource generation). A phased approach, starting with mapping regional capacities and identifying harmonization needs before moving to formal regulation, also helped build consensus among stakeholders (service delivery).
Barriers: Harmonizing case definitions, coding practices, data flows and quality indicators across 17 autonomous communities and 2 autonomous cities requires sustained technical and governance alignment that extends beyond legal mandates alone (governance). Regional disparities in existing surveillance capacities may affect the pace and completeness of integration into the future national platform, particularly in communities with more limited digital health infrastructure (service delivery). The specific regulatory decree governing the Cancer Surveillance System remained pending at the time of reporting, creating a period of regulatory uncertainty that may delay full operational implementation (governance).
The establishment of the Cancer Surveillance System within the State Public Health Surveillance Network represents a key step forward in coordinating national cancer data in Spain. Early harmonization work appears to have begun reducing regional disparities in data completeness, with regions preparing for integration into a unified national system, supporting progress on equity in cancer policy planning across the country. Preparations for shared national standards and digital interoperability are noted as likely to reduce duplication of effort between autonomous communities, contributing to longer-term efficiency gains. The policy also appears to have improved the visibility of cancer surveillance within national planning processes, elevating cancer information needs as a public health priority. Given that the specific regulatory decree remains pending, these effects remain preliminary, but they indicate early progress toward a more coordinated and robust national cancer surveillance infrastructure.
Lessons learned: Royal Decree 568/2024 and the preparatory work undertaken by the Ministry of Health and Autonomous Communities and cities indicate that early and continuous coordination across levels of government appears to be important, with regional involvement from the outset noted as critical given their responsibility for existing registries. The development process shows that harmonization requires both technical and governance alignment; standardizing data systems is only feasible when accompanied by clear governance structures, shared protocols and sustained political commitment. The phased approach taken, beginning with capacity mapping and gap identification before moving to formal regulatory development, helped build consensus and prepare the system for future implementation. The three-year regulatory requirement established in Royal Decree 568/2024 facilitated long-term implementation by creating a structured timeline and ensuring accountability at both national and regional levels.
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