EU cancer policy: fighting against the odds
As World Cancer Day was celebrated on 4 February last, the EU has reasons for concern, but also for hope.
In 2012 cancer killed nearly 1.3 million people in the European Union, being its second most common cause of death; and 2.6 million more were diagnosed with cancer – four years earlier this figure was 100,000 fewer. Given the current incidence rates (number of new cases compared to the total population), it is expected that 1 out of 3 men and 1 out of 4 women in the EU will be affected by cancer before reaching 75 years of age. Unfortunately, even these figures seem ‘optimistic’ when we take into consideration that the ageing of the European population is expected to dramatically increase such statistics.
Prevention is the golden word
EU decision-makers are justifiably concerned. And action is being taken, starting with prevention. At least one-third of cancer cases can be prevented. Tackling such risk factors, common to cancer and many other chronic diseases, offers the most cost-effective strategy. Primary prevention - targeted particularly at young people - aims at raising awareness of the importance of a healthy lifestyle: do not smoke, moderate alcohol consumption, undertake some physical activity, increase intake of vegetables, avoid excessive sun exposure and exposure to carcinogenic substances. All these are key recommendations of the European Code Against Cancer, first adopted in 1987, and now under revision. An environment that makes healthier choices easier is also to be fostered.
Moreover, for the EU strategy, early diagnosis is also paramount: many cancers can be cured if quickly detected. Thus, unlike primary prevention which aims at reducing incidence of the disease, the goal of secondary prevention is to reduce mortality through the regular screening of the population: cervical screening, for example, is advised for women from as young as 25. In this context, the EU Health Ministers adopted in 2003 a Council Recommendation on cancer screening defining principles of best practices and inviting Member States to implement national programmes. To assist them in doing so, the Commission issued guidelines for breast, colorectal and cervical cancer screening. And new guidelines are scheduled to be produced by 2015.
Ambitious as it is, the goal of reducing cancer incidence by 15% by 2020 was defined in the Commission’s Communication on the European Partnership for Action Against Cancer, of 2009.
Comparable data for tackling inequalities
Continuous collection, processing and analysis of comparable data is indispensable for monitoring the state of health in the EU. Cancer prevention and control by Member States can benefit greatly by sharing information, analysis and exchange of best practice, avoiding duplication of effort and inefficient use of scarce resources. Information at European level on the incidence, the prevalence (total cases compared with the total population), the risk factors and the outcomes concerning cancer and other chronic diseases should be comparable in order to facilitate benchmarking and evidence-based policy.
The above-mentioned European Partnership launched in 2009 aims at identifying and sharing information, capacity and expertise in cancer prevention and control. An important tool, the European Cancer Observatory has been developed in a project supported by the Commission, while a European Cancer Information System is being set up to bring together cancer registries across Europe, providing a valuable resource for cancer-related research whose need for increased coordination in the EU has been emphasised by the European Parliament in a Written Declaration of 2011.
Such an Information System will also help understand inequalities and its causes in the field of cancer. Indeed, inequalities abound, among and within Member States, between sexes and among different socio-economic groups. The incidence of colorectal cancer, for example, is 3 times as high in the worst performing Member State as in the best ; incidence of lung cancer is 2.5 times higher in men than in women, and its mortality rate in men is more than 3 times higher in the worst performing than in the best performing Member State. And in France, for instance, a blue collar worker is twice as likely to die from cancer than is a member of the managerial staff. Disadvantaged people are both more likely to contract cancer and, once affected, to die from it.
All these inequalities should be taken into consideration in health promotion and health care alike. As the Council Conclusions on Common values and principles in European Union Health Systems of 2 July 2006 recognise universality, access to good quality care, equity and solidarity as major overarching values, the EU has still a long way to go until there is full implementation of these values in the field of cancer prevention and control. Happily, some decisive steps have already been taken.