Cancer

Introduction

In 2008, 2.5 million people were diagnosed with cancer in the European Union (EU27)1. Cancer is also the second most common cause of death in the Union (29% of deaths for men or 3 out of 10 deaths, 23% for women or 2 out of 10 deaths)2 – a figure that is expected to rise due to the ageing European population.

The most frequently occurring forms of the disease in the EU are colorectal, breast, prostate and lung cancers. In men, lung cancer is the most frequent cause of cancer death, while in women, it is breast cancer. In both men and women, colorectal cancer is the second most common cause of cancer death. Although significant advances are being made in the fight against the disease, cancer remains a key public health concern and a tremendous burden on European societies.

Europe is also characterised by worrying inequalities in cancer control and care, existing within, as well as between, EU Member States. According to data from 2008, the lung cancer mortality rate in men is over three times as high in the worst performing Member State as compared with the best; mortality from cervical cancer is nearly four times higher in the worst performing Member State than in the best. Estimated colorectal cancer incidence (total population) is 3 times higher in the worst performing Member State than in the best, and inequalities can also be observed between the sexes: throughout the EU as a whole, incidence of lung cancer is two and a half times as high in men as it is in women.

In the past, EU-level cooperation has proven to be of added value in the fight against cancer. A study from 20033 measuring progress towards the targeted 15% reduction in cancer mortality in Europe by 2000, which was the goal set under the Commission's "Europe Against Cancer" programmes (1987 – 2000) showed a reduction of 9% in expected cancer deaths and a 10.5% reduction in risk of cancer death between 1985 and 2000. One of the conclusions was that the Europe Against Cancer programme appears to have been associated with the avoidance of 92 573 cancer deaths in the year 2000 in Europe.

The Commission is therefore continuing its efforts to support Member States in their efforts to protect the health of European citizens by taking concrete action. The ambitious goal set by the Commission Communication on Action Against Cancer: European Partnershippdf(74 KB) is to reduce cancer incidence by 15% by 2020.

2008 Mortality (SDR) by cancer (C00-C97) in the European Union

1 Source for all cancer incidence estimates for 2008:
Ferlay J, Shin HR, Bray F, Forman D, Mathers C and Parkin DM.
GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10 [Internet].
Lyon, France: International Agency for Research on Cancer; 2010. Available from: http://globocan.iarc.fr

2 Source for all cancer mortality data: Eurostat 2008, available at:
http://epp.eurostat.ec.europa.eu/portal/page/portal/health/public_health/data_public_health/main_tables

3 Annals of Oncology 14: 1312–1325, 2003:
http://annonc.oxfordjournals.org/content/14/8/1312.full.pdf+htmlpdf

European Partnership for Action Against Cancer

logoIn 2009, the European Commission reinforced its long-term commitment to the fight against cancer by launching a European Partnership for Action Against Cancerpdf(262 KB) Choose translations of the previous link български (bg) čeština (cs) dansk (da) Deutsch (de) eesti keel (et) ελληνικά (el) español (es) français (fr) italiano (it) latviešu valoda (lv) lietuvių kalba (lt) magyar (hu) Malti (mt) Nederlands (nl) polski (pl) português (pt) română (ro) slovenčina (sk) slovenščina (sl) suomi (fi) svenska (sv) .

The overall aim of the Partnership (2009-2013) is to support Member States and other stakeholders in their efforts to tackle cancer more efficiently. The Partnership provides a framework for identifying and sharing information, capacity and expertise in cancer prevention and control. It will also help to avoid scattered actions and duplication of efforts, and contribute towards better use of limited resources available.

By the end of the Partnership, the objective is for all Member States to have integrated cancer plans. The long-term aim is to reduce cancer incidence by 15% by 2020.

Commission Communication on Action Against Cancer: European Partnershippdf(262 KB) Choose translations of the previous link български (bg) čeština (cs) dansk (da) Deutsch (de) eesti keel (et) ελληνικά (el) español (es) français (fr) italiano (it) latviešu valoda (lv) lietuvių kalba (lt) magyar (hu) Malti (mt) Nederlands (nl) polski (pl) português (pt) română (ro) slovenčina (sk) slovenščina (sl) suomi (fi) svenska (sv)  

2nd implementation report on Cancer Screening and of Commission Communication on the EPPAC

Strong cooperation between the EU and Member States on cancer has led to improved screening rates according to a report on progress made under European Partnership on Cancer and the 2003 Council recommendation on cancer screening. The vast majority of Member States – 25 out of 28 – have met the target of putting in place a national cancer control plan. And well over 500 million screening examinations for breast, cervical and colorectal cancer are projected in the EU for the period 2010-2020. Reaching the target of a reduction of 15% in cancer incidence by 2020 is a major public health goal for the EU. In addition to coordination and support to Member States, in the last seven years the EU has invested more than €1.4 billion in cancer-related research, including finding new ways of fighting cancer and supporting patients. 

Read the full reportpdf(114 KB) Choose translations of the previous link български (bg) čeština (cs) dansk (da) Deutsch (de) eesti keel (et) ελληνικά (el) español (es) français (fr) hrvatski (hr) italiano (it) latviešu valoda (lv) lietuvių kalba (lt) magyar (hu) Malti (mt) Nederlands (nl) polski (pl) português (pt) română (ro) slovenčina (sk) slovenščina (sl) suomi (fi) svenska (sv)

First meeting of the Commission Expert Group on Cancer Control: 23-24 September 2014

Today in Milan, EU Health Commissioner, Tonio Borg, and Italian Minister of Health, Beatrice Lorenzin opened the first meeting of the Commission Expert Group on Cancer Control which has been established by a Commission Decision dated 3 June 2014. The expert group, chaired by the Commission, brings together representatives from Member State national authorities as well as representatives from patient groups, scientific and medical associations specialised in cancer, organisations working on cancer prevention, and industry.

Work of the Partnership

To develop the Partnership, the Commission held initial brainstorming workshoppdf in October 2008, as well as three consultation meetings with Member Statespdf, expertspdf and stakeholderspdf during the spring of 2009.
The Communication Action Against Cancer: European Partnershippdf(262 KB) Choose translations of the previous link български (bg) čeština (cs) dansk (da) Deutsch (de) eesti keel (et) ελληνικά (el) español (es) français (fr) italiano (it) latviešu valoda (lv) lietuvių kalba (lt) magyar (hu) Malti (mt) Nederlands (nl) polski (pl) português (pt) română (ro) slovenčina (sk) slovenščina (sl) suomi (fi) svenska (sv) broadly sets out the objectives for the European Partnership, but areas and actions have been determined by members of the Partnership themselves. These areas include:

  • Prevention (Health promotion and early detection);
  • Identification and promotion of good practice in cancer-related healthcare;
  • Priorities for cancer research;
  • Health information, collection and analysis of comparable data.

The work of the Partnership is being carried forward through a "Joint Action", a financial mechanism under the EU Health Programme (for information on joint actions, see the EAHC website). The Joint Action officially began in early February 2011, and will continue until February 2014. It benefits additionally from administrative and scientific support from the Commission.

Since the beginning of the Joint Action, the ongoing activities of the Partnership can be followed at the following website, which is managed and updated by the coordinator of the Joint Action:

http://www.epaac.eu/ 
https://webgate.ec.europa.eu/sanco/heidi/index.php/Cancer_partnership

Chronological steps in the creation of the European Partnership for Action Against Cancer

Launch of the European Partnership for Action Against Cancer

The European Commission launched the European Partnership for Action Against Cancer on 29 September 2009, see press release.

Click here to see more details

Open call for interested stakeholders to apply for participation in the preparatory meeting for the European Partnership for Action Against Cancer (closed October 2009)

Preparatory meetings for the European Partnership for Action Against Cancer


The initial meetings of the Steering Committee and of the Working Group on national cancer plans


Since activities began under the Joint Action, information is available at the following website:

http://www.epaac.eu/
https://webgate.ec.europa.eu/sanco/heidi/index.php/Heidi/Cancer_partnership

Expert Group on Cancer Control

The first meeting of the Expert Group on Cancer Control took place on 23 -24 September 2014 in Milan in the presence of Commissioner Borg and the Italian Minister, Beatrice Lorenzini.

"Cancer has for many years been a priority issue for EU public health policy – since 1985 in fact.   And it was here in Milan at the European Council in 1985 – nearly 30 years ago – that the 12 Heads of State of the then countries of the European Community decided to launch the first "Europe Against Cancer" programme, which became operational in 1987," Commissioner Borg stated.

The Expert Group has been established by a Commission Decision dated 3 June 2014pdf(438 KB).

Prevention of Cancer


Primary Prevention

It has been estimated that more than one third of all cancers are preventable. Prevention also offers the most cost-effective, long-term strategy for reducing the European burden of diseases. This is why primary prevention by tackling major health determinants, such as smoking, unhealthy diet and physical inactivity, is a long-term priority for the Commission.

Further information on Commission work in health determinants can be found here

The European Code Against Cancer is a key prevention tool, based on scientifically proven evidence. This simple list of recommendations gives citizens two very clear messages:

1) Certain cancers may be avoided – and health in general can be improved – by adopting healthier lifestyle:
  • Do not smoke; if you smoke, stop doing so. If you fail to stop, do not smoke in the presence of non-smokers;
  • Avoid obesity;
  • Undertake some brisk, physical activity every day;
  • Increase your daily intake and variety of vegetables and fruits: eat at least five servings daily. Limit your intake of foods containing fats from animal sources;
  • If you drink alcohol, whether beer, wine or spirits, moderate your consumption to two drinks per day if you are a man and one drink per day if you are a woman;
  • Care must be taken to avoid excessive sun exposure. It is specifically important to protect children and adolescents. For individuals who have a tendency to burn in the sun active protective measures must be taken throughout life;
  • Apply strictly regulations aimed at preventing any exposure to known carcinogenic substances. Follow all health and safety instructions on substances which may cause cancer. Follow advice of national radiation protection offices.
2) Cancers may be cured, or the prospects of cure greatly increased, if they are detected early:
  • Women from 25 years of age should participate in cervical screening. This should be within programmes with quality control procedures in compliance with European Guidelines for Quality Assurance in Cervical Screening;
  • Women from 50 years of age should participate in breast screening. This should be within programmes with quality control procedures in compliance with European Union Guidelines for Quality Assurance in Mammography Screening;
  • Men and women from 50 years of age should participate in colorectal screening. This should be within programmes with built-in quality assurance procedures;
  • Participate in vaccination programmes against Hepatitis B Virus infection.

See also: EU funded cancer projects

See also: the European Code against Cancerpdf(432 KB) Choose translations of the previous link български (bg) čeština (cs) dansk (da) Deutsch (de) eesti keel (et) ελληνικά (el) español (es) français (fr) italiano (it) latviešu valoda (lv) lietuvių kalba (lt) magyar (hu) Malti (mt) Nederlands (nl) polski (pl) português (pt) română (ro) slovenčina (sk) slovenščina (sl) suomi (fi) svenska (sv)

Cancer Screening


While primary prevention aims to reduce the incidence of cancer by tackling the major determinants of cancer, such as smoking, nutrition and physical activity, secondary prevention aims to reduce mortality by early detection of cancer through population screening.

Regular and systematic examinations can detect the disease early, when it is more responsive to less aggressive treatment. Followed by appropriate treatment, these examinations can significantly reduce cancer mortality and improve the quality of life of cancer patients.

In 2003, the EU Health Ministers unanimously adopted a Council Recommendation on cancer screeningpdf , setting out principles of best practice in the early detection of cancer. They invited all Member States to take common action to implement national population-based screening programmes for breast, cervical and colorectal cancer, with appropriate quality assurance at all levels.

In December 2008 the Commission adopted its first Report on the Implementation of the Council Recommendation on cancer screeningpdf of 2 December 2003. The Report found that much has been done to attain high standards of screening practices across the EU. However, fewer than half of the minimum number of recommended examinations are taking place if the screening tests specified in the Council Recommendation were available to all EU citizens of appropriate age (approximately 125 million examinations per year), and not always within the organisational framework necessary to ensure thorough quality assurance.

See also: " Cancer Screening in the European Union – Report on the Implementation of the Council Recommendation on Cancer Screeningpdf(3 MB) "

To assist the Member States with cancer screening, the Commission has produced European guidelines for quality assurance in cervical cancer screening, European guidelines for quality assurance in breast cancer screening and diagnosis and European guidelines for quality assurance in colorectal cancer screening and diagnosis.

Data and Information


To effectively monitor the state of health in the European Union, it is essential to continuously collect, process and analyse comparable data. Cancer data and information is not only an important basis for regular reporting on health status, but it also gives us indications on how national health care systems are managing and responding to the burden of cancer across the EU. In addition, by sharing information, analysis and exchange of best European practice, there is considerable scope for improving efficiency and cost-effectiveness of cancer control on Member State and on European level.

The European Commission is involved in several projects to create appropriate and comparable indicators to monitor cancer. The EUROCHIP (European Cancer Health Indicator Project), coordinated by the Istituto Nazionale per lo Studio e la Cura dei Tumori (Milan, Italy), was selected for funding under the Public Health Programme 2003-2008, to discuss and prioritise the relevance of a preliminary list of 134 cancer health indicators. The suggestions initially proposed by the national working groups were then refined through a series of international meetings and by the subsequent EUROCHIP-2 and EUROCHIP-3 projects.

For further information, see the EUROCHIP Project website, the EUROCHIP list of indicators for the final reportpdf and the availability forms, set out according to Member State.

In order to best use cancer indicators and to present the extensive panorama of the cancer burden in the EU, the Commission funded in 2006 the Fighting against cancer today (FACT) project, which was coordinated by the Institute of Public Health of Slovenia. Key findings, as detailed in the 2008 final report of the FACT project, Responding to the challenge of cancer in Europepdf, include:
  • In 2006 there were about 2.3 million new cases of cancer and over 1 million cancer deaths in the former EU25.
  • Men bore slightly more than half (55%) of the total disease burden (new cases and deaths). This imbalance between the sexes is seen both in the former EU25 (1.25 million cases in men and 1.04 million cases in women).
  • Four cancers dominate the overall cancer burden profile throughout Europe: cancers of the breast (in women), prostate, colorectum (colon and rectum combined, or large bowel) and lung accounted for over half the total cancer incidence burden in 2006.
  • With an estimated 320 000 new cases, female breast cancer was the most frequently diagnosed cancer in the former EU25, closely followed by around 300 000 new cases estimated for both prostate and colorectal cancer.
  • The ten next most frequent types of cancer account for a further 30% of the total burden of cancer incidence (and mortality). As individual cancers, they each represent some 2% to 4.5% of the total cancer burden.

The Commission is funding several projects to create appropriate and comparable indicators to monitor cancer. See EU funded Projects on Cancer and Additional Cancer Links.





Further key data on cancer can be found in the Eurostat database under the theme Health. Eurostat have been collecting and disseminating health data for the EU Member States since 1994.

See also: "Estimates of the cancer incidence and mortality in Europe in 2006 – Annals of Oncology

See also: the European Cancer Observatory, developed by the International Agency on Research on Cancer (IARC), for information and data on cancer incidence and mortality in European countries, as well as cancer fact sheets, according to country and cancer. The data presented on this site are those made publicly available by cancer registries and by national statistics agencies.

See also: GLOBOCAN database 2002 housing the vast amount of data available by the Descriptive Epidemiology Group of the International Agency for Research on Cancer.

EU Funded Projects on Cancer


ACCIS (Automated Childhood Cancer Information System) aims to collect, present, interpret and disseminate data on childhood cancer in Europe. See ACCIS Summary tables of incidence and survival on childhood cancer.

CaMon (Comprehensive Cancer Monitoring in Europe) aims to compile and maintain an updateable database of indicators of cancer, as well as the study of time trends and the provision of projections of future cancer burden, and the role of prevalence as a cancer indicator in different health settings.

Development of European Guidelines for Quality Assurance of Colorectal Cancer Screening. The main objective of the project is to develop EU guidelines on evidence-based best practice for quality assurance in colorectal cancer screening.

DOMAINE (Creating a Safe and Sufficient Donor Population in Europe: Comparing and Recommending Good Donor Management Practice) aims to achieve a safe and sufficient blood supply for all European citizens by establishing Good Donor Management practice in all Member States. Human blood is the basis for many, often life saving, therapeutic treatments for many ailments and diseases including cancer.

DYNAMO-HIA (Development of a Dynamic Modelling Tool to assess the Health impact of Policies) aims to develop a web-based tool to assess the health impact of policies. This tool will quantify the health impact of policies, including those on cancer, in the EU through their influence on health determinants.

ECCG (European Cooperation on Development and Implementation of Cancer Screening and Prevention Guidelines) aims to develop urgently needed supplements to the current EU guidelines in order to take into account new developments and improve prevention of cervical cancer through HPV vaccination and testing.

ECN (European Cancer Network) promotes best practice in secondary cancer prevention. The project brings the new Member States and applicant countries into the mainstream of European efforts toward continuous improvement of best practice in secondary cancer prevention.

ENSP (European Network for Smoking Prevention) aims to promote comprehensive tobacco control policies and greater coherence between smoking prevention activities at regional, national and EU levels. It addresses issues such as inequalities linked to smoking, young women, a smoke-free environment and the WHO Framework Convention on Tobacco Control.

ENYPAT (European Network for Young People and Tobacco) aims to promote health and prevent disease through addressing health determinants across all policies and activities in smoking area.

EPIC (European Prospective Investigation into Cancer and Nutrition) investigates the relationship between diet, nutrition status, lifestyle and environmental factors and the incidence of cancer and other chronic diseases. EPIC is the largest study of diet and health in Europe (Denmark, France, Germany, Italy, the Netherlands, Norway, Spain, Sweden and the United Kingdom).

EPIDERM (European Prevention Initiative for Dermatological Malignancies) aims to acquire and disseminate knowledge on skin cancers in relation to their occurrence, risk factors, treatments and cost of illness, in order to develop prevention and risk reduction strategies and best practices recommendations.

EUNICE (EU Network for Information on Cancer) aims to compile, compare, analyse and disseminate information relevant for monitoring of the status of cancer burden in the European populations, as well as planning and evaluation of cancer control measures at national and EU level. The outcomes of the project will include the establishment of a common database, which will be used to plan programmes of cancer control in the EU (benchmarking and scenario development) and to monitor their outcome.

EUROCAN Plus: Improving Coordination of Cancer Research in Europe, continues the work done in the field of cancer research coordination, as outlined in the 2008 Feasibility Study for the Coordination of National Cancer Research Activities in Europepdf.

EUROCARE (European Cancer Registries' Study on Cancer Patients’ Survival and Care) is an international collaborative study on the survival of cancer patients in Europe coordinated by the Istituto Nazionale per lo Studio e la Cura dei Tumori (Milan, Italy). It currently involves 67 population-based cancer registries operating in 22 European countries. See EUROCARE-3 summary: cancer survival in Europe at the end of the 20th century.

EUROCHIP-3 (European Cancer Health Indicator Project – 3) is a multidisciplinary project, aiming to develop strategies for information exchange and responses to cancer, with special emphasis on major European cancer inequalities. This is the third EUROCHIP project to date, all of which have the overarching aim of fighting inequalities in the field of cancer and improving information and knowledge on the disease. For further information, see the websites for EUROCHIP-1 and EUROCHIP-2.

EUROCIM (European Cancer Incidence and Mortality Database) will be renewed and become available to participating cancer registries. This database will include additional data items to enable a wider range of studies. The EUROCIM-2 dataset will be provided to contributing registries according to common rules listed in the ENCR website.

EUROCOURSE (Europe against cancer: optimisation of the use of registries for scientific excellence in research) aims to tackle the fragmentation in the funding and usage of cancer registries in Europe. It also seeks to optimize the use of cancer registration data for the improvement of cancer control and the strengthening of population-based cancer research in Europe.

European Cervical Cancer Screening Network aims to continue the long term monitoring and epidemiological evaluation of the cervical screening in several European regions. The outcomes of the project have contributed to determine the diagnostic parameters of new technologies in cervical screening in terms of sensitivity, specificity, predictive values and reproducibility.

European Network of Paediatric Hodgkin’s Lymphoma – Europe-wide Organisation of Quality Controlled Treatment aims to work for high cure rates and a significant reduction of late effects (e.g. secondary cancer) in paediatric Hodgkin's lymphoma. Due to limited experience with this rare disease in local hospitals, many EU countries have decided to join this central reference system, which falls under the broader European Networks of Reference for Rare Diseases.

EUROSUN (Quantification of Sun Exposure in Europe and of its effects on Health) aims to monitor ultraviolet exposure in the European Union and its effect on the incidence of skin cancers and cataracts. It will provide indicators on UV exposure and predict the global EU burden of UV-related diseases in coming years.

HAEMACARE (Cancer Registry-Based Project on Haematologic Malignancies) aims to revise the haematologic malignancies coding procedures used by cancer registries, ensuring strict adherence to the International Classification of Diseases for Oncology (ICD-O) codes, and by making them consistent with the various classification of diseases categories currently used by clinicians across the Union.

RARECARE (Surveillance of Rare Cancers in Europe) assesses the quality and comparability of data on rare cancers across European countries. For selected rare cancers considered a high priority, an effort will be made to improve data quality by reviewing information currently collected by cancer registries and disseminating the results, and by linking the data to other information resources via a specially designed website.

WELAS (Women in Europe Against Lung Cancer and Smoking) aims to contribute to the prevention and control of lung cancer among European women by providing a better understanding of lung cancer trends, risk factors, prognostic factors and tobacco control issues specifically for European women.

Please also see the research projects funded under the current 7th Framework Programme (2007-2013) of the Commission, and the list of past research projects on cancer selected under the 6th Framework Programme (2002-2006).

See also: the Executive Agency for Health and Consumers for further details on projects financed under the Health Programme.

Additional Cancer Links

ECHI (European Community Health Indicators) Choose translations of the previous link български (bg) čeština (cs) dansk (da) Deutsch (de) eesti keel (et) ελληνικά (el) español (es) français (fr) italiano (it) latviešu valoda (lv) lietuvių kalba (lt) magyar (hu) Malti (mt) Nederlands (nl) polski (pl) português (pt) română (ro) slovenčina (sk) slovenščina (sl) suomi (fi) svenska (sv) is a list of indicators for the public health field arranged according to a conceptual view on health and health determinants.

ENCR (European Network of Cancer Registries) aims to improve the quality, comparability and availability of cancer incidence data, to create a basis for monitoring cancer incidence and mortality in the EU, to provide regular information on the burden of cancer in Europe, and to promote the use of cancer registries in cancer control and health-care planning and research.

International Agency on Research on Cancer aims to coordinate and conduct research on the causes of human cancer, the mechanisms of carcinogenesis, and to develop scientific strategies for cancer prevention and control. The Agency is involved in both epidemiological and laboratory research and disseminates scientific information through publications, meetings, courses, and fellowships.