The theme of World Cancer Day (4 February) this year – and indeed next year – is “We can. I can.” According to the Day’s official website, the theme is about exploring how everyone – as a collective or as individuals – can do their part to reduce the global burden of cancer. One collective body that 500 million Europeans currently participate in is the European Union (EU). Later this month the Maltese Presidency of the EU will host the final conference of a three-year “Joint Action” between the Union’s Member States looking at improving cancer control. World Cancer Day, therefore, seemed like a good opportunity to look in a bit more depth at what EU health policy is doing to reduce the burden of cancer.
Action against cancer now and then: overview
- This article reflects on EU action against cancer in light of World Cancer Day (4 February) and the launch by the Maltese EU Presidency of the European Guide on Quality improvement in Comprehensive Cancer Control on 14-15 February.
- EU cooperation against cancer started in 1985. The three areas of action defined then – prevention, early detection and quality of treatment – are still valid today
- From the 1980s to the 2000s prevention and early detection (cancer screening) were top of the EU policy agenda. There were EU laws restricting tobacco marketing in the early 2000s and a (non-binding) Recommendation on Promoting Cancer Screening.
- In 2009 the European Commission set a target of reducing the disparity in cancer care between the best and the worst-performing Member States by 70% by 2020
- It has subsequently funded the European Partnership for Action Against Cancer Joint Action 2009-2014 to help all Member States to establish national cancer control plans and programmes
- The European Guide on Quality improvement in Comprehensive Cancer Control has been produced by another Joint Action between the Member States and the Commission called CanCon 2014-2017.
- The Guide will contain recommendations on good practice and how to improve the quality of care, focusing on areas such as the patient’s experience, service delivery and accessibility.
EU health activism against cancer stalling?
EU cooperation against cancer has a surprisingly long history. The first EU initiative in this area was a programme called Europe Against Cancer. It was proposed by the French President, François Mitterrand, at an EU summit (Mitterrand later died of cancer and knew his diagnosis at the time). It was launched in 1985 despite there being nothing about health cooperation in the EU Treaties at that time. It had three areas of action:
- Cancer prevention;
- Early diagnosis of cancers; and
- The quality of cancer treatment.
Even though there have been major changes to EU health cooperation since 1985, these 3 priorities for EU action on cancer are still valid.
From the late 1980’s onward the EU put a major focus on cancer prevention. The high point of EU activism in this area came in the early 2000s with the EU passing laws severely restricting the marketing of tobacco products. Most forms of tobacco advertising and sponsorship were banned and large health warnings covering 60% of the front of the pack were placed on cigarettes. Those days of EU health activism have long gone. The EU’s main cancer prevention tool these days is a document called the European Code Against Cancer. This was last updated in 2014 with evidence compiled by WHO’s International Agency for Research on Cancer (IARC) and contains 12 recommendations on how people can reduce their risk of getting cancer. The European Cancer Leagues produced a video clip communicating these recommendations for World Cancer Day 2016 – see the video here.
In the late 1990s and the 2000s, the EU turned its focus to early diagnosis of cancer. The most high profile outcome from this was the Council Recommendation on Promoting Cancer Screening in the EU adopted by EU health ministers in 2003. The Commission then worked with the IARC to produce European guidelines on quality assurance for breast (2013), cervical (2007, updated in 2014) and colorectal (2010) cancer screening.
In 2009 the Commission adopted a “Communication on Action Against Cancer” and turned its attention to the quality of cancer treatment. The EU had just enlarged to take in 10 Central and Eastern European countries and was concerned about health inequalities between its members. For example, in 2010 life expectancy for men varied between 79.8 years in Italy (the longest living EU men) to and 68 years in Lithuania. Part of this difference was due to differences in wealth and lifestyle, but the quality of healthcare also seemed to play a role. The Commission’s 2009 Communication, therefore, set a target of reducing the disparity in cancer care between the best and the worst-performing Member States by 70% by 2020. Reducing these inequalities and getting every Member State to design and implement a comprehensive cancer control plan should, in the Commission’s view, reduce the incidence of cancer in the EU by 15% by 2020.
Next steps for EU cooperation in cancer prevention and treatment
Between 2009 and 2014 the Commission funded a Joint Action with the EU Member States called the European Partnership for Action Against Cancer (EPAAC). This provided support and guidance to the Member States on establishing national cancer control plans, and programmes of action based on them. By the end of this Joint Action in 2014, nearly all Member States (24 out of 28) had established plans, and the others were in the process of doing so (see a report on implementation). The Cancer Control Joint Action (CanCon) launched by the Commission and the Member States in 2014 follows on from the EPAAC Joint Action. The key output from CanCon will be a European Guide on Quality improvement in Comprehensive Cancer Control. It is this Guide that will be launched in Malta on 14-15 February at a conference organised by CanCon and the Maltese Presidency of the EU.
Research institutes, hospital oncology departments, health officials from ministries, patient advocates and NGOs have all had an input in developing the Guide. According to Dr Tit Albrecht, Coordinator of CanCon, in a recent interview, the Guide will give recommendations on how cancer care should be organised in theMember States. It will contain recommendations on good practice and how to improve the quality of care, focusing on areas such as the patient’s experience, service delivery and accessibility.
The EU Member States will not be obliged to follow the new Guide. It will not have any formal legal or political status, and does not impinge on Member States’ rights to run their health systems in whichever way they see fit. But the fact that health institutes and organisations from all Member States were involved in developing the Guide should mean they take it seriously. All Member States are keen to improve their cancer services but have little extra cash available to do this. They will be happy to align their services with “European best practice” – provided doing so doesn’t cost large amounts of money.