COMMISSION OF THE EUROPEAN COMMUNITIES 
Brussels, 21 04.1995 
COM(95) 131 final 
94/0105 (COD) 
Amended proposal for a 
EUROPEAN PARLIAMENT AND COUNCIL DECISION 
adopting an action plan 1995-1999 
to combat cancer 
within the framework for action 
in the field of public health 
(presented by the Commission pursuant to Article 189 a (2) 
of the EC-Treaty) 
Explanatory Memorandum 
1. The original Commission Proposal for a European Parliament and Council 
Decision adopting an action plan 1995-1994 to combat Cancer was adopted by the 
Coramiision on 29 March 1994. 
2. The original Commission Proposal received favourable opinions of the Economic 
*a4 Social Committee1 and aie Committee of the Regioâs^. 
X. Following the opinion of the European Parliament delivered at first reading on 1 
March 1995, the Commission is presenting an amended proposal for a Decision, 
pursuant to Article 189a of the Treaty. The text contains two main types of 
amendment: 
those adding useful details and clarifications to the initial proposal; 
a second group of amendments slightly strengthening the proposal in the sense of 
greater emphasis of Community action On the areas of prevention identified as 
having priority by the European Parliament. 
4. The European Parliament adopted 36 amendments at its vote on 1 March 1995, 
26 of which are fully or partly acceptable to the Commission (1, 2, 6, 7, 8, 10, 12, 
13, 14, 15, 16, 18, 20, 21, 22, 23, 25, 26, 28, 30, 31, 32, 33, 34, 35 and 42). 
5. The remaining ten amendments are not acceptable to the Commission. 
Amendment 3 has not been accepted because the formulation put forward by the 
Commission is more faithful to the text of Article 3b of the Treaty. 
Acceptance of amendment 4 on the distribution of budget resources within the programme 
would have distorted the management of the programme by allocating funds in advance 
to certain areas without knowing the quality of the projects to be financed. 
Amendment 9 envisages the participation of non-governmental organisations in the 
Advisory Committee on the plan. This would be contrary to the current comitology rules. 
Amendment 17 refers to a ban on advertising for tobacco products. The Commission 
completely shares the concerns expressed in the amendment, but has already proposed a 
Council Directive on this subject. 
Amendment 19 envisages project arrangements which would not suit every case. 
Plenary Session on 14.09.1994 
Plenary Session on 27/28.09.1994 
•2 
Amended 27 proposes a pilot scheme to involve political leaders and others in anti-
smoking activities. This type of action does not fall within the scope of the proposed 
action plan. 
Amendment 29 limits the action proposed by the Commission to the risks associated with 
excessive exposure of the skin to the rays of the sun, rather than ultraviolet radiation. 
This limitation makes it unacceptable. 
As far as amendments 36 and 43 are concerned, it should be noted that the role and 
existence of the Committee of Cancer Experts are not directly linked to the adoption of 
the proposal for a third action plan, as this Committee has existed since the creation of 
the programme in 1986. In addition, cooperation and research activities are regarded as 
satisfactory. These two amendments have been rejected. 
Amendment 46 concerns the creation of no-smoking areas in the buildings of the 
European Parliament. Such action is outside the scope of the proposed plan, although the 
Commission supports the initiative. 
Proposal for a European Parliament and Council Decision 
adopting an Action Plan 1995-1999 to combat cancer 
within the framework for action in the Field of Public Health 
COM (94) 83 final 
The European Parliament and the 
Council of the European Union, 
Having regard to the Treaty establishing 
the European Community, and m 
particular Article 129 thereof, 
Having regard to the proposal by the 
Commission, 
Having regard to the opinion of the 
Economic and Social Committee, 
Having regard to the opinion of the 
Committee of the Regions, 
1. Whereas, at its meetings in June 
1985 in Milan and in December 1985 in 
Luxembourg, the European Council 
underlined the advantages of launching 
a European programme against cancer; Modified proposal 
1. Whereas measures to reduce tne risk 
of cancer from exposure to carcinogens 
are included in a number of existing 
programmes in particular, in the 
programmes on the environment, 
worker protection, consumer protection, 
nutrition, agriculture and the internal 
market: 
2. Whereas the Council and the 
representatives of the Governments of 
the Member States meeting within the 
Council adopted a resolution on 7 July 
1986 on a first programme of action of 
the European Communities against 
cancer and on 17 May 1990 a decision 
establishing a second action plan under 
the "Europe against Cancer" 
programme for the period 1990-1994; 
3. Whereas the European Parliament, 
in its resolution of 15 December 1993, 
asked that activities against cancer be 
intensified; 
«V 
COM (94183 final Modified proposal 
4. Whereas in the Resolution of 13 
December 1993 the Council invited the 
Commission to submit in due course a 
draft third action plan, taking into 
account the Council resolution of 27 
May 1993 on future action in the field of 
public health as well as the objectives 
and improvements set out in the Annex. 
5. Whereas the prevention of cancer 
is a priority for Community action within 
the framework for action in the field of 
public health set out by the Commission 
while remaining compatible with other 
measures already undertaken by the 
Community in this field; 
6. Whereas, in accordance with the 
principle of subsidiarity, actions on 
matters not under the exclusive 
competence of the Community, such as 
those on cancer prevention, must only 
be undertaken by the Community when, 
bv -eason of their scale or effects, they 
msv be better carried out at Community 
level; 4a (new) whereas cancer research is 
covered in the "Biomedicine and 
Health" (1994-1995) specific research 
and technological development 
programme. 
7. Whereas cooperation with the 
competent international organisations 
and with third countries should be 
strengthened; 
8. Whereas cancer is a major disease 
associated with lifestyle, and the 
inherent risk factors need to be 
overcome, especially tobacco 
consumption, which also has an effect 
on combating other diseases, in 
particular cardiovascular diseases; 
COM (94) 83 final 
9. Whereas by ensuring wider 
dissemination of knowledge of causes 
of cancer and of its prevention, 
ensuring improved comparability of 
actions especially in health education, 
the programme will contribute to 
achievement of the Community 
objectives set out in Article 129; Modified proposal 
9a.(new) whereas action must be taken 
to combat media advertising promoting 
habits conducive to cancer, including 
wrong dietary habits. 
10.Whereas an important role is played 
in the implementation of the Programme 
by the Advisory Committee and the 
National Coordinating Committees; 
11. Whereas, from the operational point 
of view, the investment made during the 
preceding action plans in terms of both 
the European pilot networks and of the 
mobilisation of all those involved in 
combating cancer should be 
safeguarded and developed; 
12. Whereas, however, possible 
duplication of effort should be avoided 
by the promotion of exchanges of 
experience and by the joint 
development of basic information 
modules for the public, for health 
education and for training members of 
the health professions; 12. Whereas, nowever, possioie 
duplication of effort should be avoided 
by the promotion of exchanges of 
experience and by the joint 
development of basic information 
modules for the public, for health 
education and for training members of 
the health professions, which mav be 
targeted on specific groups. 
12a.(new) Whereas the principles of 
sound financial management must be 
observed if this action plan is to be fully 
effective. 
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COM (94) W final Modified proposal 
13. Whereas, in order to increase the 
value and impact of the action plan, a 
continuous assessment of the 
measures undertaken should be carried 
out, with particular regard to their 
effectiveness and the achievement of 
objectives both at national and 
Community level and, where 
appropriate, to make the necessary 
amendments; 
14. Whereas this action plan should be 
of five-year duration in order to allow 
sufficient time for actions to be 
implemented to achieve the objectives 
set; 14a.(new) Whereas a systematic policy 
for combatting cancer includes all 
aspects of primary, secondary and 
tertiary prevention, including exchange 
of experience on quality control of 
diagnosis and treatment, and taking into 
account psycho-social aspects with 
particular emphasis on quality of life. 
Article 1 : A Community plan of action 
against cancer is adopted for the j. 
1 January 1995 to 31 December i »»3. 
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COM (94) 83 final 
Article 2 : The Commission shall 
ensure implementation of the actions 
set out in Annex in accordance with 
article 5 of this decision and in close 
cooperation with the Member States 
and with institutions and organisations 
active in the prevention of cancer. Modified proposal 
Article 2 : The Commission, in close 
cooperation with the Member States, 
the national coordination committees 
and with institutions and organisations 
active in the prevention of cancer, shall 
ensure implementation of the action 
plan in the following fields : 
I. development and strengthening 
of a European network of Cancer 
registers and support to 
epidemiological studies focused on 
prevention. 
II. public information and health 
education 
III. training of health workers on 
cancer prevention. 
IV. early detection and systematic 
screening. 
V. exchanges of experience on 
quality control of diagnosis and 
treatment, including palliative care 
and supporting contributions for 
selecting priorities in cancer 
research and transfer of results of 
brr? rrsear^h into clinical trials 
specific actions in tnese fields are set 
out in the annex. 
Article 3 : The budgetary authority will 
determine the financial resources 
available for each exercise. 
ST 
COM (94) 83 final Modified proposal 
Article 4 : The Commission shall 
ensure that there is consistency and 
complementarity between the 
Community actions to be implemented 
under this action plan and the other 
relevant Community programmes and 
initiatives including the Biomedical and 
Health Research Programme under the 
Community's framework programmes 
for research. Article 4 : The Commission shall 
ensure that there is consistency and 
complementarity between the 
Community actions to be implemented 
under this action plan and the other 
relevant Community programmes and 
initiatives including the Biomedical and 
Health Research Programme under the 
Community's framework programmes 
for research and the programmes 
establishing an integrated information 
network (information technology in 
areas of general interest). 
Article 5 : In implementing this action 
plan, the Commission shall be assisted 
by an advisory committee consisting of 
representatives of each Member State, 
and chaired by the Commission 
representative. 
The Commission representative shall 
submit to the committee a draft of the 
measures to be taken. The committee 
shall deliver its opinion on the draft, 
within a time limit which the chairman 
may lay down according to the urgency 
of the matter, if necessary by taking a 
vote. 5b The Commission shall make every 
effort to simplify and improve the 
Programme's ^sir administrative 
procedures: these procedures shall be 
properly publicised. 
The opinion shall be recorded in the 
minutes; in addition each Member State 
shall have the right to ask to have its 
opinion recorded in the minutes. 
COM (94V 83 final 
The Commission shall take the utmost 
account of the opinion delivered by the 
committee, it shall inform the committee 
of the manner in which its opinion has 
been taken into account. Modified proposal 
Article 6: 
1. In the course of implementing this 
action plan, cooperation with third 
countries and with international 
organisations competent in the field of 
public health, including the World 
Health Organisation and the 
International Agency for Research on 
Cancer, will be encouraged. 
2. The EFTA countries and the 
countries of Central and Eastern 
Europe may be associated with the 
activities described in the Annex under 
the conditions set out in the agreements 
concluded with the European 
Community. 
Article 7 : 
1. The Commission will regularly 
publish information on the progress of 
the action plan and on potential 
Community financing in the various 
fields of action; this shall be forwarded 
to the European Parliament, the 
Council, the Economic and Social 
Committee and the Committee of the 
Regions in the form of an annual report, 
with account being taken of reports to 
be drawn up by each of the Member 
States. Article 7/1 : The Commission will 
regularly publish information on the 
progress of the action plan and on 
potential Community financing in the 
various fields of action. The report shall 
pav particular attention to the 
complementary between this action and 
those mentioned in Article 4. It shall be 
forwarded to the European Parliament, 
the Council, the Economic and Social 
Committee and the Committee of the 
Regions in the form of an annual report, 
with account being taken of reports to 
be drawn up by each of the Member 
States. 
CO 
COM (94) 83 final 
2. On the basis of an interim report to 
be submitted by the Commission before 
the end of 1997, the Council and the 
European Parliament will evaluate the 
actions undertaken. An overall report 
will be submitted at the end of the 
action plan. Modified proposal 
Annex 
Measures to be implemented in the 
period 1995-1999 
I. Cancer registers and 
epidemiological studies 
1. Support for exchanges of 
information and experience relating to 
the collection and dissemination of 
reliable and comparable data for cancer 
registers (incidence, mortality and 
survival rate). Development and 
strengthening of a European network in 
cooperation with the International 
Agency tor Research on Cancer 
(IARC). 1. Support for exchanges of 
information and experience relating to 
the collection and dissemination of 
reliable and comparable data for cancer 
registers (prevalence, incidence, 
mortality and survival rate and age 
groups). Development and 
sire. .^u'li,. .<ng of a European network in 
cooperation with the International 
Agency for Research on Cancer 
(IARC). 
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COM {94) 83 final Modified proposal 
2. Support for the carrying out of 
epidemiological studies at European 
level and for the dissemination of their 
conclusions with regard to the 
identification of carcinogens (physical, 
chemical and biological), the risks 
arising from exposure to them, methods 
of prevention and for estimating survival 
rates and sources of disparities in those 
rates. On the basis of these 
conclusions, support for the drawing up 
and dissemination of recommendations. 
Cohort studies on cancer, diet and 
health (EPIC network), support for 
epidemiological studies based on 
research into nutrition as a potential 
preventive factor (identification of 
protective agents, modification of 
specific dietary factors) and, where 
appropriate, preventive chemical 
agents. 2. Support for the carrying out of 
epidemiological studies at European 
level and for the dissemination of their 
conclusions with regard to the 
identification of carcinogens (physical, 
chemical and biological), the risks 
arising from exposure to them (types of 
exposure and the population subgroups 
affected), methods of prevention and 
the introduction of programmes for the 
objective estimation of survival rates on 
the basis of certain criteria (age, sex, 
location of the tumour, evolutionary 
staoe. histological type, etc.). and for 
estimating sources of disparities in 
those rates. On the basis of these 
conclusions, support for the drawing up 
and dissemination of recommendations. 
Cohort studies on cancer, diet and 
health (EPIC network), support for 
epidemiological studies based on 
research into nutrition as a potential 
preventive factor (identification of 
protective agents, modification of 
specific d:3tar* factors) and, where 
appropriate, preventive chemical 
agents. 
II. Prevention 
A. Public information 
3. Establishment of an annual "Europe 
against Cancer" week. 
12-
COM (94) 83 final Modified proposal 
4. Improving the effectiveness of 
cancer prevention messages, in 
particular the recommendations of the 
European Code against Cancer, by 
supporting targeted measures (for 
teachers, general practitioners, etc.) 
and pilot projects, studies and analyses 
of health promotion techniques and 
assessments of action in this field. 4. Improving the frequency and the 
effectiveness of cancer prevention 
messages, in particular the 
recommendations of the European 
Code Against Cancer, by supporting 
targeted measures (for educators, 
oncologists, general practitioners, 
pharmacists, journalists and other 
media persons) and pilot projects, 
studies and analyses of health 
promotion techniques and assessments 
of action in this field. 
5. Supporting pilot action networks for 
providing information and exchanges 
with regard to cancer prevention, taking 
into account the recommendations of 
the European Code against cancer and 
those of the committees of experts 
meeting for this purpose in order to 
contribute to the highlighting and 
dissemination of best practice. 5. Supporting and expanding pilot 
action networks for providing 
information and exchanges with regard 
to cancer prevention, taking into 
account the recommendations of the 
European Code against cancer and 
those of the committees of experts 
meeting for this purpose in order to 
contribute to the highlighting and 
dissemination of best practice. 
6. Promoting information ano 
awareness-raising campaigns for 
specific population groups on health 
promotion and cancer prevention, 
particularly in public places and at work. 
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COM (94) 83 final Modified proposal 
7. Encouraging projects with a 
European dimension relating to the 
prevention of tobacco consumption; 
assessment of the implementation of 
recommendations on the use of tobacco 
in public places, particularly on public 
transport and in education 
establishments. Promotion of a policy 
aimed at protecting the most vulnerable 
groups from the risk of passive 
smoking, in particular pregnant women 
and children. Assessment of the effect 
of measures taken in the Member 
States to reduce tobacco consumption, 
for example by the banning and control 
of direct or indirect advertising, 
exclusion of tobacco from the price 
index and dissemination of knowledge 
acquired from such assessments. 
Support and assessment of pilot 
measures for preventing tobacco 
consumption as part of the exchange 
networks between Member States, for 
example networks of no-smoking towns, 
no-smoking hospitals and youth c'., 
cooperation with health-care workers 
and teachers. 
8. Selection, dissemination and 
evaluation of the impact of the best 
methods of reducing tobacco 
consumption in the Member States as 
part of pilot measures to implement 
these methods in liaison with health­
care workers. Continuing classification 
of dangerous substances and 
preparations with the aim of improving 
packaging and labelling. 
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COM (941 83 final 
B. Health education 
9. Contributing to the formulation and 
implementation of integrated health 
education programmes in different 
contexts, with cancer prevention given 
a particularly important role. Definition 
and implementation of supplementary 
cancer prevention projects for specific 
groups in different contexts. Evaluation 
of health education initiatives with 
priority being given to making 
individuals more aware of their 
responsibility for their own health, 
preventing tobacco consumption, 
promoting a healthy diet and making 
people aware of the risks associated 
with excessive exposure of the skin to 
ultraviolet radiation, targeted at young 
people. Modjffed proposal 
9. Contributing to the formulation and 
implementation of integrated health 
education programmes in different 
contexts, with cancer prevention given 
a particularly important role. Definition 
and implementation of supplementary 
cancer prevention projects for specific 
groups (town planners, environmental 
specialists, architects, radiologists) in 
different contexts. Evaluation of health 
education initiatives with priority being 
given to making individuals more aware 
of their responsibility for their own 
health, preventing tobacco 
consumption, promoting a healthy diet 
including an increased consumption of 
fruit and vegetables and appropriate 
media campaigns on healthy diets and 
making people aware of the risks 
associated with excessive exposure of 
the skin to ultraviolet radiation, targeted 
at young people. 
10. Support for exchanges of 
experience under the integrated health 
education programmes with the aim of 
improving initial and continuing training 
for teachers and project supervisors in 
the field of cancer prevention, taking 
account in this context of the 
experience gained in the framework of 
programmes such as Erasmus and the 
supporting actions of the Commission in 
the education field. 
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COM (941 83 final 
11. Support for the production, 
dissemination and evaluation of the 
impact of Community teaching materials 
relating to cancer prevention, 
particularly those tested in the pilot 
networks. Modified proposal 
12. Implementation of studies and 
dissemination of their conclusions, 
making it possible to improve the level 
of knowledge on the perceptions of 
young people with regard to cancer, 
tobacco, diet and the risks associated 
with excessive exposure of the skin to 
ultraviolet radiation. Carry out analyses 
with the aim of increasing the 
effectiveness of preventive programmes 
among children and young people. 
C. Training for health-care 
workers 
13. Purouin. u.w irr.^a: .jntatin of the 
Commission recommendation of 8 
November 1989 concerning the training 
of health personnel in the matter of 
cancer; assistance with the introduction 
and periodic assessment of the impact 
of the European pilot networks on initial 
and continuing training in cancer for the 
medical, nursing and dentistry 
professions 13. Pursuing the implementation of the 
Commission recommendation of 8 
November 1989 concerning the training 
of health personnel in the matter of 
cancer; assistance with the introduction 
and periodic assessment of the impact 
of the European pilot networks on initial 
and continuing training in cancer for the 
medical, nursing and dentistry 
professions with particular attention to 
personnel working in paediatric 
oncology. 
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COM (941 83 final 
14. Support the mobility of the health 
professions (particularly trainers) in 
order to improve theoretical and 
practical knowledge of cancer (primary 
prevention, mass screening, particularly 
for cervical and breast cancer, early 
diagnosis and quality of care) between 
those centres of excellence in Member 
States offering training of a high quality, 
where such mobility is not ensured 
under existing Community programmes 
such as COMETT II or FORCE. 14. Support the mobility of the health 
professions (particularly trainers) in 
order to improve theoretical and 
practical knowledge of cancer (primary 
prevention, early diagnosis, mass 
screening, particularly for cervical and 
breast cancer, therapeutic principles, 
health-care conventions, individualized 
treatment) between those centres of 
excellence in Member States offering 
training of a high quality, where such 
mobility is not ensured under existing 
Community programmes such as 
COMETT II or FORCE. 
15. Support exchanges of experience 
and the drawing up and dissemination 
of conference recommendations for a 
consensus on good medical practice 
and of recommendations by groups of 
experts in order to speed up the 
dissemination and implementation of 
the results of controlled studies. 
Preparation of teaching ~nterials of 
European interest aimed ^ improving 
training in cancer for health-care 
workers, particularly through the use of 
interactive computer programmes; 
assessment of the impact of these 
materials in the pilot networks. In 
particular, support for the development, 
implementation and evaluation of 
prevention modules intended for the 
health professions and of models to 
assist in diagnosis and in making 
decisions with regard to treatment. 
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COM (941 83 final 
III. Prevention by means of early 
detection and systematic 
screening 
16. Support the introduction and 
evaluation of European pilot project 
networks in the field of mass screening 
for breast and cervical cancer, on the 
basis of recommendations established 
at European level with regard to 
ensuring the quality of screening, and 
support for the organisation of meetings 
to examine the feasibility of extending 
pilot projects to national and regional 
levels. Modified proposal 
17. Support the preparation at 
European level and dissemination of a 
common terminology and classification 
in order to improve the quality of 
anatomical and cytopathological 
interpretation, particularly of suspect 
growths in the breast and uterus, in 
particular for anatomists ano 
cytopathologists in the European 
Community. 
18. Support European feasibility studies 
for early mass screening for other 
cancers (of the ovary, prostate, skin, 
colon/rectum and mouth), taking 
particular account of the medical, 
psychological, social and economic 
aspects. 18a. In order to improve earlv detection 
techniques and systematic screening, 
promotion of pilot action involving the 
collaboration of interdisciplinary teams 
specialized in a broad spectrum of 
fields such as immunology, genetics, 
anatomy, cvtopatholoov and molecular 
biology, with a view to increasing 
biomedical and clinical cooperation. 
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COM (941 83 final 
IV. Studies and measures relating to 
the quality of care for cancer 
patients 
19. Support European studies and 
dissemination of their conclusions, 
particularly in the context of European-
level meetings and exchanges of 
experience, in order to gain a better 
understanding and improve the 
effectiveness of quality control methods 
both in diagnosis (radiological and 
anatomo-cytopathological exam ination) 
and in treatment (radiation therapy and 
chemotherapy), including palliative care, 
taking into account the psychological 
and social aspects, with particular 
regard to the quality of life of patients. 
Dissemination and evaluation of best 
practice in quality assurance in the pilot 
project networks. Modified proposaj 
19. Promote initiatives and support 
European studies and dissemination of 
their conclusions, particularly in the 
context of European-level meetings and 
exchanges of experience, in order to. 
identify shortcomings and to gain a 
better understanding and improve the 
effectiveness of quality control methods 
both in diagnosis (radiological and 
anatomo-cytopathological exam ination) 
and in treatment (radiation therapy and 
chemotherapy), including palliative care, 
correctly administrated at a sufficiently 
early stage, taking into account the 
psychological and social aspects, with 
particular regard to the quality of life of 
patients. Dissemination and evaluation 
of best practice in quality assurance in 
the pilot project networks, including that 
related to checks on radiotherapy 
installations and to 
healthcare personnel. trie it amine ~t 
Support for European studies on the 
introduction of a common terminology 
for the classification and evaluation of 
complications arising from the treatment 
of patients affected bv various forms of 
cancers, 
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COM (941 83 final 
V. Research 
20. Make a supporting contribution to 
selecting priorities for cancer research 
to be carried out under the 
Community's framework programmes 
for research and specifically the 
Biomedical and Health Research 
Programme which includes basic and 
clinical cancer research. Support for the 
establishment of an inventory of 
European basic and clinical cancer 
research measures; help with the 
transfer to clinical trials of the results of 
basic research; information exchange 
networks for clinical trials in progress, 
and help with the launching of multiple-
centre and multinational clinical trials in 
order to speed up the assessment of 
new methods of care. Modified proposal 
20. Make a supporting contribution to 
selecting priorities for cancer research 
to be carried out under the 
Community's framework programmes 
for research and specifically the 
Biomedical and Health Research 
Programme which includes basic and 
clinical cancer research, and promote 
liQSS of investigation aimed at 
establishing accurate and reliable earlv 
diagnosis through laboratory diagnostic 
technioues based in particular on 
immunology and genetics. Support for 
the establishment of an inventory of 
European basic and clinical cancer 
research measures; help with the 
transfer of the results of basic research 
to clinical trials and from there to 
standard therapeutic practice. Help with 
the setting UP and establishment of 
information exchange networks for 
clinical trials in progress and access 
systems for involvement in such trials 
and help with the launching of multiple-
centre and multinational clinical trials in 
order to speed up the assessment of 
new methods of care. 
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ISSN 0254-1475 
COM(95) 131 final 
EN OS 
Catalogue number : CB-CO-95-138-EN-C 
ISBN 92-77-87634-4 
Office for Official Publications of the European Communities 
L-2985 Luxembourg