No C 329/60 Official Journal of the European Communities 30. 12. 89 
Opinion on the draft Council Resolution concerning an action plan 1990-1994 in the 
framework of the 'Europe against Cancer' programme (J) 
(89/C 329/20) 
On 12 June 1989 the Council, acting in accordance with Article 235 of the EEC Treaty, asked 
the Economic and Social Committee for an Opinion on the abovementioned Resolution. 
The Committee instructed its Section for Protection of the Environment, Public Health and 
Consumer Affairs to prepare its work on the matter. The Section adopted its Opinion on 3 
October 1989 (Rapporteur: Mr Aspinall). 
The Committee unanimously adopted the following Opinion at its 270th plenary session 
(meeting of 19 October 1989): 
1. General comments 
1.1.1. This is the second action plan 1990-94 in the 
framework of the 'Europe against cancer' programme 
and is to be endorsed subject to the following comments 
(summarized in the conclusions). 
1.1.2. The previous action plan 1987-89 on which 
the Committee gave its Opinion (2) made some specific 
comments with regard to research into substitute prod­
ucts and processes and alcohol abuse. The Committee 
wishes to reiterate the need for greater attention to be 
given to these subjects. 
1.2. Consultation with ESC 
1.2.1. It is appropriate that this Council Resolution 
should be referred to the Committee during the Euro­
pean cancer information year and that the Committee 
should have the opportunity of making its views known. 
1.2.2. The Committee represents the various econ­
omic and social interest groups in our society. It is 
important that this assembly be fully involved and 
informed by the Commission of the developments in the 
fight against cancer, in the same way as the European 
Parliament in order that greater emphasis can be made 
to cancer issues when the Committee and its members 
are communicating with their representational sectors. 
1.2.3. The action plan would greatly benefit from a 
more active involvement by social partners. 
1.3. Funding 
1.3.1. The Committee is concerned that if the Com­
mission is going to 'declare war on cancer' as stated 
in its information video, then the 55 millions ECU 
earmarked for this action plan will be insufficient in 
itself to carry out the whole campaign. Cancer needs 
(*) OJNoC 164, 1.7. 1989, p. 11. 
(2) OJNoC 105,21.4. 1987. to be treated seriously and therefore the actions being 
proposed can provide considerable inspiration to the 
strategic policies of individual Member States. 
1.3.2. The funding of this action plan will act as a 
trigger and coordinate national activity. However, 
unless additional funds are made available and effective 
administration and disclosure of information is assisted 
by the activities of Member-State governments (in a 
similar approach to that of the AIDS campaign), then 
the cancer programme objectives will fail. 
1.3.3. It must be acknowledged that, if Member State 
governments can be inspired and followed through with 
effective media presentation, publications to the public 
in such places as doctors' and dentists' surgeries, li­
braries, schools and health care premises, then the 
public will be provided with greater awareness. All this 
will require additional national funding. 
1.3.4. The Committee urges approval of the Council 
financial sheet adapted to take account of the views 
expressed in this Opinion. 
1.4. National structures 
1.4.1. The structure for preventive screening set up 
in each Member State needs urgent review since we 
understand that screening objectives vary enormously 
across the Community. This ranges from excellent pre­
ventive screening to little or no action. 
1.4.2. The Committee would suggest that those in 
our society who are at risk should be given identical 
opportunities for preventive screening action right 
across the Community. 
1.4.3. Special attention should be payed to the scre­
ening of those groups of people particularly at risk, e.g. 
where more than one factor is involved. 
Additionally there should be a review of actions taken 
at Community and Member State level to take into 
account certain categories of people, where they live 
30. 12. 89 Official Journal of the European Communities No C 329/61 
and work (e.g. inner cities, industrial areas, rural areas) 
and the type of environment. 
Research should be undertaken (much has already been 
carried out but it needs greater qualifications) to ident­
ify which people and where are at risk. 
1.4.4. It must be stated that in order to fulfill the 
preventive screening objectives Member State govern­
ments will have to provide incentives not only in the 
form of information to the public but also by providing 
financial inducement to health professionals to under­
take screening measures. 
In the Committee's view the investment will have an 
excellent pay back if less people have to be treated for 
acute cancer intervention. 
1.5. Education of the young and parents 
1.5.1. 1989 being the European cancer information 
year is an ideal time to promote cancer prevention to 
the public especially to young people who can be edu­
cated for the future, their future. In order to do this 
the educationalists should be provided with information 
and encouragement to pass this onto their pupils and 
their parents. 
1.5.2. Health education should be integrated into 
existing subjects in school curriculums and teaching 
staff should be specially trained for this purpose. 
1.6. More information 
1.6.1. Other suggestions which Member State 
governments and national bodies should examine in 
cooperation with the Commission are: 
— detailed information on a regular basis to the media, 
— presentation of the Commission's information video 
which can be shown on TV, at health clinics, volun­
tary organizations, and in educational establish­
ments, 
— a special presentation package which can be sent to 
all national legislators to seek their support and for 
them to give a lead by setting an example, 
— more effective cooperation with the social partners 
so that all employers will allow paid time off work 
to enable their employees to attend either mobile 
screening units or local health clinics. The social 
partners could have a bigger role in the fight against 
cancer and trade unions should be encouraged to 
publish articles in their journals to advise their 
members to take preventive action. 1.7. Nuclear activity 
1.7.1. The Committee wishes to endorse actions 
being taken under the Treaties establishing the EEC 
and European Atomic Energy Community (EAEC) to 
prevent cancers arising from exposure to ionizing radi­
ation or exposure to chemical carcinogens. It is impor­
tant that serious examination is made in the course of 
normal ongoing research of 'unknown' dangers such as 
radiation fallout and other areas of public concern. 
1.7.2. Currently the greatest exposure to radiation 
in the EC, comes from naturally occurring radon gas 
in deep mines and well-insulated homes built in areas 
with high levels of natural radiation. 
A Community information programme on this is 
urgent, particularly given the tendency to construct 
homes with better insulation so as to conserve heat. 
1.7.3. The Committee considers that the nuclear 
industry should be more open. Their activities cannot 
be secret and therefore more information and under­
standing must be relayed to the public to allay their 
fears about possible cancer. 
2. Specific comments 
2.1. Review of projects 
2.1.1. The Committee urges that the projects con­
ducted under this action plan be reviewed on a regular 
basis to ensure that objectives are met and that assess­
ment is undertaken at regular intervals. There appears 
to be no machinery under which the Commission can 
undertake such a review and assessment. 
2.1.2. Funds allocated over the five-year period must 
be accountable and therefore the Committee, whilst not 
wishing in any way to restrict funding of voluntary 
organizations, must at the same time urge the Com­
mission to be certain that these bodies have the expertise 
to provide a service to the general public. 
2.1.3. The programme must in our view concentrate 
on getting information to the general public in an 
effective way. Under the terms in which the action plan 
is written funding is geared mainly towards health care 
professionals and although we do not oppose this we 
must get assurance that the strategic objective is for 
these health professionals to inform and advise those 
individuals who are at risk. 
2.2. The European code against cancer should be 
made more available and given greater attention by 
governments, national bodies, employers and trade 
unions. Much more can be done to provide information 
to the public. 
No C 329/62 Official Journal of the European Communities 30. 12. 89 
2.3. Cancer prevention 
2.3.1. Fight against tobacco addiction 
2.3.1.1. The Committee supports the action pro­
gramme. However, Member State governments could 
set an example by banning smoking (except in desig­
nated areas) in all establishments under their control 
(e.g. health care centres, schools, and libraries). 
2.3.1.2. The social partners could do more to aid the 
fight against tobacco addiction by supporting innova­
tive information campaigns based on the European 
code against cancer. It is important that they are fully 
involved and respond to the wishes of all employees. 
2.3.1.3. Furthermore, non-smoking areas could be 
established in private buildings where large numbers of 
people congregate such as hotels and leisure facilities. 
2.3.2. Nutrition and cancer 
2.3.2.1. The programme set out in the Resolution is 
fully supported by the Committee. The first priority 
is further research into any connection, including the 
statistical association, between nutrition and cancer. 
Guidelines and information campaigns need to follow 
once these facts have been established. 
2.3.2.2. To have a clear Community nutrition plan 
may not be feasible across the 12 Member States bearing 
in mind different cultures, diets and habits. However, 
once there are sufficient hard facts, the drafting of 
nutrition guidelines should take note of national diffi­
culties and be formulated in cooperation with Member 
States. 
2.3.3. Fight against carcinogenic agents 
2.3.3.1. Activity is mainly undertaken by other Com­
mission services and therefore the action plan should 
provide only the stimulation to see that progress is 
made. Duplication of activity should be avoided. 
2.3.4. Systematic screening and early diagnosis 
2.3.4.1. The first objective of any strategy should be 
to prevent cancer. But early diagnosis of cancer is also 
essential: it saves lives, pain and suffering. Furthermore 
it is cost effective in terms of expenditure on hospitals 
and drugs. 
2.3.4.2. Once cancer has arisen screening is designed 
to identify early cancers which have produced no symp­
toms; early diagnosis by doctors involves early recog­nition of signs, symptoms and clusters of signs and 
symptoms which suggest cancer. 
2.3.4.3. Early diagnosis is known to be beneficial 
and to improve the outcome for some types of cancer. 
There is clear evidence for example that early diagnosis 
improves the outcome in cancer of the cervix, cancer 
of the breast, in melanoma and in some bowel cancers. 
Theoretically it could be true of all types of cancer but 
confusion arises because at some sites (e.g. bowel) 
different types of cancer with different speeds of devel­
opment may arise at the same site. For very slowgrow-
ing cancers early diagnosis is not essential. At the other 
end of the scale for the most invasive types it is likely 
that spread via the blood stream or lympatic system 
from the primary site has already occurred before pre­
sent diagnostic tests, however meticulously applied, can 
discover the primary cancer. 
2.3.4.4. The Committee supports the Commission's 
objectives in the field of screening and early diagnosis. 
It believes the time has come to go beyond pilot schemes 
and to institute/encourage measures which will increase 
the take-up and effectiveness of screening in member 
countries by: 
— Improving the attitudes of the public towards pre­
ventive and screening programmes on a national 
and local level. 
— Obtaining professional agreement and approval 
that health promotion and screening are valid com­
ponents of primary care at a national level. 
— Increasing the knowledge and skills of the health 
professionals who carry out screening. 
— Providing financial and professional inducements to 
primary doctors (generalist and specialist) consist­
ent with national health structures. 
2.3.4.5. Earlier diagnosis should be encouraged by: 
— Reducing delays in diagnosis at the primary level by 
education (particularly of established practitioners). 
— Reducing administrative delays between primary 
and secondary care. 
— Reducing delays in appointments and in diagnostic 
procedures within hospitals. 
30. 12. 89 Official Journal of the European Communities No C 329/63 
— Development of sensitive tests to detect the presence 
of malignant disease in its earliest stages. 
2.3.4.6. The Committee believes that although most 
of these actions should be the responsibility of Member 
States on a national basis the Commission could be 
expected to stimulate supranational activity in the edu­
cational and research fields. The Committee is of the 
opinion that specific training actions for the dissemi­
nation of knowledge and skills about prevention and 
early diagnosis for the generality of primary medical 
and surgical practitioners should be included in the 
training budget of the 1990-94 programme. 
2.4. Cancer registration and similar actions 
The Committee supports and encourages the proposals. 
2.4.1. In order to monitor progress in the prevention 
of cancer, epidemiological studies of cancer incidence 
and deaths are required. Member States should estab­
lish harmonized procedures for making data on cancer 
incidence and causes of death available to accredited 
researchers so that sensitive studies may be undertaken 
on large, pan-European populations. 
2.5. Information and health education 
2.5.1. Information to the public 
2.5.1.1. In addition to the objectives set out under 
this heading the Committee considers that Member 
State governments should take action at regional and 
local levels to develop machinery to inform the public 
on a regular basis, taking into account the problems of 
communicating with certain groups, e.g. ethnic min­
orities, illiterates, etc. 
2.5.1.2. The Commission cannot be expected to 
undertake the whole of the responsibility for informing 
the public since it is at Member State level that the 
appropriate communication systems can be made to 
work. 
2.5.1.3. The Council should give an assurance that 
they will undertake this action and provide the expertise 
to carry it out. 
2.5.2. Health education in cancer preven­
tion 
The Committee points out that the actions proposed 
are mainly under the authority of the Member States. 
The Commission will be able to give guidance and set 
objectives but it will be of no use if the Member State 
governments do not fully cooperate in the implemen­tation of the actions. The objective covered by health 
education will be worthless. 
2.5.3. Training of health professionals 
2.5.3.1. Health professionals are an important link 
in the development of any action to prevent cancer and 
every effort should be taken to encourage their support. 
2.5.3.2. In the 'fight against cancer' training of all 
primary care physicians surgeons and nurses in preven­
tion, screening and recognition of early signs and symp­
toms of cancer is crucial to success. This arises because 
of two inescapable facts: 
Firstly, because doctors in primary care regularly see 
up to 90 % of the population at home or in their offices 
each year. They are the only group which has regular 
personal contact with the majority of the population 
and they do so in a situation in which their advice 
about health is likely to be heeded. They are therefore 
potentially prime actors in providing information and 
changing public attitudes. 
Secondly, because primary care doctors and nurses 
(whether generalists or specialists) are the principal 
actors in carrying out basic screening procedures and 
early diagnosis. 
It is for this reason that the Committee commends an 
increase in the proportion of the budget spent on train­
ing of health personnel proposed for 1990-94. 
2.5.3.3. The Committee is not convinced that 
encouraging the mobility of individual health pro­
fessionals to improve their training in oncology will aid 
the fight against cancer to any considerable extent. In 
order to disseminate knowledge of good practice wide­
ly, it would be more cost effective to provide resources 
to train nursing and general practice teachers. 
2.5.3.4. We also understand that an explanatory bro­
chure is in the course of production which will aim at 
health care professionals. Such a Commission initiative 
is to be encouraged and given priority. 
The Committee would suggest that this brochure could 
include advice on how health professionals can intro­
duce preventive activities into their daily work and how 
they can provide more information to the public. 
No C 329/64 Official Journal of the 
The Committee recommends that this explanatory bro­
chure should be produced and distributed at Com­
munity level through those representing the professions. 
2.6. Research and cancer 
2.6.1. The main activity for cancer research should 
be covered by the research and technological develop­
ment (R & TD) framework programme and more funds 
should be allocated out of that budget. 
2.6.2. Quality of life is affected not just for the cancer 
patient but also for those who have to care for them 
(professionals and relatives) and therefore research on 
this illness should be intensified. We should never 
accept that there cannot be a cure nor preventive action. 
3. Conclusions 
The whole of the 1990-94 action plan should be geared 
towards prevention and this can only be done by: 
Done at Brussels, 19 October 1989. European Communities 30. 12. 89 
— providing additional funds, 
— total cooperation of all Member State governments, 
— the dedication of health professionals who must be 
provided with incentives if they are to undertake 
additional preventive screening measures, 
— the active intervention of teachers in the medical 
and nursing professions, 
— the active intervention of educationalists who can 
provide information to the young and their parents, 
— more active support of both sides of industry (public 
and private), 
— greater attention being given to providing infor­
mation to the public. 
The Committee endorses the Commission's objectives 
but hopes that the Council will take into account the 
need for Member State governments to acknowledge 
that this action plan is but a trigger and incentive to 
setting up structures in each Member State to fight 
cancer. 
The Chairman 
of the Economic and Social Committee 
Alberto MASPRONE