28.12. 85 Official Journal of the European Communities No C 336/11 
II 
(Preparatory Acts) 
COMMISSION 
Proposal for a Council Resolution on a programme of action of the European Communities on 
cancer prevention 
COM(85) 628 final 
(Submitted by the Commission to the Council on 18 November 1985) 
(85/C 336/09) 
& THE COUNCIL OF THE EUROPEAN COMMUNITIES 
Having regard to the Treaties establishing the European 
Communities, 
Having regard to the draft submitted by the Com­
mission, 
Having regard to the opinion of the European Parlia­
ment, 
Having regard to the opinion of the Economic and 
Social Committee, 
Whereas, under Article 2 of the Treaty establishing the 
European Economic Community, the Community shall 
have in particular as its task, by establishing a common 
market and progressively approximating the economic 
policies of Member States, to promote throughout the 
Community a harmonious developing of economic 
activities, a continuous and balanced expansion and an 
accelerated raising of the standard of living; 
Whereas the European Council in Milan on 28-29 June 
1985 emphasized the value of launching a European 
action programme against cancer; 
Whereas this European Council approved the proposals 
of the ad hoc Committee on a Peoples' Europe calling 
for appropriate follow-up to the Commission's com­
munication on cooperation at Community level on health 
problems; 
Whereas various Community actions to prevent cancers 
arising from exposure to ionizing radiation or exposure 
to chemical carcinogens are already being carried out 
under the Euratom Treaty and the Treaty establishing 
the European Economic Community; 
Whereas actions to reduce the risk of cancer from 
exposure to carcinogenic substances are included in a 
number of existing Community programmes on the 
environment, worker protection, consumer protection, 
nutrition, agriculture and the internal market; Whereas the present programme should increase knowl­
edge about the causes of the cancer and the possible 
means of preventing and treating it; 
Whereas by ensuring a wider dissimination of knowledge 
about the causes, prevention and treatment of cancer, 
and an improvement in the comparability of information 
about those matters, in particular concerning the nature 
and degree of risk of cancer arising from exposure to 
given substances or processes, the programme will 
contribute to the achievement of Community objectives, 
in particular the removal on non-tariff barriers to trade, 
while contributing to the overall reduction of risk of 
cancer; 
Whereas research into cancer and the carcinogenic 
effects of physical and chemical agents is undertaken in a 
number of Community research programmes; 
Whereas the coordination of national research activities 
relating to the early detection and treatment of cancer 
will form part of the proposal for a Council Decision 
adopting the fourth medical and public health research 
programme of the European Economic Community 
(1987-1989) to be submitted in early 1986, 
Whereas cooperation with international and national 
organizations carrying out work in this field will ensure 
a wider dissemination of knowledge about cancer and 
assist in avoiding duplication of effort; 
HEREBY ADOPTS THIS RESOLUTION: 
1. The Council hereby identifies the following objectives: 
i) to halt the increase of cancer in the Community 
leading to a downward trend in both incidence 
and mortality from the disease, 
No C 336/12 Official Journal of the European Communities 28.12.85 
iv) Improvement in the availability and comparability 
of epidemiological data on cancer. 
v) Development of programmes of health education 
for cancer prevention and treatment. 
vi) Collaboration with international and national 
organizations in the field covered by these 
actions. 
3. The Council, noting those actions relating to cancer 
prevention already undertaken at Community level, 
expresses the necessity for them to be strengthened and 
coordinated with the actions established by the present 
programme. 
4. The Council hereby invites the Commission to submit a 
proposal or the setting up of a Committee to assist the 
Commission in the preparation and implementation of 
this programme. 
ANNEX 
ACTION PROGRAMME OF THE EUROPEAN COMMUNITIES ON CANCER PREVENTION 
1. Introduction 
1.1. Cancer may appear either as local solid tumours or as systemic diseases such as the various types of 
leukaemia. The characteristic feature of all cancers is that some cells of the human body are altered 
in such a way that they divide and proliferate independently of the normal controlled growth. They 
are further characterized by the fact that the cancer cells may spread throughout the body. The 
spread of the tumour locally or to other parts of the body will inevitably lead to death if left 
untreated. 
1.2. Most cancers take several years to develop and some cancers are easily curable whereas others are 
almost always incurable by the time they are clinically diagnosed, depending largely on the organ of 
the body (lung, intestine, etc.) in which the first altered cells originate. The low rate of success in the 
treatment of certain cancers, for example lung cancer, underlines the importance of a strategy of 
prevention. 
1.3. Cancer is second to cardiovascular diseases in causing most deaths annually in the Community. In 
approximate terms, one million people develop cancer each year and 500 000 die from it. All forms 
of cancer account for some 25 % of deaths. 
1.4. Another way of quantifying the impact of cancer on the health of the population is to calculate the 
potential years of life lost due to premature deaths from the disease. This indicator is essentially 
designed to give a broad view of the relative importance of the various major causes of premature 
mortality. The figures show that death from all forms of cancer before age 70 contributes up to 20 °/o 
of the total. 
1.5. In the past 40 years the total incidence of cancer has been increasing. Concealed within this rising 
trend, the incidence of some cancers has increased markedly (lung, bladder, kidney) and some have 
decreased (stomach, oesophagus). ii) to decrease the potential years of life lost from 
cancer. 
2. The Council, approving the Action programme of the 
European Communities on Cancer Prevention as 
proposed by the Commission and annexed to the present 
resolution, adopts the following priority actions: 
i) Development of a nutritional strategy, including 
alcohol, to complement existing actions at 
Community level in the fields of food production 
and consumer protection. 
ii) Development of a strategy against cigarette 
smoking with coordination and support of 
national programmes and actions. 
iii) Development of guidelines for the allocation of 
resources to preventive and therapeutic services. 
28.12.85 Official Journal of the European Communities No C 336/13 
1.6. It is now recognized that the common fatal cancers occur in large part as a result of personal, social 
and environmental factors. These include exposure to natural and man-made carcinogens, nutritional 
deficiencies or excesses, infections, reproductive activities and a variety of other factors determined 
wholly or partly by personal behaviour. In principle, therefore, these cancers are largely preventable. 
1.7. The variations noted in the incidence of various cancers in recent years serve to underline the fact 
that the agents or habits which greatly increase or decrease the likelihood of developing one 
particular type of cancer may have little effect on other types of cancer, so that the prevention of 
each type must be considered separately. 
1.8. The objective of definitive treatment is to destroy the altered cells by surgical removal, chemotherapy 
or radiotherapy. The main parameter for measuring the success of treatment is the proportion of 
patients surviving for 5 years after treatment. For some cancers this proportion is small, i.e. approx­
imately 5 % for lung cancer; for other cancers the figure is greater, i.e. approximately 50 % for 
bladder cancer. There is considerable variability in the figures for 5 year survival both between and 
within Member States. 
1.9. In general the earlier a cancer is diagnosed, the more successful treatment is likely to prove. 
However, as commented previously many cancers are beyond the scope of definitive treatment by the 
time they have caused signs or symptoms of their presence leading to diagnosis. 
1.10. These reasons have led to much effort in recent years to develop and evaluate screening and 
diagnostic methods for the early detection of cancers. For two cancers in particular (cervix, breast) 
there is evidence that population screening is effective in reducing mortality. For cancer of the large 
intestine the evidence suggests that there might be a similar benefit; by contrast, for cancer of the 
lung there is evidence that population screening by mass X-ray examinations does not reduce 
mortality. 
1.11. The increasing number of cancer patients, the development of new diagnostic techniques and 
treatment regimes, and the development of programmes of population screening have all contributed 
to greater demands on available health care resources. It is not unreasonable to predict that these 
demands will continue to escalate. 
1.12. The nature of the disease, the results of treatment and the increasing load on treatment services 
support the case for a strategy of prevention or avoidance. In determining this strategy due 
consideration must be given to recent published analyses which show that of the various classes of 
factors involved, approximately one third of all cancer deaths can be attributed to diet, including 
alcohol, one third can be attributed to cigarette smoking, and the remaining third to a variety of 
factors amongst which the most notable are infection, reproductive and sexual behaviour, and 
occupation. 
2. Recent Community Actions and Activities Related to Cancer Prevention 
2.1. Activities at Community level have been undertaken to identify carcinogenic agents (both chemical 
and physical) and to prevent exposure of the public and workers to such agents. These have been 
contained in a number of different Community programmes, for example, elimination of technical 
barriers to trade, environment, occupational safety and health, consumer protection, and agriculture. 
2.2. Community research programmes have provided support for these activities. Close cooperation has 
been maintained with the World Health Organization and the International Agency for Research on 
Cancer. 
2.3. Protection of the population and workers against the long-term effects (cancer) of ionizing radiation 
is embodied in the Euratom Treaty. Since 1959, Directives have been adopted to limit exposure of 
the population and the workers. Recently a Directive was adopted to reduce the possible 
carcinogenic risk of medical X-rays. 
No C 336/14 Official Journal of the European Communities 28.12. 85 
2.4. Community legislation on chemical carcinogens under Article 100 EEC covers labelling, prohibition 
of use, prohibition or limitation of discharge and limitation of exposure. The principle of labelling 
carcinogenic compounds was established by a Directive in 1979 and practical guidelines defined in 
1983. Simultaneously the obligation to test new chemicals for their carcinogenic potential was also 
introduced. 
2.5. The possibility exists of prohibiting or limiting the use of specific compounds and preparations. For 
example, the placing on the market and use of crocidolite, blue asbestos, was proscribed by a 
Directive of 1983. Similarly, in the field of cosmetic products and food additives, lists have been 
established prohibiting the use of carcinogens as food additives or their introduction into cosmetic 
preparations. Lists have been established of toxic chemicals, including carcinogens, the discharge of 
which in the aquatic environment is prohibited or strictly limited. 
2.6. For worker protection Directives limit exposure to vinyl chloride and asbestos and a proposal has 
been made for a Directive proscribing certain dangerous (carcinogenic) substances. In a broader 
sense, the Directive of 1982 under Article 100 EEC on major accident hazards of certain industrial 
activities aimed at protecting the workers and the population contains a list of 178 substances and 
classes of substances, including carcinogens. 
2.7. This outline of actions at Community level in various sectors might suggest that chemical carcinogens 
are easily identified. This is not correct and it is important that at Community level the same 
scientific evidence and conclusions are used as a basis for all actions. The Scientific Advisory 
Committee to examine the toxicity and ecotoxicity of chemical compounds, set up by the 
Commission in 1978, has undertaken at the request of the Commission to provide such scientific 
opinions. In the framework of the Action Programme on Toxicology for Health Protection, 
submitted to the Council in 1984, it is proposed to enhance and accelerate the work of the 
Committee in this field. To avoid duplication of work and to ensure that all information on 
carcinogenicity is available to the Commission, close contacts are maintained with international and 
national institutes and agencies. 
3. Alms and objectives of the present programme 
3.1. The first aim of the programme is to contribute to an improvement of the health and quality of life 
of the citizens within the Community by the prevention of cancers. 
3.2. The objectives of the programme are: 
(i) to halt the increase of cancer in the Community leading to a downard trend in both incidence 
and mortality from the disease, 
(ii) to decrease the potential years of life lost from cancer, 
(iii) to establish health strategies for those factors to which cancer is attributed, 
(iv) to improve the data available on cancer incidence and mortality and the data for epidemiological 
studies for monitoring the health of specific groups of the population and for identifying new or 
unforeseen risk factors for cancer, 
(v) to facilitate cooperation at Community level and exchange of information relating to 
programmes for population screening and treatment in order to improve their performance, 
(vi) to collaborate with international and national organizations in the field of cancer prevention to 
the attainment of these objectives and the application of the results of cancer research. 
3.3. A second aim of this programme is to provide a setting in which existing actions and future initiatives 
in the field of prevention can be made more coherent. 
4. Initiatives to be taken at Community level 
4.1. Attainment of these objectives requires many initiatives involving the health care professions, 
educators and administrators. Such initiatives presuppose the effective participation of individuals in 
managing their own health. In broad terms the prevention or avoidance of cancer can only be 
brought about by means that are socially and personally acceptable. 
28.12. 85 Official Journal of the European Communities No C 336/15 
4.2. It has, therefore, to be appreciated that the timescale for many of the actions has to be long. The 
nature of the problems and the actions to be taken mitigate against any short-term impact on the 
morbidity and mortality experience of the population. 
4.3. The following areas will be addressed: 
(i) Development of a nutritional strategy, including alcohol, to complement existing actions at 
Community level in the fields of food production and consumer protection, 
(ii) Development of a strategy against cigarette-smoking with coordination and support of national 
programmes and actions, 
(iii) Development of guidelines for the allocation of resources to preventive and therapeutic services, 
(iv) Development of the date base for the evaluation of preventive services and the identification of 
new or unforeseen risk factors for cancer, 
(v) Development of programmes of health education for cancer prevention and treatment, 
(vi) Collaboration with international organizations active in the field. 
5. Nutrition 
5.1. There is strong but indirect evidence that many of the common cancers could be made less so by 
suitable modification of national dietary habits. Diet is implicated in cancer of the stomach and large 
intestine as well as of the body, of the uterus and gallbladder. Diet may also prove to have a material 
effect on the incidence of cancers of the breast and pancreas, and, perhaps through the anti-
carcinogenic effects of various micronutrients on the incidence of cancers in many other tissues. 
5.2. There are many mechanisms by which diet may operate to promote cancer. Carcinogens may be 
present in foodstuffs as naturally occurring substances or may be introduced by cooking or contami­
nation. The constituents of the diet influence digestion and excretion. Micronutrients may be 
deficient. And lastly excessive calorie intake and obesity are associated with an increase in cancer 
risk. 
5.3. Alcohol is also implicated in cause of cancers of the mouth, pharynx and oesophagus, and there is 
evidence that alcohol consumption sufficient to cause liver disease will also increase the incidence of 
liver cancer. Of particular importance, however, is the potential role of alcohol in enhancing the 
effect of other agents. For example, it would seem that alcohol interacts with tobacco to produce a 
greater effect than either factor acting independently. 
5.4. Nutritional policies in Member States have mainly been concerned with an adequate total intake of 
calories and essential nutriments. Currently there is a growing concern over the constituents of diet 
causing or contributing to disease patterns in the population, not only cancer but also cardio-vascular 
disease, for example. 
5.5. It is, therefore, becoming necessary for the Community to identify dietary objectives for, inter alia, 
cancer prevention. The Commission will review the development of national policies in this area and 
their impact on dietary consumption and disease. The Commission will make periodic reports and 
recommendations. 
6. Tobacco 
6.1. No single measure is known that would have as great an impact on the number of deaths attributable 
to cancer as a reduction in the use of tobacco or a change to less dangerous use. Cigarette-smoking 
is the principal single factor causing lung cancer and cancers of the mouth, pharynx, oesophagus, 
pancreas and bladder. 
6.2. The contribution of cigarette-smoking to mortality from cancer is now widely acknowledged and all 
Member States have initiated one or more anti-smoking measures. These various measures lack 
coherence both within and between Member States. 
No C 336/16 Official Journal of the European Communities 28.12.85 
6.3. It is a matter of urgency to establish a common strategy to reduce the toll of smoking related 
diseases. To this end the Commission will assess the impact of measures already taken by Member 
States with a view to proposing harmonization of suitable regulatory provisions and coordination of 
supporting actions. 
7. Services for screening and early diagnosis 
7.1. Population screening or case-finding for cancers of the cervix and breast are now established 
activities within Member States, although the stage of development of facilities and the geographical 
distribution varies. New procedures are under evaluation and there is a continuing and increasing 
pressure on those responsible to enhance the services available. 
7.2. To improve the use of resources within Member States there, should be an exchange of information 
on service development and evaluation. 
7.3. The Commission proposes to establish a cleaning-house for this exchange, to undertake a series of 
studies on the cost-effectiveness of different approaches within national settings, and to prepare 
periodic reports on the utilization and impact of such preventive services. 
8. Mortality and morbidity data 
8.1. In 1979, a group of scientists and doctors from 8 Member States initiated studies to compare data 
from death certificates to examine possible hazards related to occupation and the environment, 
including factors concerned with cancer. It was concluded that the data were not strictly comparable 
due to systematic differences. These findings only served to underline the difficulties of making 
cross-national comparisons and the caution necessary in interpreting apparent differences in mortality 
rates between even neighbouring countries. 
8.2. A second inquiry demonstrated that only in a minority of Member States was it possible, even with 
considerable difficulty, to undertake follow-up studies of groups of workers exposed to particular 
hazards in order to discover any long-term risks particularly cancer. In practice the large majority of 
such studies has been undertaken in only two Member States. 
8.3. Work in progress is revealing that systems of cancer registration will not, with the present degree of 
coverage and data comparability, provide the means necessary for monitoring potential cancer 
hazards, particularly those hazards of a specific or limited nature. 
8.4. It is necessary, therefore, to improve systems for the recording of vital statistics and cancer 
registration and to allow the means for individual records to be accurately and completely collated. 
8.5. To this end the Commission will undertake consultations with the responsible agencies in Member 
States to achieve a better comparability and use of data for identifying factors causing cancer and 
influencing its treatment. 
8.6. The Commission will seek to establish at Community level a common understanding regarding the 
protection of medical data on individuals. 
9. Health education 
9.1. Health education is the corner-stone of any programme against cancer directed towards the popu­
lation. Health education is necessary to produce the climate of social acceptability for the measures 
involved and to influence the behaviour of individuals in modifying habits and lifestyles. It is 
fundamental to the proper use of health care resources. Health education indirectly influences the 
political process by helping to determine the needs and demands of the population. 
28.12. 85 Official Journal of the European Communities No C 336/17 
9.2. All Member States have health education programmes with some or all of these aims. However, the 
extent, nature and content, and penetration of these vary greatly. There is virtually no programme 
coordination between Member States and as a result confusion may arise. Programme effectiveness 
has often been questioned, although the bases of many past evaluative studie have been wrong, 
incomplete or the timing has been inappropriate. 
9.3. Increasing spread of media productions will require a greater coherence of actions in the field of 
health education with the opportunity for saving in cost if material can be jointly developed and 
shared. 
9.4. Health education is a collective activity involving individuals, parents and group leaders with 
teachers, health care workers and media professionals. As an educational activity its needs are not 
different from the mainstream of education and the actions implemented in this field, namely 
exchange, closer relations, information and training with the identification of common unders­
tanding. 
9.5. The Commission, therefore, will sponsor a series of collaborative ventures, joint projects and 
workshops to improve the cost-effectiveness of health education resources. 
10. International collaboration 
10.1. Many organizations are active in the field of cancer, the principal ones being the World Health 
Organization and the International Agency for Research on Cancer. Close collaboration has already 
been established, for example in the fields of toxicology, protection against dangerous substances and 
workers' health. 
10.2. In 1984, the Regional Committee for Europe endorsed a document on 'Regional Targets in Support 
of the Regional Strategy for Health for All by the Year 2000'. One target specifically relates to 
cancer and proposes a reduction in mortality of 15% mainly as a consequenceof a reduction in 
smoking. Cancer is subsumed under a number of other targets. 
10.3. This programme would seek to support WHO and IARC goals by coordinating the efforts of 
Member States in working towards the stated objectives. 
10.4. In a similar manner the Commission has established collaboration with other international organi­
zations, e.g. the International Union for Health Education, European Organization for Cooperation 
in Cancer Prevention Studies, European School of Oncology and with national organizations. 
10.5. The Commission will maintain and develop this collaboration, placing emphasis on joint activities 
and, thereby, avoiding unnecessary duplication and improving the use of scarce resources.