COMMISSION OF THE EUROPEAN COMMUNITIES 
COM(93) 93 final 
Brussels, 15 March 1993 
REPORT FROM THE COMMISSION TO THE COUNCIL, 
THE EUROPEAN PARLIAMENT AND THE ECONOMIC AND SOCIAL COMMITTEE 
on the evaluation of the effectiveness of Community 
action undertaken in the context of the 
"Europe against Cancer" programme 
(1987-1992) 
I. INTRODUCTION 
1. The Decision of the Council and the representatives of the Governments of the 
Member States meeting within the Council dated 17 May 1990 (90/238/Euratom, 
ECSC, EEC) <!> enjoined upon the Commission of the European Communities to 
implement, from 1990 to 1994, an action plan in the context of the "Europe against 
cancer" programme, the purpose of which is to increase knowledge of the causes of 
cancer with emphasis on the possible means of preventing cancer. 
2. The Decision provided that the Council and the Ministers of Health will carry 
out a scientific evaluation of the effectiveness of the action undertaken and that, to 
this end, the Commission will submit a report on the subject during the second half of 
1992. 
3. The purpose of this communication is to report to Council on the evaluation of 
the effectiveness of the actions undertaken under the action plan. However, since 
such actions constitute, to a large degree, a continuation of actions undertaken since 
1987 in the context of the "Europe against cancer" programme, and cannot therefore 
be viewed in isolation, and that the avowed aim of reducing deaths from cancer by 
15% by the Year 2000 cannot be determined at present, the evaluation carried out by 
the Commission was extended to cover the five years (1987-1992) of the programme. 
4. In evaluating the effectiveness of the programme, the Commission has had 
recourse to material produced in the course of implementing the various actions, 
assessments concerning specific projects and, lastly but most importantly, to the work 
(i) OJL 137, 30.5.90, p. 31. 
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carried out by an Evaluation Committee which has been submitted to the Commission 
as a report entitled "Europe against cancer - Evaluation of the first five years 1987 -
1991". This report, which also contains a number of policy recommendations, will be 
made available on request. 
n. BRIEF DESCRIPTION OF THE "EUROPE AGAINST CANCER" 
PROGRAMME 
5. Launched on the initiative of the European Council, the "Europe against 
cancer" programme covers the following five areas of action: 
a) smoking; 
b) nutrition; 
c) carcinogenic agents; 
d) cancer screening; 
e) cancer treatment. 
The Council Decision of 17.5.1990 reorganised the measures to be implemented in 
the period 1990 to 1994, grouping them under the following headings: 
a) cancer prevention (including screening), 
b) health information and education, 
c) training of the health professions, 
d) research and cancer. 
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Research actions will not be described in this communication, having been the subject 
of a separate evaluation. 
6. Within the context of the first (1987-1989) and the second (1990-1994) 
Action Plans, and on the basis of the opinions of the Committee of Cancer Experts, 
the following means have been mobilised: 
a) adoption of Community legislation; 
b) financial assistance for studies and research to promote cancer prevention and 
screening, public information campaigns and school health education 
campaigns, cancer training schemes for health personnel, pilot cancer 
screening projects, and exchanges of experience in the field of cancer 
treatment. 
7. In order to reach the target set for the Programme in 1986 - a 15% reduction 
in cancer deaths in Europe by the Year 2000 - the Commission has followed a 
strategy of partnership, mobilising all the governmental and non-governmental 
players in the twelve Member States. 
8. The Commission has proceeded on the principle of non-intervention except in 
cases where Community intervention would add value to national actions. This added 
value has taken the following forms: 
a) promoting the adoption throughout the European Community of the hest 
practices or national legislative provisions; 
b) promoting and stimulating cooperation in the field of study and research; 
c) setting-up of networks concerning pilot projects, sharing of experience and 
exchange of information. 
•BEL E¥ALUA3TON OF THE EFFECTIVENESS OF THE ACTION 
UNDERTAKEN 
9. As stated already, the overall objective of the programme is to bring about by 
the Year 2000 a 15% reduction in cancer mortality. In view of the difficulties 
involved in accomplishing this ambitious objective, the Commission decided, from 
the outset, to enlist the aid of decision-makers at national and European level, the 
scientific experts, and national governmental and non-governmental organisations, in 
designing and implementing a bold set of actions which would be judged to have the 
greatest chance of success. Guided principally by the advice given by the Committee 
of Cancer Experts which was set up in 1986 and by the Programme's Consultative 
Committee, the Commission decided to give priority to certain actions from among a 
large inventory of possible actions, and to deploy for each action the means 
considered most appropriate given the limited resources allocated to the Programme. 
The priorities could have been, and still could be, extended and/or beefed up with 
additional funding. 
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10. In answering, therefore, the question whether the right things were done in 
order to render the Programme effective, the Commission would like to recall that, at 
a time of its inception, the programme constituted a wholly innovative endeavour, on 
a wide scale, involving, for the first time, the Member States, experts, interested 
organisations and the Commission; and to underline the uncertainty over the best 
practicable means with which it was faced at the launch of the Programme, as well as 
the difficulty in defining the proper yardsticks by which each selected action was to 
be measured. The Commission believes that the effectiveness of the actions selected 
have to be judged against the intermediate indicators of agenda-setting and awareness 
raising, a view espoused by the Council when adopting Decision 90/238. 
11. The selection of actions was by and large based on commonly accepted major 
risk factors for several types of cancer and on the possibilities for prevention. The 
Commission considered that primary prevention by means of a reduction of smoking, 
and reduction of exposure to carcinogenic agents constituted the main targets if the 
requisite reduction in cancer mortality was to be achieved: the Commission believes 
that this choice of targets remains valid. The main thrust of the Programme as 
regards primary prevention, indeed the privileged measures in the fight against the 
identified major risk factors, were chosen to be health information, training, and 
education. Both collection of information and its dissemination were, and still are, 
considered to be the most potent areas of action, whereas education directed towards 
appropriate groups has stood the test of time. 
12. As regards the possibilities for secondary prevention, systematic screening and 
diagnosis were identified as the most promising courses of action: the Commission is 
of the opinion that the experience accumulated from implementing relevant measures 
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under the Programme showed that systematic screening for certain types of cancer 
has proved its worth. For other types of cancer the results have been inconclusive and 
prompted a number of Member States to refrain from carrying out such screening. 
13. In the area of treatment, it was felt that the greatest contribution could be 
made towards supporting the operation of bone marrow banks and by promoting 
quality control. 
14. The training of the health professions remains the condition sine qua non for 
ensuring that cancer prevention and treatment practitioners have acquired the 
necessary knowledge and skills to intervene timely and decisively. 
IV. EVALUATION OF MEANS DEPLOYED 
15. In order to implement the actions thus selected, the Commission used the 
following means : 
1. Extension, through Community legal instruments or financial incentives of 
the best national measures in the fight against cancer. 
2. Funding of qualified scientific teams for studies and research whose results 
will be useful for application throughout the Community. 
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3. Fostering of cooperative partnerships in the fight against cancer among 
Community bodies and persons locally, nationally, and between Member 
States. 
The implementation of the "Europe against cancer" programme was organised 
through the structure described in Annex I. 
As regards financial means, the first plan of action comprising 56 measures was 
allocated 18.5 million over 1987-1989, whereas the cancer research budget 
(19 actions) amounted to 18 million over 1987-1991. The second action plan for 
1990-1994, including 38 points of action (besides the continuation of medical 
research activities), was allocated a budget of 50 million, although the Decision of 17 
May 1990 stipulates that the Council and the Ministers for Health, meeting within the 
Council, will review this total amount in the light of this present evaluation report 
with the possibility of increasing it by 5 million from 1 January 1993. 
16. The Commission believes that the kind of means, if not the magnitude, was 
globally appropriate for the actions pursued under the programme. Through the 
judicious combination of actions and the nature of the means, the programme has 
succeeded in both raising awareness concerning the fight against cancer among the 
public at large, among health professionals and the decision-makers, and in tracing 
the road towards the sought-after reduction in cancer mortality. In terms of added 
value for the whole of the European Community the programme : 
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. has succeeded in guiding or assisting in the passage through the European 
Parliament and the Council of Ministers of a number of legislative proposals 
concerning preventive actions vital to the reduction of exposure to tobacco and to 
carcinogenic substances; 
. has coordinated and spread the messages of the ten components of the 
European Code against cancer which by means of simple messages distils the existing 
knowledge useful for cancer prevention within the European Community. The large 
distribution of the code has helped to increase awareness and better inform the 
general public on risks associated with cancer; 
. has contributed to numerous joint efforts in public information via various 
forms of popular media events, including the European Year of Information on 
Cancer in 1989, and the cancer weeks which take place on a yearly basis; 
. has supported demonstration programmes in cancer screening and research 
projects on nutrition and on carcinogenic substances for the benefit of all Member 
States. This research is expected to generate results applicable in the European 
context, thus increasing the effectiveness of the research investment; 
. has initiated health care curriculum development and continuing professional 
training in oncology as well as professional exchange programmes which facilitate 
the transfer of experience and knowledge aimed at improving standards within the 
Member States; 
. has facilitated the dissemination of technical standards for health care 
professionals regarding cancer prevention, cancer diagnosis, and quality of care for 
cancer patients; 
. has succeded in demystifying the subject of cancer among the public at large, 
greatly enhanced awareness on relevant risks and prevention and protection measures, 
and cultivated a willingness to seek treatment promptly. 
17. A detailed description of the measures implemented under the programme, 
grouped under the headings contained in the Annex of the Decision 90/238, is 
presented in Annex III. 
18. With regard to the efficacy of means deployed in the implementation of 
measures under the programme, the Commission is of the opinion that: 
a) As smoking is the most important cause of death from cancer that is 
preventable, the most significant way to achieve a reduction in deaths from cancer is 
to reduce smoking. The Commision has pursued this aim by means of a combination 
of regulatory actions and information campaigns targctted at the general population 
and at certain specific groups such as young persons and, therefore, the emphasis 
placed upon them by the programme was amply justified. 
b) Concerning carcinogenic agents, a series of actions carried out in other 
Community policies also lent support to the cancer programme, in particular by the 
application of legislative measures adopted in the framework of those policies, 
notably in the field of safety and health at work; 
10 
c) Many actions have been undertaken at national level in the area of 
nutrition since 1987, with the scientific advice of the Committee of Cancer Experts 
and thanks to the involvement of the associations against cancer. These efforts have 
been complemented by the large scale prospective study on "Nutrition, Health and 
Cancer" which was initiated in 1989, although the results have not yet been fully 
analysed. There is value in persisting with the actions and studies undertaken in this 
important area of the programme. 
d) Concerning promotion of awareness and information of the public, the 
concentration of important resources in campaigns and the involvement of 
organisations and individuals has had a major and beneficial impact; based on the 
experience acquired from the implementation of the first plan of action, campaigns 
undertaken during the second plan were better organised and targetted on specific 
groups. 
e) Concerning health education in schools, the programme instigated 
developments, in particular the review and improvement of curriculum and learning 
resources and the development and dissemination of teaching materials, which would 
not otherwise have taken place. These health education activities could not have taken 
place without the active involvement of the national Ministries and the national 
organisations against cancer which became involved in health education against 
smoking from a very early stage, and more recently in health education for healthy 
nutrition. However, the specific issue of cancer education in schools needs to be seen 
in the more general setting of health education in schools. 
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0 Concerning training of health professionals, the emphasis on 
curriculum development and relevant exchange of information as well as the granting 
of financial assistance for specialised training of health care professionals, proved 
their usefulness and demonstrated the need for continuing support. 
g) Concerning cancer screening, vital lessons have already been learnt 
which can be put to good use in relation to screening of cancers other than those 
already dealt with and in relation to assisting resource allocation decision-making 
concerning the place of screening in overall health policies. 
h) Concerning treatment and palliative care, little work has been carried 
out. Thus it is premature to attempt to rush to statements, even of a qualitative 
nature, as to the effectiveness of pertinent measures, although a promising area 
appears to be the exchange of information on quality control. 
i) Concerning project administration, an overall good performance was 
marred, basically through lack of resources, by some delays and a relative deficiency 
in the circulation of information to inquirers, which would require a review of the 
procedures established for managing the activities under the programme with a view 
to their amelioration and strengthening. 
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V. GLOBAL APPRAISAL 
19. The "Europe against cancer" programme, judged by its impact in agenda -
setting and awareness raising, and as a pointer to what may be achieved by bringing 
forces in the European Community into a proper relationship so as to yield added 
value» has proved a success. 
It is appropriate, therefore, to pursue the actions under the programme. The 
adjustments that need to be made to maximise this added value could only be 
discerned thanks to the experience accumulated by implementing the programme. 
More emphasis must be placed on the information of target groups, smoking 
reduction, specialised training of health care professionals, and screening ; in 
addition, more effort should be devoted, in the coming years, to supporting the 
dissemination in Member States of the best practices in treatment quality control and 
in palliative care management, as requested by the Council of Health Ministers in its 
Decision of 17 May 1990. School health education and nutrition are at present 
indissociable elements of the programme. It is recognised that these are generic 
issues, the importance of which also needs to be seen in a more general framework. 
In this context, the allocation of additional funding, mentioned as a possibility in the 
Decision of 17 May 1990, would be both useful and justified. 
In conclusion, the Commission reiterates the position expressed in its communication 
COM(92) 2000 final ("From the Single Act to Maastricht and beyond - The means to 
match our ambitions"). Thus, the "Europe against cancer" programme should 
continue to be pursued, and should be intensified in all areas: prevention, information 
and education, training and research. 
(3 - ANNEX 1 
ORGANISATIONAL STRUCTURE. 
There are five organisational entities forming the structure of the Programme "Europe against Cancer" 
Committee of Cancer Experts 
The creation of this Committee was decided in December 1985, by the Council of Ministers for Foreign 
Affairs. The Committee is composed of fifteen members (one or two cancer experts per country) and is 
chaired by Professor Maurice Tubiana of France. These cancer experts were appointed by their respective 
Head of State, Prime Minister, or Health Minister to advise the European Commission in the elaboration 
of the plans and their unplementaUon. Several observers are also members of that Committee, notably 
WHO-Europe and the WHO agency for cancer research (International Agency for Research on Cancer). 
This allowed an effective cooperation between WHO and the European Commission. 
Consultative Committee of "Europe against cancer". 
This committee of twenty-four senior officials of the Member States was created by the Council Decision ) 
concerning the second action plan. One of its tasks is to assure the smooth coordination of proposals funded 
by the Commission and by national government bodies. Furthermore, this Committee assists the 
Commission in the implementation of those actions involving national governmental bodies, notably actions 
concerning health education activities. 
National Coordination Committees. 
These twelve National Coordination Committees were set up at the beginning of the first action plan to 
ensure that public information and health education activities subsidized by "Europe against cancer" would 
be properly coordinated and evaluated at the national level. These committees are usually chaired by the 
corresponding member of the Cancer Experts Committee. Members represent the Health and Education 
Ministries and influential non-governmental organisations involved directly or indirectly in the fight against 
cancer. 
Non-governmental organisations/groups 
Several working groups were set up under the programme at the beginning of the first action plan, "including: 
* anti-cancer leagues 
* anti-tobacco associations 
* representatives of general practitioners. 
These groups have played a key role in the implementation of the public information chapter of Europe 
against Cancer. 
European Commission ("Europe against Cancer") 
The programme was managed by a "Europe against cancer" unit which now forms a part of the unit "Public 
Health and Programme of Action Against Cancer". Thirteen Commission officials were assigned to the 
Programme for the implementation of the first action plan. They have reinforced by five national officials 
in 1990. Part-time consultants have also been recruited to assist in specialized matters (information and 
health education specialists, training of health personnel, screening of cancer). These consultants represented 
the equivalent of four full-time persons at the end of 1991. 
ANNEXE II EUROPE AGAINST CANCER PROGRAMME 
SUBVENTIONS - (ECU) - % GLOBAL BUDGET 
Tobacco 
Information 
Health 
Education 
Nutrition 
Carcinogens 
Training 
Cancer 
Registries 
Screening 
Treatment 
SUB TOTAL 
SUBVENTIONS 
Coordination & 
Management 
TOTAL 1987 
80.000 
(11,8%) 
564.112 
(83,5%) 
0 
0 
0 
32.000 
(4,7%) 
0 
0 
0 
676.112 
(100%) 
250.000 
926.112 1988 
495.255 
(6,5%) 
4.058.775 
(53,6%) 
166.766 
(2,2%) 
641.000 
(8,5%) 
244.945 
(3,2%) 
505.385 
(6,7%) 
116.000 
(1,5%) 
1.118.787 
(14,8%) 
226.300 
(3,0%) 
7.573.213 
(100%) 
677.385 
8.250.598 1989 
679.249 
(8,8%) 
5.183.294 
(67,3%) 
493.423 
(6,4%) 
349.506 
(4,5%) 
204.995 
(2,7%) 
298.099 
(3,9%) 
7100 
(0,1%) 
331.939 
(4,3%) 
155.020 
(2,0%) 
7.702.625 
(100%) 
1.098.412 
8.801.037 Budget 
breakdown 
objectives 90-94 
14% 
14% 
18% 
17% 
4% 
17% 
2% 
12% 
2% 
100% 1990 
1.178.850 
(16,3%) 
1.398.964 
(19,3%) 
738.304 
(10,2%) 
871.900 
(12,0%) 
540.750 
(7,4%) 
1.460.950 
(20,2%) 
318.516 
(4,4%) 
740.800 
(10,2%) 
0 
(0%) 
7.249.034 
(100%) 
1.651.481 
8.900.515 1991 
1.410.391 
(15,6) 
1.479.265 
(16,4%) 
1.247.863 
(13,8%) 
1.213.800 
(13,4%) 
376.000 
(4,2%) 
1.815.049 
(20,1%) 
239.739 
(2,7%) 
1.123.500 
(12,5%) 
119.483 
(1,3%) 
9.025.090 
(100%) 
1.937.253 
10.962.343 .. —, L_i_ 
1992 (estimated) 
(1.10.92) 
1.793.840 
(18,1%) 
1.181.278 
(11,9%) 
1.263.660 
(12,7%) 
1.949.750 
(19,7%) 
271.000 
(2,7%) 
1.777.279 
(17,9%) 
437.601 
(4,4%) 
961.161 
(9,6%) 
278.000 
(2,8%) 
9.913.569 
(100%) 
1.862.607 
11.776.176 -f 
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ANNEX I I I 
Detailed description of actions undertaken as foreseen 
In Annex I of Counc11 Decision 90/238/Euratom, ECSC, EEC 
O 
% 
ANNEX I I I 
The anti-smoking campaign 
The Programme's two Action Plans both advocated an overall, integrated 
approach to the fight against smoking. To this end, numerous actions 
directed exclusively towards the prevention of smoking have been 
Implemented, In particular In the fol lowing fle Ids: 
public Information; taxes and prices, labelling; tobacco Ingredients; 
production; protection of children; banning of smoking In public 
places; advertising; stop-smoking campaigns. 
These actions have taken two main forms: 
the drafting of legislative measures; 
activities "on the ground". 
Legislative measures 
Legislative action since 1988 has so far led to the adoption of the 
fol lowing texts: 
Resolution of the Council and the Ministers for Health of the 
Member States meeting within the Council of 18 July 1989 on banning 
smoking In places open to the public (89/C189.01); 
Council Directive of 13 November 1989 concerning the labelling of 
tobacco products (89/622/EEC); 
- Council Directive of 17 May 1990 concerning the maximum tar yield 
of cigarettes (90/239/EEC); 
Council Directive of 15 May 1992 amending Directive 89/622/EEC 
concerning the labelling of tobacco products and the prohibition of 
the marketing of certain types of tobacco for oral use (92/41/EEC). 
Activities on the ground 
In the course of the two Action Plans since 1988 the Programme has 
financed 150 anti-smoking projects. These have Included school health 
education projects. Information campaigns for the general public and 
young persons In particular, and programmes to help smokers break the 
nicotine habit. 
As regards exchanges of information and experience, the Programme has 
supported the establishment of a consultation group comprising 
representatives of the anti-smoking organisations and the responsible 
government departments. The main achievement of this network of anti-
smoking NGOs has been to Increase public awareness of the Community's 
anti-smoking activities. 
Nutrition and Cancer 
The Programme has subsidised a number of studies designed to Improve 
our understanding of the possible links between diet (including 
alcohol) and cancer, for example cancer of the breast, colon, pancreas 
and bile ducts. There has also been research Into the role of antl-
promotlng substances (selenium, calcium, etc.). 
Finally, the Prospective European Study on Diet and Cancer (acronym-. 
EPIC) has been launched. The advantages of conducting this prospective 
study on a Community-wide scale are evident, since only the Community 
offers the diversities of populations and diets necessary to produce 
significant results. This study Is coordinated by the International 
Agency for Research on Cancer (IARC) and Involves epidemiological teams 
from seven Member States, who will monitor 350 000 citizens of Europe 
with a view to examining how diet and other habits correlate with the 
incidence of cancers and other diseases (cardiovascular diseases, 
hypertension, diabetes, etc.). France, Spain, the United Kingdom and 
Italy have begun the project proper, while Germany, Greece and the 
Netherlands are still finalising the pilot phase. 
As regards the Informing of the public, all the partners In the Europe 
Against Cancer Programme In the twelve Member States have adapted their 
public information campaigns to take account of the two nutrition 
commandments In the European Code Against Cancer. Numerous new 
information brochures have also been published with the financial 
assistance of the European Community. 
As regards legislation, the Programme has benefited from Important 
advances In the field of nutrition labelling and pesticide residues In 
fruit and vegetables. 
In 1990, for example, the Council adopted Directive 90/496/EEC 
harmonising nutrition labelling for foodstuffs in the European 
Communlty(') . Subsequent to this Directive the Scientific Committee 
for 
Food drew up two reports In 1991: 
one on recommended dally amounts of nutrition; 
the other on the definition of dietary fibre (which could be used 
as part of nutrition labelling) and a common method of analysis. 
Additionally, In April 1992 the Commission adopted two proposals for 
amendments to the four Council Directives 76/895/EEC, 90/642/EEC, 
86/362/EEC and 86/363/EEC concerning the fixing of maximum levels for 
pesticide residues In and on fruit and vegetables and other products of 
vegetable origin, cereals and foodstuffs of animal origin. } 
(1) OJ L 276, 6.10.90 
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Carclnogons 
With regard to the carcinogenic properties of certain chemical 
substances, several studies have been conducted on occupational cancers 
suffered by workers exposed to various carcinogenic agents. 
The following legislative actions have supported the Implementation of 
the Programme In this field: 
a) Classification and labelling of carcinogens. Including 
preparations containing carcinogens 
On 1 March 1991 the Directive on the classification and 
labelling of dangerous substances (67/548/EEC) was adapted to 
technical progress for the twelfth time. Also In 1991, the 
number of substances or groups of substances classed within 
categories 1, 2 or 3 In Annex 1 to Directive 67/548/EEC was 
Increased by 52, bringing the total to 147. 
Directive 88/379/EEC (classification and labelling of dangerous 
preparations) came Into force on 8 June 1991. Under the terms 
of this Directive dangerous preparations must be labelled; In 
particular, those containing any substance classified as 
carcinogenic must bear the message "May cause cancer" if the 
substance Is present In the preparation at a concentration 
exceeding that fixed by the Directive. 
b) Marketing of dangerous substances and preparations 
In 1991. Directive 76/769/EEC of 27 July 1976 relating to 
restrictions on the marketing and use of certain dangerous 
substances and preparations was amended on four occasions by 
Directives 91/173/EEC, 91/338/EEC, 91/339/EEC and 91/659/EEC. 
These amendments relate to restrictions for asbestos fibres, 
pentachlorophenol and Its derivatives, and cadmium and Its 
derivatives. 
c) Prevention of occupational cancers 
A decisive step In the fight against carcinogens at the 
workplace was taken with the adoption of Directive 90/394/EEC 
of 28 June 1990 on the protection of workers from the risks 
related to exposure to carcinogens at work (0J L 196, 26.7.90, 
p.1). 
As regards the specific problem of asbestos, a Council 
Directive was adopted on 25 June 1991 amending Directive 
83/477/EEC on the protection of workers from the risks related 
to exposure to asbestos at work (second Individual Directive 
within the meaning of Article 8 of Directive 80/1107/EEC) (0J L 
206, 27.7.91, p.16). 
In the field of protection against ionising radiation, the following legislative action has been taken with 
the support of the Programme. 
Euratom Regulation No 3954/87 (OJ L 371 of 30.12.87) laying down maximum permitted 
levels of radioactive contamination of foodstuffs and of feedingstufîs following a nuclear 
accident or any other case of radiological emergency was supplemented by Regulation 770/90. 
Adoption of Council Regulation (EEC) No 2219/89 on the special conditions for exporting 
foodstuffs and feedingstuffs following a nuclear accident or any other case of radiological 
emergency (OJ L 211 of 22,7.89). 
Directive No 618/89 Euratom (OJ L 357 of 7.12.89) on informing the general public about 
health protection measures to be applied and steps to be taken in the event of a radiological 
emergency was supplemented in 1991 by a communication (OJ C 103 of 19.04.91) designed 
to facilitate the Member States' transposai of the Directive into national law. . ) 
Directive No 641/90 Euratom (OJ L 349/21 of 13.12.90) on the operational protection of 
outside workers exposed to the risk of ionizing radiation during their activities in controlled 
areas. 
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Screening 
On the basis of the experience already acquired In certain Member 
States a network of breast cancer screening pilot projects was set up 
in 1990, the purpose being to Initiate an exchange of experiences 
betweeen Member States and establish the foundations for a high-quality 
system of breast cancer screening within the Community. 
Nine Member States are involved at present. Although the United 
Kingdom, Germany and the Netherlands do not have any projects financed 
within the network, the expertise of the centres operating In these 
three countries Is being put to use In the management and evaluation of 
the network, so the network can be regarded as covering the entire 
Community. The functioning of the network Is assessed continually by 
Independent experts, and three general assessment meetings have already 
been held (Colmbra - 1990, Athens - 1991, Dublin - 1992). 
The assessments revealed a need for better training of health 
personnel, and the Programme reacted by organising training courses In 
this field, In particular In the Utrecht and Florence screening centres 
(1990-1991). 
It was also found that the quality assurance of several pilot projects 
needed Improving. To this end the Programme has drafted a document, In 
collaboration with experts from the Member States, laying down European 
guidelines for quality assurance In mammographie screening. This 
document covers the organisation of such screening, together with the 
technical and professional aspects (procedure, training of radiological 
teams, performance Indicators, assessment, technical aspects concerning 
the dose). Publication Is scheduled for the end of 1992. 
As regards cervical cancer screening, the Programme has funded numerous 
studies, Including studies on the link with the HP virus, on the uptake 
by women of cervical screening, on the role and training of general 
practitioners, and on alternative screening techniques such as 
cervicography. 
As with breast cancer screening, It was found that the quality 
assurance of cervical screening needed Improvement. The Programme has 
therefore produced, In collaboration with a group of experts, a 
document laying down guidelines for quality assurance In cervical 
cancer screening. This document will be published at the end of 1992. 
It Is planned to set up a Community network of pilot projects In 1993, 
with a view to testing the applicability of these guidelines. 
As regards other cancers, the programme Is financing a study on the 
feasibility of prostate cancer screening. As for colorectal cancer, the 
programme has funded a small number of studies (the effectiveness of 
colorectal cancer screening In the United Kingdom, Germany and France) 
which evaluate the screening methods employed for this form of cancer. 
- M 
Cancer registers and similar measures 
As part of the action for the establishment of cancer registers, 
described In the second Action Plan, preparatory work has begun on the 
establishment of a European network of cancer registers. The aim Is to 
Improve the comparability of data contained In cancer registers and 
thus create a reliable data base. This will allow cancer problems In 
the Community to be monitored more effectively and will enable the data 
to be put to optimum use In the context of research and planning work. 
This project Is being managed for the Programme by the International 
Agency for Research on Cancer and the Danish Cancer Register. 
Completed and ongoing activities Include: 
definition of a coding system involving a set of entities 
comprising approximately 700 cancers, with a view to establishing 
comparability between the various cancer registers; 
development of a database management system (EUROCIM) for use on 
PCs, to facilitate research Into tjie Incidence of cancers and the 
associated mortality rates, and permit the statistical analysis of 
such data-, 
- survey of existing cancer registers within the Community with a 
view to Identifying possible participants in the network; 
- publication of data on the estimation of the damage caused by 
cancer In the European Community.2 O 
O.M. Jensen, M. Estève, H. Mol 1er and H. Renard (1990), Cancer 
In the European Community and Its Member States, Europ. J. 
Cancer, No 26, 1167-1256. 
-Xl-
Qther aspects: treatment and bone marrow banks 
Various measures have already been Introduced to give effect to the 
actions recommended In the Council Decision of 17 May 1990^) with 
regard to treatment and bone marrow banks. 
As regards treatment, a study on ways of Improving qua I Ity control In 
radiotherapy has been launched with a view to harmonising good practice 
In this type of treatment. With regard to palliative care, a group of 
experts has drafted a report on the situation within the Community. And 
a similar report has been drawn up by another group of experts on the 
treatment of children with cancer (this report too will be available at 
the end of 1992). 
Finally, a group composed of members of the Committee of Cancer Experts 
has been set up to examine what initiatives the Programme could develop 
In the medium term In the field of treatment. 
As regards bone marrow banks, the Programme has associated Itself with 
the AIM programme, which Is funding the EMDIS (European Marrow Donor 
Informatics Systems) projects, covering nine bone marrow banks and 
approximately 300 000 donors. A European Donor Secretariat (Paris) has 
also received modest Community support, in the course of the next two 
years the Programme will examine the arrangements which need to be 
Introduced to Improve exchanges of experience In this field. 
(1) OJ L 137 of 30.05.90 
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Information of the Public. 
One of the major objectives of the information aspect of the 
Programme has been to make appropriate resources available to 
partners in the campaign against cancer. In addition to 
financial support for actions related to the objectives of the 
Programme, these resources include the European Code Against 
Cancer, TV and video films, posters, the brochure of the 
Programme, the Diaporama (slide show) and the national 
newsletters. In addition, the publication of the 1/91 edition 
of Social Europe provided a convenient collection of both 
scientific and administrative/legal documentation on the 
Programme. 
The added value of networks, in bringing together partners with 
similar interests, is not in doubt. Among those maintained by 
the information sector are the Group of Associations and Leagues 
Against Cancer, the Group of producers of medical and scientific .r"\ 
TV programmes, the Group of Correspondents based in the Offices •' 
of the Commission in the Member States, and the Group of Chairmen 
of National Coordination Committees. The national coordination 
committees established in each country to facilitate the 
development of cancer prevention activities have had a positive 
effect in promoting coordination at the national level. 
From the start the use of surveys based on proven methodology has 
been seen as a vital contribution to identifying areas of action 
and evaluating the effectiveness of information campaigns. Since 
1987 regular surveys on awareness of cancer prevention, smoking 
behaviour and other issues have been conducted on a 12 country 
basis. Surveys of special target groups such as teachers, 
general practitioners, 11 - 15 yearolds (on tobacco and alcohol) 
and women (with special reference to screening and nutrition) 
have provided the necessary data for giving priorities to 
different types of action. 
Numerous information actions were undertaken at Community level ^ 
to promote information on cancer prevention. The most important 
are : 
European Year of Information on Cancer The European Year, 
from January 1989 to January 1990 involved the mobilisation 
of the widest possible range of partners. The Year was 
launched by press conferences attended by senior Ministers. 
10 TV programmes were commissioned for broadcast throughout 
the Community. Leading representatives of NGOs were 
received at Strasbourg by the European Parliament. Mobile 
exhibitions and sporting events to promote awareness of 
cancer prevention took place throughout Europe. 
Eurovision Against Cancer. January 1990 11 channels from 9 
Member States collaborated in this unique achievement of a 
live Eurovision programme on a scientific subject. The 
content was based firmly on the European Code Against 
Cancer. 
-h-
European Weeks Against Cancer The European Weeks have 
proved an effective means of maintaining interest in the 
Europe Against Cancer Programme. A xTest' Week was held in 
May 1988. Subsequently the second week in October each 
year was chosen on a regular basis, for which a theme based 
on the European Code Against Cancer is selected. This 
leads to the stimulation of flagship actions in each Member 
State. Moreover, hundreds of spontaneous actions take 
place each year in the context of the Week. 
Health Education and Cancer Prevention 
1. Key activities in health education in the first Action Plan 
of the "Europe against Cancer" Programme (1987-1989) were 
as follows: 
A comparative survey of health education programmes in 
the member states was carried out. A survey of 27 50 
teachers included questions on the provision of health 
education. 
A meeting of the anti-cancer associations took place 
in Viterbo, Italy to discuss the role of the school in 
the prevention of cancer. 
Financial assistance was provided to national projects 
for school-based health education programmes 
incorporating cancer prevention and tobacco education. 
2. Actions of the Second Action Plan (1990-94) are based on 
the "First European Conference on Health Education and A 
Cancer Prevention in schools" which was held in Dublin in 
1990. 
2.1. Support for efforts to inform schoolteachers about their 
awareness of the European Code against Cancer : 
Particular attention has been devoted to teacher training in 
health education and cancer prevention. The programme has 
collaborated at the European level Trith other international 
agencies (WHO -Regional Office for Europe; Council of Europe) in 
the organization of European Summer Schools on in-service teacher 
training in health .education in which cancer prevention issues 
(tobacco, nutrition, etc..) have been addressed (Southampton, 
U.K.; Flensburg, Germany; Montpellier, France). 
At the national level, teacher training initiatives which pass 
on the key messages and approaches of these European summer 
schools have been supported in Portugal, Greece and Belgium. 
Furthermore, conferences to discuss the implementation in each ) 
Member State of the recommendations of the Dublin Conference have 
taken place or are planned in each of the Member States with 
support of Europe against Cancer. 
At Community level, a European pilot network of teacher training 
institutions is being developed to test a common minimum 
curriculum on teacher training in health education including 
cancer prevention, and an information campaign has been prepared 
to increase the awareness of teachers and school-based personnel 
on their role in health education and cancer prevention. 
Materials include a poster and information brochure agreed at 
European level. 
Finally, a European framework for health promotion and the 
prevention of cancer in the primary school has been developed. 
- ">( -
2.2. Dissemination of teaching material on health education : 
A video for tobacco education ("Smoking and You") in second-level 
schools has been produced and is being pilot-tested in every 
member state. It is accompanied by a teachers'guidebook for its 
use. 
Furthermore, a European Festival on the Use of Audio-visual 
Materials in Health Education (including tobacco and nutrition 
education) is being supported. 
In several Member States, (Spain, Belgium, Netherlands, Italy and 
the U.K.) support has been provided for the development of 
materials for use in school-based projects that promote a healthy 
lifestyle and the prevention of cancer. Pilot projects in 
schools on cancer prevention which are set within the context of 
the health promoting school have been supported (Belgium and 
Luxemburg). 
2.3. Encouragement at school of healthy dietary habits and in 
particular encouragement of the consumption of fruits and 
vegetables during break and mealtimes. 
A European summer school on nutrition education in the health 
promoting school was supported and national projects in nutrition 
education were supported in Germany, Ireland and Spain. 
- ;.v 
Training of Health Personnel 
In the training field, emphasis was set on the need to adapt and 
enhance the knowledge and skills in oncology of general 
practitioners, specialists and oncologists, and nurses. 
Further to the Commission Recommendation of 8 November 1989 
concerning the training of health personnel in the matter of 
cancer (O.J. L 346,89/601/EEC ) the Europe against Cancer 
Programme has supported the following activities : 
- European Conference on a Curriculum in Oncology 
for Medical Students in Europe, May 1988, Bonn 
(EORTC). 
- European conference on dentists and cancer 
prevention, June 1990. Copenhagen Royal Dental 
College of Copenhagen. 
- European conference on a curriculum in oncology 
for dental students in Europe, October 1990, 
Copenhagen. Royal Dental College of Copenhagen. 
- European conference on a core curriculum for a 
post-basic course in cancer nursing, January 
1991, London. European Oncology Nursing Society 
(EONS). 
- European conference on cancer training for 
general practitioners, June 1991, Copenhagen. 
European Union of General Practitioners (UEMO). 
The recommendations from these conferences have been endorsed by 
the advisory committees on training of Nurses (April 1991), 
Dentists (November 1991) and Doctors (November 1991). They have 
since then been distributed to the competent authorities and to 
professional non governmental organisations of the 12 Member 
States. 
In the framework of the implementation of these conferences, 
several initiatives were realised or are at present ongoing : 
In view of curriculum development : 
A European network of pilot projects based on the core 
curriculum for a post-basic course in cancer nursing is 
currently being established in Portugal, Greece, Belgium, 
Denmark, Germany, Ireland, Italy. 
A feasibility study to develop a joint network involving 
France, Spain and Portugal is being organised in the same 
context. 
A network of pilot projects of cancer training for G.Ps. is 
being established involving the 12 Member States to 
implement the recommendations of the Copenhagen 1991 
Conference on Specific Training in Cancer for G.Ps. 
Two pilot projects on cancer training for dental students 
are being supported in Italy and Portugal by the Programme. 
- M-
A common non-compulsory training programme for medical and 
paramedical personnel participating in cervical cancer 
screening in the European Community is being developed in 
collaboration with the cytopathology societies of the 12 
Member States. 
Numerous in-service training seminars and workshops on 
cancer-related topics have been organised for doctors, 
nurses and dentists in the Member States in 1990 and 1991 
with the support of the E.A.C. Programme. 
Following on the European consensus conferences for 
dentists in 1990 the Royal Dental College of Copenhagen is 
organising in 1991 and 1992 two seminars to train trainers 
from the twelve Member States in oral cancer training. 
As regards mobility of medical personnel : 
support has been provided through fellowships to facilitate 
the mobility of doctors and nurses between Member States. 
In 1990, 50 fellowships were awarded to doctors to 
facilitate their access to specialised courses organised by 
the European School of Oncology (E.S.O.). 
Access to excellence centres was facilitated for 25 
European nurses with the assistance of the European 
Oncology Nursing Society (EONS). In 1991 30 doctors and 25 
nurses were offered fellowships in the same context. 
Participation in data management courses organised by the 
E.O.R.T.C. is being supported as well. 
In the field of teaching material : 
Manuals designed for general practitioners on "Lung 
Cancer","Breast Cancer", were published in 1990. 
A multi media training package for distance learning 
courses on "Reducing the risks of Cancer" has been 
developed by the Open University (U.K.) since 1990 to train 
health workers in Europe in cancer prevention. 
A computer-based interactive video-disk developed to train 
doctors and nurses on cancer is currently being evaluated 
in four Member States (U.K.). 
A brochure explaining the scientific background to the 
"European Code against Cancer" for general practitioners 
produced by the group of representatives of European 
general practitioners' associations is being finalised and 
will be disseminated in the near future throughout the 
Community. 

^1- ISSN 0254-1475 
COM(93) 93 final 
DOCUMENTS 
EN 05 
Catalogue number : CB-CO-93-114-EN-C 
ISBN 92-77-53575-X 
Office for Official Publications of the European Communities 
L-2985 Luxembourg