P9_TA(2022)0038

Strengthening Europe in the fight against cancer

European Parliament resolution of 16 February 2022 on strengthening Europe in the fight against cancer — towards a comprehensive and coordinated strategy (2020/2267(INI))

(2022/C 342/12)

The European Parliament,

— having regard to its decision of 18 June 2020 on setting up a special committee on beating cancer, and defining its responsibilities, numerical strength and term of office (1),

— having regard to the working document of its Special Committee on Beating Cancer of 27 October 2020 entitled ‘Inputs of the Special Committee on Beating Cancer (BECA) to influence the future Europe’s Beating Cancer Plan’ (2),

— having regard to the Commission communication of 3 February 2021 on Europe’s Beating Cancer Plan (COM(2021)0044),

— having regard to the EU’s Framework Programme for Research and Innovation 2021-2027 (Horizon Europe) (3) and the dedicated Horizon Europe Mission on Cancer (4),

— having regard to the Commission communication of 11 December 2019 on the European Green Deal (COM(2019)0640),

— having regard to the Council conclusions of 15 June 2021 on access to medicines and medical devices for a stronger and resilient EU (5),

— having regard to the guides developed by the Joint Actions on cancer (EPAAC, CANCON, iPAAC) and the Rare Cancer Agenda 2030 established under the Joint Action on Rare Cancers (JARC),

— having regard to the Commission communication of 30 September 2020 on a new ERA for Research and Innovation (COM(2020)0628),

— having regard to Council Recommendation 2003/878/EC of 2 December 2003 on cancer screening (6),

— having regard to the report of the International Agency for Research on Cancer (IARC) of May 2017 on the implementation of the Council Recommendation on cancer screening (7),

— having regard to the European guidelines for quality assurance in breast, cervical and colorectal cancer screening and diagnosis,

— having regard to the Commission communication of 20 May 2020 entitled ‘A Farm to Fork Strategy for a fair, healthy and environmentally friendly food system’ (COM(2020)0381),

— having regard to the Commission communication of 28 June 2021 on the EU strategic framework on health and safety at work 2021-2027 (COM(2021)0323),

— having regard to the Commission communication of 25 November 2020 on the Pharmaceutical Strategy for Europe (COM(2020)0761),

— having regard to the Commission communication of 14 October 2020 entitled ‘Chemicals Strategy for Sustainability — Towards a Toxic-Free Environment’ (COM(2020)0667),

— having regard to the Commission communication of 12 May 2021 entitled ‘Pathway to a Healthy Planet for All — EU Action Plan: “Towards Zero Pollution for Air, Water and Soil” (COM(2021)0400),

— having regard to Directive 2004/37/EC of the European Parliament and of the Council of 29 April 2004 on the protection of workers from the risks related to exposure to carcinogens or mutagens at work (the Carcinogens and Mutagens Directive — CMD) (8), including its three amending directives and the proposal by the Commission for the fourth amending directive (COM(2020)0571),

— having regard to Council Directive 98/24/EC of 7 April 1998 on the protection of the health and safety of workers from the risks related to chemical agents at work (9),

— having regard to the public consultation synopsis report of its Special Committee on Beating Cancer of 19 April 2021 entitled “The impact of the COVID-19 pandemic on cancer prevention, health services, cancer patients and research: lessons from a public health crisis”,

— having regard to the Commission communication of 11 November 2020 entitled “Building a European Health Union — preparedness and resilience” (COM(2020)0724), and to the related Commission proposals for, and the provisional agreements on, regulations of the European Parliament and of the Council of 11 November 2020 on serious cross-border threats to health (COM(2020)0727), on a reinforced role for the European Medicines Agency in crisis preparedness and management for medicinal products and medical devices (COM(2020)0725), and amending Regulation (EC) No 851/2004 establishing a European Centre for disease prevention and control (COM(2020)0726),

— having regard to Regulation (EU) 2021/522 of the European Parliament and of the Council of 24 March 2021 establishing a Programme for the Union’s action in the field of health (“EU4Health Programme”) for the period 2021-2027 (10),

— having regard to the Commission proposal for, and the agreement on, a regulation of the European Parliament and of the Council on health technology assessment and amending Directive 2011/24/EU (COM(2018)0051),

— having regard to Regulation (EU) No 536/2014 of the European Parliament and of the Council of 16 April 2014 on clinical trials on medicinal products for human use, and repealing Directive 2001/20/EC (11) (the Clinical Trials Regulation) and to the Clinical Trials Information System set up in accordance with that regulation,

— having regard to Regulation (EU) 2021/694 of the European Parliament and of the Council of 29 April 2021 establishing the Digital Europe Programme (12),

— having regard to Report No 21/2019 of the European Environment Agency (EEA) entitled “Healthy environment, healthy lives: how the environment influences health and well-being in Europe” (13),

— having regard to the opinion of the European Economic and Social Committee of 9 June 2021 on Europe’s Beating Cancer Plan (14),

— having regard to the conclusions and recommendations of the study prepared for its Panel for the Future of Science and Technology (STOA) in July 2021 on “The health impact of 5G” (15),

— having regard to the UN Sustainable Development Goals (SDGs), in particular SDG 3 on good health and well-being,

— having regard to the fourth edition of the European Code Against Cancer (16),

— having regard to the European Code of Cancer Practice (17),

— having regard to the Commission communication of 24 March 2021 entitled “EU strategy on the rights of the child” (COM(2021)0142),

— having regard to the Commission staff working document of 19 July 2018 on combatting HIV/AIDS, viral hepatitis and tuberculosis in the European Union and neighbouring countries — State of play, policy instruments and good practices (SWD(2018)0387),

— having regard to the report of the World Health Organization (WHO) of 2020, entitled “Alcohol and cancer in the WHO European Region: An appeal for better prevention” (18),

— having regard to the activity and conclusions of the all-party interest group MEPs Against Cancer (MAC),

— having regard to its resolution of 15 January 2020 on the European Green Deal (19),

— having regard to its resolution of 2 March 2017 on EU options for improving access to medicines (20),

— having regard to its resolution of 10 July 2020 on the Chemicals Strategy for Sustainability (21),

— having regard to its resolution of 12 February 2019 on the implementation of the Cross-Border Healthcare Directive (22),

— having regard to its resolution of 16 January 2019 on the Union’s authorisation procedure for pesticides (23),

— having regard to its resolution of 10 July 2020 on the EU’s public health strategy post-COVID-19 (24),

— having regard to its resolution of 17 September 2020 on the shortage of medicines — how to address an emerging problem (25),

— having regard to its resolution of 15 December 2016 on the regulation on paediatric medicines (26) and the Commission’s inception impact assessment concerning the revision of the EU legislation on medicines for children and rare diseases,

— having regard to Rule 54 of its Rules of Procedure,

— having regard to the report of its Special Committee on Beating Cancer (A9-0001/2022),

A. whereas Europe’s Beating Cancer Plan (“the Plan”) should effectively respond to the call for progress by the families and health professionals of the 1,3 million people who die from cancer each year in Europe, including 6 000 children and young people, the crucial needs of patients who are currently in need of timely diagnosis and effective, innovative, accessible and affordable treatments and care for cancer and cancer-related complications and comorbidities, the rightful expectations of more than 12 million cancer survivors and their families facing the difficult return back to a “normal life”, the clear will of future generations to be protected against health threats and risk factors, and the concern of governments facing a growing economic and social burden from cancer and its related treatments; whereas Union actions in the fight against cancer should aim to increase the five-year survival rate of cancer patients;

B. whereas Europe represents less than 10 % of the world’s population, but accounts for a quarter of all cancer cases, and whereas cancer is the second leading cause of death in Europe after cardiovascular diseases and the first cause of death by disease in children older than one year; whereas the specific needs of children and adolescents with cancer require continued attention and support globally, and paediatric oncology should be differentiated from adult cancer management; whereas although there has been a slight decrease in mortality rates thanks to screening campaigns, improved diagnostics and therapeutic innovation, the number of cases diagnosed is nevertheless increasing, notably due to longer life expectancies, which result in ageing populations; whereas almost three quarters of all cancer diagnoses in the EU occur in people aged 60 or above;

C. whereas cancer illustrates social injustice and inequity in healthcare, as differences in cancer survival rates across the EU Member States exceed 25 %; whereas EU citizens are facing inequities in terms of prevention, and are unequally protected against risk factors, unequally educated in terms of healthy behaviours and unequally equipped against misinformation; whereas EU citizens are unequal in terms of timely access to affordable and quality treatment and care from Member State to Member State and from region to region in any given country; whereas access to fully multidisciplinary and multiprofessional medical teams varies widely across Europe; whereas after recovery or when in remission, EU citizens are unequal in their ability to return to work, to be financially independent and to return to a harmonious familial, social and emotional life; whereas class and gender are important measures and drivers of inequalities and inequities at all stages of the disease;

D. whereas specific national or regional cancer policies have been set up in most Member States, whose missions, capacities and budgets are heterogeneous; whereas some regions have become hubs in the fight against cancer, with an expertise that should be shared all over the Union;

E. whereas the goal of the Plan should not only be to fight against a crucial public health issue and to help patients live longer and better lives, but should also be to initiate a reduction in health inequalities and inequities and lower the social and economic burden of the disease; whereas the Commission should promote a patient-centred and citizens’ rights-based approach by integrating considerations of justice, sustainability, equity, solidarity, innovation and collaboration at the very core of the Plan, including its ‘Helping Children with Cancer Initiative’;

F. whereas the COVID-19 pandemic has caused, and is still causing, severe disruptions to cancer screening programmes, treatment, research, and survivorship and follow-up services, with the resulting impact on cancer patients, families and healthcare professionals; whereas the pandemic has created an urgent need to build back cancer services in all European countries and to address highly concerning backlogs in prevention actions, as well as in early detection and diagnosis; whereas an estimated 100 million screening tests were not performed in Europe during the pandemic and 1 million cancer cases are undiagnosed; whereas 1 in 5 cancer patients did not receive the surgical or chemotherapy treatment they needed on time (27); whereas healthcare professionals have taken on the burden of a pandemic and have had to cope in a very stressful working environment;

G. whereas health literacy includes the acquisition of knowledge and skills, awareness of rights and the confidence to take action to improve personal and community health; whereas actions to promote health literacy under the Plan should focus on empowering patients and citizens through state-of-the-art communication tools, and also by seeking the expertise of, and collaborating with, patient organisations and other NGOs which have been working on disseminating and spreading health literacy for years; whereas patient empowerment requires assisting patients in understanding their rights; whereas all efforts to increase health literacy, including digital literacy, should take into account people who are experiencing exclusion and the needs of people with learning disabilities; whereas inequalities in knowledge of, access to and use of IT technologies, as well as regional, national, social and economic differences, should be taken into account; whereas the necessary information should be available in common non-EU languages in order to reach migrants, new arrivals and other vulnerable groups and minority communities; whereas in efforts to improve health literacy, the onus should also be on assisting citizens in identifying misinformation, noting the harmful impacts this can have across all areas of cancer care, including prevention, vaccination and treatment;

H. whereas about 40 % of cancer cases in the EU are preventable; whereas prevention is more effective than any cure, as well as the most cost-effective long-term cancer control strategy; whereas the Plan should address all key risk factors and social determinants of cancer; whereas the EU level is crucial in cancer prevention as it has significant competences that have an impact on most risk factors for cancer;

I. whereas according to Report No 21/2019 of the EEA, cancer is the top non-communicable disease attributable to the environment, with more than 250 000 cancer deaths attributed to the environment in 2016 in 32 high-income European countries; whereas the EEA identified ambient air pollution, chemicals, indoor fuel combustion and radiation as environmental risk factors for cancer;

J. whereas air pollution is a main driver of mortality, with pollutants from a wide range of sources, including energy, transport, agriculture and industry, contributing to 400 000 premature deaths per year, including from lung cancer, heart disease and strokes;

K. whereas the Commission communication on strengthened cooperation against vaccine-preventable diseases (COM(2018)0245) recommends developing EU guidance to establish comprehensive electronic immunisation information systems at national level for effective monitoring of immunisation programmes; whereas this should be done in full compliance with data protection rules; whereas human papillomavirus (HPV) is a sexually transmitted infection associated with almost 5 % of all cancers in women and men worldwide, namely cervical and oropharyngeal, but also anal, penile, vaginal and vulval cancers; whereas both reaching HPV vaccination coverage targets for girls and setting up high-quality organised cervical cancer screening is necessary in order to reach the 2030 WHO goals regarding the elimination of cervical cancer as a public health problem; whereas HPV vaccination rates are worryingly low across the Member States; whereas, regretfully, there are major discrepancies in vaccination coverage between Member States, ranging from less than 30 % to more than 70 % (with the required level of population immunity being at 70 %); whereas Helicobacter pylori is the principal infectious cause of cancer worldwide, mainly for non-cardia gastric adenocarcinoma;

L. whereas certain endocrine cancers (such as thyroid, breast and testicular cancer) are on the rise; whereas endocrine treatments for hormone-dependent cancers can have endocrine side effects; whereas cancer treatments can have long-term effects such as endocrine comorbidities in cancer survivors; whereas obesity is a known risk factor for many cancers, including endocrine cancers; whereas exposure to endocrine-disrupting chemicals (EDCs) is known to have an effect on the development of obesity and cancer; whereas EDCs cost the Member States between EUR 157 and 270 billion annually (up to 2 % of EU GDP) (28) in healthcare expenses and lost earning potential, largely due to neurodevelopmental and metabolic disorders and cancer;

M. whereas exposure to dangerous substances at work is responsible for about 120 000 work-related cancer cases each year, leading to approximately 80 000 fatalities annually, which represents 8 % of all cancer deaths (12 % of cancer deaths among men, and 7 % of cancer deaths among women); whereas it can be difficult to establish causal relationships, however, due to long latency periods; whereas the WHO’s IARC has identified 50 priority carcinogens and shown that workers are widely exposed to them in Europe; whereas the vast majority of cancers induced by occupational carcinogens at work appear to be preventable if the carcinogens are regulated accordingly but, under Directive 2004/37/EC, binding occupational exposure limit (OEL) values exist to date for only 27 of them; whereas further action is necessary to prevent, detect and better recognise occupational cancers related to night-shift work as well as UV radiation (for outdoor workers);

N. whereas a changing labour market with demographic developments, new technologies and new types of jobs has potential impacts on occupational health and safety; whereas more workers are moving into platform work, non-traditional work or atypical employment; whereas factors such as radiation, stress, work organisation and working conditions have all been linked to work-related cancer (29); whereas there is currently a lack of reliable and comparable EU-level data on workplace exposure to cancer risk factors (30);

O. whereas contrary to workplace accidents, where injuries can be more easily assessed and compensation awarded, it can take years or decades before work-related cancers are diagnosed and the cause is properly identified; whereas the Commission Recommendation on occupational diseases (31) recommends that Member States introduce, as soon as possible, into their national laws, regulations or administrative provisions concerning occupational diseases liable for compensation the European schedule set out in Annex I to the aforementioned recommendation; whereas the existing disparities between Member States with regard to the recognition rate of occupational diseases mean that many workers never have their occupational disease recognised;

P. whereas radon is a radioactive gas that has no colour or odour, and as radon decays in the air, it releases radiation that can damage the DNA of cells inside the body; whereas radon levels vary widely in different regions or even residential areas and can be present in both outdoor and indoor air;

Q. whereas in 2011 the IARC classified radiofrequency electromagnetic fields as possibly carcinogenic to humans, based on an increased risk of glioma associated with mobile phone use; whereas there are studies, published in 2015 and 2018, showing a significant increase (more than doubling) in glioblastoma tumours over 20 years (1995-2015) in all age groups, and others showing the increased risk of glioblastoma associated with mobile and cordless phone use in people aged 18-80; whereas more studies are needed to establish these associated risks;

R. whereas 24 % of all new cancer diagnoses, including all paediatric cancers, across Europe each year are rare forms of cancer and represent a public health challenge in themselves; whereas patients with rare cancers face challenges linked to late or incorrect diagnosis, lack of access to appropriate therapies and expertise, lack of understanding of underlying science, lack of commercial feasibility in developing new therapies, few available tissue banks, difficulties in conducting well-powered clinical studies, and also feelings of isolation;

S. whereas the Plan should be implemented in close association with the recommendations and actions of the IARC, the UN SDGs for global health, including the objective of achieving universal health coverage, the recommendations and guidelines of the WHO, international health agreements including the WHO Framework Convention on Tobacco Control and the WHO Global Initiative for Childhood Cancer, the EU Joint Actions on Cancer, and recommendations and guidelines by experts and patients’ associations; whereas the Plan should acknowledge as a priority the EU’s solidarity and partnership with low- and middle-income countries, including those in the wider WHO Europe region;

T. whereas the Act concerning the conditions of accession of Austria, Finland and Sweden grants an exemption to Sweden from the EU-wide prohibition of the sale of certain types of tobacco for oral use;

U. whereas the Mediterranean diet is known as a healthy, balanced diet that plays a protective role in the primary and secondary prevention of the main chronic degenerative diseases;

V. whereas while the Plan gives remarkable attention to a range of policy needs in respect of cancer screening, less initiative is offered for early detection of cancers not covered by screening programmes; whereas targeted action is therefore necessary to foster better awareness of cancer warning signs among citizens and healthcare professionals;

W. whereas the increase in the prices of cancer medicines has exceeded the increase of total cancer spending, and new cancer medicines coming onto the market at a high price were identified as an important driver of the increase in cancer care expenditure; whereas the WHO Technical Report of 2018 on the pricing of cancer medicines and its impacts (32) recognised that prices of cancer medicines were higher than for other indications and their costs were growing at a faster rate, resulting in lack of access to treatment for many patients worldwide and hampering the capacity of governments to provide affordable access for all;

X. whereas addressing cancer in a comprehensive strategy such as the Beating Cancer Plan presented by the Commission could be used as a model for other non-communicable diseases, and whereas patients with other chronic diseases should therefore also benefit from the achievements and principles of the Plan, and similar plans should be developed for other pathologies with high mortality rates;

Y. whereas coordination between European countries, a common policy driven at European level and cross-border knowledge-sharing are absolutely essential for progress in the area of cancer; whereas the primary responsibility for health protection and healthcare systems lies with the Member States;

Z. whereas a comprehensive, multidisciplinary and coordinated approach to addressing behaviour-related, biological, environmental, work-related, socio-economic and commercial health determinants is needed at regional, national and European level in order to support actions targeting all aspects of cancer (prevention, detection, treatment, palliative care, follow-up care for survivors and reintegration) through the effective mobilisation of key tools such as adequate resources and funding, legislation, research and knowledge-sharing; whereas patient-centred approaches to treatment have been shown to improve the quality of life and overall survivorship of patients; whereas new technologies and artificial intelligence have high potential for improvements in the field of cancer research, treatment processes and care;

AA. whereas research and innovation are our only hope of definitely beating cancer one day; whereas sustained and effective funding is needed to support ambitious projects and good and stable working conditions for researchers working in the cancer field; whereas pharmaceutical companies, including SMEs, are key stakeholders for innovation in the cancer field;

AB. whereas the ‘Health in All Policies’ and ‘One Health’ approaches should be promoted further, and efforts to fight cancer should be integrated into all EU policies;

AC. whereas the EU and its Member States should mobilise their forces and provide adequate incentives and sustainable budgets so as to achieve the ambitious objective of conquering the cancer burden and the fatality of cancer in Europe;

AD. whereas the Plan could therefore represent an important step towards a real European Health Union and a public demonstration to citizens of the success that EU health cooperation can achieve;

1. Welcomes the Plan and calls on the Commission to seek new synergies between the Plan and the EU4Health Programme, the Pharmaceutical Strategy for Europe, the Chemicals Strategy and the updated European Industrial Strategy; considers that such a comprehensive cancer framework would contribute to the prevention, early detection and curing cancer; calls on the Commission to work towards developing a common cancer policy which includes, where necessary, proposals for draft legislation;

A. Areas of action

I. Cancer prevention in all European policies

2. Strongly believes that comprehensive preventive actions against cancer, through measures supporting the elimination or reduction of harm caused by modifiable risk factors, should be implemented across all European policies and funding programmes; calls on the Commission and the Member States to integrate public awareness-raising campaigns about cancer prevention into all relevant policies; calls on the Commission to streamline the objectives of the Plan into all relevant sectoral policies; strongly believes that preventive actions should be evidence-based; therefore, calls on the Commission and Member States to increase the funding for scientific research into the causes of cancer and the efficiency and implementation of preventive measures;

3. Calls on the Commission and Member States to design and implement effective prevention measures at national and EU level which are based on independent scientific expertise, best practices and lessons learned, and clinical guidance; in this regard calls, in particular, for the implementation of the European Code Against Cancer (ECAC) to reduce cancer risks on the basis of the latest scientific evidence, and for regular updates to the ECAC through a cycle that is based on continuous monitoring and evaluation;

4. Acknowledges that more than 40 % of all cancers are preventable through coordinated actions targeting behaviour-related, biological, environmental, work-related, socio-economic and commercial health determinants; calls for more attention to be dedicated to maintaining a healthy lifestyle in order to prevent cancer and reduce recurrence of certain cancers;

5. Supports Horizon Europe Mission on Cancer’s aim of averting more than 3 million additional premature deaths over the 2021-2030 period, by accelerating progress in cancer prevention and control programmes, which strive for equal opportunities in access to these programmes; calls on the Commission to allocate adequate funding to the Horizon Europe Mission on Cancer and other relevant programmes (such as ‘Science and Policy for a Healthy Future’ — HBM4EU) in order to achieve this objective;

6. Deplores the significant health inequalities and inequities in the EU in cancer prevention; insists on the need to identify, as well as to pay special attention to, vulnerable, marginalised, socially excluded populations and people living in remote areas (such as in rural, isolated or outermost regions far from medical centres), in order to ensure their access to cancer prevention services; considers in this regard that cancer prevention also needs to be framed in the context of social justice, entailing the need for systemic changes through population-wide public policies beyond changes in individual behaviour;

7. Acknowledges that tobacco use is by far the largest preventable cause of cancer in the EU, as the cause of 15-20 % of European cancer cases and the main risk factor for cancer death in Europe (27 % of cancer fatalities equalling 700 000 cancer deaths annually in the EU); recalls that major differences exist across the EU since the proportion of smokers varies more than fivefold from one country to another;

8. Strongly supports the goal of a ‘tobacco-free generation’, as set out in the Plan, whose aim is for less than 5 % of the population to use tobacco by 2040, compared to around 25 % today; urges the Commission to establish interim goals that are constantly monitored and promoted, including at national level, and are reported within the Cancer Inequalities Registry in order to best direct efforts to achieve the overall target; calls on the Commission to fund programmes that promote smoking cessation; calls on the Commission to back cooperation between Member States in exchanging the best and most effective practices for reducing smoking;

9. Welcomes the Commission’s intention to review the Tobacco Products Directive ( 33 ) , the Tobacco Products Tax Directive ( 34 ) and the legal framework on cross-border purchases of tobacco by private individuals, and urges the Commission to take appropriate measures and to bring forward legislative proposals, in order to introduce the following: (a) an increase and an upward convergence in minimum excise duties for all tobacco products and their final market price, which would improve prevention by reducing tobacco uptake and use, notably among current smokers, and prevent young people from starting smoking; (b) a requirement for standardised plain packaging and the obligation to include health warnings on 80 % of the front and back of tobacco product packaging, including pictorial warnings; and (c) the strict enforcement of the ban on characterising flavours in tobacco products to reduce the appeal of these products to smokers, non-smokers, and young people;

10. Calls for the evaluation and review of currently used measurement methods for tar, nicotine and carbon monoxide in tobacco and related products, based on independent and recent scientific research;

11. Calls for the full implementation by Member States of the obligations under the Single Use Plastics Directive (EU) 2019/904 ( 35 ) as regards filters in tobacco products containing plastics to address environmental and health concerns related to these filters;

12. Calls on the Commission to follow up on the scientific evaluations of the health risks related to electronic cigarettes, heated tobacco products and novel tobacco products, including the assessment of the risks of using these products compared to consuming other tobacco products, and the establishment at European level of a list of substances contained in, and emitted by, these products; considers that electronic cigarettes could allow some smokers to progressively quit smoking; considers at the same time that e-cigarettes should not be attractive to minors and non-smokers; calls on the Commission, therefore, to evaluate, in the framework of the Tobacco Products Directive, which flavours in e-cigarettes are in particular attractive to minors and non-smokers, and to propose a ban on these, and furthermore, to propose a ban on all characteristic flavours in heated tobacco products and novel tobacco products;

13. Calls for the rapid and complete implementation of the WHO Framework Convention on Tobacco Control (FCTC) ( 36 ) and the WHO Protocol to Eliminate Illicit Trade in Tobacco Products ( 37 ) , paying specific attention to the FCTC Article 5.3 and its guidelines on protection of public health policies from the vested interests of the tobacco industry; urges the Commission to implement specific rules of conduct for all of its officials and other servants when interacting with the tobacco industry, in line with the European Ombudsman’s decision in case 852/2014/LP ( 38 )

14. Supports the Commission’s proposal to update the Council recommendation of 30 November 2009 on smoke-free environments ( 39 ) to extend its coverage to emerging products, such as e-cigarettes and heated tobacco products, and to extend smoke-free environments to include outdoor spaces;

15. Recalls that ethanol and acetaldehyde from the metabolism of ethanol in alcoholic beverages are classified as carcinogenic to humans by the IARC, and that in Europe an estimated 10 % of all cancer cases in men and 3 % of all cancer cases in women are attributable to alcohol consumption ( 40 ) ; underlines that the lower the amount of alcohol consumed, the lower the risk of developing cancer is; underlines that harmful alcohol consumption is a risk factor for many different cancers, such as oral cavity, pharynx, larynx, oesophagus, liver, colorectal and female breast cancer; recalls the study referred to by WHO ( 41 ) which recognises that the safest level of alcohol consumption is none when it comes to cancer prevention, and stresses the need to take this into account when devising and implementing cancer prevention policy ( 42 )

16. Welcomes the Commission’s target of achieving a reduction of at least 10 % in the harmful use of alcohol by 2025; encourages the Commission and the Member States to promote actions to reduce and prevent alcohol-related harm within the framework of a revised EU alcohol strategy ( 43 ) , including a European zero alcohol consumption strategy for minors, accompanied, where appropriate, by legislative proposals, while respecting the principle of subsidiarity and current national legislation on age limits on alcohol consumption; supports the provision of better information to consumers by improving the labelling of alcohol beverages to include moderate and responsible drinking information and introducing the mandatory indication of the list of ingredients and nutritional information, and in addition, by introducing digital labelling; asks the Commission to take specific actions targeting heavy and risky drinking ( 44 ) ; considers it important to protect minors from commercial communication on alcohol consumption, as well as product placement and sponsorship of alcohol brands, including in the digital environment, as advertising must not be aimed specifically at minors and not encourage alcohol consumption; calls for the prohibition of alcohol advertising and sponsorship at sport events when those events are mainly attended by minors; calls for the close monitoring of the implementation of the revised Audiovisual Media Service Directive ( 45 ) ; calls for the proposed Digital Services Act to strengthen the ability of Member States to uphold and enforce legislation seeking to protect minors and other vulnerable populations from commercial communication for alcoholic beverages; encourages the allocation of public funds for national and European awareness campaigns; supports the planned review of EU legislation on the taxation of alcohol and on cross-border purchases of alcohol by private individuals and a review of alcohol pricing policies, including considering an increase of taxes on alcoholic beverages;

17. Underlines that food has a significant influence on the health of individuals, and that scientific evidence shows that the consumption of inappropriately-sized food portions has negative impacts on health and may increase the risk of developing cancer; calls for the development of comprehensive nutrition campaigns, aligned with the European Union’s Farm to Fork Strategy;

18. Encourages Member States to consider making nutrition counselling available in primary healthcare;

19. Emphasises the role of a healthy diet in preventing and limiting the incidence and the recurrence of cancer, and stresses that individual cancer risks can be reduced by an increased consumption of sustainably-produced plants and plant-based foods, such as fresh fruits and vegetables, whole grains and legumes; emphasises, furthermore, the need to address the overconsumption of meat and ultra-processed products, and products high in sugars, salt and fats; welcomes, therefore, the upcoming revision of the EU school fruit, vegetables and milk scheme and of the EU’s policy on the promotion of agricultural products; asks the Commission and the Member States to encourage and help consumers to make informed, healthy and sustainable choices about food products by means of the adoption of a mandatory and harmonised EU front-of-pack nutritional label that is developed based on robust and independent scientific evidence; welcomes the focus on healthy nutrition in the EU Child Guarantee ( 46 ) and calls for a new EU Action Plan on Childhood Obesity; supports fiscal measures to make fresh foods (such as fruits and vegetables, pulses, legumes and wholegrains) more affordable and accessible at national level, especially for people on low incomes; encourages Member States to use pricing policies, such as value added tax differentiation, and marketing controls to influence demand for, access to, and the affordability of food and drink low in saturated fats, trans-fats, salt and sugar; supports Member States in revising the relevant provisions to restrict the advertising of sweetened beverages and processed food products high in fats, salt and sugar, including advertising on social media, and calls on the Commission to come forward with a proposal for a comprehensive EU-wide regulation to prohibit such advertising to minors;

20. Acknowledges that obesity is considered as a risk factor for many types of cancer, such as colorectal, kidney or breast cancers, among others; calls on the Member States to actively fight against obesity by making available healthy dietary choices and the practice of sports, not only by educating and encouraging citizens to make the right choices, but also by including integral programmes in primary healthcare that help patients suffering from obesity to lose weight in a healthy way; calls on the Commission and Member States to support research and innovation related to obesity aiming to describe the influence of genetic factors, the human microbiota or psychological status, among others, on body weight, and to explore the most effective interventions;

21. Welcomes the Commission’s intention to tackle the presence of carcinogenic contaminants in food; recalls to the Commission Parliament’s resolution of 8 October 2020 ( 47 ) calling for setting strict legal limits for the presence of acrylamide in food to adequately protect consumers, especially the most vulnerable such as infants and children; urges the Commission to swiftly come forward with regulatory proposals;

22. Calls on the Commission to heed Parliament’s various calls in its resolution of 16 January 2019 to improve the Union’s authorisation procedure for pesticides;

23. Calls on Member States, regional and local governments, civil society representatives and employers to promote and facilitate the practice of physical activities and sports throughout life, as they are known to limit both the incidence and the recurrence of cancer, as well as to reduce mental health problems and to favour social inclusion; highlights the importance of making the practice of physical activity and sports accessible and inclusive from a young age, in particular for vulnerable groups, by financing public infrastructures, equipment and programmes; calls on the Member States to facilitate access to physical activity for hospitalised patients if clinically recommended;

24. Welcomes the launch of the EU’s ‘HealthLifestyle4all’ campaign involving the promotion of sports, physical activity and healthy diets, in addition to other key sectors; recommends that schools include health education in their curricula to ensure that minors and adolescents learn how to lead a healthy lifestyle and are made aware of the ECAC, and calls for health education to be an integral part of social assistance educational policies;

25. Points out that radiation from the sun contains invisible ultraviolet (UV) radiation which can lead to skin cancer; calls therefore on the Commission to revise Directive 2006/25/EC on the exposure of workers to risks from physical agents (artificial optical radiation) ( 48 ) and to include solar radiation in its scope; supports the strengthening of protection against exposure to UV radiation at EU level, especially through occupational health and safety legislation for outdoor workers; welcomes the Commission’s commitment to explore measures on exposure to UV radiation, including from artificial tanning devices (sunbeds) ( 49 ) ; points out the importance of information campaigns to make people aware of the risks associated to excessive sun exposure and to teach them how to recognise possible warning signs; calls for specific measures to reduce the exposure to UV radiation of minors and adolescents; calls for stricter legislation on the use of sunbeds for cosmetic purposes and a ban on the use of it by minors; calls on Member States to include the reporting of melanoma skin cancer in national cancer registries;

26. Acknowledges that around 2 % of the European cancer burden can be attributed to ionising radiation and that indoor exposure to radon and its decay products is the second leading cause of lung cancer in Europe; looks forward to the results of the Euratom Research and Training Programme ( 50 ) , which will improve knowledge on exposure to radon, and the proposed countermeasures to reduce its accumulation in dwellings; recalls that ionising radiation could also be present in private households; encourages therefore the Commission and Member States to map current and potential critical areas in order to effectively react to this threat; calls on the Commission to allocate funds to the creation of such a forecast map and to promote information campaigns for the public in order to raise awareness on this matter; encourages Member States to regularly update their national plans to reduce exposure to radon, as requested in the Directive on Exposure to Radioactive Sources ( 51 ) and to update guidelines on radon mitigation for new constructions; calls on the Commission to assess the implementation and effectiveness of current measures to protect workers exposed to ionising radiation such as airline crews, nuclear power plant workers, workers in relevant industrial settings and researchers, health professionals and veterinarians working in the radiology, radiotherapy or nuclear medicine sectors, and to review these measures where necessary and proportionate;

27. Calls on the Commission to promote multidisciplinary scientific research on the existence of links between electromagnetic fields (EMFs), including 5G, and cancer in order to gather scientific evidence on the long-term effects of EMFs, and to inform the public in a timely manner of the outcome of those studies; calls for the promotion of research into the development of technology that reduces radio frequency exposure;

28. Sees the European Green Deal as a significant contributing factor to cancer prevention in Europe, by means of reducing air, food, water and soil pollution and chemical exposure; calls for an evaluation of the impact of policies on cancer incidence to be integrated into the Farm to Fork Strategy, the Chemicals Strategy for Sustainability, the Zero Pollution and the Non-Toxic Environment Strategies; welcomes the upcoming revision of the EU’s air quality standards and calls on the Commission to align them with WHO guidelines as referred to in Parliament’s resolution of 25 March 2021 on the implementation of the Ambient Air Quality Directives ( 52 ) ; calls on the Commission to ensure that the common agricultural policy helps farmers to reduce the use of pesticides; encourages the research into, the use and the development of medicines that are safer for the environment, and encourages the implementation of efficient waste removal mechanisms that avoid polluting the environment, in line with the objectives of the Pharmaceutical Strategy for Europe;

29. Stresses the need for full implementation of the revised Drinking Water Directive ( 53 ) and the implementation and enforcement of the Water Framework Directive ( 54 ) , which will reduce the concentrations in surface and ground waters of certain pollutants that could contribute to cancer incidence;

30. Calls in particular for the strengthening of the information requirements on carcinogenicity under the Registration, Evaluation, Authorisation and Restriction of Chemicals Regulation (REACH) ( 55 ) in order to enable the identification of all carcinogenic substances manufactured or imported, irrespective of their volume, in line with the Chemicals Strategy for Sustainability, and calls also for the registration, evaluation, authorisation and restriction of chemicals, including EDCs, under the REACH Regulation to be conducted in association with the IARC and the WHO assessments; welcomes the commitment of the Chemicals Strategy for Sustainability to extend the generic approach to risk management to ensure that consumer products do not contain chemicals that cause cancers, gene mutations, affect the reproductive or the endocrine system, or are persistent and bioaccumulative and toxic; calls on the Commission to swiftly implement the measures planned in the Chemicals Strategy for Sustainability to reduce citizens’ exposure to carcinogenic and endocrine-disrupting substances through all exposure pathways; calls on the Commission to devote particular attention to segments of the population that are particularly vulnerable to hazardous chemicals and to better take into account these vulnerable populations in the risk assessments of chemicals; stresses that information to consumers on exposure pathways in their everyday life is key to strengthening prevention, and welcomes in this regard the establishment of the Substances of Concern in Products database; calls on the EEA to produce a report together with the European Chemicals Agency on chemicals in the environment in Europe; calls for the report to assess the systemic nature of carcinogenic and EDCs within Europe’s production and consumption systems, their use in products, their occurrence in Europe’s environment, and the harm caused to human health, especially concerning cancer;

31. Considers that the next edition of the ECAC will have to take into account the latest knowledge on environmental carcinogens; calls on the Commission to propose without delay a revision of Article 68(2) of REACH, the Regulation on Food Contact Materials ( 56 ) , the Regulation on Cosmetic Products ( 57 ) , the Directive on Toy Safety ( 58 ) and other relevant consumer product legislation to ensure that consumer products do not contain chemicals that cause cancer, in line with the Chemicals Strategy for Sustainability; calls, furthermore, for the regular revision of this legislation to take account of the development of new materials, trends and products; underlines that endocrine disruptors (EDs) are present in food, food contact materials, cosmetics, consumer goods, toys, as well as drinking water, and that exposure, even at low doses, can induce adverse effects in the short and long term, including cancer ( 59 ) ; highlights that given the widespread exposure of the EU population to many suspected and known EDs and the fact that combined exposure to several EDs acting on similar or different pathways can have cumulative effects, there is a need to minimise exposure to EDs and to make EU regulation more consistent across sectors; encourages further research in order to determine the capacity of chemicals to act as endocrine disruptors;

32. Fully supports the Commission’s commitment under the Chemicals Strategy for Sustainability to amend the Regulation on the classification, labelling and packaging of chemicals (Regulation (EC) No 1272/2008 ( 60 ) ) to introduce new hazard classes on, inter alia, EDs, including suspected EDs, and to update the information requirements in all relevant legislation to allow their identification;

33. Calls on the Commission to integrate the ‘benign by design’ approach into the regulatory requirements related to the production of chemicals and pharmaceuticals, in order to take a true precautionary approach to mitigating risks for our health, society and the environment;

34. Welcomes the publication of the new EU strategic framework on health and safety at work for the 2021-2027 period notably the ‘Vision Zero’ approach to work-related deaths, as well as the planned stock-taking occupational health and safety summit in 2023 to evaluate progress towards ‘Vision Zero’; stresses the need for the close and regular involvement of social partners and stakeholders in this strategy; regrets, however, the limited number of substances addressed in the strategy; encourages the constant analyses and research on new substances suspected of being carcinogenic, mutagenic and/or reprotoxic, the establishment of OELs for chemical agents for which they do not yet exist, and periodic revisions whenever this becomes necessary in the light of further recent scientific data and technical developments; welcomes the workers survey prepared by the European Agency for Safety and Health at Work (EU-OSHA) on exposure to cancer risk factors; stresses that more systematic human biomonitoring programmes in full compliance with data protection measures, both in occupational settings and non-occupational settings, can be one of several relevant sources of information on general chemical exposure effects and health impacts; calls therefore on the Commission to increase its ambition as a matter of urgency through ambitious and regular updates of Directive 2004/37/EC on the protection of workers from the risks related to exposure to carcinogens or mutagens at work; to do so, calls on the Commission, following consultation of the Advisory Committee on Health and Safety, to present an action plan to achieve OEL values for at least 25 additional substances, groups of substances or process-generated substances by 2024; stresses, in this regard, the need for the Commission to increase the capacity for reviewing OELs and adding new ones, including through increased staffing in relevant units and authorities; recalls, in this context, that ongoing negotiations on the fourth revision of Directive 2004/37/EC are an opportunity to also include in Annex 1 work involving exposure to hazardous medicinal products meeting the criteria for classification as carcinogenic, mutagenic and/or toxic for reproduction category 1A or 1B set out in Annex I to Regulation (EC) No 1272/2008, in order to ensure the best possible general and individual protection measures for workers handling these products; reiterates its calls for a new coherent, transparent and risk-based system to be established for setting exposure limits and to better take into account workers’ exposure to a combination of substances; welcomes the commitment by the Commission to add EDs as a category of substances of very high concern under Regulation (EC) No 1907/2006 (REACH Regulation) and to classify them under Regulation (EC) No 1272/2008; stresses that workers should also be protected from exposure to EDs; welcomes the Commission’s commitment to presenting in 2022 a legislative proposal to further reduce workers’ exposure to asbestos, a proven carcinogen (group 1) according to the IARC, which remains responsible for around half of all occupational cancers in Europe; reiterates in this regard Parliament’s requests in its resolution of 20 October 2021 on protecting workers from asbestos ( 61 ) , in particular its call for a European strategy for the removal of all asbestos and its proposals for a better evaluation of the risks linked to non-occupational exposure to asbestos; asks Member States to facilitate recognition of and compensation for proven work-related cancers and to reinforce the monitoring of work-related exposure by labour inspectorates;

35. Encourages the Commission and the Member States to achieve the UN SDGs that target communicable diseases in order to promote the prevention of cancers related to infectious diseases; welcomes vaccination programmes in the fight against HPV transmission; insists that a gender-neutral and publicly-financed HPV vaccination programme be implemented in the Member States in order to ensure the elimination of all HPV-related cancers, and calls for 90 % of girls to be fully vaccinated, and for a significant increase in the vaccination of boys, with the HPV vaccine by the age of 15 by 2030; urges that progress towards the goals of Europe’s Beating Cancer Plan on HPV vaccination be reported in the Cancer Inequalities Registry; calls on Member States to implement the Council recommendation of 7 December 2018 on strengthened cooperation against vaccine-preventable diseases ( 62 ) in order to reduce immunisation inequalities among vulnerable groups and to improve childhood immunisation; welcomes the Commission’s intention to propose a Council recommendation on vaccine-preventable cancers; stresses, in this context, the need for coordinated actions targeting carcinogenic viruses, such as HPV and the hepatitis B virus (HBV), in order to prevent their transmission; calls for more harmonisation of HPV and HBV vaccination within Member States’ national programmes, while ensuring the provision of information about vaccination and promoting equal access for vulnerable and at-risk adult groups; encourages the regular monitoring of current HPV and HBV vaccination at EU level using a tracking system similar to the COVID-19 vaccine tracker developed by the European Centre for Disease Prevention and Control (ECDC), that will also encourage Member States to adopt best practice and maintain momentum; calls on the Member States for data harmonisation, interoperability and enhanced development of national immunisation data systems; underlines that the ECDC should play a key role in tracking Member States’ progress; supports further research on vaccine development against other viruses such as the hepatitis C virus and the human immunodeficiency virus (HIV); considers that in the meantime therapeutic solutions ought to be used massively to reach the WHO’s goal of eradicating hepatitis C by 2030, and calls on the Commission to use financial resources under the Recovery and Resilience Fund to reach these targets by funding screening efforts; calls for cooperation with Member States and international organisations to combat the impact of misinformation on vaccination and to address vaccine hesitancy; calls for the EU4Health and other EU funding streams to be used for this purpose, including for supporting awareness-raising efforts for citizens, education providers and healthcare professionals, as well as for support to behavioural research under the Horizon Europe programme; recommends a strengthened application of the EU’s Code of Practice on Disinformation particularly with regard to vaccine misinformation;

36. Points out that recent data confirms that people suffering from chronic inflammation, including from rheumatic and musculoskeletal diseases (RMDs), are at a higher risk of developing cancer and other malignancies; calls on the Commission and Member States to boost research on the relationship between chronic inflammation, cancer and RMDs;

37. Calls on the Commission and Member States to further invest in research into the causes of adult and also paediatric and adolescent cancers;

38. Highlights the importance of allocating appropriate funding to science and social humanities research in order to evaluate inequalities in access to standards of care and innovation in childhood cancer across Europe, which account for differences in survival rates of paediatric cancer patients of up to 20 % among Member States, and of formulating mitigating measures in order to guarantee equal rights and access to treatment for all children and young people with cancer in Europe; regrets, in this regard, the disparities in terms of access to high-quality healthcare services among Member States, and also among different regions within Member States, and asks the Commission to address those disparities through the appropriate legislative measures in order to ensure equal rights in the EU;

39. Recommends that breastfeeding be encouraged so as to limit the risk of breast cancer in women by means of informing and educating mothers on the benefits of breastfeeding;

40. Points out that genetic predisposition to cancer linked to mutations of specific genes has been demonstrated; highlights that methods to detect these mutations are available, either at birth for early detection of certain paediatric cancers or over the course of a lifetime, especially for breast, ovarian and colorectal cancers, and that the detection of these mutations may help to prevent or detect early-stage cancer and guide treatment choices; recommends therefore that Member States support increased access for patients in all age groups to genetic testing coupled with medical counselling and advanced sequencing diagnostics by earmarking financing and creating clear pathways for fast and efficient reimbursement, and raise awareness about to what extent citizens can access such services in the Union; recommends boosting investment in infrastructure and skills related to genetic sequencing platforms and the training of specialised genetic counsellors in specific units, such as already exist in some centres; calls on the Commission to support research in genetics in order to find genotypes with higher likelihood of developing certain cancers, including childhood cancers, as diseases with short exposure to external agents;

41. Highlights that techniques such as molecular epidemiology can provide new insights into the gene-environment interactions in cancer compared to in regular epidemiology; points out that these insights, together with further studies in epigenetics, can be used to improve the understanding of risk factors contributing to cancer causes and increase early detection;

42. Strongly supports the planned revision of the ECAC in order to develop, share and implement best practices in cancer prevention programmes, with a dedicated focus on disadvantaged groups, and the launch of a user-friendly EU mobile application which supports people and covers from cancer prevention and education to care, as announced in the Plan; highlights that in addition to being available on mobile applications, all up-to-date information should also be made available in non-digital formats to ensure inclusiveness; stresses that the ECAC should be systematically evaluated by IARC and that the evaluation work should continue to be coordinated by the Commission;

43. Encourages the Commission and the Member States to further promote health literacy on cancer risks and determinants as well as digital literacy that is linked to it, to develop educational tools for prevention, and to support the creation of e-learning platforms and applications; calls for particular attention be paid to disadvantaged, vulnerable, socially excluded, and marginalised people, and underlines that specific awareness-raising campaigns for groups with particular health literacy needs are essential; notes the importance of increasing health literacy on carcinogenic substances at work, and calls on the Commission and Member States to ensure that employers provide appropriate training; underlines that primary healthcare providers have an important role in health promotion among several population groups, since they can adapt their health promotion actions to the needs of patients in the light of patients’ digital skills, or even if they have no digital skills at all; considers cancer prevention to be a first step towards a European public health education policy;

44. Calls for the continuous strengthening of the Knowledge Centre on Cancer, which should be tasked with establishing a European roadmap for devising and coordinating large-scale prevention campaigns, in synergy with national programmes, and effective communication campaigns on health promotion in educational programmes (harmless behaviours, healthy nutrition, physical activity, transmission routes of carcinogenic viruses and vaccination and treatment opportunities for such infections, etc.), with a special focus on young people and disadvantaged groups; notes the importance of cooperating with national and local civil society organisations when developing the messaging for these campaigns;

45. Underlines that tobacco and harmful alcohol consumption, poor nutrition, a high body mass index, a sedentary lifestyle and environmental pollution are risk factors common to other chronic diseases; believes, therefore, that cancer prevention and risk reduction measures have to be implemented in the context of an integrated chronic disease prevention programme, in close cooperation with the Steering Group on Health Promotion, Disease Prevention and Management of Non-Communicable Diseases; calls for a stock-taking and prevention summit focusing on commercially-produced determinants of cancer and other chronic diseases, which would bring together the EU institutions, Member States, patient associations and civil society organisations active in the field of health;

46. Calls for the implementation of prevention programmes to be inclusive by involving regions and municipalities, citizens, the social partners, civil society and patient associations at all steps of the decision-making process, especially through the Conference on the Future of Europe;

II. Inclusive screening and detection of cancer

47. Deplores the frequent delays to and shortcomings in the timely diagnosis of symptomatic cancers related to a lack of information or adherence to cancer screening and detection processes; recognises the need to pay particular attention to the continuity of screening programmes and early detection and cancer care services during a health crisis (such as the COVID-19 crisis) or in situations where the capacity of the healthcare systems decreases; encourages the Commission and Member States to organise, in partnership with cancer stakeholders, public health campaigns to address any delays in screening, early detection and care that a health crisis might cause; stresses the importance of quick and up-to-date data on cancer screening programmes in order to enable swift reaction and follow-up in case of disruptions to regular screening capabilities with the goal of reducing the number of postponed screenings to an absolute minimum;

48. Regrets the inequalities between Member States in access to cancer screening, resulting in lower chances of survival due to late diagnosis of cancer, which represents an unacceptable discrimination of EU citizens based on their country of residence; underlines that in the case of breast cancer screening, differences in coverage are at least tenfold across the EU according to Eurostat; points out that the ‘Health at a Glance: Europe 2018’ publication noted that for cervical cancer screening, the difference between Member States in coverage of the target population ranges from 25 % to 80 %; notes that, for instance, only 18 Member States reported having national or regional population-based screening programmes for breast, cervical and colorectal cancers, according to the most recent report by the IARC on the implementation of the 2003 Council Recommendations on screening; calls on the Commission to support projects, for example via EU4Health, Horizon Europe Mission on Cancer or other relevant programmes, to explore the barriers limiting the early detection and early diagnosis of cancer in Europe;

49. Invites Member States to work together, especially in cross-border regions and isolated areas (including mountain areas and urban areas remote from screening centres), to reduce social and geographical inequalities in cancer screening and early diagnosis services;

50. Supports the launch of a new EU-supported cancer screening scheme, as announced in the Plan, to help Member States to ensure that 90 % of the EU population who qualify for breast, cervical and colorectal cancer screenings are offered screening by 2025; calls on the Commission to include other cancers in the scheme, based on the latest scientific evidence, with clear targets for each type of cancer; supports research on other types of cancers which may be effectively detected by screening; calls on the Commission to evaluate every two years the results of the cancer screening scheme in terms of equal access of the target population, to keep track of inequalities between Member States and regions, propose appropriate new measures and correlate screening programmes with the latest cancer screening research results, and if necessary, present measures for increasing the coverage of screening and prevention services in the Member States; urges the Member States and the Commission to report and monitor the achievement of screening targets in the Cancer Inequalities Registry;

51. Encourages Member States to promote cancer screening for breast, cervical and colorectal cancers, as part of organised population-based national and regional programmes, including in the remote and outermost regions, and to provide adequate resources for this; reiterates that, at the same time, there should be increased focus under the Plan on screening, diagnosis and treatment initiatives for cancers that cannot be prevented; encourages the Commission and the Member States to promote targeted screening for high-risk groups; strongly recommends that Member States develop a comprehensive screening policy which allows for timely screening when cancers with hereditary characteristics are detected; recommends that Member States establish research programmes into, and the development of, effective, accurate, non-invasive and innovative early diagnosis methods, such as biomarkers, for different types of cancer;

52. Calls on the Commission and the Member States to fully implement the European guidelines for quality assurance in cancer screening for breast, cervical and colorectal cancers and early detection services to minimise the diagnosis time for such cancers; recommends that inequalities within Member States regarding screening be addressed, possibly by making the criteria for cancer screening, legal frameworks and governance and quality assurance structures more stringent and science-based; considers that in order to address disparities in cancer screening, common standardised screening protocols are needed at EU level, going beyond best practice guidelines, e.g. on algorithms for the organisation of screening programmes and indicators for assessing the quality of screening programmes;

53. Encourages the improvement and harmonisation of cancer screening data collection to allow for an annual European report; encourages, furthermore, the regular monitoring of current screening programmes at EU level; highlights the need to link data sets on cancer incidence from screening programmes with occupational categories, which can help to identify appropriate preventive measures; considers that stepping up public health services (including financing, infrastructure and aspects involving health professionals) is key to improving cancer prevention, screening and diagnosis; stresses the importance of screening for and collecting data on common cancer comorbidities in order to better anticipate them; underlines that scientific advances in cancer risk prediction should allow for the development of risk-appropriate screening programmes;

54. Stresses the need to closely monitor current and former hepatitis B and C patients to prevent cancer development;

55. Encourages the Commission to consider the possibility of facilitating a ‘second opinion’ system within the Cross-Border Healthcare Directive ( 63 ) for difficult or atypical cancer cases, and recommends that the Member States introduce the right of patients to request that specialists from one Member State seek the advice of specialists from another Member State within a single coherent system;

56. Welcomes the process initiated by the Commission’s Group of Chief Scientific Advisors and the Scientific Advice Mechanism on the upcoming update of the 2003 Council recommendation on breast, cervical and colorectal cancer screening, which will take into account new screening tests and the most recent data on the best screening protocols (magnetic resonance imaging, HPV testing, risk-stratified approaches and risk calculators); emphasises that information on those screening programmes should be transmitted to the Joint Research Centre’s Knowledge Centre on Cancer (age of initiation and subsequent uptake, impact on survival, cost-effectiveness etc.) and that they should be regularly evaluated by the competent national authorities; calls on the Commission to develop EU guidelines for fostering research efforts in order to assess the inclusion of new science-based cancer screening programmes (including lung, prostate, stomach and ovarian cancers) and the role of artificial intelligence as part of the update of the Council recommendation in 2022, in close cooperation with the IARC, the WHO, healthcare professionals and patient organisations; calls for the evidence that proves the positive effect of targeted lung cancer screening on mortality to be recognised; encourages the Council, based on the outcome of the above-mentioned assessment, to consider including lung and prostate cancer screening in the update of the Council recommendation in 2022; calls, further to the opinion of the Commission’s Group of Chief Scientific Advisors and the 2022 update of the Council recommendation on cancer screening, for clear and tangible targets to be set for any new cancers that need to be tackled;

57. Advocates the launch by the Commission and the Member States of an EU platform for national screening centres, drawing on the experience of similar platforms for exchange and cooperation such as the European Network for Health Technology Assessment and the Heads of Medicines Agencies; recommends that this platform be entrusted with sharing expertise and implementing best practices, discussing common challenges, encouraging collaboration, training and capacity-building for improving quality in screening programmes, acting as a central hub for projects and initiatives on cancer screening supported by the EU, and maintaining in the long term the network of providers of data to the implementation report by the IARC on cancer screening;

58. Stresses the importance of increasing awareness about and the uptake of cancer screening and early detection among people in the EU via a Union-wide awareness-raising campaign as part of the European awareness days, motivation surveys and better implementation of existing communication campaigns; calls on the Commission and the Member States to support, fund and implement further actions aimed at raising awareness of cancer screening and promoting participation in screening both among the general population and to eligible residents via direct notifications; encourages the Member States to actively work on educational strategies in primary healthcare centres; encourages research into behavioural adherence factors and obstacles impeding early detection and diagnosis of cancer to boost participation in screening programmes, supported by EU funding such as that provided under the Horizon Europe research programme;

59. Calls for reinforced cooperation with non-EU countries and especially with the broader European region to encourage the organisation of screening campaigns and early diagnosis programmes, in particular for women’s cancers and especially in low- and middle-income countries and for minority communities, while also taking into account the specificities of women’s cancers in those countries; stresses that this can mark an important contribution by the EU to the achievement of international goals in cancer, such as the WHO goal to eliminate cervical cancer as a public health problem;

60. Recognises the importance of health mediators, patient navigators and non-governmental organisations and calls for their inclusion in decision-making processes and resource allocation strategies; acknowledges the vital role they play, especially in prevention and vaccination campaigns, by helping to break down barriers between authorities and society, including vulnerable groups;

61. Calls on the EU and the Member States to reinforce cooperation with the WHO and to work towards the implementation of WHO policy recommendations and guidelines;

IIIa. Equal access to cancer care: towards best quality care

62. Deplores the fact that EU patients still face challenges in accessing healthcare services and participating in clinical trials in other Member States and that only a minority of patients, and not all healthcare professionals, are aware of the right of patients to seek cross-border healthcare under the two existing frameworks: the Cross-Border Healthcare Directive and the Social Security Regulation ( 64 ) ; calls for a reform of the Cross-Border Healthcare Directive, notably to allow for mobility and access to highly specialised equipment and care through the reinforcement of the national contact points by providing them with more budgetary resources, and to allow for the development of Commission guidelines setting acceptable and harmonised review and approval timelines to expedite time-to-treatment in the EU under the Social Security Regulation; calls for an increase in the number of information campaigns on patients’ rights to cross-border healthcare, including those aimed at health professionals, as well as the development of a one-stop-shop for information on the EU’s cross-border access pathways; emphasises the need to reduce logistic and linguistic barriers faced by patients when accessing healthcare in another EU Member State; stresses the need to provide patients with clear information on prior authorisation requirements that apply to certain Member States; underlines the need to provide particular financial support to low-income parents accompanying their child abroad for treatment; emphasises the need to facilitate the process through a holistic revision of the cross-border healthcare frameworks, giving equal weight to the Cross-Border Healthcare Directive and the Social Security Regulation, for patients who, in view of unmet needs and potential benefits, travel abroad for clinical trials and may face issues such as a lack of clarity on follow-up protocols after their return home and on coverage of costs related to their clinical trial participation by national insurance agencies; emphasises the need for clarification regarding access to cross-border clinical trials, as this is not clear in the Cross-Border Healthcare Directive; underlines that all costs related to a treatment should be financed before it begins to avoid the exclusion of low-income patients; calls on the Commission to consider, in the context of the next revision of the existing frameworks, the setting up of a single set of authorisation and reimbursement rules for the access to cross-border healthcare, including a right to a second opinion; calls on the Commission and the Member States to work together to conduct regular evaluations of the Commission’s eHealth strategy from 2018 to ensure interconnected electronic health records, better interoperability, and improved data quality, privacy and security for cancer patients at regional, national and EU level, while ensuring strict adherence to patient health data privacy and security rules; notes the potential of the Cancer Inequalities Registry as a means of reporting and measuring improvement in these areas;

63. Notes the importance of rapidly administering treatment and providing the results of relevant medical exams to cancer patients in a timely fashion, since the more time this takes, the more the disease progresses, threatening the patient’s survival; regrets that in certain Member States, public resources are inadequate to guarantee timely detection and treatment, which leaves patients who depend on publicly provided social insurance with lower chances of survival, thus leaving them with no other option but the private sector;

64. Calls for the mutual recognition of health-related qualifications in cancer care across the EU and a common recognition scheme for non-EU countries to be considered, as requested in Directive 2005/36/EC ( 65 ) , ensuring that it is facilitative for oncology-related specialties; calls for the development of upskilling programmes to enable those wishing to move into oncology to do so at any point in their career;

65. Calls for full recognition of medical oncology and paediatric oncology as specialist disciplines, the establishment of pan-European quality standards for administering and supervising medical treatments for cancer, both for adults and children, and the facilitation of patient access to cancer specialists so that they may benefit from innovations and access to early clinical trials on new promising drugs, health technologies and reference centres for complex treatments like cell and gene therapy; highlights the need to ensure that access to innovation in early clinical trials for relapsed or difficult-to-treat malignancies is covered by the relevant provisions;

66. Calls for surgical skills in the EU to be strengthened via the recognition of surgical oncology as a specialist discipline, the establishment of pan-European quality standards for cancer surgery, the facilitation of patients’ access to ‘high-volume’ centres for cancer surgery and access to innovative surgical procedures; calls for the recognition of high-quality surgery and highlights its importance in curing cancers detected at an early stage; stresses the need to promote the development of a core curriculum in surgical oncology as well as individual specialist training in surgical oncology, and calls for programmes to harmonise surgical oncology education in the EU; supports the development of clinical trials in surgical oncology as part of local-regional treatment and promotes greater investment of EU and national research and innovation funds in surgical oncology research; stresses the importance of standardised surgical oncology treatments to improve long-term quality of life for cancer survivors;

67. Supports the improvement of and increased and equal access to high-quality radiation therapy in the EU through the recognition of medical physics and radiation therapy as dedicated disciplines, the promotion of common education and training standards, increased EU funding for Member States to expand their radiation therapy infrastructure, and greater investment of EU and national research and innovation funds in radiation therapy research;

68. Calls for the promotion of geriatric oncology as a branch that deserves special consideration and needs to be enriched by scientific research in order to ascertain best treatment and diagnostic methods for elderly patients; recalls that in the EU, over 60 % of new cancer cases and over 70 % of cancer deaths occur in people aged 65 and older; notes that this proportion is expected to increase as the population in the EU ages, thus representing a crucial challenge for healthcare systems; calls on the Commission and the Member States to urgently address this situation with concrete actions; specifically asks the Commission and the Member States to take action in order to facilitate clinical trials in the elderly, the implementation of multidisciplinary and comprehensive onco-geriatric care models in routine clinical pathways, and the creation of centres of excellence in geriatric oncology; calls on the Commission and the Member States to foster opportunities for the training and upskilling of the oncology workforce in the principles of geriatrics;

69. Calls on the Commission and the Member States to plan actions that promote, in the context of care and treatment, greater attention to the protection of patients’ fertility, in particular in the case of paediatric and juvenile cancers;

70. Welcomes the new action plan under the strategic agenda for medical ionising radiation applications ( 66 ) , which will support the security of production capacities for and supply of radioisotopes through the replacement of the current ageing fleet and the implementation of existing technologies, notably reactors and particle accelerators, under existing financial instruments, avoid shortages of radioisotopes by facilitating the crossing of borders and exemptions for transportation, and enhance the quality and safety of radiation technology in medicine, which is currently not equally available in all EU Member States, through the evaluation of radioisotopes via health technology assessments, the harmonisation of market access, the affirmation of nuclear medicine as a fully independent medical specialty, the promotion of training standards, and investment in nuclear medicine research;

71. Calls on the Commission to promote, and on the Member States to strengthen, the role of general practitioners, paediatricians, nurses, primary care professionals and specialist physicians, given the important role they play in referring patients for diagnostic tests and to oncology specialists, as well as the role of specialised nutritionists or dieticians, psychologists and rehabilitation specialists during cancer treatment and follow-up care, in order to ensure access to the right treatment and care at the right time via an optimal care pathway; calls for the development of multidisciplinary teams to manage cancer patients throughout their treatment journey, and multidisciplinary decision-making in the framework of dedicated cross-discipline concertation meetings (consilium) bringing together various cancer specialists and primary care professionals; underlines the importance of constant training for health professionals to keep them updated on new cancer treatment options; calls for the role of treatment coordinator to be made more widespread in order to ensure that patient treatment is appropriately coordinated, and to give patients easy access to updated information related to cancer diagnosis and advice on how to use the health system;

72. Considers that the scope of Directive 2005/36/EC should be revised to allow for the mutual recognition of cancer nursing education and education for other medical staff supporting the treatment process;

73. Calls on the Member States to develop, within their national cancer control programmes (NCCPs), strategies that encompass and implement preventive measures against the risk of burnout among cancer care professionals; urges the Commission and EU-OSHA to pay attention to this concern, and stresses that they should be considered important implementation partners of the Plan in this respect;

74. Encourages, where feasible and safe, the use of ambulatory cancer treatments in order to preserve the quality of life of patients and their families; stresses, in particular, that ambulatory treatments for children should be promoted, provided that the relevant spaces/environments and medical devices available are designed in such a way as to cater for the needs of paediatric patients; stresses the role of pharmacists, oncologists and nurses in the multidisciplinary follow-up of patients taking oral anticancer medicines; calls on the Member States to implement or improve e-health technologies, telemedicine and telecare services to ensure the continuity of inpatient and outpatient cancer care as well as community care; urges the Commission to deploy Horizon Europe research funding to support the use of telemedicine and to assist with the establishment of evidence-based guidelines; calls for actions to ensure equal access to telemedicine services across the Member States, and for EU4Health and Digital Europe funding to support an increase in digital literacy for patients and healthcare professionals;

75. Calls on the Member States to provide integral and multidisciplinary palliative care services for cancer patients in order to ease their pain and discomfort, promoting comfort care and ensuring the presence of nurses or carers, while preserving their dignity and taking into account advance care planning and the autonomy of the patient; calls on the Commission to support and coordinate regular exchanges of information and the implementation of best practices on hospice and home palliative care at EU level; calls for the development of child-specific palliative care, especially in Member States where this type of care is not yet widely provided; encourages the Member States to address palliative care in their NCCPs, maximise the number of palliative units in each region in order to appropriately adjust their number to the needs of patients, minimise waiting times, and ensure sustainable funding and sufficient numbers of well-trained staff; considers that the EU regulatory framework for the recognition of professional qualifications should be broadened to allow for the standardisation of palliative care education and best practices of health professionals; emphasises the need for reference networks for palliative care and their integration with cancer pathways at all levels, namely specialist hospitals, primary healthcare centres, hospice and home care, as well as the need for hospital-territory integration; stress that patient access to supportive and palliative care (including psycho-oncology services) across the EU should be measured and reported via the Cancer Inequalities Registry; calls for deeper cooperation between healthcare systems and social assistance systems in all Member States;

76. Encourages the Commission and the Member States to adopt specific quality assurance criteria and schemes (including common standards of care, adequate organisation, infrastructure and competences, multidisciplinary practice, continuing education for professionals, patient education and participation in clinical research), and joint clinical guidelines to ensure accreditation standards are applied to public and private hospitals treating cancer patients, in order to guarantee efficient, safe and equal management of cancers all over the EU; insists that these criteria must adhere to the highest available standards of evidence-based science that have been published in peer-reviewed scientific journals; insists that both public and private institutions that meet the quality assurance criteria should be included in NCCPs as part of the Plan with the goal of providing the highest quality of cancer treatment to all patients across the EU; calls on the Member States to create maps of oncology health needs, coupling them with realistic mappings and inventories of their existing oncological infrastructure; takes the view that this mapping exercise will allow Member States to better plan access to existing medical infrastructure, determine clear areas of action and prioritise the allocation of resources, and plan cross-border cooperation between the oncological reference centres;

77. Welcomes the planned establishment, as announced in the Plan, of an EU network linking recognised national comprehensive cancer centres (reference centres) in every Member State to facilitate the uptake of quality-assured diagnosis and treatments, including through training in, research on and the promotion of clinical trials across the EU; calls on the Member States and the Commission to support the establishment of such centres for rare cancers and cancers requiring complex treatments; calls on the Commission to identify existing centres of this type within the EU, to promote the establishment of at least one national comprehensive cancer centre in each Member State and to support the coordination of the network of these centres; stresses that the objectives of that network should include the reduction of inequalities and the strengthening of translational, clinical and outcome research; highlights that the promotion and development of translational research should be considered as an important core objective of the EU Network of Comprehensive Cancer Centres; notes that when developing this EU network, the Commission should consider the need to invest in state-of-the-art equipment and well-trained physicians and other healthcare specialists with various specialties, and recommends that a variety of well-developed cancer specialties and medical disciplines be involved from the start in the work of the envisioned EU Network of Comprehensive Cancer Centres to reinforce multidisciplinary cooperation, therefore improving outcomes for patients; calls on the Commission and the Member States to support the sustainability of pre-existing cross-border collaborations, such as the European Reference Networks and those relating to paediatric cancer; calls on the Commission to support the Member States by earmarking some of the budget in the cohesion and regional funds to support the establishment of these centres to ensure full coverage of the population;

78. Calls for the identification, reinforcement or creation in each Member State of an NCCP, in line with WHO guidance on NCCPs, consisting of a unique structure, possibly a national cancer institute, in charge of the implementation and follow-up of the respective NCCPs, with adequate objectives and resources; calls for the content of the NCCPs to be aligned as closely as possible with the Plan in order to facilitate the successful implementation of the latter; recommends that the NCCPs are set up in accordance with the European Guide for Quality National Cancer Control Programmes initiated by the European Partnership for Action Against Cancer (EPAAC) and calls for the inclusion of a dedicated paediatric cancer and rare cancers component in all NCCPs to ensure that appropriate resources are allocated and adequate implementation programmes are introduced to meet the specific needs of these patients; welcomes the setting up of a network of these organisations; stresses that NCCPs should include provisions on adequate staff capacities so as to guarantee a sufficient number of oncologyworkers in each Member State, commensurate with the overall population number;

IIIb. Equal access to cancer care and medicines in the EU

79. Calls on the Commission to strengthen the EU medicines market in order to improve equal access to treatment, including innovations and personalised medicine, reduce medicine shortages, overcome the problem of high prices for innovative technologies and treatments, encourage the use of generic and biosimilar medicines and improve cancer treatments for adults and children; calls on the Commission and the national competition authorities to assess the EU medicines market, focusing on acquisitions of SMEs by large pharmaceutical companies that undermine fair competition; encourages a multi-stakeholder dialogue on access to medicines and innovations based on models such as ACCELERATE ( 67 ) in the paediatric cancer sector and involving all relevant actors including academics, industry, health professionals and patient representatives;

80. Calls on the Member States to step up national research and production capacity for medicines and other health products, including by establishing national pharmaceutical laboratories, with a view to providing equal access to treatment, reducing medicine shortages and dependence on the pharmaceutical industry, securing cost-free access to innovative treatments and improving cancer treatments for adults and children; calls on the Member States, furthermore, to provide cost-free access to treatments and medicines used by cancer patients by means of their public health services and to consider medicine policies that provide cost-free access to medicine for users over the age of 65, the chronically ill and families in economic need;

81. Calls on the Commission to revise Directive 2001/83/EC of the European Parliament and of the Council of 6 November 2001 establishing a Community code relating to medicinal products for human use ( 68 ) and Regulation (EC) No 726/2004 of the European Parliament and of the Council of 31 March 2004 laying down Community procedures for the authorisation and supervision of medicinal products for human and veterinary use and establishing a European Medicines Agency ( 69 ) (EMA) to strengthen the marketing authorisation framework, improve medicine availability and increase generic and biosimilar competition;

82. Notes that cancer patients are frequently affected by medicine shortages and that severe disruptions in the supply of cancer treatments are highly detrimental to them, their carers and their families; calls on the Commission and the Member States to work together to prevent and manage shortages of all medicines and medical products and of cancer medicines in particular, including shortages of inexpensive essential cancer medicines; supports the development of a common basket of cancer drugs of which there may be shortages to ensure that patients have continuous access to appropriate treatment, based on transparently and appropriately defined patient needs;

83. Calls for the reinforcement and diversification of the supply chain, in particular that of cancer drugs, within the EU, close monitoring of supply tensions and shortages, and the creation of a strategic stockpile of such critical medicines, active ingredients and raw materials, particularly where the number of suppliers is limited; calls for EU pharmaceutical legislation to introduce a legal obligation for pharmaceutical companies to report information to the EMA on adequate safety stocks of essential cancer medicines; stresses the importance of the role of sustainable procurement practices in preventing medicine shortages; urges the Commission, in the context of the EU Public Procurement Directive ( 70 ) , to develop guidelines to support public procurement practices in the pharmaceutical field for cancer drugs, in particular with regard to the implementation of the criteria for the most economically advantageous tender, aimed at ensuring long-term sustainability, competition and security of supply and stimulating investment in manufacturing;

84. Points out that generic and biosimilar medicines enable efficient and safe cancer care, increased competition, innovation and savings for healthcare systems, thus helping to improve access to medicines; calls for the introduction of a strategic objective in the Plan and the NCCPs to actively promote the use of off-patent medicines, where appropriate and beneficial for patients; stresses that their market entry should not be hampered or delayed and their development process should be promoted and funded; calls on the Commission to ensure healthy competition on the expiry of intellectual property rights as a matter of urgency by ensuring the accessibility of biosimilar medicines from day one and removing all barriers to access to competition, for example through patent linkage, by banning intellectual property evergreening practices that unduly delay access to medicines and by allowing single global development;

85. Considers that Member States should converge on the evaluation of medical technologies; welcomes, therefore, the agreement on the Health Technology Assessment Regulation reached by the European Parliament and the Council on 22 June 2021 to support harmonised assessment of, and faster access to, innovative cancer diagnosis and treatments and considers that a more efficient decision-making process could, among other measures, play a role in facilitating it; welcomes that cancer medicines is one of the first medicinal product groups to be jointly assessed under the Health Technology Aassessment Regulation; calls on the Commission and Member States to take further measures aimed at encouraging the uptake and use of Joint Clinical Assessments that are to be carried out under the regulation; highlights the existence of tools being used by the WHO to incorporate cancer medicines on the WHO Model List of Essential Medicines;

86. Recalls that all patients have the right to optimal treatment, regardless of their financial means, gender, age or nationality; notes with concern that there is a great disparity in the availability of and access to different cancer therapies, with unaffordability being one of the main reasons; insists, therefore, on the need to ensure equal access to safe, effective and affordable drugs, in particular cancer drugs, within the EU; calls on the Member States to consider joint price negotiation with pharmaceutical companies, as per the Beneluxa Initiative on Pharmaceutical Policy and the Valletta Declaration; calls on the Commission to make fair pricing and affordability of new treatments a core element of the Plan and the Pharmaceutical Strategy for Europe, notably by attaching conditionalities to EU public funding (e.g. under Horizon Europe and the Innovative Health Initiative), and to ensure that public investment in R&D is accounted for and that medicines resulting from publicly funded research are available at fair and affordable prices; underlines that this should also be the case for medicines benefiting from specific regulatory or market protection such as medicines developed to treat rare or paediatric cancers; calls for more transparency throughout the pharmaceutical system, especially regarding pricing components, reimbursement criteria and the actual (net) prices of medicines in different Member States to ensure fairer prices and bring public accountability to the pharmaceutical sector;

87. Strongly advocates the extension of joint procurement procedures, especially for (ultra) rare, paediatric and novel cancer medicines and treatments, diagnostic procedures, companion diagnostic tests, and cancer-preventing vaccines like the HPV and hepatitis B vaccines, to counter shortages and improve affordability and access to cancer treatments at EU level; notes that joint procurement procedures should improve response times and be transparent; highlights that joint public procurement should not hinder patient access and medical innovation;

88. Calls on the Commission to support a regulatory framework which strengthens incentives for rare cancer treatment in the EU to effectively address existing shortcomings; underlines that patent systems all over the world are drafted in a way that for a specific period of time — i.e. only for the duration of the patent — only the inventor is allowed to commercially exploit their patent, whereas thereafter the invention can be freely produced by anyone; calls on the Commission to develop new targeted incentives to ensure equitable access to cancer medicines also in areas where the development of products would otherwise not be sustainable;

89. Calls on the Commission to submit a proposal for the revision of Council Directive 89/105/EEC on the transparency of measures regulating the prices of medicinal products ( 71 ) in order to ensure effective controls and full transparency of the procedures used to determine the price of and reimbursement amount for medicines, in particular cancer medicines, in Member States; encourages the competent authorities to ask pharmaceutical companies to provide information on research and development costs, including the financing from public resources, prior to market authorisation, as we