COMMISSION OF THE EUROPEAN COMMUNITIES 
C0M(93)U8 final 
Brussels, 7 April 1993 
'Europe against Cancer" programme 
REPORT FROM THE COMMISSION 
TO THE COUNCIL, THE EUROPEAN PARLIAMENT 
AND THE ECONOMIC AND SOCIAL COMMITTEE 
ON THE EXECUTION OF THE PROGRAMME IN 1992 
- 1 -
I. INTRODUCTION 
I. A. FOREWORD 
The European campaign against cancer is half way through the second action 
plan (1990-1994) adopted by the Council of Health Ministers in May 1990 
(OJ L 137 of 30.5.1990). 
In accordance with Article 3(3) of that Decision, which provides that "the 
Commission will keep the European Parliament, the Council and the Economic 
and social Committee regularly informed of progress", this report summarises 
the execution of the "Europe against Cancer" programme in 1992. It is a 
collaborative work produced by the various departments and programmes of the 
European Commission involved in the European campaign against cancer. 
This annual report from the Commission is in addition to the information 
distributed during the year to the Programme's partners, in particular the 
newsletters distributed every two months (around 17 500 copies) throughout 
the Community via those involved in the Programme in the Member States. 
I.B. GENERAL REVIEW OF 1992 
An assessment of activities in 1992 shows that the European campaign against 
cancer continued to progress, both in terms of legislation on the subject and 
in practical achievements brought about with logistical and financial support 
from the Commission and its partners in the Member States. 
ï-B-1 Legislative activity relating to cancer prevention focused on the 
transposition in the Membres States of directives already adopted, 
particularly those on combating smoking and protection against carcinogenic 
agents. 
I,B-2 Activities subsidised by the commission: 598 projects were submitted 
for the "Europe against Cancer" programme (not including biomedical 
research), 263 of which were approved in 1992 (276 in 1991). At the same time 
the level of funding granted increased from ECU 9 025 090 in 1991 to ECU 
10 763 449 in 1992 (see Table 1, p. 19). 
In the prevention field measures to make the public more aware of the 
European Code against cancer were more particularly geared in 1992 towards 
the working environment, to coincide with the European Year of Safety, 
Hygiene and Health Protection at Work. 
In this context the subject selected for the European Week Against cancer 
(12-18 October) was "cancer prevention and health promotion in the 
workplace". Activities mainly covered the prevention of nicotine addiction, 
improving diet and preventing carcinogenic hazards at work. Two European 
surveys on the prevention of smoking were carried out in 1992 among a 
representative sample of the Community population, and showed that a majority 
of people in Europe would accept restrictions on the freedom to smoke in 
places open to the public or at work. 
At the suggestion of the various leagues and associations against cancer in 
the Member States, discussions were started in 1992 with the national 
partners on methods for improving the scientific evaluation of the impact of 
information campaigns carried out during the European Weeks Against Cancer. 
In any event the European public's awareness of the European Code remained 
- 2 -
well-established or even increased in eight Member States in 1992, in 
comparison with previous years (1988-1992). (cf. graph on p. 20). 
Also, the results of a 1992 European survey on "Europeans and the sun -
Connotations - Attitudes - Behaviour" were distributed in the Member States 
in connection with a campaign to alert the public to the risks related to 
excessive skin exposure to solar radiation. 
Prevention studies in 1992 mainly focused on developing and consolidating the 
prospective study on "nutrition, health and cancer" involving seven Member 
States. 
As regards health education in schools, measures in 1992 concentrated on 
developing and extending the pilot experiment networks set up in 1991 on 
combating smoking, on nutrition education and all the themes of the European 
Code. 
In the field of screening, activities in 1992 served to consolidate various 
European network programmes supported by the Programme, particularly on 
breast cancer screening (nine Member States involved). The emphasis here was 
on the application of European recommendations on quality control in 
mammography screening, which were developed by an international group of 
experts and are to be officially published by the Commission in 1993. 
Activities in the field of cancer training for members of the health 
professions supported by the Programme concentrated on implementing the 
cancer training programmes for doctors, nurses and dental practitioners 
agreed on at European level in 1990 and 1991. As part of this, a pilot 
network of continuing training courses on cancerology for nurses was set up 
in seven Member states. Steps have been taken to organise similar initial 
training for dental practitioners and specific training for general 
practitioners. 
18 coordinated medical research projects on cancer were also carried out as 
part of the medical research programme. In this area, the consultative 
committees involved considered that "mortality and morbidity from cancer 
could be considerably reduced by the better implementation of knowledge and 
existing technologies"; for this reason there is "an urgent need to research 
under which conditions this current knowledge and technology can be put at 
the disposal of those suffering from cancer in the most general and immediate 
way possible, and this within the limits of the available budget in the areas 
of research and health", (cf. European Strategy for Reasearch, CAN-MED 3/8.1 
p. 15, 26-27 March 1992). 
Telematics can contribute to the improvement of the quality, efficiency and 
cost/benefit anyalysis of medical interventions, including those which are 
cancer-related. Among the 36 projects which were launched in 1992 by the AIM 
sub-programme (Advanced informatics in Medicine), 6 directly concerned cancer 
and 8 had potential applications in this field. Their objectives are the 
promotion of effective collaboration among all those involved in cancer care; 
the development of tools, techniques and practices which support a common 
approach regarding informatics and telecommunications in cancer care; and the 
promotion of the acceptance of these tools, techniques and practice. 
An international committee of senior independent experts was set up by the 
commission in accordance with Article 3(2) of the Council Decision on the 
second action plan, which states "The Council and the Ministers of Health 
- 3 -
will carry out a scientific evaluation of the effectiveness of the action 
undertaken. To this end the commission will submit a report on the subject 
during the second half of 1992". This committee submitted its report to the 
Commission in June 1992. A report from the Commission to the Council based on 
it was adopted by the Commission on March 15, 1993. Approval by the Council 
should release an extra ECU 5 million for the final two years of the 
Programme. 
The following is a summary of the main initiatives and actions carried out in 
1992 in each of the 38 fields of activity relating to the prevention of, 
screening for and treatment of cancer, and biomedical research on cancer. 
II. PREVENTION OF CANCER 
II.A. Current legislative activity 
1. Legislation on tobacco consumption 
a. Ban on smoking in public places 
A Resolution on banning smoking in places open to the public was adopted on 
18 July 1989 (OJ C 189 of 26.7.89). It calls upon the Member States to inform 
the Commission every two years of measures taken to ban smoking in public 
places or places open to the public, including public transport. 
On 30 October 1992 the Commission published an interim report on the response 
to this Resolution (Doc. SEC (92) 1979), based on information supplied by the 
health authorities and various public and private organisations in the Member 
States. It describes the main features of the situation in the European 
Community, and contains an annex outlining the regulations applicable in the 
various Member states. 
b. Labelling of tobacco products 
National legislation was introduced in 1992 in all the twelve Member States 
to comply with Directive 89/622/EEC on the labelling of tobacco products, 
adopted in November 1989 (OJ L 359 of 8.12.89). 
Under the Directive, all unit packages of tobacco products must carry on the 
most visible surface the general warning "Tobacco seriously damages health". 
In addition, cigarette packets must carry a specific warning chosen from the 
list attached to the Directive. On this basis each Member State has drawn up 
a list of warnings, which must include the following two specific messages: 
"Smoking causes cancer", and "Smoking causes heart disease". 
On 15 May 1992 the Council adopted a Directive (92/41/EEC, OJ L 158 of 
11 June 1992) amending Directive 89/622/EEC, which provides for specific 
warnings for tobacco products other than cigarettes (rolling tobacco, other 
smoking tobacco products, smokeless tobacco products). It also bans the 
marketing of certain tobacco products for oral use which have recently 
appeared on the market and are regarded as particularly dangerous for young 
people. Two different deadlines are given for implementing the Directive: 
1 July 1992 for banning the tobacco products for oral use and 1 January 1994 
for the provisions on labelling. It should be noted that the provisional 
timetable for the adoption and notification of national transposition 
measures have not been met, probably because of the very short deadlines 
fixed by the Council. 
- 4 
c. Maximum tar yield of cigarettes 
All the Member states except the Netherlands have already adopted laws and 
regulations transposing into national legislation Directive 90/239/EEC 
concerning the maximum tar yield of cigarettes, adopted in May 1990. From 
31 December 1992 the maximum tar yield of cigarettes sold in the European 
Community must not exceed 15 mg per cigarette, to be reduced to 12 mg from 
31 December 1997. Greece has been given a special temporary derogation until 
2006. 
d. Advertising for tobacco products 
A new amended proposal for a Directive on advertising for tobacco products, 
adopted in May 1991 (OJ C 167 of 27.6.91), provides for the complete 
harmonisation of such advertising and restricts it exclusively to the 
interior of retail outlets. On 11 February 1992 the European Parliament 
issued a favourable opinion on the proposal, which was then amended by the 
Commission (OJ c 129 of 21.5.92) to take account of this opinion. 
The proposal was discussed at the two Councils of Ministera of Health on 
15 May and 13 November 1992, when opposition from a minority of four Member 
States prevented a final agreement on the text. Talks are still continuing on 
basic problems such as whether the Directive is justified or is compatible 
with basic rights, and on how it should be applied (admissibility of 
voluntary agreements as a means of transposing the Directive, and application 
to publications from third countries). The Commission has maintained its 
proposal, which is to be rediscussed in the Council in 1993. 
e. Taxation on tobacco products 
On 19 October 1992 the Council adopted three directives on taxes on tobacco 
products (OJ L 316 of 31.10.92). They implement the political agreement 
reached on 24 June 1991 by defining the structure of taxes levied on tobacco 
products (92/78/EEC) and establishing minimum tax levels for cigarettes 
(92/79/EEC) and other tobacco products (92/80/EEC). 
The minimum tax levels, excluding VAT, must be at least 57% of the retail 
selling price for cigarettes of the price category most in demand. For other 
tobacco products the minimum tax levels are as follows: 
cigars and cigarillos: 5% of the retail selling price or ECU 7 per 
thousand items or per kilogram 
for rolling tobacco: 30% of the retail selling price or ECU 20 per 
kilogram 
for other smoking tobaccos: 20% of the retail selling price or ECU 15 
per kilogram. 
These provisions are supplemented by the Directive on the approximation of 
VAT rates (92/77/EEC, OJ L 316 of 31.10.92), which provides in general terms 
that the standard VAT rate must be at least 15% of the final price of the 
products in question. However, a number of temporary derogrations are made 
for countries which previously had lower rates. 
f. Reform of the common agricultural policy in the tobacco sector 
On 30 June 1992 the Council of Ministers for Agriculture adopted Council 
Regulation (EEC) No 2075/92 on the common organisation of the market in raw 
tobacco, which changes the criteria for awarding Community subsidies and the 
system of production control. It also provides for the setting up of a 
- 5 -
Community fund for tobacco research and information. The Fund is to finance 
and coordinate research and information programmes to promote greater 
knowledge of the harmful effects of tobacco and the appropriate preventive 
and curative measures, and to orientate Community tobacco production towards 
the least harmful varieties and qualities. 
Article 14 provides for a three-year programme for the conversion of 
plantations of Mavra, Tsebelia, Forchheimer, Havana lie and hybrids of 
Geudertheimer tobacco to varieties more in line with market requirements or 
to other agricultural crops. The programme will be launched immediately after 
the 1993 harvest and will be carried out in accordance with Commission 
Regulation (EEC) 3616/92 of 15 December 1992. 
Although these measures do not have a direct effect on health problems, they 
nevertheless indicate that the health factor is being taken into account in 
decisions within the common agricultural policy. 
2. Legislation on nutrition 
a. Nutrition labelling 
In response to Directive 90/496/EEC on nutrition labelling for foodstuffs in 
the European Community, adopted by the Council in 1990 (OJ L 276, 6.10.90), 
the Scientific committee for Food adopted in 1992 a report drawn up for the 
Community on the recommended daily amounts of nutrition. This will be 
distributed in 1993. 
b. Pesticide residues in fruit and vegetables 
In April 1992 the Commission adopted two proposed amendments to Directives 
76/895/EEC, 90/642/EEC, 86/362/EEC and 86/363/EEC relating to the fixing of 
maximum levels for pesticide residues in and on fruit and vegetables, certain 
products of plant origin, cereals and foodstuffs of animal origin. The 
proposals fix new maximum levels or amend the authorised levels of residues 
for 60 pesticides. They are currently being examined by the Council. 
3. Legislation on carcinogenic agents 
Cf. Fields 7-10 below. 
II.B Preventive measures subsidised by the Programme 
II.B.l. Prevention of tobacco consumption 
Field 1. Stimulation of projects of European interest concerning the 
prevention of nicotine addiction, especially amongst such target 
groups as young people, women, teachers and members of the health 
professions. 
The measures to combat smoking given financial support by the Commission in 
1992 mainly concerned the organisation of pilot projects and exchanges of 
experience in the European networks set up in 1990 and 1991. 
Network of non-smoking towns (Empoli, Besançon, Toledo, Namur) set up in 
1990. A similar experiment was started in 1992 in Royan (France). The 
network may be extended to include Luxembourg in 1993. 
- 6 -
European network of "smokebusters" clubs for young people started in 1991 
(UK, France, Belgium, Spain, Portugal). A European conference is 
scheduled for 1993 to evaluate experience. 
Consolidation of pilot experiments in health education and the prevention 
of smoking in schools, started in 1991 in France, Spain, Belgium and 
Portugal. A network was set up in 1992 to implement a joint teaching 
programme in these four countries, coordinated by the "Epidaure" 
prevention centre in Montpellier (France). New pilot projects were 
started in 1992 in Germany, Denmark, Greece and Ireland. 
Coordination of measures to disseminate information at European level on 
the prevention of tobacco consumption, with the help of the BASP 
(European Bureau for Action on Smoking Prevention). In 1992 the Bureau 
published and distributed to the Member states four quarterly information 
bulletins and three monographs on smoking at work, tobacco consumption 
and insurance, and taxation on tobacco products. 
Organisation of international meetings, and in particular the ninth World 
Conference on tobacco and health to be held in 1994 in Paris. The results 
of a European seminar held in London in November 1992 indicated that a 
pricing policy based on taxation is one way of reducing the demand for 
and perhaps also consumption of tobacco in the long term. 
Other measures aimed at specific target groups such as pregnant women were 
also funded in France and Spain, 
Field 2. Stimulation of pilot projects to teach methods of breaking 
nicotine addiction to members of the health professions and to 
teachers. 
Measures to publicise and promote centres providing help in breaking nicotine 
addiction were funded in Belgium, Greece, France, Portugal and the United 
Kingdom. 
The Group of Representatives of GPs' Associations in the EC has organised and 
contributed to a European symposium to be held in 1993 on the subject of 
"general practitioners and the prevention of nicotine addiction". 
The results of a comparative study on the effectiveness of the various 
methods of breaking nicotine addiction carried out in 1992 by a group of 
European experts with the help of the European School of oncology (ESO) will 
be distributed to health professionals in the Member States in 1993. 
A number of projects on preventing smoking in schools which were funded in 
1992 contained a section on training for teachers in the prevention and 
breaking of nicotine addiction (Germany, Denmark, Spain and Portugal). 
Field 3. Stimulation of innovative information campaigns to prevent the 
use of tobacco among the general public and in the workplace. 
Two European surveys were carried out in 1992 to evaluate the impact of 
information campaigns on the public in Europe. The results were distributed 
in the Member states and show, with slight variations from one country to 
another, that the majority of those interviewed would be prepared to accept 
restrictions on the freedom to smoke in places open to the public and at 
work. 
- 7 
Information campaigns organised as part of the European Year of safety, 
Hygiene and Health Protection at Work mainly covered the provision of non­
smoking areas in workplaces: 14 projects on preventing smoking at work were 
funded in 1992 in Belgium, Germany, Denmark, Spain, France, Greece, Portugal 
and the United Kingdom. 
On 31 May the Commission and its partners in the Programme took an active 
part in the WHO'S world no smoking day. Information campaigns (distribution 
of brochures, press conferences, joint declarations, etc.) were organised in 
the Member States and in the community pavillion at Expo '92 in Seville. 
Field 4. Financing of a study on the possibilities for putting tobacco-
growing areas to other uses. 
Measures were taken in 1992 to reform the common agricultural policy in the 
tobacco sector (see II.A.l.f). 
In cooperation with the Directorate-General responsible for agriculture, the 
"Europe against Cancer" Programme is to provide financial support in 1993 for 
a study on the possibilities for putting tobacco-growing areas to other uses. 
II.B.2. Studies and preventive measures on diet (including alcohol) 
Field 5. Stimulation of studies into eating habits and cancer in close 
conjunction with the Community medical research programme (meta­
analyses, case studies, prospective studies, intervention studies 
on "anti-promoting" agents). 
- The EPIC network (European Prospective Investigation on Diet and Cancer), 
which was set up in 1987 and covers seven Community countries (Germany, 
France, Spain, Greece, Italy, the Netherlands and the United Kingdom), 
entered its implementation phase in four countries (France, Spain, Italy and 
the United Kingdom) and its pilot phase in Germany, the Netherlands and 
Greece in 1992. The investigation, which currently covers 399 000 people who 
are to be monitored for 10 years, aims to establish links between diet, 
lifestyle and state of health. It is coordinated by the International Agency 
for Research on Cancer (IARC) and the European Commission. A steering 
committee for the network was set up in 1992 and the Committee of Cancer 
Experts recommended that an independent expert should be appointed to 
evaluate progress every year starting in 1993. 
The intervention study launched in 1991 on preventing the incidence and 
growth of benign tumours in the large intestine entered its development phase 
in 1992 (recruitment of 1000 patients). It involves nine Member states of 
the Community and is coordinated by the European Organisation for Cooperation 
in Cancer Prevention studies (ECP) and the European Commission. The aim of 
the study is to evaluate the effects of calcium and fibre on the formation, 
growth and prevention of this type of tumor. 
Four studies were launched in 1992 in the Netherlands, Greece and the 
United Kingdom to investigate links between diet and breast cancer. The 
results are expected in 1993. 
Field 6. Drafting and publication of guidelines on nutrition aimed at 
improving cancer prevention. 
On the basis of the conclusions of studies already funded by the Europe 
- 8 -
against cancer Programme and recent scientific findings, there is no reason 
to change the nutrition guidelines given in the European Code Against cancer. 
II.B.3. Campaign against carcinogenic agents 
Fields 7 Continuation of all Community action concerning protection 
against 
and 8. ionising radiation. Support for comparative studies of European 
interest aimed at improving protection against ultra-violet 
radiation. 
In the legislative field, Directive 92/3/EURATOM on the supervision, control 
and shipment of radioactive waste between Member States and into and out of 
the Community was adopted on 3.2.92 (OJ L 35 of 12/2/92). 
The Community non-legislative measures launched in 1991, which mainly aim to 
inform the general public about protection against ionising radiation and to 
improve training for health personnel in this field, continued in 1992. 
On 23 December 1992 the Commission approved a proposal for a Council 
Directive based on Article 118a of the EEC Treaty on the minimum safety and 
health requirements regarding the exposure of workers to the risks arising 
from physical agents. The scope of the proposal covers electric or magnetic 
fields or combinations thereof with a frequency equal to or less than 
S.IO1^ Hertz (wavelength of 100 nanometres or more). It is also designed 
to provide increased protection against ultra-violet radiation. 
Two studies on protection against ultra-violet radiation (UV) were funded by 
the Programme in 1992: one multi-centre case-control study on the aetiology 
of skin cancers (Italy) and one study on the role of nitric oxide and free 
oxygenated radicals on UV-related lesions. 
Field 9. Support for European studies on the possible carcinogenic risks 
of certain chemicals. 
A number of studies received funding from the Commission in this field in 
1992: 
an evaluation of the hazards involved in certain types of work in the 
wood, leather and paper production sectors was commissioned from the IARC; a 
study is examining hazards in biological laboratories; 
a study at a university in Greece is investigating the risks associated 
with pesticide use in greenhouses; 
a study involving three electricity industries in France, Italy and Spain 
is assessing the specific risks associated with electromagnetic fields; 
technical support is continuing to be provided for the secretariat of the 
European mesothelioma panel. 
The Commission also financed three studies in 1992, on the possible 
carcinogenic risks of oral contraceptives, exposure to dioxin, and organic 
solvents and pesticides and their impact on cancers of the lympho-
haematopoietic system. 
Three other epidemiological studies were also financed on renal cancers, skin 
cancers, and the incidence of cancers at work which could be indirectly 
linked to exposure to chemical substances. 
Furthermore, as part of the fifth ECSC medical research programme, 13 
projects are currently being carried out on the detection and prevention of 
occupational cancer in the coal and steel industries; they are investigating 
in particular the risks presented by genotoxic chemical substances, aromatic 
hydrocarbons including benzene, and silica. 
- 9 -
Field 10. Continuation of the classification and labelling, at European 
level, of carcinogens and continuation of the information 
campaign by means of specialised annual publications. 
The Directive on the classification and labelling of dangerous substances 
(67/148/EEC) was amended in 1992 as part of the 19th adaptation to technical 
progress (Annex 1 of the Directive) to include 20 new substances: one new 
substance for category 1: 14 new substances for category 2; and five new 
substances for category 3. 
The following warnings apply: R45 "may cause cancer" for categories 1 and 2; 
R40 "possible irreversible effects" for category 3. 
II.B.4 Information for the public on preventive measures 
Field 11. Possible updating of the European Code against Cancer 
The Committee of Cancer Experts examined whether it was appropriate to update 
the European Code Against Cancer in 1992. It felt that the ten 
recommendations contained in the Code were still entirely relevant from the 
scientific point of view and should still be used by the Programme as a 
reference for any public information campaigns. 
Field 12. Repeat of European campaigns of cancer information, if possible 
during the second week of October. Encouraging, within this 
context, private and public television stations to run spots free 
of charge on the subject of the fight against cancer. 
The fifth European Week Against Cancer from 12 to 18 October 1992 focused on 
cancer prevention and health promotion in the workplace, to complement the 
activities of the European Year of Safety, Hygiene and Health Protection at 
Work. Its message "Your work - your health - your life" was widely 
disseminated in the Member states by the Programme's partners in the form of 
posters (32 000) and brochures (2 700 000) produced with funding from the 
Programme. A total of 27 events (press conferences, seminars, etc.) were 
organised in the Member States with funding from the Programme, dealing with 
the protection of workers in firms from the hazards presented by the main 
carcinogenic agents, as part of a general approach to health promotion. 
The Programme's regular partners (associations, leagues), together with 
industrial and commercial firms and the trade unions, were closely involved 
in the measures taken at European level and in the Member States. 
In order to improve the scientific evaluation of the impact of the 
information campaigns organised during the European Week Against Cancer, the 
cancer leagues and associations organised discussions on the methods used, 
involving all the national partners. The conclusions will be available in 
1993. 
A feasibility study was carried out in 1992 on the potential impact of a 
European information campaign in which private and public television stations 
would broadcast spots free of charge on the subject of the fight against 
cancer. The results indicate that this operation would have little impact and 
would be very expensive because of the wide range of languages and cultures 
in the Community. They also show that a European video information bulletin 
accompanied by a press release for the media in the Member States could be 
more effective. This option is to be studied in 1993. 
- 10 -
Field 13. Production of European information modules on the prevention, 
screening and treatment of cancers, adaptable to national 
requirements. 
The main information documents on cancer prevention and health promotion in 
the workplace prepared by the Programme for the 1992 European Week were used 
by the national partners as a reference for information campaigns supported 
by the Commission targeting adults at work in the Member States. 
Field 14. Publicising of the European Code among the general public by the 
partners in the action plan. 
As in previous years, the Programme's national partners continued to help to 
publicise the European Code among the general public. A campaign was held 
throughout Europe in 1992 to make the public more aware of the risks 
associated with excessive skin exposure to the sun, and used the results of a 
European survey carried out in 1992 on "Europeans and the sun - Connotations 
- Attitudes - Behaviour", distributed to the Member States in June 1992 
(press packages, press conferences). This survey also showed that the 
public's awareness of the European code had increased in some countries, 
while remaining well-established in others (1988-1992) (cf. graph on p.20). 
Field 15. Support for innovative information campaigns on cancer prevention 
among targeted groups. 
Priority was given to funding campaigns designed to train and increase 
awareness among relay groups, to ensure that prevention messages were passed 
on effectively to certain target groups in the Member States. The relay 
groups included health professionals, women, students and sports teams who, 
once trained, took part in campaigns to publicise prevention among the 
general public and at the workplace (Belgium, Greece, Ireland, Portugal, 
France, United Kingdom). 
The Group of Representatives of GPs' Associations in the EC produced a 
brochure in 1992 explaining the scientific basis for each recommendation 
given in the European Code against Cancer. It was designed for family doctors 
in the Member States and is intended to ensure that cancer prevention 
messages are passed on more effectively to the general public. It was 
distributed to all GPs in Italy and France, an exercise to be repeated in 
1993 in Germany, Greece, Ireland, Portugal and the United Kingdom. 
Field 16. Informing workers, and migrant workers in particular, under 
existing Community Directives, of the fight against job-related 
cancers. 
Ten campaigns of this type were carried out by the Programme's national 
partners in seven Member States. They covered not only specific cancer 
hazards at work, but also the risks associated with smoking, a badly balanced 
diet and excessive skin exposure to solar radiation. The campaigns were 
carried out as part of the European Year of Safety, Hygiene and Health 
Protection at Work. 
II.B.5. Health education: preventive measures 
Conclusions concerning health education were adopted on 13 November 1992 by 
the Health Council (92/C 326/02) on the basis of the report of the Commission 
on the implementation of the resolution of the Council of the Education 
Ministers of 23 November 1988 concerning health education in schools (O.J. 
C3, 5.1.1989). In these conclusions, the Council invites the Commission to 
- 11 -
develop activities aimed at other specific target groups, and in other 
settings, in close collaboration with the health and education authorities of 
the Member States. Conclusions on health education in schools (92/C 336/07) 
were adopted by the Council of the Ministers of Education on 27 November 1992 
on the basis of the above mentioned Commission report. In its conclusions 
the Council invites the Commission to pursue the implementation of the 
resolution of 23 November 1988. 
Field 17. Support for efforts to inform and increase the awareness of 
school teachers of the European Code against Cancer. 
National conferences to disseminate the recommendations of the first European 
conference on health education and cancer prevention in schools (Dublin, 
February 1990) were held in 1992, with funding from the Commission, in a 
number of countries (Belgium, Spain, Luxembourg), with the aim of making 
school teachers more aware of cancer prevention measures and effective ways 
of transmitting messages based on the European Code against Cancer. 
A total of ten Community countries have held national conferences since 
Dublin. Greece, Spain, Italy and Portugal also organised supplementary 
training seminars (initial or continuing) for teachers on cancer prevention. 
The conclusions of the groups of national experts on health education in 
schools set up by the Programme following the recommendations of the Dublin 
conference were approved by the Sub-Committee on Health Education. They 
include a recommended programme for health education and cancer prevention in 
primary schools, designed for teachers, which was distributed to the Member 
States in January 1993. They also include the production of a poster and 
brochure for secondary school teachers. A number of Member States have 
announced that they intend to distribute these in 1993 as part of awareness-
raising campaigns (Belgium, Denmark, Spain, the Netherlands, Portugal). 
Field 18. Dissemination of European teaching material for health education. 
The group of national experts on training for teachers on health education in 
schools produced a charter in 1992 on a minimum health education and cancer 
prevention training programme for teachers. This was distributed to teacher 
training instructors from the twelve Member states at a European seminar in 
Rotterdam in November 1992. 
Germany, Denmark, Ireland, the Netherlands and the United Kingdom joined 
forces in 1992 to produce teaching materials, intended for primary school 
pupils in northern Europe, on the prevention of skin cancer associated with 
excessive exposure to solar radiation. 
The first European Festival on the Use of Audiovisual Materials in Health 
Education was held in Royan (France) in October 1992, with the support and 
involvement of the Commission. The main topics covered included smoking, 
nutrition and alcohol. Recommendations were adopted for the Commission and 
the Member States on ways of improving the quality and effective use of 
audiovisual materials, and these were distributed to the Programme's partners 
in the Member states. 
The teaching package (video and guide) on "Smoking and You", produced at 
European level in 1991, was distributed in the Member States in 1992 as part 
of a pilot experiment to assess its impact in a sample of secondary schools. 
The results of this experiment will be collated in 1993. 
- 12 -
Field 19. Promotion of pilot projects to promote awareness of the European 
Code among young people. 
Pilot projects on health education in schools designed to promote the 
recommendations of the European Code Against Cancer among young people were 
funded in 1992 in Germany, Belgium, Spain, France and Luxembourg. A project 
involving France, Portugal, Greece, Spain and Italy, designed to find a way 
of evaluating campaigns to increase young people's awareness of the themes of 
the European code, was launched in 1992 (results expected in 1993). 
Field 20 Encouragement at school of a change in dietary habits and, in 
particular, encouragement of the consumption of fruit and 
vegetables during break and at meal times. 
Special efforts were made in 1992 to remedy shortcomings in this priority 
field, as noted in the report on the execution of the programme in 1991. A 
note was sent in April 1992 to the representatives of the Member States on 
the Sub-Committee on Health Education and to other partners in the National 
Coordination Committees to promote the introduction of nutrition education 
projects. 
The Member States were also informed of the Community provisions concerning 
surplus fruit and vegetables withdrawn from the markets, which could be 
distributed to schools free of charge (Council Regulation No 1035/72 of 
18.5.72). 
This information campaign has produced a considerable increase in the number 
of applications for funding sent to the Programme at the end of 1992 for the 
first round in 1993: 17 compared with 13 for the whole of the 1992 budget 
year. 
A European seminar on nutrition education was held in October 1992 in 
Lagonissi (Greece), at which teacher training instructors from the Member 
States involved in pilot projects in the field of nutrition education were 
able to exchange experiences. Pilot projects on nutrition education were 
also funded in Germany, Greece and Portugal in 1992. 
III. CANCER TRAINING MEASURES SUBSIDISED BY THE PROGRAMME FOR MEMBERS OF 
THE HEALTH PROFESSIONS 
Field 21. support for the organisation of national or regional meetings to 
promote the 1989 European recommendations on the cancerology 
content of basic training programmes for members of the health 
professions. 
As part of the promotion of the 1989 European recommendations, conferences on 
oncology training for nurses were organised with funding from the Programme 
in 1992 in Belgium, the united Kingdom, France and Spain. Italy and Greece 
are planning to hold similar conferences in 1993. 
A national conference on cancer training for dental practitioners was held in 
Italy in October 1992. 
Field 22. Support for setting up three European pilot networks of medical 
schools, nursing colleges and dental schools implementing the 
recommendations on training in cancer formulated in 1988 by the 
three European advisory committees on the training of the health 
professions. 
- 13 -
Training for nurses 
In 1992 the Programme provided funding for the European pilot network of 
continuing training courses on cancer for nurses set up in 1991. The courses 
are based on the recommendations adopted at the European conference on 
continuing training on cancer for nurses, held in London in January 1991 
~7Doc. V-^B04/91/9ËC") . Pilot training projects were carried but in this field 
in 1992 in Belgium, Denmark, Germany, Greece, Ireland and Portugal. Sweden 
also organised a similar project. A joint initiative to define a common 
minimum continuing training programme for nurses is currently being studied 
by France, Spain and Portugal. 
Training for general practitioners 
A European seminar on specific cancer training for general practitioners was 
held in September 1992 in Antwerp (Belgium), in cooperation with the European 
School of Oncology (ESO), with the aim of setting up a European network of 
pilot training courses in the twelve Member States and Sweden. The network 
will be based on the recommendations of the European conference on training 
in cancerology for general practitioners, held in June 1991 in Copenhagen. 
These recommendations (Doc. V-1310/91/9EC) were sent to the governments and 
the main general practitioners' organisations in the Member States in 
September 1992. 
Training for dental practitioners 
Two pilot projects on oncology training for dental practitioners were funded 
in Italy and Portugal in 1992. The Programme also organised a first meeting 
in June 1992 attended by representatives of dental faculties in Belgium, 
Denmark, Greece, Italy, Spain, Ireland and France to plan the development of 
a European network of dental faculties. In a survey of all the dental 
faculties in the Community, 64 said they would be interested in introducing 
training courses based on the recommendations adopted in October 1991 in 
Copenhagen at the European consensus conference on oncology training for 
dental students (DOC V-241/91/9EC). This document was distributed to the 
Member States in 1992. 
Field 23. Promotion of cancerology training projects 
Twelve projects were selected in this field in 1992. 
- In Greece three training projects on this subject for nurses were funded by 
the Commission. 
- A number of training projects for general practitioners were selected in 
this field: training for general practitioners in general oncology (Portugal, 
Spain, Greece, Belgium); training on cervical cancer (Portugal), and training 
in oncology for instructors of general practitioners (Italy and Portugal). 
Field 24. Support for the mobility of the health professions between Member 
States in order to improve their specialised training in 
cancerology. 
150 grants for practical oncology training courses were financed by the 
Programme in 1992, 50 for nurses and 100 for doctors. 
- Mobility for nurses: the ULB nursing college in Brussels awarded 20 
training grants to attend specialised oncology centres in Paris, London, 
- 14 -
Amsterdam and Milan. The European Oncology Nursing Society (EONS) awarded 30 
training grants in the United Kingdom, Ireland and the Netherlands for nurses 
from EC Member states (two or three participants per country). 
- Mobility for doctors: the European Oncology School in Milan (ESO) awarded 
40 grants for specialised instructing physicians from the Member states to 
attend European seminars on leukaemia, colorectal cancer and breast cancer. 
The European Haematology School (EEH) awarded 35 grants for residential 
training courses for medical specialists and researchers during 1992. 
The European Society for Therapeutic Radiology and Oncology (ESTRO) awarded 
25 grants for radiotherapy specialists to attend the first specialised 
European training course on radiotherapy. 
Field 25. Collection and exchange of teaching material of European interest 
for the training of members of the health professions. 
Two projects were selected by the Programme in this field in 1992. One dealt 
with the evaluation in four Member States (the United Kingdom, Germany, the 
Netherlands, Portugal) of a video-disc training programme for doctors and 
nurses, which has received funding from the Programme since 1990. The project 
was led by St Bartholomew's Hospital Medical College in London. 
The Open University (United Kingdom) started two multimedia distance 
vocational training courses in Europe in 1992 on "Reducing the risk of 
cancer", one for workers in the health sector, the other for teachers and the 
general public. 
Field 26. Exchange of experience and support for the organisation of 
European seminars on the continuing education of members of the 
health professions. 
Eight operations received funding from the Programme in 1992 in this field, 
six on a European scale. 
The European Paediatric Oncology Centre (Italy) organised a paediatric onco-
haematology course for nurses as part of the organisation of a European 
network. 
In the field of training for specialists, the Programme helped to organise 
three symposia: two in Greece (breast-related pathology and lung cancer) and 
one in France (Société Française de Sénologie, on impalpable anomalies of the 
breast). 
A European continuing training programme for doctors and laboratory 
technicians on diagnostic cytology in cervical cancer, funded since 1990, was 
completed and tested in 1992 at a number of seminars (Denmark, Germany) 
coordinated by St Mary's Hospital, London. The programme is intended to 
improve the practice of these health professionals in screening for cervical 
cancer. It will be presented at a European conference in 1993. 
The EORTC began discussions with experts from Belgium, Italy, France, the 
Netherlands, the United Kingdom and Sweden on the development of a common 
training programme in Europe for radiotherapy specialists and technicians, 
and nurses working in radiotherapy departments. 
- 15 -
Field 27. Exchange of experience between Member States in the area of pain-
relieving treatments, palliative and continuing care and the role 
of the health professions. 
An ad-hoc group of European experts presented the conclusions of its work on 
palliative care to the Committee of Cancer Experts, which approved them in 
London in October 1992. These conclusions highlighted the need to provide 
better training for health professionals in palliative care. 
The conclusions of the European survey carried out as part of the Programme 
were presented at a European conference in London (November 1992). They 
indicate that palliative care for cancer patients needs to be promoted. 
Two European meetings were organised in 1992 with funding from the Programme, 
at which Member States were able to exchange experiences in the fields of 
palliative care (Brussels) and the treatment of chronic pain in advanced 
cancer (Montpellier, France). 
Preparatory work was also started in 1992 for a meeting scheduled for 
March 1993 on the feasibility of a European training programme on palliative 
care for doctors. 
VI. SCREENING AND RECORDING OF CANCERS: STUDIES AND PROJECTS SUBSIDISED BY 
THE PROGRAMME 
Field 28. Continuation of comparative studies to improve the organisation 
of cancer screening programmes. 
Three studies were funded by the Programme in 1992 on improving participation 
rates in breast cancer screening programmes, improving the quality of 
screening and evaluating the cost-effectiveness ratio of regional screening 
programmes in Greece and France. 
A similar operation was carried out in Italy on screening for cervical 
cancer. The results of these studies will be available in 1993. 
The European recommendations on quality assurance in mammography screening, 
the clinical aspects of which were drawn up in 1991 by a group of 
international experts, were supplemented in 1992 by technical aspects to 
promote quality control of radiological equipment in order to optimize 
diagnostic information and the radioprotection of patients. These 
recommendations will be published by the Commission for distribution to the 
Member States in 1993. A European meeting was held in Dublin in October 1992 
to test the quality of mammography interpretation by radiologists involved in 
the European network of pilot breast cancer screening projects. The meeting 
concluded that there was no noticeable difference in mammography 
interpretation skills (the level of which was judged to be very high) among 
radiologists at the pilot centres. 
A training course on quality assurance and control in mammography diagnosis 
was organised in November 1992 by the University of Utrecht (Netherlands) for 
16 radiological physicians and radiology technicians from eight Community 
countries. 
Field 29 Extension and the monitoring of the European network of breast 
cancer screening pilot programmes to help the Member States 
determine a general screening policy 
The European network of breast cancer screening pilot programmes, launched in 
1989 and involving nine Member States, continued to make progress in 1992. A 
European meeting of the pilot project leaders was held in Dublin in 
October 1992 and concluded that better quality assurance was needed in 
screening before the projects could be extended to national level. Those 
- 16 -
involved agreed to comply with the European recommendations on quality 
assurance in mammography screening (cf. Field 28) by the end of 1994 to 
enable the desired quality level to be attained. 
A preliminary study was started in 1992 on the meta-analysis of results from 
the seven pilot centres involved in the screening programme for more than two 
years (Belgium, Spain, France, Greece, Ireland, Italy and Portugal). The 
conclusions will be published in 1993. 
As part of the follow-up and evaluation of the network one of the Programme's 
consultant experts carried out on-the-spot inspections. 
Field 30 Evaluation of existing cervical cancer screening programmes and 
setting up of a European network of regional or local pilot 
programmes. 
The cervical cancer screening pilot programmes set up in 1991 in Greece, 
France and Ireland were continued in 1992. A note was also distributed in 
the Member States in 1992 with a view to extending the network to include 
other Community countries in 1993. It laid out the criteria for assessing 
the eligibility of applications, including the requirement that pilot 
programmes must comply with the European recommendations on quality assurance 
in cervical cancer screening. These recommendations were laid down in 1992 
by a group of European experts, and will be disseminated in the Member States 
in 1993. 
Field 31. Continuation of evaluation studies on screening programmes for 
colorectal cancer and possible setting up of a European network. 
The results of evaluation studies carried out in France and the United 
Kingdom on colorectal cancer screening programmes using the faecal occult 
blood test - funded by the programme since 1988 - were submitted to the 
Committee of Cancer Experts for an opinion. In a recommendation issued in 
1992, the Committee expressed reservations about using this test in mass 
screening for colorectal cancer. 
A supplementary evaluation study was started in 1992 based on faecal occult 
blood testing with or without sigmoidoscopy. The results are expected in 
1994. 
Field 32. Promotion of studies of European interest on the effectiveness 
and feasibility of early screening for other cancers. 
A study was started in 1992 on the effectiveness of screening for cancer of 
the lining of the womb (Sweden). The results are expected in 1994. 
The results of the random feasibility study on prostate cancer screening, 
organised at European level by the universities of Antwerp and Rotterdam 
since 1991, were collated in 1992. On the basis of this, a Europe-wide study 
is to be carried out in 1993 in cooperation with the University of Rotterdam 
and with financial assistance from the Commission. 
Field 33 Promotion of, and support for, screening programmes where the 
results of exploratory studies have proved positive, in close 
coordination with the AIM and RACE programmes. 
The Institut Bordet in Brussels carried out a feasibility study on cervical 
cancer screening using cervicography in 1992. The results are to be 
submitted to the Committee of Cancer Experts for an opinion in 1993. 
- 17 -
Field 34. Support for exchanges of experience in establishing cancer 
registers in the Community and for setting up a European network 
in cooperation with the International Agency for Research on 
Cancer and in close coordination with the AIM and RACE 
programmes. 
A European network of cancer registers was set up under the Europe against 
Cancer Programme with the help of the International Agency for Research on 
Cancer (IARC) in 1990. It is designed to facilitate exchanges of experience 
between. „the various registers and to improve the comparability of the data 
collected. A follow-up committee was set up in 1992 to establish future 
priorities and evaluate progress. A European computerised information 
management system (EUROCIM programme) was developed in 1992. A sample survey 
among existing cancer registers in the European Community was carried out in 
1992 on the operational status of the registers, and the results will be 
disseminated in 1993. 
V. STUDIES AND PROJECTS RELATED TO TREATMENT 
Fields 35 Evaluation of the operation of the various bone marrow 
and 36 banks. Feasibility study on cooperation between such banks and, 
if appropriate, support for existing European cooperation. 
A European databank of marrow donors and receivers (European Marrow Donor 
Informatics Systems "EMDIS") was set up with funding from the AIM programme 
and involves Germany, France and the United Kingdom. During the pilot phase, 
agreement was reached in 1992 between those involved in the project on the 
definition of and conditions governing the data transmission programme (SRD) 
after the operation of each data collection centre was assessed. The 
operational phase will start in 1993. 
Fields 37 Exchanging experience regarding the quality control of care 
and 38 given. Establishing an up-to date list of treatments recognised 
as worthwhile by the international scientific community. 
The Committee of Cancer Experts set up a working party to look at the whole 
area of treatment and quality control. It is to examine whether it would be 
appropriate to organise consensus conferences in this field or to carry out 
quality control programmes, and will decide on how such operations should be 
implemented, in particular through the provision of training for health 
professionals. 
The working party's preliminary conclusions will be available in early 1993. 
Two studies were carried out in 1992 at European level on standardising the 
diagnosis and administration of care in breast cancer and on the 
implementation of quality assurance programmes in radiotherapy. 
Finally, a group of European experts set up by the European School of 
Oncology drafted a report in 1992 on quality assurance in cancer treatment, 
which was published in the European Journal of Cancer (Vol. 29A, No 2). 
VI. CANCER RESEARCH 
Research actions on cancer taking place in 1992, occured within the framework 
of the BIOMED 1 programme and the sub-programme AIM (Advances Informatics in 
Medicine). 
The research projects on cancer carried out in 1992 formed part of the BIOMED 
1 Programme. 20 training grants designed to encourage mobility among 
- 18 -
esearchers in the cancer field were awarded in 1992 as part of the research 
training programme in operation since 1988. 
In 1992 the European Commission provided funding for 18 coordinated projects 
in the field of cancer research (including 14 new projects) from among more 
than 500 proposals submitted for the BIOMED 1 Programme. Ten of the 
coordinated projects cover basic research. In the field of clinical 
research, the coordination of clinical oncology trials involving 328 
institutions continued in 1992 with financial support from the European 
Commission. In the field of clinical research applied to treatment 
techniques, two projects on radiotherapy were funded in 1992 (evaluation of 
the impact of improved local radiotherapy control on the survival of cancer 
patients; clinical trials on neutron capture therapy). Two studies on 
chemotherapy were funded in 1992, one using molecular targeting during the 
development of leukaemia, the other using new chemical substances combined 
with radioactive substances. A joint European study on Ewing's sarcoma was 
started in 1992. 
In 1992 through the AIM sub-programme, the European Commission also supported 
14 projects on telematic systems for the improvement of the quality of cancer 
care, its effectiveness and cost/benefit analysis. 
Six projects are directly related to cancer and concern for example the 
improvement of neurological diagnosis; the fractionation of irradiation in 
radiotherapy; a control system for qualityt assurance in therapeutic 
decisions; bone marrow transplants (see actions n° 35 and 36); the automation 
of microscopic diagnoses; the improvement of diagnosis in gastro enterology; 
and the optimization of choice in medical treatment. 
8 other projects have potential applications in the field of cancer. 
VII CONCLUSIONS 
During 1992 the Europe against Cancer Programme consolidated and built on the 
progress made in previous years in the main fields covered by the second 
action plan: prevention through information and awareness-raising for the 
general public, health education in schools, screening, and training for 
health professionals. 
This was made possible by the dedicated, comprehensive and excellent work of 
the Committee of Cancer Experts, which has provided scientific back-up and a 
quality guarantee for the Programme in all the sectors concerned. There was 
further support from all the Programme's partners (associations and leagues 
against cancer, general practitioners' representatives, anti-smoking 
associations, national education and health officials, etc.) working together 
at European level. Progress was also facilitated by the work done in each 
country by the National Coordination Committees, which made an effective 
contribution not only in the selection of projects to be funded, but also 
through their involvement in policy-making and project evaluation. 
In November 1992 the Committee of Cancer Experts drew up recommendations for 
the Commission on a third action plan after 1994. These are based on the 
conclusions of the evaluation report on the Programme drawn up by the 
Committee of Independent Experts, and on the guidelines drafted by the 
Commission in its document "From the Single Act to Maastricht and beyond: the 
means to match our ambitions" ((COM 92) 2000 final of 11.9.92, p. 28 "The 
Europe Against cancer operation should be pursued, both in the research field 
and to develop cooperation between States, health centres and so on"). The 
text of the detailed recommendations will be available during in 1993. 
TABLE 1 : "EUROPE AGAINST CANCER" : OVERALL DETAILS OF PROJECTS FINANCED IN 1991 AND 1992 
ECU Number 
of 
projects 
approved 
1991 
(a) Total 
funding 
approved 
1991 in % Number of 
projects 
submitted 
in 1992 Total cost 
of projects 
submitted 
in 1992 Total 
funding 
requested 
1992 Number of 
projects 
approved 
1992 
(b) Total 
number of 
projects in 
hand in 
1992 
(a+b) Total cost 
of projects 
approved 
1992 Total 
funding 
approved 
1992 in % 
1. PREVENTION : projects based on the European Code Against Cancer 
1.1. SMOKING 
Health education and information 62 1,410,391 16% 129 7,731,024 4,185,834 56 118 3,956,488 1,782,589 17% 
1.2. NUTRITION - SCREENING (and risk factors mentioned in the European Code Against Cancer) 
Information of the public 
Health education 53 
56 1,479,265 
1,247,863 16% 
14% 115 
78 9,724,151 
8,993,022 4,580,812 
4,957,333 49 
32 102 
88 3,090,296 
3,617,067 1,221,278 
1,293,660 11% 
12% 
2. PREVENTION: scientific research 
2.1. NUTRITION 
2.2. CARCINOGENS 18 
11 1,213,800 
376,000 13% 
4% 30 
25 7,886,175 
4,118,036 3,295,666 
2,298,974 15 
7 33 
18 6,638,748 
1,272,232 2,481,552 
271,000 23% 
3% 
3. SCREENING AND TREATMENT: training, studies, pilot projects 
3.1. TRAINING 
3.2. REGISTERS 
3.3. SCREENING 
3.4. TREATMENT 
TOTAL 47 
4 
21 
4 
276 1,815,049 
239,739 
1,123,500 
119,483 
9,025,090 20% 
3% 
12% 
1% 
100% 110 
24 
56 
31 
598 13,395,660 
3,225,730 
10,513,688 
3,269,433 
68,856,919 7,904,596 
1,567,521 
3,746,382 
1,926,358 
34,463,476 55 
12 
29 
8 
263 102 
16 
50 
12 
539 5,164,963 
1,825,398 
5,950,497 
1,154,110 
32,669,799 1,948,308 
460,900 
1,011,161 
293,000 
10,763,449 18% 
4% 
29% 
3% 
100% 1 
- 20 -
Development in awareness of the European Code Against Cancer among those aged 15 or over in the twelve Com­
munity Member states, 1988-1992 
(% who have heard of the Code) 
B DK D GR E F IRL I 
1988-89 H 1990 g 1991-92 NL P UK EC 
Development in the percentage of non-smokers among those aged 
15 or over in the twelve Community Member states, 1987 - 1992 
80 T 
70 t 
60 -H 
50 "H 
40 -H 
30 H 
20 "H 
10 
B DK D GR 
1987 D 1990 H 1992 
Sources : Eurobarometer surveys and European omnibus Survey for the Europe Against Cancer Programme (EC). 

ISSN 0254-1475 
COM(93) 148 final 
DOCUMENTS 
EN 05 
Catalogue number : CB-CO-93-172-EN-C 
ISBN 92-77-54510-0 
Office for Official Publications of the European Communities 
L-2985 Luxembourg