TV»IV EUROPEISKA GEMENSKAPERNAS KOMMISSION 
Bryssel den 18.07.1995 
KOM(95)356 slutlig 
Programmet "Europa mot cancer" 
RAPPORT FRÄN KOMMISSIONEN 
TILL RÅDET, EUROPAPARLAMENTET, EKONOMISKA OCH SOCIALA 
KOMMITTÉN OCH REGIONKOMMITTÉN 
OM GENOMFÖRANDET AV DEN ANDRA ATGARDSPLANEN 
(1990-1994) 

SAMMANFATTNING 
Programmet "Europa mot cancer" startades 1985 av Europeiska rådet vid stats- och 
regeringschefernas möte, och en kommitté bestående av cancerexperter inrättades som 
rådgivande organ för detta europeiska initiativ. Kommittén antog vid sitt första möte i 
Paris i februari 1986 ett yttrande som innehöll en beskrivning av huvudlinjerna i ett 
vittomfattande program. Detta yttrande ledde till att kommissionen utarbetade en*första 
handlingsplan för perioden 1987-1989. I december 1989 berömde stats- och 
regeringscheferna de resultat som uppnåtts under den första handlingsplanen och uttryckte 
sin tillfredsställelse med lanseringen av en andra handlingsplan för perioden 1990-1994 
Målsättningen för den andra handlingsplanen om cancer var att utveckla information om 
förebyggande av cancer och möjliga metoder för att kunna ställa diagnos och sätta in 
behandling på ett tidigt stadium. 
Den andra handlingsplanen omfattade 38 verksamhetsområden som i huvudsak baserades 
på det första programmet och avsåg följande tre huvudområden: a) Förebyggande av 
cancer, där kampen mot rökning prioriterades, eftersom en tredjedel av alla dödsfall i 
cancer hänförs till tobak. De medelsom användes omfattade införande av europeisk 
lagstiftning om tjära och märkning, användning av gemenskapsbidrag för att stimulera 
till undersökningar och forskning, offentliga informationsåtgärder, hälsoundervisning i 
skolor och utbildning av hälsovårdspersonal. De budskap om förebyggande som spreds 
var i huvudsak baserade på den europeiska koden mot cancer som utarbetats av 
cancerexpertkommittén och godkänts av häl somini strama. 
b) Diagnos på ett tidigt stadium och systematiska massundersökningar med avseende 
på cancersjukdomar. Även här stödde gemenskapen informations-, utbildnings- och 
yrkesutbildningsatgärder, undersökningar och forskning av europeiskt intresse och 
upprättandet av europeiska nätverk för pilotprojekt om massundersökningar. 
c) Kvalitetssäkring för behandling av cancersjukdomar. Genom gemeiiskapsbidrag 
finansierades yrkesutbildningsåtgärder för hälsovårdspersonal, jämförande undersökningar 
och erfarenhetsutbyte avseende smärtlindring, samt europeiska utbyten av 
forskningsresultat. 
Den grundprincip som Europeiska kommissionen följt var att åtgärder endast skulle vidtas 
då det bidrog till att förhöja nationella åtgärders verkan. Denna förhöjda verkan har fått 
följande former: 
a) Främjande av spridning i hela gemenskapen av bästa nationella praxis eller 
lagstiftning. Gemenskapsdirektiv om tjärinnehåll och märkning av tobaksvaror har 
till exempel utformats för att tillnärma nationell lagstiftning och säkerställa en hög 
hälsoskyddsnivå för alla unionens medborgare. Programmet främjade också 
spridningen av den europeiska koden mot cancer i alla medlemsstater. 
Upprättandet av europeiska nätverk för pilotprojekt om massundersökningar 
avseende cancersjukdomar bidrog till att påskynda spridningen av bästa 
vetenskapliga praxis i hela gemenskapen, och bidrog till att successivt eliminera 
icke-optimala förfaranden. 
b) Främjande av och stimulering till samarbete om undersökningar och forskning 
för att harmoniera medicinsk praxis i Europa, i avsikt att minska viktiga skillnader 
som är orsaken till att överlevnadsstatistiken för cancersjukdomar varierar. 
c) Utbyte av erfarenheter av bästa praxis när det gäller etablerade förebyggande 
metoder som till exempel massundersökningsprogram, hälsoundervisning i skolor 
och rökavvänjningsmetoder. 
En oberoende utvärderingskommitté lade 1992 fram en rapport om "Europa mot cancer"-
programmets första fem år för rådet och Europaparlamentet. Utvärderingskommitténs 
huvudsakliga slutsats var att programmet på ett framgångsrikt sätt hade sammanfört 
hälsovårdspersonal av olika kategorier och andra berörda parter i en gemensam satsning 
för att få kontroll över cancerproblemet i Europa, och rekommenderade starkt att 
programmet skulle fortsätta på grund av cancerproblemets långsiktiga natur. 
Rådet antog utvärderingskommitténs slutsatser och bidrog med ytterligare medel 
(5 miljoner ECU) till programmet. Rådet anmodade i sin resolution av den 13 december 
1993 kommissionen att lägga fram ett förslag till en tredje handlingsplan, med beaktande 
av den tidigare resolutionen av den 27 maj 1983 om framtida åtgärder på folkhälsans 
område. Den föreslagna tredje handlingsplanen bygger vidare på erfarenheterna från de 
tidigare handlingsplanerna och är samtidigt förenlig med det ramverk för åtgärder på 
folkhälsans område som föreskrivs i artikel 129 i fördraget om Europeiska unionen 
Genomförandet av den andra handlingsplanen om cancer har understrukit behovet av nära 
samarbete mellan Europeiska kommissionen samt organisationer och organ på nationell 
eller europeisk nivå som är engagerade i kampen mot cancer. Detta samarbete har 
åstadkommits genom det viktiga nätverket för samarbets- och samrådsförfaranden som 
upprättades under den första och andra handlingsplanen, och ger frivilliga grupper som 
är engagerade i kampen mot cancer, särskilt cancerförbund och föreningar och 
aktionsgrupper mot rökning, en viktig roll. Dessa organisationer och grupper ingår i 
nätverket med nationella samordningskommittéer, som har spelat en viktig roll i 
handlingsplanens genomförande och för att säkerställa ett gott resultat. 
Sammanfattningsvis kan sägas att "Europa mot cancer"-programmet har gjort avsevärda 
framsteg, i synnerhet på följande områden: Åtgärder för förhindrande av rökning och 
rättsligt stöd för denna åtgärd, informationsverksamhet särskilt vad gäller främjande av 
den europeiska koden mot cancer, utveckling av hälsoundcrvisningsstrategier och material 
för skolor om förebyggande av cancer, utveckling av massundeisökningsnälveik för 
bröstcancer och livmoderhalscancer, utbildning av hälsovårdspersonal samt 
undersökningar avseende näringslära och cancer. 
Närmare information om dessa åtgärder återfinns i den rapport om programmets 
genomförande som bifogas. 
"Europe Against Cancer" Programme 
REPORT FROM THE COMMISSION 
TO THE COUNCIL, THE EUROPEAN PARUAMENT, THE 
ECONOMIC AND SOCIAL COMMITTE AND THE COMMITTEE OF 
THE REGIONS 
ON THE IMPLEMENTATION OF THE SECOND ACTION PLAN 
(1990-1994) 
INDEX 
I SUMMARY 1 
II. IMPLEMENTATION REPORT, PREVENTIVE MEASURES SUPPORTED BY 
THE PROGRAMME 4 
A) Prevention of tobacco consumption 4 
B) Studies and preventive measures on diet (including alcohol) ... 7 
C) Campaign against carcinogenic agents 8 
D) Information for the public on preventive measures 10 
E) Health education: preventive measures 13 
F) Cancer training measures for health professionals 15 
G) Cancer screening 19 
H) Studies and projects related to quality assurance in the cancer 
treatment 24 
I Cancer research 25 
III PRESENTATION OF THE "EUROPE AGAINST CANCER" 
PROGRAMME 26 
III.A. GENERAL REMARKS 26 
III.B. SOME DATES AND KEY DECISIONS 27 
1. EUROPEAN COUNCIL 27 
2. EUROPEAN COMMISSION 27 
3. EUROPEAN PARLIAMENT 28 
4. COUNCIL 29 
IV. MANAGEMENT STRUCTURE OF THE PROGRAMME 31 
1. COMMISSIONERS RESPONSIBLE 31 
2. COMMISSION SERVICES 31 
3. COMMITTEES AND OTHER GROUPS 32 
A. Advisory Committee 32 
B. Cancer Experts Committee 32 
C. National Coordination Committees 33 
V RELATIONS WITH NON-GOVERNMENTAL ORGANISATIONS 34 
1. National Non-Governmental Organisations 34 
2. International Non-Governmental Organisations 34 
Cooperation with the World Health Organisation (WHO) 34 
Cooperation with the (EORTC) 36 
Cooperation with the European School of Oncology 37 
Cooperation with the International Union Against Cancer 37 
VI. FIELDS OF ACTIONS OF THE SECOND PLAN OF ACTION 38 
VII. ANNEX 41 
APPROVED SCIENTIFIC REPORTS BY THE CANCER EXPERTS 
COMMITTEE 41 
RECOMMENDATIONS, RESOLUTIONS AND STATEMENTS BY THE 
CANCER EXPERTS COMMITTEE 42 
I. SUMMARY 
The "Europe against Cancer" programme was initiated in 1985 by the European 
Council of Heads of State and Government, and a Committee of Cancer Experts was 
set up to advise on this European initiative. In February 1986, the Committee adopted 
at its first meeting in Paris an opinion describing the main lines of a comprehensive 
programme. That opinion led to the elaboration by the European Commission of a first 
1987-1989 action plan. In December 1989, the Heads of State and Government 
praised the achievements of this first action plan and expressed their satisfaction on 
the launch of a second plan for the period 1990-1994. 
The objective of the second cancer action plan was to develop information on 
prevention of cancer and possible methods of early detection and treatment. 
The second action plan comprised 38 fields of action largely based on those in the first 
programme and which concerned three main areas: a) Cancer prevention, in which 
priority was given to the fight against smoking, as one third of deaths by cancer is 
attributed to tobacco. Among the means utilized were the introduction of European 
legislation on tar and labelling, and the use of Community grants to stimulate studies 
and research, public information actions, health education in schools and health 
personnel training. Prevention messages diffused were largely based on the European 
Code against Cancer which was developed by the Committee of Cancer Experts and 
approved by the Ministers of Health. 
b) Early detection and systematic screening of cancers. Here again, Community 
support was given for information, education or training actions, for studies and 
research of European interest and for the setting up of European networks of 
screening pilot projects, c) Quality assurance on treatment of cancers. Community 
subventions financed training actions for health personnel, comparative studies and 
exchanges of experience in palliative care, as well as European exchanges of 
research results. 
The basic principle followed by the European Commission was to intervene only if this 
intervention brought an added value to national actions. This added value has taken 
the following forms: 
a) To promote the diffusion throughout the Community of the best national 
practise or legislation. For example, Community directives on tar content and 
labelling of tobacco products have been conceived in such a way as to 
harmonize national regulations and to guarantee a high level of health 
protection to all citizens of the Community. The programme also encouraged 
the circulation of the European Code against Cancer in all the Member States. 
The creation of European networks of pilot projects for cancer screening 
advanced the spread through the Community of best scientific practise, 
contributing to the progressive elimination of non-optimal procedures. 
b) To promote and stimulate cooperation in the matter of studies and research 
in order to harmonise medical practise in Europe, helping to reduce important 
differences, responsible for varying cancer survival rates. 
To exchange experience on best practice in the field of established preventive 
methods such as screening programmes, health education in schools and 
tobacco cessation methods. 
In 1992 an independent evaluation committee reported to the Council and the 
European Parliament on the first five years of the "Europe against Cancer" 
programme. The main conclusion of the evaluation committee was that this 
programme had successfully brought together various categories of hearth 
professionals and other interested parties in a common effort to control the cancer 
problem in Europe and strongly recommended continuation of the programme, 
because of the long term nature of the cancer problem. 
The Council adopted the conclusions of the evaluation committee and provided the 
programme with additional funding (5 million ECU). In its Resolution of 13 December 
1993, the Council invited the Commission to submit a proposal for a third action plan, 
taking into account its earlier resolution of 27 May 1993 on future action in the field 
of public health. This proposed third action plan is built on the experience gained by 
the previous action plans and, is at the same time coherent with the framework for 
action in the field of public health laid down in Article 129 of the Treaty on European 
Union. 
The implementation of the second cancer action plan has illustrated the need for close 
cooperation between the European Commission and those organisations and bodies 
on national or European level which are concerned with the fight against cancer. This 
cooperation has been achieved by the important network of cooperation and 
consultation procedures put in place during the first and second action plans, and 
which gives an important role to voluntary groups active in the fight against cancer, 
in particular cancer leagues and associations and anti-smoking groups. 
These organisations and groups form part of the network of national coordination 
committees, which have played a significant part in implementing the action plan and 
ensuring its success. 
In conclusion, it may be noted that the "Europe against Cancer" programme made 
significant progress particularly in the following areas: Action on smoking prevention 
and the legislative support for this action, information activities dealing especially with 
promotion of the European Code against Cancer, development of health education 
strategies and materials on cancer prevention at schools, development of breast 
cancer and cervical cancer screening networks, training of health professionals and 
studies related to nutrition and cancer. 
Specific details of these actions can be found in the attached implementation report. 
II. IMPLEMENTATION REPORT, PREVENTIVE MEASURES SUPPORTED BY THE 
PROGRAMME 
A) Prevention of tobacco consumption 
Action 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 during 
the second action plan mainly concerned the organisation of pilot projects and 
exchanges of experience in the European networks. 
Network of non-smoking towns (Empoli, Besançon, Toledo, Namur) set up in 
1990. A similar experiment started in 1992 in Royan (France). Steps were taken 
to extend the network to include Luxembourg and Cascais (Portugal). 
European network of "smokebusters" clubs for young people, started in 1991 
(UK, France, Belgium, Spain, Portugal). This was a new strategy to promote a 
non-smoking approach by young people. The method consist of a participatory 
club for schoolchildren age 7-11 (age groups differ from country to country). 
A European conference took place in Seville (Spain 1993) to exchange 
experiences. 
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 Montpelier 
(France). New pilot projects were started in 1992 in Germany, Denmark, 
Greece and Ireland. A progress report on the prevention of smoking among 
young people at school for the first four members has been presented in 
Frascati in 1994. Similarly, an evaluation of all the measures taken to prevent 
smoking among young people outside the school environment was started in 
1993; the first results will be known in 1995 (ASH Scotland, Edinburgh) and will 
be presented at a conference in Autumn 1995. 
The "Europe against Cancer" programme has continued to finance the 
"European Bureau for Action on Smoking Prevention" (BASP) which was 
created in 1988 following a call for tender. This office operates as a European 
information centre in the area of smoking prevention and has made an 
important contribution to the improvement of the exchange of information and 
experience in this area. 
In addition to general information services and technical support to the services 
of the European Commission, the BASP publishes a quarterly newsletter and 
regular reports on specific issues. These publications are distributed to all 
programme partners and to a large number of other organisations working in 
the field in Europe and internationally. 
Since 1990, BASP has published 11 special reports covering the following 
issues: the use of moist oral tobacco and its promotion among young people; 
the tobacco industry in Eastern Europe; advertising of tobacco products and its 
impact on the uptake of smoking among young people; smoke free flights; 
women and smoking; differential insurance premiumsfor non-smokers; smoking 
policies in the workplace; the taxation of tobacco products in the European 
Union; passive smoking; the labelling of tobacco products in the European 
Union; and a country profile of tobacco use in the European Union. 
The Ninth World Conference on tobacco and health was held in Paris from 9-14 
October 1994 with the Europe Against Cancer Programme as Official Partner. 
There was a useful exchange of experience and information on tobacco-related 
issues and the opportunity was taken to outline the progress made in the 
European Union in combatting tobacco consumption. 
Involvement in meetings organised by the World Health Organisation (WHO) 
on the prevention of smoking in Europe. 
Action 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 representatives of the main GP's associations in the EU expressed their 
commitment to combatting smoking at a European symposium held in Paris in June 
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) were published in 1993 (Smoking 
cessation methods: recommendations for the European Community). 
The Programme funded training projects for GP's in Spain and Portugal on the 
prevention and treatment of nicotine addiction. 
A number of multi annual projects on preventing smoking in schools, with a section 
on training for teachers in the prevention and breaking of nicotine addiction, received 
funding (Germany, Denmark, Spain ancj Portugal). 
Action 3. Stimulation of innovative information campaigns to prevent the use 
of tobacco among the general public and at the workplace. 
Several surveys on smoking in the Member States (Eurobarometer) were carried 
between 1990 - 1994. 
An analysis was carried out of the replies given to questions on passive smoking, the 
rules on smoking in public places and at work, and advertising for tobacco products. 
The conclusions of the surveys show a consistency throughout the years. The results 
of the survey were disseminated in the Member States, particularly on the WHO's 
World No Smoking Day. 
In addition, as a follow-up to the measures on cancer prevention and health promotion 
at the workplace carried out in 1992 as part of the European Week against Cancer, 
the Programme supported a number of measures to make people at work more aware 
of the risks associated with smoking in general and with passive smoking in particular. 
As an experiment, a centre (L'observatoire permanent des publicité et promotion des 
produit de tabac) was set up In 1993 in France to monitor the application of the rules 
on banning advertising for tobacco products in France. The first report was published 
in March 1994 
The Commission provided funding in 1993 for an existing telematics network 
(Globalink) to develop an application to improve the rapid transmission of information 
on the prevention of smoking between the Programme's partners in the 12 Member 
States. The network is also to supply information on cancer from 1994 onwards. 
The Commission encouraged its partners in the Programme to take an active part in 
the WHO's World No Smoking Day (every year on 31 May.) 
Action 4. Financing of studies on the possibilities for putting tobacco-
growing areas to other uses. 
Measures were taken in 1993 to reform the common agricultural policy in the tobacco 
sector. 
Article 13 of Council Regulation (EEC) No. 2075/92 on the common organisation of 
the market in raw tobacco1 provides for the setting up of a Community fund for 
tobacco research and information, to be financed from the proceeds of a deduction not 
exceeding 1% from the premium at the time of payment. The fund shall finance and 
coordinate programmes of research and information to promote greater knowledge of 
the harmful effects of tobacco and the appropriate prevention and curative measures 
relevant to such effects, and to orientate Community tobacco production towards the 
least harmful varieties and qualities. 
A call for proposals was issued by the Commission2 with a deadline for receipt of 
' OJ No. L215 of 30.7.1992, p. 70 
2 OJ No C179 of 1.7.1994, p. 8 
completed proposals by 21 October 1994. These proposals will then be considered by 
the Scientific and Technical Committee and the Group of Independent Experts, 
established under the fund, who will advise the Commission Services on the proposals 
to be accepted. 
B) Studies and preventive measures on diet (including alcohol) 
Action 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), 
the pilot phases of which were carried out between 1988 and 1991 and which 
covers seven countries of the European Union (Germany, France, Spain, 
Greece, Italy, the Netherlands and the United Kingdom), operates in 
accordance with the terms of the joint protocol drawn up at the end of 1991. 
This provided for a gradual increase in the number of volunteers involved in the 
study to around 40 000 to 70 000 in each country. At the moment, the 
participation rate for the population studied is extremely satisfactory in all the 
countries which signed the protocol. Data have already been collected by 
means of a questionnaire from 77 000 people (Spain, France, Ireland, the 
Netherlands and the United Kingdom), together with biological samples from 22 
000 of them. Collecting all the basic data needed to carry out the study will take 
three years. From 1995, the network will be in a position to register the first 
cases of cancer to appear in the categories with the highest incidence; the data 
will be analyzed and preliminary results provided in 1997-1998. 
The intervention study launched in 1991 on preventing benign tumours in the 
large intestine and which involves ten Member States is also operational. It was 
provisionally scheduled to run for three years and is coordinated by the 
European Organisation for Cooperation in Cancer Prevention Studies (ECP) 
and the European Commission. Its aim is to evaluate the effects of preventive 
treatment with calcium and fibre on the appearance and development of this 
type of tumour. The total number of patients included is 658. The first results 
should be available in 1995. Several smaller studies are carried out on national 
level to show the correlation between nutrition and specific cancers (eg breast 
cancer). The report on the results of the scientific studies co-financed by the 
programme has been updated in 1994. 
Action 6. Drafting and publication of guidelines on nutrition aimed at 
improving cancer prevention. 
The results of the prospective investigation on diet and cancer (EPIC) will enable the 
nutrition guidelines given in the European Code Against Cancer to be defined in 
greater detail. These results are scheduled for the end of the third action plan. 
C) Campaign against carcinogenic agents 
Actions 7 Continuation of 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 Sates 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 were 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. 
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 3.1015 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. 
The measures taken since the start of the second action plan to combat ionising 
radiation, particularly the information programme on radiation and radiation protection 
for the general public and certain target groups of workers had the following results; 
An information handbook for teachers was produced and four courses were organised 
for health personnel in 1993, covering mainly quality assurance and the optimisation 
of radiation protection in medicine. 
The Programme provided funding in 1993 for the first phase of a study on the links 
between electromagnetic fields and other risk factors in the aetiology of leukaemia in 
children. 
In addition, the procedure was started for the revision of the Directive on basic safety 
standards for the protection of the general public and exposed workers against the 
dangers of ionising radiation. 
Action 9. Supportfor European studies on the possible carcinogenic risks of 
certain chemicals. 
A number of studies on carcinogenic agents have been funded, particularly on 
carcinogenic risks for workers in biological research laboratories, the risk of exposure 
to dioxin and non-occupational exposure to asbestos. 
The IARC in Lyon commissioned an evaluation of the hazards involved in certain types 
of work in the wood, leather and paper production sectors. The final reports on wood 
and leather have now been drawn up, and the IARC monograph on wood is reviewed 
in the light of the report at a meeting of IARC experts in October 1994. 
The three-year study being carried out in Greece on the risks associated with the use 
of pesticides in greenhouses is finalised. The final report is expected in early 1995 
A study on specific hazards in the electricity production industries involving France, 
Italy and Spain is currently being made, using historical cohorts, of deaths associated 
with exposure to asbestos and artificial mineral fibres. 
Technical support has been provided for the secretariat of the European mesothelioma 
panel. A report (ISBN 92-826-4821-4) was published by the Community's Publications 
Office. 
As part of the fifth ECSC medical research programme, 15 projects were funded on 
the detection and prevention of occupational cancer in the coal and steel industries. 
Three final reports have already been forwarded to the Commission. 
Action 10. Continuation of the classification and labelling of dangerous 
substances. 
On 1 September 1993 the Commission adopted a Directive making the 19th 
adaptation to technical progress of Directive 67/548/EEC on the classification and 
labelling of dangerous substances, adding or reclassifying 19 substances or groups 
of substances classified as carcinogenic, 14 of them as category 1 or 2. Annex I of 
Directive 67/548 now contains 168 dangerous substances or groups of substances 
classified as carcinogenic and to be labelled as such, 105 of which are category 1 or 
2. 
D) Information for the public on preventive measures 
Action 11. Possible updating of the European Code against Cancer 
The Commission invited the European School of Oncology (ESO) to assemble a group 
of high-level international experts to examine and possibly update the scientific 
aspects of the recommendations given in the current European Code Against Cancer. 
This exercise took place and a new version was adopted by the Cancer fxperts 
Committee in November 1994 pending editorial changes in the annex. The revised 
code will be the theme for the European Week 1995. 
EUROPEAN CODE AGAINST CANCER 
Certain Cancers may be avoided and general health improved 
if you adopt a healthier lifestyle 
1 Do not smoke. Smokers, stop as quickly as possible and do not smoke in the 
presence of others. If you do not smoke, do not experiment with tobacco 
2 If you drink alcohol, whether beer, wine or spirits, moderate your consumption. 
3 Increase your daily intake of vegetables and fresh fruits. Eat cereals with a high 
fibre content frequently. 
4 Avoid becoming overweight, increase physical activity and limit daily intake of 
fatty foods. 
5 Avoid excessive exposure to the sun and avoid sunburn especially in 
childhood. 
6 Apply strictly regulations aimed at preventing any exposure to known cancer-
causing substances. Follow all health and safety instructions on substances 
which may cause cancer. 
More cancers may be cured if detected early 
7 See a doctor if you notice a lump, a sore which does not heal (including in the 
mouth), a mole which changes in shape, size or colour, or any abnormal 
bleeding. 
8 See a doctor if you have persistent problems, such as a persistent cough, 
persistent hoarseness, a change in bowel or urinary habits or an unexplained 
weight loss. 
For women 
9 Have a cervical smear regularly. Participate in organised screening 
programmes for cervical cancer. 
10 Check your breasts regularly. Participate in organised mammographie screening 
programmes if you are over 50. 
Action 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 
advertisements free of charge on the subject of the fight against 
cancer. 
The European Week Against Cancer, normally every second week of October 
addressed over the last five years the following topics: 1990: Tobacco and Alcohol 
(including the film Smoking and You), 1991 : Early detection and systematic screening, 
1992: cancer prevention and health promotion on the workplace, 1993: Passive 
smoking, 1994: Fruit and vegetables every day, A key to health. 
Action 13. Production of European information modules on the prevention, 
screening and treatment of cancers, adaptable to national 
requirements. 
At each press conference organised for the European Week in the Member States, 
a press package was produced by a European working party and containing scientific 
documents giving background information on the issue addressed during that week. 
These documents were widely distributed among the press and the Programme's 
partners. The packages also contained contributions from these partners, who were 
responsible for organising the information campaign for the European Week in each 
Member State. 
In 1991, an issue of Social Europe was dedicated to the "Europe against Cancer" 
programme. The initiatives of the programme and all directives are well presented in 
this publication. 
An international seminar on mobile exhibitions was held in Aachen (D) in 1993. 
At this international seminar, experts from the Netherlands, Belgium, Luxembourg, 
France and Germany discussed the experience being gained in mobile exhibitions 
dealing with cancer prevention. 
Actions 14 and 15. Publicizing of the European Code among the general 
public by the partners in the action plan. Support for 
innovative information campaigns on cancer 
prevention among targeted groups. 
A number of measures to publicise the European Code Against Cancer among the 
general public and among certain specific target groups received funding during the 
second action plan. For instance; introduction of telephone helplines, production and 
distribution of cartoon strips, participation at national or international trade fairs such 
10 
as the one in Hanover, in close cooperation with the "Helios" programme for the 
disabled and the occupational health and safety services. The aim of most of these 
measures was to raise awareness, motivate and train relay groups (the health 
professions, voluntary workers in cancer associations etc.) likely to disseminate 
information among the general public, and to promote innovative approaches such as 
games or stage productions on cancer related themes. 
A number of measures focused specifically on the prevention of melanomas and the 
risks associated with excessive skin exposure to solar radiation both at work and at 
leisure. 
A brochure on the European Code Against Cancer which explains the scientific basis 
of the Code for GP's in the Community was produced in 1992 by the Group of 
Representatives of GP's Associations in the Member States. Already available in 
France and Italy, in 1993 it was widely distributed in Ireland, the United Kingdom and 
Scandinavia. 
Action 16. Informing workers, and migrant workers in particular, under 
existing Community Directives, of the Fight against job-related 
cancers. 
Following the European Year of Safety, Hygiene and Health Protection at Work in 
1992, the main cancer associations formed a liaison group in order to continue efforts 
to prevent cancer and to promote health in firms. 
The group prepared a European conference "a healthy company - enhanced 
competitiveness through a healthy work force" in Berlin in September 1994. This 
conference examined parameters to measure the cost - effectiveness of health 
promotion schemes and gave examples of best practice presented by companies 
themselves. This type of presentation appeared to have a very positive impact on the 
participants who were mostly personnel managers and persons responsible for 
occupational health, and demonstrated that prevention is an area of growing interest 
within companies that should be developed further. 
A number of initiatives were funded in Germany, Belgium, Spain, Greece, Ireland, 
Italy, the Netherlands and the United Kingdom to provide information on the risks 
associated with certain lifestyles (smoking, nutrition) and with exposure to carcinogens. 
A European conference on exposure to carcinogens was held in Frankfurt (D), and 
had a major impact in the German press, which has given the subject regular 
coverage ever since. 
A number of these projects were continued without further funding, showing that the 
initial financing from the Commission had given an incentive for extended action. 
11 
E) Health education: preventive measures 
The actions of the second action plan on health education and cancer prevention are 
based on the principles adopted at the first European Conference on health education 
and cancer prevention in schools, which was held in Dublin in 1990. 
These principles aim to improve cancer prevention by promoting health among 
children,- adolescents and adults in schools, in line with the recommendations given 
in the European Code Against Cancer. 
A second European Conference on Health Education and Cancer Prevention at 
schoc!s has taken place in Dublin from 9th to 12th November 1994. The aim of the 
conference was to assess progress in cancer education since the first conference on 
health promotion in schools. 
The Conference has drawn up recommendations to the European Commission for the 
future direction of health education and cancer prevention in schools for the years 
1995-1999. 
Action 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 Dublin Conference 
on health education and cancer prevention in schools were held in 1992 and 1993 in 
ten countries. The aim of these conferences was to make school teachers more aware 
of cancer prevention measures and effective ways of transmitting messages based on 
the European Code. 
Three working groups have been established after the Dublin conference (1990) to 
evaluate all the health education and cancer prevention measures taken in schools 
with the support of the Programme. These working groups include European experts 
on cancer prevention in primary schools, European experts on cancer prevention in 
secondary schools and European experts on cancer prevention in teacher training. 
Their conclusions on health education were endorsed in 1992 by the Council of Health 
Ministers (92/C 326/02) and by the Council of Education Ministers (92/C 336/07). 
A European Charter, laying down a minimum health education training programme for 
teachers to enable them to increase children's and adolescents' awareness of cancer 
prevention and risk factors, was widely distributed in 1993 following a European 
seminar held in Rotterdam in November 1992. Bearing these guidelines in mind, the 
Programme provided funding for six local or regional projects on initial and/or 
continuing training for teachers in cancer prevention through health promotion. 
12 
Action 18. Dissemination of European teaching material for health education. 
On the basis of the conclusions of the working party on cancer prevention in primary 
schools (cf. above), a methodological guide for primary school classes was produced 
and distributed in the French-speaking community in Belgium. In addition in 1994, a 
European seminar was held in Brussels, organised with the help of the Free University 
of Brussels, in order to publicise the conclusions of the working party and to exchange 
experiences on cancer prevention in primary schools. 
As part of the implementation of the conclusions of the working party on secondary 
schools, a draft brochure and posters on the subject of health promotion in schools 
produced by the Netherlands Centre for Health Promotion and Health Education were 
distributed among the relevant authorities in the Member States. The Programme also 
funded the preparation of a guide for secondary school health education coordinators 
designed to help field workers with knowledge of and/or experience in health education 
to organise specific cancer prevention courses in the schools where they work. The 
guide, produced by Health Promotion Wales, is to be completed and distributed in 
1995. 
The Programme funded the production of a prototype "spiral" nutrition education 
module taking account of the results of the two European seminars on the subject 
organised in 1991 in Flensburg (D) and 1992 in Lagonissi (GR). The module, designed 
for use in health-promoting schools, is completed and distributed. 
The Programme continued to provide support for the production of teaching materials 
intended for primary school pupils on the prevention of skin cancer associated with 
solar radiation. The first conclusions of this project, which involves teachers in schools 
in Germany, Denmark, Ireland, the Netherlands and the United Kingdom, show 
interesting differences between Member States on the information children receive on 
skin cancer prevention. These results will be used to develop new teaching material. 
Action 19. Promotion of pilot projects to promote awareness of the European 
Code among young people. 
The Programme supported several regional and national pilot projects designed to 
make children and young people more aware of the recommendations of the European 
Code Against Cancer. The main themes of the projects are the prevention of smoking 
and encouraging healthy eating habits as part of wider educational programmes 
promoting a healthy lifestyle. 
Action 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. 
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 
13 
projects in the field of nutrition education were able to exchange experiences. 
The Programme provided funding for local and regional projects designed to help 
improve the dietary habits of children and young people at school. One of the priorities 
of the projects is to use school canteens, where these exist, to encourage the 
consumption of fruit and vegetables. 
F) Cancer training measures for health professionals 
The technical content of training programmes for various health professionals in the 
matter of cancer was agreed at the following conferences: 
European Conference on a curriculum in Oncology for Medical Students in 
Europe, May 1988, Bonn (EORTC)(Doc. V-1822/88/9EC). 
European Conference on dentists and cancer prevention, June 1990. Royal 
Dental College of Copenhagen. 
European Conference on a curriculum in oncology for dental students in 
Europe, October 1991. Royal Dental College of Copenhagen. (Doc. 
V-241/91/9EC). 
European Conference on a core curriculum for a post-basic course in cancer 
nursing, January 1991, London. European Oncology Nursing Society (EONS) 
(Doc. V-604/91/9EC). 
European Conference on cancer training for general practitioners, June 1991, 
Copenhagen. European Union of General Practitioners (UEMO) 
(doc.V-1310/91/9EC). 
The recommendations from these conferences have been translated into the 9 official 
languages of the Community and endorsed by the advisory committees (DG XV) on 
training of Nurses (April 1991), Dentists (November 1991) and Doctors (November 
1991). They have since then been distributed to the competent authorities and to 
professional non governmental organisations of the 12 Member States. 
Action 21. Support for the organisation of national or regional meetings to 
promote the 1989 European recommendations on the oncology 
content of basic training programmes for members of the health 
professions. 
An evaluation has been carried out in 1993 on the impact on university medical 
courses following the conclusions of the European consensus conference on oncology 
training in medical courses in Europe, which was held in Bonn in 1988 (Doc. V-
1822/88/9EC). The results are foreseen for the end of 1994. 
The conclusions of a European conference on initial training on cancer for nurses, held 
from 18 to 20 November 1992 in Copenhagen, were widely distributed. Two national 
conferences took place in 1993 in Denmark and the United Kingdom in order to 
promote these conclusions, which are based on the 1989 European recommendations. 
14 
A national conference on specific cancer training for GP's was held in Italy in 1993 
and a similar conference is to be held in Greece with the support of the Programme. 
Action 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. 
- Training for nurses 
As GP's and nurses are the people who are closest to the patients, they have a vital 
role to play in combating cancer. A European network of pilot projects, based on the 
core curriculum for a post-basic course in cancer nursing was established in 1991 with 
the support of the "Europe against Cancer" Programme in Belgium, Denmark, 
Germany, Greece, Ireland, Italy, Portugal. 
The members of this network organize courses, based on the recommendations of the 
European conference on continuing training on cancer for nurses (Doc. V-604/91/9EC) 
- Training for doctors 
The Programme supported specific cancer training courses for GP's in Belgium, 
Denmark, Spain, France, Ireland, Italy, the Netherlands, Portugal and the United 
Kingdom. The courses are based on the conclusions of the European conference on 
training in cancerology for general practitioners held in June 1992 in Copenhagen 
(doc. V-1310/91/9EC), and form part of the network of exchanges of experience, set 
up in Antwerp in 1992 at a European seminar organised together with the European 
School of Oncology (ESO). When the network was set up, the conclusions of the 
conference were very widely distributed in the Member States with funding from the 
Programme. 
- Training for dental practitioners 
Several pilot projects on initial oncology training for dental practitioners were funded 
by the Programme. An exchange network was set up at the end of 1993 involving 
representatives of dental faculties and associations in Belgium, Denmark, Spain, 
Greece, France, Ireland, the Netherlands, Portugal and the United Kingdom in order 
to promote the conclusions of the European conference on initial oncology training for 
dental students, with particular reference to prevention, which was held in Copenhagen 
in 1991 (Doc. V-241/91/9EC). 
Action 23. Promotion of oncology training projects 
Several national and regional projects were selected over the last five years. 
- two continuing training courses for nursing staff in Greece 
15 
seven continuing training courses in general oncology for general practitioners 
(two in Portugal and two in Spain), medical specialists (Greece) and 
interdisciplinary groups (France, Greece) 
Action 24. Support for the mobility of the health professions between Member 
States in order to improve their specialised training in cancerology. 
Support has been provided through fellowships to facilitate the mobility of doctors and 
nurses between Member States. During the second action plan, ± 300 fellowships 
were awarded to doctors to facilitate their access to specialised courses organised by 
the European School of Oncology (E.S.O.). 
Access to centres of excellence was facilitated for ± 150 European nurses with the 
assistance of the European Oncology Nursing Society (EONS). Participation in cancer 
related data management courses organised by the European Organization for 
Research and Treatment of Cancer was also supported. 
Fellowships for cancer specialists and statisticians have been given in 1993 and 1994 
to attend the EORTC data center. These persons have been working for 12 months 
at the EORTC Data Center to study EORTC experience in the conduct of clinical trials 
and the management of clinical trials data. 
Action 25. Collection and exchange of teaching material of European interest 
for the training of members of the health professions. 
For cytopathologists and cytotechnicians involved in screening for cervical cancer, an 
initial consensus was reached on aptitude testing and European classification of 
cervical pathology. These recommendations are published in the European Guidelines 
for Quality Assurance in Cervical Cancer Screening, Supplement of the "European 
Journal of Cancer" (supplement 4 to Volume a, 1993) 
In the field of cancerology training for nurses, a training module was developed by the 
University of Southampton. This will be tested in continuing cancerology training 
courses in 1994 in a small number of training establishments in the Member States. 
On the subject of training for dental practitioners, the Programme supported the 
production by the European Faculty of Oral Health Sciences (EFOHS) of a training 
module (texts and slides) designed to improve oncology training for dental students. 
This module will be tested in a small number of training establishments in the Member 
States in 1994. 
Action 26. Exchange of experience and support for the organisation of 
European seminars on continuing education of members of the 
health professions. 
Several European seminars were funded by the Programme during the second action 
16 
plan. 
1990: 
1991: 
1992: 
1993: 
1994: Training seminar for European Health Professionals. 
European conference on dentists and cancer prevention, June 1990 Royal 
Dental College of Copenhagen. 
European conference on a curriculum in oncology for dental students in Europe, 
October 1991. Royal Dental College of Copenhagen. 
European conference on a core curriculum for a post-basic course in cancer 
nursing, January 1991, London. European Oncology Nursing Society (EONS) 
European conference on cancer training for general practitioners, June 1991, 
Copenhagen. European Union of General Practitioners (UEMO). 
The European Paediatric Oncology Centre (Italy) organised a paediatric onco-
haematology course for nurses as part of the organisation of a European 
network. 
Three symposia were held in the field of training for specialists: breast related 
pathology (Greece), Lung cancer (Greece) and impalpable lesions of the breast 
(France). 
a European seminar on the internal evaluation of the training courses for 
instructors of general practitioners funded by the Programme since 1991. The 
seminar demonstrated the need to improve the cancer training content of the 
courses, using the European consensuses on prevention, screening and 
treatment to provide a solid scientific basis, and the need to step up exchanges 
of experience between training establishments for general practitioners in the 
Member States. 
Two seminars for medical specialists: a course for medical cytopathologists on 
recent progress in immunology and molecular biology and their consequences 
for professional practice in the cancer field; one seminar on reconstructive 
surgery in oncology. 
European School of Oncology (ESO): Education and training activities in 
oncology 
A five day course on oral cancer and precancer: The course aimed to increase 
European integration in the field of teaching and management of problems 
associated with oral cancer and precancer. 
European course on cancer clinical trials (EORTC): This course is designed at 
advanced level and benefit to medical doctors, specialists in oncology, and is 
17 
of particular value to data managers and oncology nurses involved in the 
management of clinical trials. 
G) Cancer screening 
Action 27. Continuation of comparative studies to improve the organisation of 
cancer screening programmes. 
In the period 1990-1994 several studies have been conducted to improve the 
organisation and quality assurance of cancer screening programmes. The activities will 
be discussed under each topic. 
- Breast cancer: 
The European guidelines on quality assurance in mammography screening, which lay 
down parameters to achieve an optimal level of organisation and minimum and optimal 
quality criteria for screening devices used in mass screening of breast cancer, were 
published in 1992 and distributed by the Commission to the Member States, in 
particular to the health authorities and other relevant national bodies (insurance 
companies, screening project leaders). This document is the basis for future quality 
assurance programmes on breast cancer in the Member States. Also based on this 
document, a European network of reference centres for the promotion of good quality 
mammography screening (EUREF) was set up in 1993, coordinated by the University 
of Nijmegen (NL), in order to consolidate exchanges between pilot project leaders. Its 
aim is to ensure quality in the pilot breast cancer screening programmes in the 
Member States so that screening models can be more easily applied at national or 
regional levels and so that training courses in breast cancer screening can be 
proposed for the health professions. 
A European nomenclature of criteria for identifying histocytopathological lesions in 
breast cancer together with an index of terminology is being prepared following a 
project co-funded by the Commission in 1992 and 1993 (Royal Marsden Hospital, 
London), in cooperation with representatives from the relevant professional 
organisations in the Member States. This nomenclature will be added to the revised 
edition of the European Guidelines for Quality Assurance in Mammography Screening 
which will be published in 1995. 
In the light of the conclusions of a study carried out in France in 1992 and 1993 to 
evaluate the cost-effectiveness of breast cancer screening, a meeting was held in 
1994 to compare methods for the medical/economic evaluation of breast cancer 
screening on the basis of work carried out in a number of Member States (DK, F, NL, 
UK). The model developed by the University of Rotterdam to calculate cost-
effectiveness, is being used in four countries (NL, D, I, Esp). 
Cervical cancer: 
Based on the European Guidelines for Quality Assurance in Mammography Screening, 
18 
the Commission asked a group of leading European experts to develop European 
Guidelines for Quality Assurance in Cervical Cancer Screening. The recommendations 
of this expert group were published in the "European Journal of Cancer" (supplement 
4 to Volume 29A, 1993); 1 000 copies were sent to subscribers and over 700 
additional copies were distributed by the Programme. On the basis of these guidelines, 
a network of pilot projects on cervical cancer screening started in 1994. 
A multi-centre random study on the usefulness of cervicography in the early diagnosis 
and monitoring of cervical cancer was launched in 1993 (Institute Jules Bordet, 
Brussels) following the positive results of the feasibility study carried out by the 
Institute in 1991. 
The IARC launched a multi-centre study in 1993 to evaluate the role of HPV 
papillomavirus infections and other factors in the appearance of cervical cancer. This 
question has also been discussed at an international conference organised in Paris 
in 1994 with the support of the Commission. 
Action 28 Extension and the monitoring of the European network of breast 
cancer screening pilot programmes to help the Member States 
determine a general screening policy 
Some Member States already have major breast screening programmes in operation 
and on this basis a pilot breast screening network was set up. The aim of this network 
was not to investigate the benefits to be gained from high quality breast screening, but 
to inform those countries with no breast screening experience in this area, explore 
methods of implementation and establish contact for exchange of information and 
experience between Member States. At the end of the second action plan all Member 
States participate in this network. 
As is to be expected, results from the pilot projects have been variable, but in all 
cases variance from average results has been analyzed, conclusions drawn and 
lessons learnt. If possible, remedial actions have been taken. 
During this action plan, the Breast Screening pilot programmes moved from the 
implementation phase into one of quality improvement. Much comment has been 
made as to the importance of quality issues. However, evidence is variable as to the 
carrying out of such activities. In this light, the European Guidelines for Quality 
Assurance in Mammography Screening have been developed and were therefore of 
vital significance. The difficulty of carrying out adequate professional and technical 
quality assurance in certain systems of health delivery across the Member States is 
obvious. Individual Member States variation must be respected. Nevertheless, the 
safety and value of the test to the population remains paramount. 
An annual coordination meeting was held for all the project leaders of the pilot 
screening programmes. At these meetings, the progress of each pilot project was 
discussed and experience shared. Every meeting was combined with learning 
sessions. Topics addressed were physical quality control of the equipment, cost 
19 
effectiveness analysis, quality assurance in pathology, interpilot testing of radiological 
skills, epidemiological data definition, etc. 
As part of the follow-up and evaluation of the network, one of the Programme's 
consultant experts carried out on-the-spot inspections. Every pilot project was seen 
twice during this period and the reports were presented to the Cancer Experts 
Committee and distributed within the network for learning purposes. 
An average of 50% of the screening budget went to the breast screening network. 
Action 29. Evaluation of existing cervical cancer screening programmes and 
setting up of a European network of regional or local pilot 
programmes. 
It is recognised that well organised cervical screening can reduce the mortality 
associated with this cancer. Cervical screening programmes have shown variable 
protocols, quality and organisation. 
A European network was set up in 1993 with the support of the Commission, involving 
pilot cervical cancer screening projects in the twelve Member States. All the members 
of the network met for the first time in May, 1994. 
They accepted the European Guidelines for Quality Assurance in cervical cancer 
screening as a working document and will present their data in conformity with the 
guidelines. 
Action 30. Continuation of evaluation studies on screening programmes for 
colorectal cancer and possible setting up of a European network. 
Studies carried out in Europe on mass screening for colorectal cancer using the faecal 
occult blood test did not prove that this method was yet effective in reducing mortality 
linked to this type of cancer. A meta-analysis of the results of the screening 
programmes carried out in Odense (DK) and Nottingham (UK) was started in 1993. 
A group of experts who met in 1993 as part of the Europe against Cancer Programme 
recommended that, on the basis of the results of existing studies, mass screening for 
colorectal cancer should not be carried out. This statement is still valid. 
Action 31. Promotion of studies of European interest on the effectiveness and 
feasibility of early screening for other cancers. 
A random study of prostate cancer screening involving 200 000 people in five Member 
States (B, I, NL, P, UK) was started in 1993, following the positive results of a 
feasibility study co-funded by the Commission between 1989 and 1991. The results, 
evaluated in terms of the reduction in the number of deaths caused by prostate 
cancer, are not expected before 1998. The Commission provided co-funding in 1993 
20 
and 1994 for the coordination of this random European study on screening for prostate 
adenocarcinoma. 
Action 32. 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. 
A study was started in 1993, together with the partners in the European network of 
pilot cervical cancer screening programmes, in order to integrate the first results 
obtained under the IMPACT project (Integrating Microscopy for Pathology activities 
and Computer Technology). This project, which is funded by the Commission as part 
of the Advanced Informatics in Medicine (AIM) Programme of DG XIII, is designed to 
create a computerised infrastructure for distance consultation in order to improve the 
quality of interpretation in cytopathological, histopathologal and cytogenetic 
examinations in the laboratory. Using this technology in cervical cancer screening 
could considerably improve the quality of screening in the laboratory. Three members 
of the European network of cervical cancer screening programmes are involved in 
tests and a feasibility study on expanding the infrastructure. The support of DG XIII 
is linked to the development of the technique, the DG V support is allocated for 
integrated this technique as part of a quality assurance programme in cervical 
screening. 
In addition, the European recommendations on quality assurance in mammography 
screening were defined in close cooperation with DG XII. 
Action 33. 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. 
The European network of cancer registers was set up in 1990. A steering committee 
was established in January 1994 involving representatives of the 70 general cancer 
registers in Europe. The purpose of this register is to provide regular information on 
the cancer burden in Europe with a view to improving cancer prevention and treatment 
in the EU. 
A course on cancer registration was organised in Copenhagen in January 1994 in 
order to provide minimum common training for personnel involved in registering 
cancers and to develop common teaching materials for use in future national or 
regional courses in Europe. 
The computerised database on the incidence of cancer and cancer-related deaths in 
the European Union and the software package used to analyze and interpret it, both 
of which were developed as part of the EUROCIM project, were revised to improve 
21 
their performance. A users' manual was produced. 
A publication entitled "Facts and Figures of Cancer in the European Community", 
containing the main data available (1990) on incidence and mortality in Europe, was 
produced in conjunction with the International Cancer Research Centre on the basis 
of information collected from the registers. It is planned to update this publication 
periodically. 
Preparatory work has started on a publication scheduled for 1995 on 'The position of 
cancer in the European Union". 
A number of studies on cancer registration received financial support, in particular on 
the use of cancer registers in order to define types of cancer care in Europe and to 
identify trends in cancer-related deaths in the European Union. 
Action 34. Exchange of experience between Member States in the area of 
pain-relieving treatments, palliative and continuing care and the 
rdie of the health professions. 
A working party of European experts on palliative care met in 1991 in Stockholm and 
drafted a "Report on Palliative Cancer Care". This report contains chapters on the 
present situation in palliative care in the EC, on the standard of care and its quality 
control, and on education and training in palliative care. It concludes by 
recommendations concerning education and training, the implementation and the 
financing of palliative care. The recommendations of the report together with the 
conclusions of a European survey on this subject carried out under the Programme 
were disseminated in 1993 in the Member States. 
The following actions have been funded in the field of palliative care: 
The first European congress on Palliative Care (Paris, October 1990) 
Second Congress of the European Association of Palliative Care (Brussels, 
October 1992) 
Training programme for health professionals, A home based palliative care for 
children with cancer (University of Athens) 
European workshop to study the feasibility of an European training programme 
in palliative care (March 1993, European Association of Palliative Care) 
Training workshop in palliative care for GP's in Belgium (Brussels, scientific 
society of Brussels GP's and continuing care). 
European seminar on continuing training in palliative care, organised by the 
Danish Cancer Society. 
40 training grants to enable health professionals in the Member States to attend 
refresher courses organised by the International School of Cancer Care. 
Clinical audit to improve the quality of palliative care (Irish Cancer Society) 
Prognostic significance of quality of life measures in oncology practice 
(Germany - Tumour Centre, University of Ulm) 
H) Studies and projects related to quality assurance in the cancer treatment. 
22 
Actions 35 Evaluation of the operation of the various bone marrow banks, 
and 36 Feasibility study on cooperation between such banks and, if 
appropriate, support for existing European cooperation. 
A European databank of bone marrow donors and receivers (European Marrow Donor 
Informatics System) was set up as part of the EMDIS project with support from the 
Commission's Advanced Informatics in Medicine programme of DG XIII. The aim of 
the project was to set up a computerised infrastructure, comprising a network of bone 
marrow databanks in eleven Member States. The Commission provided funding for 
the databank's secretariat in order to make it easier to coordinate donor databanks in 
the Member States, thereby helping to improve treatment for leukaemia. 
At present 700 000 donors are registered. In 1993, 2 500 requests for donors were 
received by the network. 
Actions 37 Exchanging experience regarding the quality control of care given. 
and 38 Establishing an up-to-date list of treatments recognised as 
worthwhile by the international scientific community. 
A study designed to produce a list of existing initiatives in the quality control of care 
given was started in 1993 in the fields of radiotherapy, cytopathology, clinical oncology 
and surgical oncology. 
The first work begun in 1993 was on radiotherapy and cytopathology. The relevant 
international organisations and professional bodies (such as the EORTC and ESTRO) 
have already supplied the information needed to produce the list. Following an 
analysis of the information collected on radiotherapy, a group of experts was set up 
to prepare a European consensus meeting in 1994 on acceptable practice in 
radiotherapy. 
The Programme funded a number of training initiatives such as forty scholarships to 
the International School of Cancer Care (UK) and a European course for 80 health 
professionals in Copenhagen. In addition, funding was provided for a number of 
studies in this field, such as an innovative pilot project in France on palliative care at 
home and a study of the effect of palliative care on the quality of life of long-term 
cancer patients. 
I Cancer research 
Although cancer research is not the prior objective of the "Europe against Cancer" 
action plan, the Cancer Experts made clear statements in respect to cancer research. 
They prioritise four fields of interest: fellowships, clinical oriented research, 
epidemiological research and basic laboratory research. In order not to overlap with 
the existing research programme of the Commission, a close cooperation with the 
BIOMED 1 programme of DG XII Biomedicine and Health Research was established 
Delegates of DG XII and from the Cancer Experts Committee were invited to their 
23 
biannual meetings to indicate comparative actions. 
On the following issues a common approach was agreed: 
Comparison of existing cancer registries and recommendations for their 
minimum content and conditions of access. 
European coordination on food and cancer 
European Research on Occupational Cancer especially in the field of detection 
and prevention of occupational cancers in the coal and steel industries, the 
wood, leather, pulp and paper industries, electric power stations and biology 
research laboratories. 
Research on the prevention of radiation-induced cancers 
European registration of congenital anomalies - evaluation of the impact of the 
Chernobyl accident. 
European coordination of medical research on passive smoking 
European coordination of research on clinical treatment 
Research into genetic engineering and protein engineering techniques 
potentially useful for the development of anti-cancer drugs. 
Research on the targeting of cancer killing drugs 
Research into the human genome 
Research in informatics and telematics for cancer care 
Research on cancer in tropical areas. 
A programme of training grants & fellowships in operation since 1988 and designed 
to encourage mobility for researchers in the cancer field has been continued. The 
EORTC and the ESO undertook the coordination of these fellowships. 
Other activities related to research were two seminars held for European scientific 
journalists on "Radiotherapy as a cancer treatment". The purpose was to provide 
information to a group of journalists enabling them to give the general public a better 
insight in the biological effects of ionising radiation in general and specifically in the 
clinical application of radiotherapy for the treatment of cancer. The total absence of 
any background knowledge of most patients in relation to radiotherapy is perceived 
as a frequent cause for psychological distress as well as delays or refusals of 
treatment. To continue and build upon the results of the BIOMED 1 programme, the 
Council adopted on 15 December 1994 a decision adopting a specific programme of 
research and technological development, including demonstration, in the field of 
biomedicine and health (1994 to 1998)3 which contains an important specific research 
area dealing with cancer research. 
OJ n* L361 of 31/12/94 
24 
III. PRESENTATION OF THE "EUROPE AGAINST CANCER" PROGRAMME 
III.A. GENERAL REMARKS 
METHODS OF IMPLEMENTATION 
a) The legislative part of the programme is under the responsibility of various 
services of the European Commission (DG V, VI, XI, XII, XIII, XV, XXI), 
However, the "Europe against cancer" programme played a central role for the 
creation of European legislation against smoking. 
b) Actions of cancer prevention relying on information of the public and on 
health education in schools are implemented through a partnership strategy 
involving Ministries of Health and of Education, anti-cancer organizations, anti-
smoking organizations and, for some countries, other non governmental 
organizations such as anti-alcohol organizations. Twelve national coordinating 
committees have been set up since 1987. Most often, they are chaired by the 
representative of the country concerned in the Committee of Cancer Experts. 
These committees meet about every two months. They are consulted by the 
Commission for all subvention requests addressed to the programme. They 
also support the Commission by providing coordination of these actions. For 
example, in 1991, 294 projects were submitted for consultation to these 12 
national coordinating committees; 170 of them have been retained by the 
European Commission. 
c) Financing by the Commission of studies or actions with a scientific content 
(training and screening) is settled after consultation of the Committee of Cancer 
Experts and of its sub-committees, as well as the Advisory committee of the 
programme (composed of national senior officials). As an example, in 1991, 
246 scientific projects were submitted for consultation to the Committee of 
Cancer Experts. 107 of these were retained by the European Commission. 
d) The research aspects of the cancer programme are implemented by the 
Commission services responsible for radio-protection and medical research. As 
an example, 56 projects concerning medical research are currently being 
executed. 
25 
III.B. SOME DATES AND KEY DECISIONS 
1. EUROPEAN COUNCIL 
May 1985 (Milan) : Impetus for the launching of a European programme to fight against cancer in the 
framework of a "citizens' Europe". 
December 1986 (London) : Designation of 1989 as "European Year of Information on Cancer" 
December 1987 (Copenhagen) : Official presentation of the text of the "European Code against 
Cancer" which will serve as the basis of the European campaign of public awareness and of health 
education in schools. 
December 1989 (Strasbourg) : Renewal of support for the programme and for its second action plan 
1990-94. 
2. EUROPEAN COMMISSION 
November 1985 : Transmission to the Council and to the European Parliament of a proposal setting 
out the general principles of a European programme to fight against cancer, especially in the area of 
prevention. 
January 1986 onwards : nomination of a committee of cancer experts to the European Commission. 
The president is Professor Maurice Tubiana (France). This committee advises the European 
Commission on a scientific level. 
Setting up and stimulation of several European networks of partners of the programme : leagues and 
associations against cancer, anti-smoking organisations, television producers responsible for medical 
and scientific programmes; representatives of general practitioners' associations; senior officials 
responsible for the fight against smoking; senior officials responsible for health education. 
December 1986 : Publication of the first action plan 1987-1989 of the "Europe against Cancer" 
programme; this comprises 75 points covering the following four areas : prevention and early detection; 
information and hearth education; training of health personnel; medical research (O.J. C 50 26.2.87) 
January 1987 - December 1989 : Transmission to the Council and to the European Parliament of 
several proposals for directives in the field of prevention : fight against smoking; improvement in the 
labelling of food products; prevention of occupational cancers. At the same time, co-financing of studies 
of European interest, notably on the links between nutrition and cancer, and on the evaluation of 
screening policies for colorectal cancers; setting up of a European network of pilot projects in screening 
for breast cancer by mammography. 
January 1987 - December 1989 : Preparation of recommendations on the content of cancer training 
for doctors, nurses and dentists with the help of the Committee of Cancer Experts and the three 
consultative committees for the training of health personnel. In parallel, allocation of fellowships and 
financial support for trans frontier training actions for health personnel. 
January 1987 - May 1988 - January 1990 : Preparation of the first "European Week against Cancer 
(19 May 1988) with leagues and associations against cancer and the participating television channels. 
Many public information activities were organised, in particular the broadcast of three television 
programmes by the majority of the major television channels of the European Community : "Eurojim 
against Crab Cancer"; "Lifestyles and Cancer in Europe"; "Man and Cancer". 
26 
Preparation of the "European Year of Information on Cancer" (1989) with the principal partners of the 
programme (associations and leagues against cancer, general practitioners, television channels, senior 
officials responsible for health education). Throughout 1989 various actions of public information and 
health education in schools were carried out. On 9 January 1990, a television programme "Eurovision 
against Cancer", transmitted by ten television channels of the European Community, concluded the 
"European Year of Information on Cancer". 
January 1987 - December 1991 : Transmission to the Council and to the European Parliament of 
proposals concerning a fourth programme of medical research 1987-1991. Implementation of the 
programme adopted by the Council in November 1987 : allocation of fellowships to researchers working 
in a laboratory of a Community country other than their own; support to the coordination of clinical 
research in Europe; co-financing of research projects in drug targeting; stimulation of European 
research on improved radiotherapy (projects on treatment by light ions EULIMA and by boron neutron 
capture therapy BNCT). 
June 1989 : Transmission to the Council and to the European Parliament of a proposal concerning a 
second action plan 1990-94 of the "Europe against Cancer" programme. The budget recommended by 
the Commission amounts to 55 million ecu's, an average of 11 million ecu per year, to finance actions 
of European interest in the following areas : prevention and screening; training; public information; 
health education. 
November 1989 : Commission recommendation of 8 November 1989 concerning the training of health 
personnel in the matter of cancer. 
November 1990 : Transmission to the Council and to the European Pariiament of a modified proposal 
for a directive concerning the labelling of tobacco products that extends to all tobacco products the 
labelling rules already applicable for cigarettes. 
May 1991 : Transmission to the Council and to the European Parliament of a proposal for a directive 
concerning advertising for tobacco products. 
May 1992 : Commission amended proposal for a Council Directive on the approximation of Member 
States laws, regulations and administrative provisions on advertising for tobacco products. A total ban 
of advertising is proposed. 
3. EUROPEAN PARLIAMENT 
January 1987 - December 1989 : Adoption of the budget of the "Europe against Cancer" programme. 
The European Parliament, in addition, used its margin of manoeuvre to increase the proposed budget 
(excluding research) from 4 million ecu's to 8,3 million ecu's. 
(N.B. the 1987 budget excluding research was 1 million ecu, that of 1989 was 8,5 million ecu's, 1990 
was 9 million ecu's. The budget for "medical research on cancer" is 18 million ecu's for the period 1987-
1991). 
Adoption of opinions on the proposals for directives prepared in the framework of the "Europe against 
Cancer" programme. These opinions were, in general, in agreement with the proposals submitted to 
the Parliament with only three noteworthy exceptions : 
October 1988 : The European Parliament rejected the text adopted by a qualified majority, on 
the first reading (common position), by the Council of Ministers (Social Affairs), in June 1987, 
on the protection of workers from benzene, a chemical agent responsible for cancers of the 
bone marrow. The Parliament justified this rejection by stating that the Council's text did not 
27 
sufficiently guarantee the safety of workers. The rejection ruled out the proposed directive as 
unanimity of the Council was therefore required on the second reading and Italy, for the same 
reasons as the Parliament, opposed its adoption. 
May 1989 : the European Pariiament gave its opinion on the proposal of the Commission 
concerning the maximum tar yield of cigarettes (15 mg in 1992; 12 mg in 1995). The 
Parliament voted an amendment asking for a less strict timetable than that foreseen by the 
Commission, recommending a single limit of 20 mg to be reached by 1992. The Commission 
did not accept this amendment. It transmitted to the Council a modified proposal which 
maintained the original calendar. 
February 1992 : The European Parliament, in its opinion on the proposal of partial restnction 
of advertising for tobacco products, called for a total ban. 
December 1993 : European Parliament Resolution of 13 December 1993 asking for the 
activities against cancer to be intensified 
4. COUNCIL 
May 1986 : Adoption by the Council (Ministers of Health) of a resolution on the "Europe against 
Cancer programme, based principally on prevention (O.J. C 184 23.07.86). 
November 1987 : Adoption by the Council (Ministers responsible for research) of the fourth programme 
1987-1991 for the coordination of medical research. The cancer research chapter was granted 18 
million ecu's for five years (O.J. L 334 24.11.87). 
May 1988 : Adoption by the Council (Ministers of Health) of a decision concerning the projects to be 
implemented during the "European Year of Information on Cancer" in the area of public information and 
hearth education in schools (O.J. L 160 28.06.88). 
June 1988 : Adoption by the Council (Ministers responsible for Social Affairs) of the directive 
concerning the protection of workers through the banning of four series of substances responsible for 
cancers of the bladder (2-naphtylamine, 4-aminobiphenyl; benzidine; 4 nitrodiphenyl) (O.J. L 179 
09.07.88). 
November 1988 : Resolution of the Council and the Ministers of Education meeting with the Council, 
of 23 November 1988 concerning health education in schools (OJ C3 5.1.1989, p.1). 
May 1989 : Adoption by the Council (Ministers of Health) of a resolution concerning the banning of 
smoking in public places (O.J. C 189 26.07.89). 
Adoption by the Council (Ministers of Health), on the first reading, by a qualified majority, of the 
proposal for a directive concerning the labelling of tobacco products. This imposed, at the latest by the 
31 December 1991, the placing of: 
a general warning "Seriously damages your health" on all tobacco products; 
specific warnings to be printed, in rotation, on cigarette packets : "Smoking causes cancer1:, 
Smoking causes cardio-vascular diseases", etc. 
September 1989 : Final adoption by the Council (Ministers responsible for internal market affairs) of 
the directive concerning television broadcasting. This directive imposed, at the latest by the 03.10.1991, 
the ban of all forms of advertising on television, direct or indirect, for the promotion of tobacco products. 
In addition, it seriously limited the advertising of alcoholic drinks (OJ. L 298 of 17.10.89). 
28 
November 1989 : Final adoption by the Council (Ministers of Health) of the directive concerning the 
labelling of tobacco products (O.J. L 359 of 08.12.89). 
Adoption on the first reading, by unanimous vote, of the proposal for a directive concerning the 
maximum tar yield of cigarettes (15 mg by 31.12.92; 12 mg by 31.12.97; Greece has been granted a 
temporary derogation). 
Adoption in principal, pending the opinion of the European Parliament, of the second action plan 1990-
94. The budget allocated excluding research is 50 million ecu's, with a possibility of an increase to 55 
million ecu's. 
November 1989 : Adoption by the Council (Ministers of Social Affairs), on the first reading, by 
unanimous vote, of the proposal for a directive concerning the ban on carcinogenic agents (57 
substances and 4 processes) in the workplace. 
December 1989 : Adoption by the Council (Ministers responsible for internal market affairs), on the first 
reading, by qualified majority, of the proposal for a directive concerning the labelling of food products. 
May 1990 : Final adoption by the Council (Ministers of Health) of the directive concerning the maximum 
tar yield of cigarettes (O.J. L 137 of 30.5.90). 
Adoption of the second action plan 1990-94 (O.J. L 137 of 30.5.90). The allocated budget - research 
excluded - is of 50 million ecu's, with a possible increase to 55 million ecu's. 
December 1990 : The Council (Ministers of Health) could not agree on the proposal for directive 
concerning the partial limitation of advertising of tobacco by mean of press and posters. The 
Commission withdrew its proposal and announced a modified proposal aiming at a total ban of any 
advertising. 
November 1991 : The Council (Ministers of Health) adopted at first reading the modified proposal for 
a directive concerning the labelling of tobacco products; specific warnings will have to figure on the 
packages of all tobacco products. 
(N.B. : labelling of tobacco products was already covered by directives 89/622/EEC). Moreover, 
commercialization of smokeless tobacco was to be banned in the Community from January 1992. 
November 1992 : Conclusions of the Council and the Ministers for Health of the Member States 
meeting within the Council of 13 November 1992, concerning health education and Conclusions of the 
Council and the Ministers for Education of the Member States meeting within the Council on 27 
November 1992 concerning health education at schools. OJ C326 of 11.12.92, p.2) 
May 1993 : resolution of the Council and the Ministers for Health, meeting with the Council of 27 May 
1993 on future actions in the field of public health. (OJ C.174 of 25.6.93, p.1) 
December 1993 : Council resolution of 13 December 1993 concerning future guidelines for the "Europe 
against Cancer" programme following evaluation of it for the period 1987 to 1992. (OJ C15 of 18.1.94, 
p.1) 
29 
IV. MANAGEMENT STRUCTURE OF THE PROGRAMME 
1. COMMISSIONERS RESPONSIBLE 
February 1986 : The European Commission placed the fight against cancer under the 
sole responsibility of Mr. Manuel Marin, Vice-president responsible for "Employment, 
industrial relations and social affairs". Other Commissioners concerned : "Research", 
"Environment and consumers' protection", "Internal market and taxation", "Information 
and Citizens Europe". 
January 1989 : Mrs Vasso Papandreou succeeded Mr Marin. 
January 1993 : Mr Flynn succeeded Mrs Vasso Papandreo. 
2. COMMISSION SERVICES 
February - December 1986 : Constitution of an interservice task force in order to 
create an action plan 1987-89. Chaired by Mr Michel Richonnier, Member of the 
Cabinet of Mr Manuel Marin, this task force was composed of Messrs Berlin (DG V-
Lux), Quatraro (DG Agriculture), Castille (Consumers service), Lefevre (DG Taxation) 
and Dewaleyne (OSCE) for the fight against smoking, of Messrs. Mathioudakis (DG 
Internal market), Di Carpegna and Floyd (DG Agriculture), Collin (Consumers service) 
for nutrition, of Messrs. Mosselmans (DG Internal market), Hunter and Mrs Van Der 
Venne (DG V-Lux) and of Mr Krisor (DG Environment) for the fight against 
carcinogenic agents, of Mr Eriskat (DG Environment) for radioprotection, of Mr. Larvor 
and Mrs Thévenin (DG Research) for cancer research, of Messrs. Simon and Malivoir 
(DG Information) for public awareness, of Mr Guth (Consumers service) for health 
education, of Mr Allman (DG Internal market) for training of health personnel and of 
Mr Van Der Steen (DG Finance). The report of the group was written by Mr Michel 
Richonnier under the supervision of Professor Tubiana and of the Committee of 
Cancer Experts. 
January 1987 : Creation of an administrative team "Europe against cancer", under the 
responsibility of Mr Michel Richonnier and attached to Vice-president Marin, until 1 
December 1987. Its mission was to implement the programme in cooperation with all 
the associated services of the Commission. 
December 1987 : The "Europe against Cancer" group was attached to Mr Jean 
Degimbe, Director General of DG V "Employment, industrial relations and social 
affairs". 
April 1990 : Creation of a "Tobacco and nutrition" team, under the responsibility of Mr 
Stelios Christopoulos, within the "Europe against cancer" group. 
September 1990 : Mr Régis Malbois took the responsibility ad interim of the 
programme. 
30 
November 1990 : The programme operated under the authority of Mr Steffen Smidt, 
Deputy Director General of DG V. 
July 1993 : The Commission decided on the establishment of a sector entitled 
"Europe against Cancer" within the Public Health Unit. 
May 1994 : Appointment of the Head of Sector "Europe against Cancer" programme 
and of various new officials and transfer to Luxembourg. 
October 1994 : Integration of the "Europe against Cancer" sector into Unit DG V F.2, 
"Implementation of disease - specific programmes and actions" 
3. COMMITTEES AND OTHER GROUPS 
A. Advisory Committee 
In the framework of the decision for a second action plan an Advisory 
Committee was established. It is composed of representatives of the Ministries 
of Health and Education of the Member States. The secretariat and the 
chairman are provided by the Commission services. The tasks of the advisory 
committee are: 
to examine projects and measures involving co-financing by public funds; 
to coordinate at national level projects partly financed by non-governmental 
organizations (Art. 1, 2 and 3 of the Decision of the Council and the 
representatives of the governments of the Member States meeting within the 
Council on 17 May 1990 adopting a 1990 to 1994 action plan in the context of 
the "Europe against cancer" programme - O.J. L 137, 30.5.90, p. 31). 
B. Cancer Experts Committee 
Set up at the initiative of the Council of the European Community (Conclusion 
of the Council of Ministers of Foreign Affairs of 16 December 1985 concerning 
the action against cancer), this consultative committee is composed of 
representatives from each Member State. Its first meeting was held in Brussels, 
in January 1986. During this meeting, the Committee elected Professor Tubiana 
as its Chairman. He was re-elected unanimously in November 1988. The 
secretariat is provided by the Commission. 
The Committee advises the Commission on all the scientific aspects of the 
Programme. More particularly, it formulates opinions on the scientific proposals 
requesting financing from the programme (training, prevention, screening) and 
provides guidelines on future actions and priorities related to scientific aspects 
of cancer prevention. The Committee normally meets twice a year. The place 
of the meeting is in the capital of the country having the presidency of the 
Council. 
31 
At its meeting in Athens of 18-19 April 1994, Professor Tubiana resigned as 
Chairman for the Cancer Experts Committee. Professor Veronesi was elected 
as its new chairman. The composition of the Cancer Experts Committee at the 
end of the second action plan was as follows: 
Members of the Committee: Prof. U. Veronesi (Chairman), Prof. N. Bleehen, 
Prof. T. Boon, Prof. J. Conde, Prof. V. Diehl, Prof. J. Einhorn, Prof. I. Garas, 
Dr J. Gonzalez Enriquez, Prof. R. Kroes, Dr J. Buttimer, Prof. J. Overgaard, 
Prof. H. Pujol, , Prof. M. Dicato, Prof. J. Estape, Prof. E. Van der Schueren. 
During the second action plan 19 scientific reports and 22 recommendations, 
resolutions or statements on cancer related issues received approval of the 
Cancer Experts Committee and have been diffused by the programme. (See 
annex) 
C. National Coordination Committees 
They are created at the initiative of the "Europe against Cancer" programme. 
Their mission in the framework of the second action plan is to examine and 
coordinate all the training and health education actions proposed for 
implementation in the framework of the "Europe against cancer" programme in 
the Member States. These national committees are generally chaired by the 
cancer expert representing that country in the Committee of Cancer Experts. 
They are composed of representatives of the Ministries of Health and of 
Education, and of non-governmental organizations acting in the fight against 
cancer (eg anti-cancer and anti-tobacco organizations). These committees give 
opinions on the proposals submitted to the European Commission by that 
country in the fields such as information, health education, or the fight against 
tobacco. They establish priorities and coordinate actions supported by the 
European Commission. 
32 
V. RELATIONS WITH NON-GOVERNMENTAL ORGANISATIONS 
1. National Non-Governmental Organisations 
The National Non-Governmental Organisations made a major contribution to the 
"Europe against Cancer" programme. In this respect it is important to 
distinguish three major groups: the group of associations and leagues against 
cancer, the anti-tobacco organisations and the representatives of general 
practitioners associations. 
The role of the group of associations and leagues against cancer was most 
prominent by diffusing and promoting the European Code against Cancer and 
the implementation of the objectives of the "Europe against Cancer" programme 
in their country. The results of the interaction between the Cancer Leagues and 
the Commission has resulted for example in the successful European Weeks 
against Cancer. 
The Anti-tobacco organisations have been very active in diffusing the first point 
of the Code related to tobacco, as well as general anti-tobacco strategies. 
2. International Non-Governmental Organisations 
The cooperation with the International Non-Governmental Organisations has 
been of great importance. In this respect, four major organisations should be 
mentioned: The World Health Organisation (WHO), the European Organisation 
on Research and Treatment of Cancer (EORTC), the European School of 
Oncology (ESO) and the International Union Against Cancer (UICC) 
Cooperation with the World Health Organisation (WHO) 
Cooperation with the Europe Against Cancer programme and the World Health 
Organisation (WHO) has been continuous since the beginning of the Programme on 
the basis of exchange of information and provision of expertise. 
In the first Plan of Action 1987-1989, WHO was fully represented as an observer in 
the Cancer Experts Committee. 
Cooperation was confirmed in the second Plan of Action 1990-1994 Art. 1(4) (OJ. 
N°L137 of 30.05.90). Main areas of cooperation were as follows: 
1. Cancer Experts Committee : 
WHO-European region (Dr.L.Döbrössy) and the International Agency on Cancer 
Research (Prof. L. Tomatis) were present as observers in the Cancer Experts 
Committee. 
The Programme participates in the Consultation meetings on Common European 
Policy on Cancer organized by WHO-European region. 
33 
2. Prevention : 
2.1. Tobacco 
Close collaboration in the area of tobacco consumption prevention has been sought 
since 1988. Outstanding examples of cooperation include the following: 
The First European conference on tobacco prevention policies (Madrid, 1988) was 
jointly organised by the Programme and WHO in November 1988. The Programme 
and WHO collaborated in the preparation of the 9th World conference on tobacco and 
health which took place in Paris in 1994. 
The Programme participated in the meetings organised by WHO in Copenhagen 
(1990) and in Budapest (1992). Similarly WHO is invited to attend the meetings of the 
group of Tobacco Prevention Associations representatives in the framework of the 
Programme. 
Furthermore the Programme supported activities developed by its partners at national 
level in the context of WHO World No-Tobacco Day (31 May). 
2.2. Nutrition 
Activities on nutrition and cancer carried out under the responsibility of the 
International Agency on Cancer Research (IARC) are being supported by the 
Programme: 
Coordination of the prospective study on nutrition, health and cancer (EPIC) since 
1988(E.Riboli) 
An International Congress on nutrition and cancer held in Lyon (F) in March 1993. 
The Programme was represented at the meetings organised on nutrition by WHO in 
Budapest (October 1990). It took part in the International Conference on Nutrition in 
Geneva in August 1992. 
2.3. Carcinogenic agents: 
Several epidemiological studies such as the SASCO survey on assessment of risks 
in laboratories are carried out by the IARC with the support of the Programme. 
2.4. Cancer registries 
The IARC coordinates the European network of cancer registries. 
3. Training 
The Programme participated in the meeting on Undergraduate Medical Training in 
Oncology in Europe organised by WHO-European region on 28-29 April 1992 in 
Prague which was essentially based on the European training recommendations 
resulting from the European Conferences supported by the Programme in 1988 (Bonn) 
and 1991 (Copenhagen) on medical training in Oncology. 
4. Health Education 
WHO-European region is invited to participate to the meetings of the Health Education 
sub-committee and its working groups on Health Education in schools organised by 
the Programme. 
The Programme is represented in the meetings of the European Network of Health 
34 
Promoting Schools (WHO-Euro/CEC/Council of Europe). 
The Programme and WHO-European region collaborated in the organisation of 
Summer Schools on Nutrition Education in Fiensburg (August, 1991) and on the 
Health Promoting School in Montpelier (September, 1991). 
5. Treatment 
Exchange of information on Palliative Care is facilitated between WHO and the 
Programme owing to the participation of Prof. R.Twycross, standing director of the 
WHO Collaborating Center on Palliative Care, in the ad hoc working group on 
palliative care meeting in the framework of the Programme. 
Cooperation with the (EORTC) European Organisation on Research and 
Treatment of Cancer 
The EORTC is the leading organisation in Europe concerned with Research and 
Treatment of cancer. Amongst the areas of activity into which EORTC has put more 
effort are promoting education in cancer treatment, the development of EUROCODE -
a computer network including patients in trials and for disseminating information on 
cancer treatment, the quality control of treatment, a study of the economic aspects oi 
cancer treatment and addressing the quality of life of cancer patients. In all of these 
areas the "Europe against Cancer" programme has supported well conceived projects. 
The Data Centre has played an important educational role, hosting an international 
symposium on biostatistics and participating in courses of the European School of 
Oncology (ESO) dealing with both the data management and the methodological 
aspects of Cancer clinical trials. These projects received support from the "Europe 
against Cancer" programme. 
EUROCODE - Structural contacts with national Cancer research organizations are 
rapidly developing with the organization of formal coordination meetings and with the 
imminent installation of new Eurocode nodes in Italy, Greece and Spain. Computer 
software is being developed to allow decentralized patient registration and 
randomization in each country, thus facilitating the entry of patients in clinical trials. 
The Quality Control programme activities have been aimed at improving structure as 
well as at the assessment of treatment processes itself. 
A large programme for evaluation of accuracy of data collection and transfer was 
concluded, in which over 30 European centres were site-visited. 
The programme of quality control of treatment processes further expanded the existing 
radiotherapy programme to measurements on individual patients. In the field of 
chemotherapy a procedure for the evaluation of the structure and environment 
necessary for cytotoxic treatment was developed and tested. 
35 
Cooperation with the European School of Oncology 
The European School of Oncology was founded in 1982 by Prof. Veronesi with the 
aim of providing health professionals with opportunities of continuing and updating 
their medical training in cancer care. They work in close cooperation with the EORTC. 
The "Europe against Cancer" programme made available resources (fellowships) for 
physicians to attend those courses. In the second action plan, over 100.000 ECU have 
been given for those fellowships. 
Cooperation with the International Union Against Cancer (UICC) 
The International Union Against Cancer is devoted exclusively to all aspects of the 
world-wide fight against cancer. Its objectives are to advance scientific and medical 
knowledge in research, diagnosis, treatment and prevention of cancer throughout the 
world. Particular emphasis is placed on professional and public education. 
In 1993 the "Europe against Cancer" programme supported Globalink to establish and 
link a series of European regional networks and to connect the partners of the "Europe 
against Cancer" programme to this network. Globalink is the international computer 
network of the UICC and provides users with powerful means of communication, news 
bulletins and several databases. 
36 
VI. FIELDS OF ACTIONS OF THE SECOND PLAN OF ACTION, (ref. O.J. L137 of 
30.5.90): 
Field of action 1 
Field of action 2. 
Field of action 3. 
Field of action 4. 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. 
Stimulation of pilot projects to teach methods of breaking nicotine 
addiction to members of the health professions and to teachers. 
Stimulation of innovative information campaigns to prevent the 
use of tobacco among the general public and at the workplace. 
Financing of studies on the possibilities for putting tobacco-
growing areas to other uses. 
Field of action 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). 
Field of action 6. Drafting and publication of guidelines on nutrition aimed at 
improving cancer prevention. 
Field of action 7 
Field of action 8 
Field of action 9. Continuation of Community action concerning protection against 
ionising radiation. 
Support for comparative studies of European interest aimed at 
improving protection against ultra-violet radiation. 
Support for European studies on the possible carcinogenic risks 
of certain chemicals. 
Field of action 10. Continuation of the classification and labelling of dangerous 
substances. 
Field of action 11. Possible updating of the European Code against Cancer 
Field of action 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. 
Field of action 13. Production of European information modules on the prevention, 
screening and treatment of cancers, adaptable to national 
requirements. 
37 
Field of action 14. Publicizing of the European Code among the general public by 
the partners in the action plan. 
Field of action 15. Support for innovative information campaigns on cancer 
prevention among targeted groups. 
Field of action 16. Informing workers, and migrant workers in particular, under 
existing Community Directives, of the fight against job-related 
cancers. 
Field of action 17. Support for efforts to inform and increase the awareness of 
school teachers of the European Code against Cancer. 
Field of action 18. Dissemination of European teaching material for health education 
Field of action 19. Promotion of pilot projects to promote awareness of the European 
Code among young people. 
Field of action 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 mealtime. 
Field of action 21. Support for the organization of national or regional meetings to 
promote the 1989 European recommendations on the oncology 
content of basic training programmes for members of the health 
professions. 
Field of action 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. 
Field of action 23. Promotion of oncology training projects. 
Field of action 24. Support for the mobility of the health professions between 
Member States in order to improve their specialized training in 
oncology. 
Field of action 25. Collection and exchange of teaching material of European interest 
for the training of members of the health professions. 
Field of action 26. Exchange of experience and support for the organization of 
European seminars on the continuing education of members of 
the health professions. 
Field of action 27. Continuation of comparative studies to improve the organization 
38 
of cancer screening programmes. 
Field of action 28. Extension of monitoring of the European network of breast cancer 
screening pilot programmes to help the Member States determine 
a general screening policy. 
Field of action 29. Evaluation of existing cervical cancer screening programmes and 
setting up of a European network of regional or local pilot 
programmes. 
Field of action 30. Continuation of evaluation studies on screening programmes for 
colorectal cancer and possible setting up of a European network. 
Field of action 31. Promotion of studies of European interest on the effectiveness 
and feasibility of early screening for other cancers. 
Field of action 32. 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. 
Field of action 33. 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. 
Field of action 34. Exchange of experience between Member States in the area of 
pain-relieving treatments, palliative and continuing care and the 
role of the health professions. 
Field of action 35. Evaluation of the operation of the various bone marrow banks. 
Field of action 36. Feasibility study on cooperation between such banks and, if 
appropriate, support for existing European cooperation. 
Field of action 37. Exchange of experience in quality control of treatment and care. 
Field of action 38. Establishing an up-to-date list of treatments recognized as 
worthwhile by the international scientific community. 
39 
VII. ANNEX 
APPROVED SCIENTIFIC REPORTS BY THE CANCER EXPERTS COMMITTEE: 
1990: 
Cancer in the European Community and its Member States: European Journal 
of Cancer Volume 26 (1990) number 11/12 
Breast Cancer: Textbook for General Practitioners, European Commission 
Series for General Practitioners. 
Lung Cancer: Textbook for General Practitioners, European Commission Series 
for General Practitioners. 
1991: 
European Strategy for Cancer Research 
European Community Strategy towards improved Cancer Treatment Outcome 
by Improvement of Radiotherapy 
1992: 
Palliative Cancer Care (DOC8) 
Paediatric Oncology (DOC9REV) 
European Guidelines for Quality Assurance in Mammography Screening. Office 
for Official Publications of the European Communities EUR 14821 
Colon Cancer: Textbook for General Practitioners, European Commission 
Series for General Practitioners. 
1993: 
Cancer Treatment in the Elderly (DOCCOP14) 
Management of non palpable lesions of the breast (ESO advisory report. 
Publication in The European Journal of Cancer) 
European Guidelines for Quality Assurance in Cervical Cancer Screening. Vol 
29A Suppl 4 The European Journal of Cancer 
Facts and Figures of Cancer in the European Community, IARC Lyon France 
ISBN 92 832 1427 7 
Palliative care, report of the subcommittee (DOCBRU20) 
1994: 
Evaluation report on the EPIC project (DocCan 5/94) 
Revised text European Code Against Cancer (DocCan 6/94) 
Report on cost-effectiveness in cancer treatment (DocCan 7/94) 
Report on Oral Carcinogenesis in Europe (DocCan 8/94) 
Report on Quality Assurance in Radiotherapy (DocCan 9/94) 
<f£ 
RECOMMENDATIONS, RESOLUTIONS AND STATEMENTS BY THE CANCER 
EXPERTS COMMITTEE: 
Dublin: 2-3 April 1990: 
Rome: 29-30 October 1990: 
Guidelines on quality assurance programmes for breast cancer screening 
Evaluation and funding procedures for IARC coordinated prospective study on 
diet and cancer. 
Declaration on the fight against tobacco 
Luxembourg: 8-9 April 1991: 
Resolution on tobacco advertising. 
Statement on the confidentiality of patient data 
Bilthoven (NL) 4-5 November 1991: 
Lisbon: 6-7 April 1992: 
Updated recommendations on breast cancer screening (Doc CC15-04b) 
Recommendations on cervix uteri cancer screening 
Recommendations on colorectal cancer screening 
Statement on tobacco related diseases 
London: 22-23 October 1992: 
Statement on future activities within the "Europe against Cancer" programme. 
(DOC4quarter) 
Memorandum on the European Action Against Cancer. (DOC4TER) 
Opinion on the draft communication of the Commission concerning the 
evaluation report of "Europe against Cancer" (DOCIObis) 
Copenhagen: 1-2 April 1993: 
Statement concerning the amended proposal for a Council Directive on the 
protection of individuals (COM(92) 422 final - SYN 287) (DOCCOP15/1). 
Statement on the future of the "Europe against Cancer" Programme 
(DOCCOP15/2) 
Statement on the prevention and reduction of tobacco consumption 
(DOCCOP15/3) 
Statement on health education in schools (DOCCOP15/5). 
Brussels: 21-22 October 1993: 
Resolution on the amended proposal for a Council Directive on the protection 
of individuals (COM(92) 422 final - SYN 287) (DOCBRU15/1). 
Opinion on the establishment of an Advisory Committee on Health Protection 
(DOCBRU15/2) 
Statement on Cancer Research (DOCBRU15/3) 
Athens: 18-19 April 1994: 
Advisory report on continuing medical education in Europe (DOCATH 10) 
Resolution concerning the proposed decision for a third action plan (DOCATH 
14) 
Bonn: 28-29 November 1994: 
Resolution regarding the orientations and priorities for the future third action 
plan against cancer 1995-1999 
41 
ISSN 1024-4506 
KOM(95) 356 slutlig 
DOKUMENT 
w 
SV 05 
Katalognummer : CB-CO-95-382-SV-C 
ISBN 92-77-91849-7 
Byrån för Europeiska gemenskapernas officiella publikationer 
L-2985 Luxemburg