REPORT FROM THE COMMISSION TO THE COUNCIL, THE EUROPEAN PARLIAMENT, THE ECONOMIC AND SOCIAL COMMITTEE AND THE COMMITTEE OF THE REGIONS ON THE EVALUATION OF THE EUROPEAN CANCER WEEK 1995
Date: 1997-02-10
Institutions: European Commission
Subjects: action programme, activity report, cancer, disease prevention, public awareness campaign

#**4p«Wtti 

COMMISSION  OF THE EUROPEAN  COMMUNITIES 

VOLUME  I 

Brussels,  10.02.1997 
COM(97)  19 final 

REPORT  FROM  THE COMMISSION 

TO THE COUNCIL,  THE EUROPEAN  PARLIAMENT, 
THE  ECONOMIC  AND SOCIAL  COMMITTEE 
AND  THE COMMITTEE  OF THE REGIONS 

ON THE EVALUATION OF 
THE EUROPEAN CANCER WEEK 1995 

CONTENTS 

0. 

1. 

SUMMARY 

PRESENTATION  OF EUROPEAN CANCER WEEK  1995 

1.1 
1.2 
1.3 
1.4 
1.5 

1.6 

Legal basis 
Previous Weeks 
Importance of information  campaigns 
European Code against Cancer 
General organisational principles 
1.5.1  Partnership with non-governmental  organisations 
1.5.2  European  character,  Community  added  value  and 

subsidiarity 

1.5.3  Professionalism 
Specific features  of the  1995 Week 
1.6.1  Campaign aims 
1.6.2  Campaign tone 
1.6.3  Target groups 
1.6.4  Types of material 
1.6.5  Activity levels 

II. 

QUANTITATIVE  ANALYSIS 

II. 1  Campaign aimed at general public 
II. 1.1  Posters and leaflets 
II. 1.2  Media relations 
II. 1.3  Advertising 
II. 1.4  Conclusions..... 

II.2 

Campaign targeted  on general practitioners 
11.2.1  Brochure design, publication  and dissemination 
11.2.2  Advertising 

III. 

QUALITATIVE  ANALYSIS 

III. 1  Campaign aimed at general public 

III. 1.1  Evaluation methodology 
III. 1.2  Results at European  level 
III. 1.3  Results per country 
III. 1.4  Conclusions 

III.2  Campaign aimed at general practitioners 
111.2.1  Evaluation  methodology 
111.2.2  Reaction to and views on the brochure 
111.2.3  Knowledge of and views on the Code 

4 

5 

5 
5 
6 
7 
7 
7 

8 
9 
10 
10 
10 
11 
11 
12 

12 

12 
12 
13 
14 
14 

15 
15 
16 

16 

17 
17 
18 
19 
20 

21 
21 
21 
22 

111.2.4 Reaction to and views on other materials used in the 

campaign 

111.2.5  Conclusions 

IV. 

FOLLOW-UP ACTIVITIES 

V. 

BUDGET 

22 
23 

23 

25 

0. 

SUMMARY 

Every  year  the  "Europe  against  Cancer"  Programme  holds  a  European  Cancer 
Week  in  the  second  week  of  October  with  the  support  of  Member  States'  anti 
cancer  Leagues  and  Associations.  In  1995  this  information  campaign  focused  on 
promoting the revised  version of the European  Code against  Cancer  consisting  of 
10 simple recommendations for cancer prevention. 

The aim  of the Europe-wide  campaign was to  get  the vital  message  across  to  the 
general  public  that  everyone  can  reduce  their  own  personal  risk  of  contracting 
cancer,  to  encourage  people  to  adopt  a  more  balanced  lifestyle  and  to  draw 
attention  to  the  benefits  of  early  detection.  To  achieve  these  aims  the  general 
public  was  approached  not  only  directly  but  also  indirectly  -  through  targeting 
general practitioners as intermediaries with a major  role to play in this respect. 

The  abovementioned  Leagues  and  Associations  printed  6.7  million  copies  of 
common  European  materials  (posters  and  leaflets)  made  available  by  the 
Commission  in  connection  with  the  Week.  Furthermore,  a  media  campaign 
coordinated  under  the Programme  generated  172 million  contacts  with  European 
citizens (112 million via press articles and at least 60 million via television  or radio 
programmes),  to which  can be added  some  172 million  contacts  achieved  via  free 
advertising  in  the  European  press  (37  million  contacts)  and  on  television  (135 
million contacts). 

The media pressure thus created, underpinned  by a whole host  of events  organised 
by the Leagues  during the Week,  had a major  impact  on European  Union  citizens' 
knowledge of cancer prevention.  Thus, by the end of the campaign  over 20 million 
more Europeans  were convinced  that  cancer  is preventable,  while the various  risk 
factors  (lack  of  fruit,  vegetables  and  cereals  in  diet,  fatty  foods,  excessive 
consumption  of  alcohol,  lack  of  physical  exercise,  smoking)  were  better  known 
after the  campaign. 

European  Cancer  Week  1995  also  helped  reinforce  the  profile  of  Community 
action  in  the  public  health  field:  24%  of  Europeans  said  they  had  heard  of 
European  Cancer  Week,  while  12%  (spontaneously)  and  24%  (with  prompting) 
said they knew of the European  Code against  Cancer. 

During  the Week  almost  all the Union's general  practitioners  (321 000)  received  a 
brochure  on  the European  Code  against  Cancer  published  under  the  Programme. 
A  telephone  survey  of  GPs  showed  that  this  publication  was  viewed  very 
favourably  (87.6% of doctors who recalled  receiving the brochure  said it was well 
done,  while  77.5% found  it very useful  or moderately useful).  Therefore,  GPs  can 
now be  expected  to incorporate the cancer  prevention  recommendations  into  their 
medical practice on a wider basis. 

I. 

1 

2 

3 

PRESENTATION  OF EUROPEAN  CANCER WEEK  1995 

This  report  provides  facts  and  figures  for  evaluating  (quantitatively  and 
qualitatively) the European  dimension of European  Cancer Week  1995 in line with 
the  duty  of  transparency  incumbent  upon  the  Commission  in  the  exercise  of  its 
powers. 

1.1 

Legal  basis 

As  a  key  element  in  the  activities  undertaken  as  part  of  the  "Europe  against 
Cancer"  Programme  in  the  public  information  and  health  education  field, 
organisation  of  a  European  Cancer  Week  is  one  of  the  measures  set  out  in  the 
Annex  to  the  Council  Decision  adopting  a  1990  to  1994  action  plan1  ("second 
action plan")  as well  as  in the Annex  to  the  decision  of the  European  Parliament 
and  of  the  Council  adopting  an  action  plan  to  combat  cancer  for  1996  to  20002 
("third action plan "). 

Due  to  considerable  delays  in  the  adoption  procedure,  the  decision  of  the 
European  Parliament  and  of  the  Council  adopting  the  third  action  plan  did  not 
materialise  until  29 March  1996, which  meant  that  the  Programme  had  no  action 
plan in  1995. The legal basis for organising European  Cancer Week (as well as  for 
the  other  activities  undertaken  under  the  Programme  in  1995)  was  therefore 
contained  in the  remarks  on budget  line B3-43043,  namely  that  the  appropriation 
for  the  Programme  is  intended  to  cover  "expenditure  on  public 
information 
campaigns  and  on  increasing  awareness".  It  is  worth  noting  here  that 
organisation  of European  Cancer Weeks was at no time called into question  during 
the procedure to adopt the third action plan. 

1.2 

Previous  Weeks 

4 

European  Cancer  Week  is held  every  year  in the  second  week  of  October.  Since 
the second  action plan started the Week has centred  on the following topics: 

1990 : Tobacco  and alcohol 
1991 : Early detection  and systematic screening 
1992 : Cancer prevention  at work 
1993  : Passive  smoking 
1994 : Beneficial  effects  of fresh vegetables and fruit. 

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  (OJ L  137, 30.5.1990, p.  31). 
Decision  No  646/96/EC  of  the  European  Parliament  and  of  the  Council  of  29 March  1996 
adopting  an  action  plan  to combat  cancer  within  the framework  for  action  in the field  of  public 
health  (1996  to 2000)  (OJ L 95,  16.4.1996, p.  9). 
General  Budget  of the European  Union, OJ L 369,  31.12.1994/ 

5 

Further  information  on  these  campaigns  can  be  found  in  the  report  from  the 
Commission  on  the  evaluation  of  the  action  undertaken  under  the  Programme 
between  1987  and  19924, in the report  from  the  Commission  on the  execution  of 
the  Programme  in  19935  as  well  as  in  the  report  from  the  Commission  on  the 
implementation of the second action plan6. 

1.3 

Importance of information  campaigns 

It  is  generally  accepted  that  some  70%  of  deaths  linked  to  cancer  stem  from 
personal  choices governing  lifestyle  and  environment.  Consequently,  regardless  of 
medical advances there will be no major  reduction  in the incidence  of cancers  and 
mortality  linked  to  this  disease  unless  the  public  can  be  persuaded  to  modify 
certain  habits  and  attitudes.  Therefore,  people need  information  to  allow  them  to 
choose  a  lifestyle  providing  maximum  protection  against  the  risk  of  contracting 
certain cancers, although such risks can never be totally banished. 

For this reason, providing the public with information  plays an important role both 
in  the  second  and  in  the  third  action  plans  under  the  "Europe  against  Cancer" 
Programme.  In  addition  to  annual  organisation  of  European  Cancer  Week,  the 
third action plan also focuses  on: 

- 
- 

- 

- 

getting the cancer prevention message across more  effectively; 
supporting networks involved in exchanging information  and experience on 
cancer  prevention; 
promoting  information  and  awareness  campaigns  targeted  on  specific 
groups; 
promoting  Europe-wide  cancer  prevention  projects,  especially 
concerning  smoking. 

those 

A Eurobarometer survey undertaken in the  15 Member  States in spring  1995 - see 
section  III. 1  of  this  report  for  more  details  -  shows  how  vital  it  is  to  run 
information  campaigns  on  cancer  prevention,  since  it  reveals  that  33%  of 
Europeans  believe  cancer  cannot  be  prevented  (with  the  rate  exceeding  50%  in 
some  countries).  Therefore,  Europeans  are  not  sufficiently  aware  that  every 
individual  can do something to reduce their personal risk of contracting  cancer,  an 
information  deficit  which the European  Cancer Weeks attempt to put right. 

Report  from  the  Commission  to  the  Council,  the  European  Parliament  and  the  Economic  and 
Social  Committee  on  the  evaluation  of the effectiveness  of  Community  action  undertaken  in  the 
context  of the  "Europe against  Cancer" Programme  (1987-1992), COM(93) 93 final,  15.3.1993. 
Report from  the  Commission  to the  Council,  the European  Parliament,  the Economic  and  Social 
Committee  and  the  Committee  of  the Regions  on  the  execution  of  the  "Europe against  Cancer" 
Programme  in  1993, COM(94) 550 final,  5.12.1994. 
Report from  the  Commission  to the Council,  the European  Parliament,  the Economic  and  Social 
Committee  and  the  Committee  of  the Regions  on  the  implementation  of  the  second  Action  Plan 
(1990-1994),  COM(95) 356final,  18.7.1995. 
6 

1.4 

European Code against Cancer 

Each European  Cancer  Week  concentrates  on  a  specific  topic  related  to  cancer 
prevention.  The  1995  Week  set  out  to  promote  the  revised  version  of  the 
European Code against Cancer, the first version of which was drawn up in 1987 
by the  High-level  Committee  of  Cancer  Experts7  set  up  under  the  aegis  of  the 
Commission in January  1986 and which has since become the Programme's main 
scientific  adviser.  This Code -  consisting  of  10 simple recommendations  putting 
across the essential messages on cancer prevention - has become a cornerstone of 
the Programme, with all the other information activities being based on it. Since its 
launch  in  1987  the  Code  has  mainly  been  disseminated  by  non-governmental 
organisations  active in combatting cancer in Member  States. In order to  keep up 
with scientific progress, the Commission asked the European Institute of Oncology 
(Milan) to draw up a revised version plus an annex giving the scientific reasons for 
each  of the  10 recommendations.  The Institute  coordinated  the  work  done by a 
group of European experts in drafting  the new text for the revised version of the 
Code, which the High-level Committee of Cancer Experts approved  in December 
1994 (Annex VI.4). The objective of the  1995 Week was to draw attention to all 
10 basic rules for cancer prevention (see 1.6.1). 

1.5  General organisational principles 

/. 5.1  Partnership with non-governmental organisations 

The  anti-cancer  Leagues  and  Associations  constitute  the  Programme's  main 
partners when it comes to implementing the information campaigns. These bodies -
whose role is acknowledged both in the  second  and third  action plans - not only 
have considerable  resources  allowing them  to  bolster  the European  campaign  at 
national,  regional  and  local  level,  but  also  considerable  experience  in  getting 
prevention  messages across to the public. The Programme's main partners during 
the 1995 Week are listed in Annex VI.5. 

Committee  members  in 1995: 
Prof  Veronesi 
Prof. Bleehen 
Prof  Boon 
Prof, van  der  Schueren 
Prof. Diehl 
Prof  Overgaard 
Prof. Estape 
Dr Gonzalez  Enriquez 
Prof  Kleihues 
Prof  Pujol 
Prof. Garas 
Dr  Buttimer 
Prof. Dicato 
Prof. Kroes 
Prof  Conde 
Prof. Einhorn 
Prof. Holm 

10 

11 

12 

13 

14 

Thus, the Commission makes a point of cooperating closely with the Leagues and 
Associations from the very  outset,  i.e.  when drawing up the  plans for the Week. 
To  this  end,  the  group  of  European  representatives  of  these  bodies  (which  met 
three times in 1995 under the Programme to prepare or evaluate the Week) set up 
a working group which the Commission departments running the Programme kept 
very closely involved in all decisions on the campaign's overall  strategy and target 
groups,  as  well  as  on  the  text,  slogans  and  visual  materials  to  be  used  for  the 
campaign. Furthermore the working group - which keeps the plenary group up to 
date  on  the  progress  made  at  the  preparatory  stage  -  was  consulted  by  the 
Programme organisers on selection of the contractor commissioned  to  devise and 
coordinate the campaign (see 1.5.3). Involving the Leagues upstream of the Week 
proper ensures that the messages they put across are European  ones and that they 
mobilise their resources to this end during the Week. 

As for the part of the  1995 campaign involving general practitioners (see II.2), the 
Programme  also  cooperated  with  the  European  Group  of  Representatives  of 
General Practitioners. 

/. 5.2  European character, Community added value and  subsidiarity 

From the very  outset  of the planning  stage the  Commission  and the Leagues and 
Associations  stressed  the need to  run a European  campaign based  on  a  common 
concept  and  materials  of  instantly  recognisable  Community  origin.  For  the 
Programme  this  means  showing  European  citizens  that  the  Community  plays  an 
active  role  in the public health field, cancer prevention in particular,  a role which 
also involves  developing  synergy between  all the  activities  of  national  or regional 
bodies. For the Leagues and Associations it means harnessing the campaign design 
work done  at European level  and showing that they are active  and acknowledged 
%  partners  -  not  only  at  national  level  but  also  at European  level  -  in promoting  a 

major Community cause, i.e. the war on cancer. 

The  working  group  is  the  vehicle  through  which  the  European  anti-cancer 
Leagues' expertise  in getting  messages  on prevention  across to  the general  public 
is  channelled  to  devise  and  implement  the  information  drives  run  as  part  of 
European Cancer Weeks. This pooling of effort  generates considerable  economies 
of scale (as compared to national campaigns run separately alongside one another) 
not  only  in  regard  to  human  resources  but  also financial ones.  For  example,  the 
visual  elements  of the  posters  and leaflets  are the  same  and therefore  need  to  be 
designed  and  photoengraved  only  once;  it  is just  the  texts  which  vary from one 
country to another. 

In addition to the abovementioned economies, organising a Europe-wide campaign 
also  boosts  the  impact  of  the  publicity  drive,  given  the  fact  that  certain  events 
receive  more  attention,  from  both  the  media  and  the  public,  when  presented  as 
international  events.  The  UN's  No-Smoking  Day  and  Women's  Day  would 
probably  receive  less  publicity  if they  were  purely  national  events,  and  the  same 

8 

15 

16 

17 

18 

applies to  European  Cancer Week.  It  seems that  the public  and the media like the 
idea  of people  in  several  countries  uniting  their  efforts  to  promote  a major  social 
cause for  a special day or week. 

Although  the  European  Weeks  are  homogeneously  presented  in  all  member 
countries  (same  visuals  and  basic  message),  they  do  allow  some  margin  for 
national  modifications  to  reflect  differences  in  the  health  policy  field.  Thus,  for 
example,  in  1995  Point  10 of  the European  Code  against  Cancer8  was  expanded 
on in some countries to fit in with national policy on screening for breast  cancer. 

In  specific  terms,  the  Commission  and  the  Leagues  divided  up  the  work  for  the 
1995  Week  as  follows:  the  Programme  provided  its  partners  with  the  films  for 
printing  the  leaflets  and  posters,  while  the  printing  and  dissemination  of  these 
materials  was  paid  for  by  the  Leagues  (with  a  financial  contribution  from  the 
Programme  though  -  see  V.).  Furthermore,  the  Commission  also  handled,  via  its 
contractor,  much  of  the  media  relations  before  and  during  the  Week  (see  II. 1.2) 
and  endeavoured  to  obtain  free  advertising  (see*II. 1.3  and  II.2.2).  For  their  part, 
the Leagues  organised  a whole  host  of  activities  during  the  Week  making  use  of 
the common  materials produced  (colloquies,  exhibitions,  events in schools,  shows, 
etc.). 

/. 5.3  Professionalism 

In  order  to  make  sure  the  campaign  was  highly  visible  Europe-wide,  the 
Programme  decided  to  bring  in  a  professional  public  relations  and  media 
communications  agency.  An open invitation  to  tender  was  published  in June  1995 
to sound  out the market9. There were 21 replies, and (following  the go-ahead  from 
the  working  group  of  Leagues  and  Associations)  the  firm  of  EURO-RSCG  was 
awarded  the contract not only on the basis of the quality and price of its tender but 
also  because  it  was  well  established  in  almost  all  Member  States  -  a  must, 
especially for  handling relations with the national media. 

It should be noted that the contract  with EURO-RSCG covers not  only design and 
coordination  of European  Cancer  Week  but  also  promotion  of the  Programme  in 
general.  However,  in  1995  the  company's  energies  were  almost  exclusively 
devoted  to  the  Week.  The  contract  was  concluded  for  one  year,  renewable  four 
times  for  a  further  year.  Following  the  company's  successful  work  for  the  1995 
campaign  and  in  line with  a  recommendation  from  the  Leagues  and  Associations' 
plenary group, the contract was renewed for  1996. 

"Check your  breasts  regularly.  Participate  in  organised  mammographie  screening  programmes 
if you  are  over  50. " - See  also 1.4. 
OJC  134,  1.6.1995. 

9 

1.6 

Specific  features  of the 1995 Week 

/. 6. J  Campaign  aims 

19 

The  campaign's  main aim was  to  promote  the  European  Cancer  Code  (see 1.4), 
through  highlighting  the  10 prevention  recommendations  to  ensure  that  Europe's 
citizens were: 

- 

- 

- 

informed  of  the  fact  that  everyone  can  reduce  their  personal  risk  of 
contracting  cancer; 
encouraged to adopt a healthier lifestyle based on the recommendations; 

made aware of the benefits  accruing from early detection of cancer. 

This objective was pursued by addressing the general public 

- 
- 

directly via a Europe-wide publicity campaign; 
indirectly,  by  raising  the  awareness  of  general  practitioners  as  key 
intermediaries (also see 1.6.3). 

20 

The campaign also set out to let the Union's citizens know that the Community is a 
player in the public health field (Community character of the Week). 

/. 6.2  Campaign  tone 

21 

22 

23 

All  cancer  prevention  players  agree  that  any  information  campaign  aimed  at 
modifying  certain  aspects  of  citizens'  behaviour  adversely  affecting  their  health 
needs to  adopt  a positive tone, to  encourage  and motivate,  and  avoid  pointing  the 
finger of blame. Working from general guidelines the Programme  contractor  came 
up with  a campaign  stressing that  everyone can  opt  for  a healthy  lifestyle,  consult 
their  doctor  about  certain  persistent  symptoms  or  disorders  and  -  for  women  -
participate  in  screening  programmes,  all  with  the  aim  of  reducing  the  risk  of 
contracting  cancer.  That  every  individual  can  opt  for  this  responsible  approach  is 
reflected  in the campaign slogan -  "Preventing cancer - what I can  do". 

The visual  materials used in the campaign  also reflect  this  same positive  approach, 
presenting  as they do  10 smiling and reassuring faces  (10 people  from  10  different 
countries,  one for  each of the  Code's  10 points),  each  announcing  the  choice  they 
have  made  to  reduce  their  risk  of  contracting  cancer  and  encouraging  others  to 
follow  their example (also see Annex VI.3). 

The  accompanying  texts  were  couched  in very  straightforward  language  because 
several  Eurobarometer  surveys  had  shown  that  people  with  no  more  than  a 
rudimentary  education  know  the  least  about  cancer  prevention  possibilities. 
However,  although  it  was  deemed  essential  to  keep  things  simple,  major 
importance  was  attached  to  the  scientific  content  of  the  materials,  all  of  which 
were  based  on  the  scientific  annex  to  the  European  Code  against  Cancer.  An 
expert  from  the  European  Institute  of  Oncology  in  Milan  was  given  the  task  of 

10 

24 

25 

26 

27 

28 

29 

coordinating  the  work  to  revise  the  European  Code  against  Cancer  and  thus 
ensured that the texts drawn up were scientifically  sound and consistent. 

/. 6.3  Target groups 

The main target  of the  1995 Week  was the  general  public, because  the  European 
Code against Cancer's  10 recommendations concern all Europeans. 

General practitioners formed  the campaign's  second target  group, with them being 
urged  to  pass  on  the  Code's  prevention  messages  to  their  patients.  GPs'  central 
role  in  educating  their  patients  is  self-evident  because  they  are  on  the  frontline 
when it comes to delivering health care to the populace as a whole. 

/. 6.4  Types of material 

The  pictures  of  people  promoting 
the  Code's  10  recommendations  were 
incorporated  into various types of material aimed at the general public, i.e. a series 
of 11 posters, a series of  11 leaflets,  a video and a press release. 

The series of  11 posters (A2-format),  produced  in  11 language versions,  contained 
a  general  poster  covering  the  Code  overall  plus  one  for  each  of  the  Code's  10 
points. 

Similarly,  the  series  of  11  leaflets  (folded  A4-format)  consisted  of  a  general  one 
plus  10 individual  ones pressing  home the  Code's individual  points. The  six  pages 
of these leaflets  consisted  of the following: 

- 

- 
- 

- 

Page  1: 

10 faces (general  leaflets) 
Face  of  person  "representing"  the  particular  point  of  the 
Code (other  leaflets) 
Pages 2 to 4:  Prevention  messages 
Page 5: 

Presentation  of the  10 points  of the European  Code  against 
Cancer 
Self-evaluation  test  allowing  individuals  to  determine  how 
much they know about cancer prevention. 

Page 6: 

featured  on 

the  posters  and 

A video  (35 mm, black and white) presenting  the Code's  10 key  recommendations 
was  produced  in  11 language  versions.  During  the  30-second  clip  each  of  the  10 
actors 
the  Code's  10 
recommendations  in their  mother tongue.  While the  introduction  and  ending  were 
in  the  vernacular,  the  rest  of  the  soundtrack  remained  multilingual  -  but  with 
subtitles  added  (11  language  versions)  -  thus  lending  the  video  the  desired 
multicultural  flavour.  The  video  was  then  made  available  to  the  major  European 
television networks (see II. 1.3). 

leaflets  presented 

30 

The  front  page  of the  general  leaflet  (showing  the  10 faces)  was  also used  for  an 
announcement  intended for the general press (see II. 1.3). 

11 

31 

The following  materials were produced for media relation  purposes: 

- 

- 

"master" press information  pack (European level); 
"national" press info packs; 
video  news  release  linked  to  the  campaign;  these  cassettes,  20  minutes 
long, were sent to the main European television stations. 

32 

The materials used for the GP campaign are dealt with under II.2. 

1.6.5  A ctivity  levels 

33 

34 

35 

The  1995  European  Cancer  Week  involved  two  clear-cut  levels  of  activity,  as 
explained  below. 

Drawing  on  advice  from  the  group  of  anti-cancer  Leagues  and  Associations,  the 
"Europe  against  Cancer  "  Programme  devised  and  implemented  -  through  its 
contractor  -  a  European  campaign  whose  various  elements,  based  on  common 
materials  and  a  common  approach  to  media  relations,  were  used  in  all  the 
European  Union's  15  countries.  Chapters  II  and  III  of  this  report  contain 
quantitative and qualitative analysis data on the campaign. 

The  campaign  was  supplemented  by  activities  at  national,  regional  or  local  level 
undertaken  by the anti-cancer  Leagues  and  Associations  which  organised,  in most 
countries,  a  wide  range  of  different  events  (scientific  colloquies,  health  forums, 
exhibitions,  educational  shows,  concerts,  events  in  schools,  street  theatres,  use  of 
"infomobiles",  etc.)  during  European  Week.  Although  not  directly  supported  by 
the Programme,  these  activities underscored  the European  origin  of the  campaign 
of  which  they  formed  part.  Since  such  activities  were  the  exclusive  responsibility 
of  the  anti-cancer  Leagues  and  Associations,  they  have  not  been  included  in  this 
evaluation  report.  While  difficult  to  quantify,  they  considerably  amplified  the 
impact  of the European  campaign however. 

EL 

QUANTITATIVE  ANALYSIS 

36 

This chapter  contains the main analysis data at European  level.  Annex VI.2 of this 
report  contains the  individual  results  sheets giving  the  qualitative  and  quantitative 
data.per  country. 

II.1 

Campaign  aimed  at  general  public 

II. 1.1  Posters  and leafle is 

37 

in  each  country  printed 

From  films  made  available  to  them  under  the  Programme,  the  Leagues  and 
Associations 
the  common  European  materials  in 
accordance  with  their  financial  resources  and  publicity  policies.  All  in  all, 
6  700 000  posters  and  leaflets  were  printed  in  this  manner  throughout  the 
European  Union countries,  of which there were: 

12 

5 436 000 "general" leaflets  (covering the Code's  10 points) 
964 000 "specific" leaflets (on a particular point of the Code) 
124 500 "general" posters 
170 200 "specific" posters. 

These  materials  were  disseminated  via the networks  operated  by the Leagues  and 
Associations in each Member  State. Exact distribution figures are not  available  for 
all countries, but on the basis of the available figures it is estimated  that an  average 
of  some  80%  of  the  documents  printed  by  the  Leagues  and  Associations  were 
distributed  on the occasion of European Week. 

//. 1.2  Media  relations 

The Commission's contractor was given the job of approaching the media in the  15 
countries  in  connection  with  European  Cancer  Week  and  coordinating  media 
relations,  all in cooperation with the anti-cancer Leagues and Associations. 

A European press conference,  attended by Commissioner Flynn, plus a series of  14 
press  conferences  in Member  States10  were  held  to  launch  the  Week.  More  than 
200 journalists attended  them. 

Following  the  press  conferences  and  as  a  result  of  press  relations  in  general,  the 
European  Week,  and  more  particularly  the  Code,  were  mentioned  by  some  700 
articles in the Member  States' print media. Both the national  and the regional  press 
in  most  countries  covered 
the  event.  Specific  mention  of  the  European 
Commission  and,  more  particularly,  the  "Europe  against  Cancer"  Programme  as 
the originators  of the  campaign  varies  from  country  to  country;  on  average,  some 
50%  of  the  articles  name  the  European  Commission  as  the  originator  of  the 
campaign.  The  number  of  contacts  obtained  via  the  general  press  amounted  to 
some  112 million11. 

As  for  radio  and  television  coverage,  the  European  Week  was  covered  by  some 
170 news broadcasts  or other mentions in the Union countries, both  on private and 
public  national  radios  and  televisions  as  well  as  regional  stations.  In  the  10 
countries  for  which  audience figures are  available12,  radio  and  television  coverage 
created  some  60 000 000  contacts; the total  number  of  contacts  generated  via  the 
media therefore  amounts to  at least  172 000 000. 

In  Germany  the anti-cancer  organisations  went in for  other  types  of press  relations. 
As  is  customary,  this figure  was  calculated  by  multiplying  by  2.5  the  number  of  copies  sold  of 
the  dailies  and  periodicals  concerned  so  as  to  arrive  at  the  number  of  effective  contacts 
(= circulation);  some  45  million  copies  of  the  newspapers  etc.  involved  were  therefore  sold  in 
the  15 Member  countries. 
Figures  not  communicated  for  the  61 programmes/mentions  in Spain  (38), Luxembourg  (3),  Italy 
(4), Portugal  (10) and Netherlands  (6). 

13 

38 

39 

40 

41 

42 

10 

H 

12 

43 

44 

45 

46 

47 

13 

14 

ILL3  Advertising 

Since the budget  involved was relatively modest  for  a publicity campaign  aimed  at 
getting  through  to  the  citizens  of  15 countries, the  decision  was  taken  not  to  buy 
advertising.  However,  the  Commission's  contractor  was  asked  to  obtain  free 
advertising  on television  (showing  of video)  and  in the press  (publication  of  press 
release  in  magazines  and  daily papers).  Given  the  deadlines  set  for  achieving this, 
the contractor's efforts  were focused  on television. It should be noted here that the 
legal  provisions  adopted  by  certain  countries  (in  particular  Spain,  United 
Kingdom, Finland  and - since November  1995 - Greece) limit the provision  of free 
advertising,  while  other  countries  will  grant  free  advertising  only  if advertising  is 
also  purchased. 

The  figures  given  in the  following  paragraphs  relate  only  to  advertising  obtained 
during  the  campaign',  in  some  cases  free  advertising  continued  to  be  granted 
afterwards,  thus amplifying  the Week's impact. 

Despite  the  difficulties  mentioned  above,  the  Commission  managed  -  via  its 
contractor  - to  obtain  a  large  chunk  of free television  advertising:  thus,  the  video 
was  shown  more  than  300  times  in seven  countries  (Germany,  Denmark,  France, 
Greece,  Italy,  Netherlands,  Portugal)  and  on  the  Eurosport  channel.  The  number 
of contacts  generated  by this was approximately  135 000 000  OTS13.  It  should  be 
noted  that  in  monetary  terms  the  free  television  advertising  thus  obtained 
amounted  to  around ECU  800 000. 

In  addition  to  the  above,  the  press  release  promoting  the  European  Code  against 
Cancer  was  published  for  free  on  42  occasions  in  the  general  press  in  five 
countries, thus generating some 37 000 000 contacts14,  amounting in cash terms to 
over ECU  200 000. 

77.7.4  Conclusions 

To  sum up  the  quantitative  analysis, the campaign to promote the European  Code 
against  Cancer  among  the  general  public  created  at  least  344 000 000  contacts 
(see  Annex  VI. 1,  Fig.  1):  172 000 000  via  media  relations  (112 000 000  for  the 
press  and  at  least  60  000 000  for  radio  and  television)  and  172 000 000  via  free 
advertising  (135 000 000 for  television,  37 000 000 for  the general  press).  To  this 
should  be  added  the  number  of  contacts  -  difficult  to  quantify  -  created  through 
distribution  of the 6.7 million leaflets  and posters. 

OTS  =  "Occasion  to See",  i.e.  the number of people  likely  to have seen  the  video. 
As  is  customary,  this figure  was  calculated  by  multiplying  by  2.5  the  number  of  copies  sold  of 
the  dailies  and  periodicals  concerned  so  as  to  arrive  at  the  number  of  effective  contacts 
(= circulation);  some  15 million  copies  of  the  newspapers  etc.  involved  were  therefore  sold  in 
the five  countries  in  question. 

14 

48 

49 

50 

51 

n.2 

Campaign  targeted  on general  practitioners 

II. 2.1  Brochure design, publication and dissemination 

Once general practitioners had been chosen as the campaign's second target group 
(see  1.6.2),  the  "Europe  against  Cancer"  Programme  consulted  the  European 
Group  of  Representatives  of  GPs'  Associations,  with  which  it  maintains  regular 
contact,  to jointly  determine  the  best  way  of  getting  through  to  this  group  and 
making  it  aware  of  the  prevention  recommendations  contained  in  the  European 
Code  against  Cancer.  It was  agreed to  mail  a brochure,  consisting  of  three  main 
sections as set out below, to every GP in the European Union: 

a. 
b. 

c. 

the text of the  10 points of the European Code against  Cancer; 
a  section  common  to  all  countries  setting  out  the  science  behind  each  of 
the Code's recommendations and based on the scientific  annex; 
a section  aimed  at  persuading  GPs to  incorporate  the  recommendations  of 
the European Code against Cancer into their medical practice. 

Italy  and  United  Kingdom).  The 

The  common  part  of  the  brochure  was  written  by  a  team  of  representatives  of 
general  practitioner  associations from five European  countries  (Germany,  France, 
Ireland, 
(incorporating 
recommendations  into  medical  practice)  is  specific  to  each  country,  because 
national  settings vary considerably due not  only to  different  social security  systems 
and  health  policies  but  also  different  cultures  and  customs.  The  authors  of  these 
"national"  sections were also representatives of general practitioner  associations. 

section 

last 

In order to  ensure scientific  consistency between the Annex to the European  Code 
against  Cancer and the common section of the brochure,  the European  Institute  of 
Oncology  (Milan) was asked to undertake the necessary scientific  coordination. 

The  "Europe  against  Cancer"  Programme's  contribution  to  publication  of  the 
brochure  involved: 

- 
- 
- 
- 

- 

- 

- 

approaching prospective authors;. 
organising working meetings; 
paying authors' fees, travel and secretariat expenses; 
coordinating translation of the common part  into all Community  languages, 
in cooperation with the European Commission's Translation  Service; 
formatting,  proof-reading  and  printing  the  brochure,  in  cooperation  with 
the  Office 
for  Official  Publications  of  the  European  Communities 
(EUROFFICE); 
compiling a list (in electronic form)  of addresses of all GPs in the  European 
Union15; 
addressing and mailing the brochure, in cooperation  with EUROFFICE. 

15 

official 
For  most  countries 
associations;  in countries  where  this was not possible  - in particular  for  data protection  reasons 
- these  addresses  were obtained  through a broker. 

these  addresses  were  supplied  by  the  general  practitioners' 

15 

52 

53 

54 

It should be noted that all the necessary data protection measures were taken when 
handling the GPs' addresses. 

The  16  versions16  of  the  brochure  (containing  a  foreword  from  Commissioner 
Flynn) were  distributed  to  the  GPs  at the  beginning  of  European  Cancer  Week. 
The  total  number  of  copies  mailed  was  around  321 000,  covering  almost  all 
general practitioners in the European Union.  The percentage of those  "returned to 
sender"  was  under  1% on  average,  which  testifies  to  the  high  reliability  of  the 
address files used. 

The  editions  for  Denmark  and  the  Netherlands  did  not  keep  to  the  general 
structure  of  the  brochure  as  described  in  paragraphs  48  and  49  above.  In 
Denmark's  case,  the  professional  associations  contacted  opted  for  a  brochure 
bereft of a national part and containing the Annex to the European Code instead of 
the common text mentioned above. In the Netherlands, the brochure distributed to 
GPs contained  only the  Code's  10 points and the  common  part,  since the general 
practitioners'  associations  there  did  not  wish  to  write  a  national  part.  As  the 
qualitative  analysis  shows,  this  different  approach  had  an effect  on  the  reception 
accorded the brochure by the medical profession in these two countries (see III.2). 

II. 2.2  Advertising 

The  Commission  contractor  was  asked  to  obtain  free  advertising  in  professional 
health journals in the  15 countries in the form  of publication  of  an announcement 
informing  GPs  that  the  "Europe  against  Cancer"  Programme  would  be  sending 
them a brochure. The negotiations were difficult  in view of the short deadlines and 
the media priorities laid down for television as part of the general public campaign. 
Nevertheless,  free  advertising  was  obtained  on  11  occasions  in  eight  medical 
journals in four countries. This corresponded to a monetary value of ECU  100 000 
and generated over 800 000 OTS among the medical professions. 

m. 

QUALITATIVE  ANALYSIS 

55 

56 

Qualitative  analysis  of European Cancer Week  1995  is based  on two  main tools: 
"Eurobarometer" surveys covering the campaign aimed at the general public and a 
telephone survey for the campaign targeted on general practitioners. 

This chapter gives the main findings of the qualitative analysis.  See Annex VI.2  of 
this  report  for  the  individual  results  sheets  containing  the  qualitative  and 
quantitative data, per  country (general public campaign and GP campaign). 

16 

Two versions for  Belgium. 

16 

EQ.1  Campaign aimed at general  public 

III. 1.1  Evaluation  methodology 

57 

58 

The  1995  European  Cancer  Week's  impact  on  the  general  public  has  been 
evaluated  on  the  basis  of  Eurobarometer  surveys  43.0  (March/April  1995)  and 
44.0  (October/November  1995).  During  these  two  surveys  -  which  involved  a 
representative sample of some  16 000 Europeans17 and were carried out by INRA 
(EUROPE), a European network of market research and public opinion agencies -
a  number  of  identical  questions  were  asked  before  and  after  European  Week; 
comparing  the replies  received  during the two  surveys  allows  us to  draw  certain 
conclusions  about  the  campaign's  impact  on  the  Union's  citizens.  As  far  as  the 
Commission departments running the  "Europe against Cancer" Programme know, 
no  major  "rival"  campaign  informing  the  general  public  of  ways  of  preventing 
cancer was held in the period between the two surveys. 

The  campaign's  main  objective  was  to  promote  the  European  Code  against 
Cancer,  which  contains  the  essential  recommendations  enabling  everyone  to 
reduce their own individual risk of contracting cancer. Thus, most of the questions 
concerned  ways  of  preventing  cancer  and  the  factors  likely  to  increase  cancer 
risks. Other  questions  concerned  people's  awareness  of  European  Cancer  Week 
and the European Code against Cancer. 

59 

In order to  obtain a more detailed analysis per country, the Eurobarometer  survey 
results were used to calculate the following two performance indices: 

- 

- 

performance  index  pertaining  to  the  change  in  Europeans'  attitudes, 
calculated by comparing the change in the percentage  of the population in 
a particular country believing that cancer can be prevented with the change 
in the European average18; 

performance  index  pertaining to  awareness  of the European  Code  against 
Cancer,  calculated  by  comparing  the  change  in  the  percentage  of  the 
population  in  a  particular  country  aware  of  the  European  Code  against 
Cancer with the change in the European average19. 

17 

18 

2  000 for  Germany,  1 100 for  Great Britain,  300 for  Northern Ireland,  500 for  Luxembourg  and 
1 000 for  the  other  countries. 
This index  i, is calculated  as  follows: 
ij  =  100  x  nt' - nt 
Et'  - Et 

x  Et 
nt 

where:  E  =  Europe 

n  = country  considered 
t  = spring  95  value 
t'  = autumn  95  value 

19 

This index  i2 is calculated  as  follows: 

17 

Furthermore,  the rate  of media pressure was  established  for  each  country; this is 
calculated  by  dividing  the  total  number  of  contacts  generated  nationally  via  the 
campaign (advertising + media relations) by the number of that particular country's 
inhabitants. The two performance indices plus the rate of media pressure are given 
in  the  quantitative  and  qualitative  analysis  results  sheets  per  country  in  Annex 
VI.2. 

III. 1.2  Results at European level 

Prior to  the  campaign (March/April  1995  survey)  33.3% of the Union's citizens20 
did not think it was possible to prevent cancer; after the campaign (Eurobarometer 
October/November  1995 survey) this figure had dropped by 7.2 percentage points 
to  26.1%  (see  Annex  VI. 1,  Fig.  2).  Applied  to  the  entire  population  of  the 
European  Union  aged  15  and  over  (286.6  million)  -  the  age  range  of  the 
population sample surveyed - this reduction means that after the campaign over 20 
million  more  Europeans  believed  it  possible  to  prevent  cancer.  One  of  the 
campaign's main aims had therefore been achieved, i.e.  to  make European citizens 
aware  of  the  fact  that  combatting  cancer  also  hinges  on  doing  more  for  one's 
health. 

This same trend towards greater awareness of cancer preventability emerges when 
comparing  attitudes before  and after the campaign towards  certain individual risk 
factors  forming  a  sub-group  of  the  risk  factors  highlighted  in  the  Code  (see 
Annex VI. 1,  Fig. 3).  Thus,  the  percentage  of  Europeans  believing  that  excessive 
weight can increase the risk of cancer rose from 40% before the campaign to 48% 
after; the corresponding rate for excessive consumption of alcohol rose from 60 to 
67%, for too much fatty food from 56% to 60%, for lack of exercise from 36% to 
41%,  for  a diet low  in fruit and vegetables from 50 to  53% and for  a diet low in 
cereals from 45  to  48%.  Awareness  of  the risks associated  with  smoking  - very 
high  before  the  campaign  started  (94%  of  Europeans  believed  that  smoking 
increased  the risk of  cancer)  -  rose  even  higher,  because  after  the  campaign  the 
corresponding figure was 96%. 

Both  surveys  contained  two  questions  on  screening  for  breast  cancer,  and  these 
were  therefore  directly  linked  to  Point  10  of  the  European  Code  against  Cancer 
("Check  your breasts regularly.  Participate  in organised  mammographie screening 
programmes  if you  are over 50"). The first asked whether women  had ever heard 
about  national  screening  programmes  in  connection  with  breast  cancer.  Prior  to 
the campaign  77% of European women  said they had heard of such programmes, 

60 

61 

62 

/,  =  100  x  nt'-nt 

Et'  - Et 

x  Et' 
nt' 

where:  E  = Europe 

n  = country  considered 
t  = spring  95 value 
t'  = autumn  95 value 
Weighted  European  averages. 

20 

whereas  after  the  campaign  the  corresponding  figure  was  81%.  The  second 
question  asked  women  whether  they  would  take  part  in  such  a  screening 
programme. The percentage of women stating that they would participate on their 
own initiative  in such  programmes  rose from 65% before  the  campaign to  66% 
afterwards,  while  the  percentage  of  women  replying  that  they  would  participate 
only if  they received  a written  invitation or reminder from their doctor  remained 
the same at 27%, and the percentage of women saying they would not take part in 
a screening programme fell from 7% before the campaign to  6% afterwards.  The 
campaign for  1997 European Cancer Week (whose main theme will be prevention 
of  female  cancers)  will  focus  on  this  subject  and  endeavour  to  further  heighten 
women's awareness in this key prevention  field. 

Both surveys asked two identical questions aimed at measuring people's awareness 
of  the  European  Code  against  Cancer  (which  has  existed  since  1987  and  the 
revised  version  of  which  formed  the  campaign's  focal  point).  The first measures 
spontaneous  knowledge  of  the  Code,  whereas  the  second  jogs  respondents' 
memory  somewhat  by giving  an example  of the Code, thus evaluating knowledge 
when prompted  (i.e. assisted recall). An increase in such awareness,  by as much as 
eight  percentage  points,  is  observed  in  all  countries  apart  from  Sweden  (see 
III. 1.3);  the  European  average  for  spontaneous  knowledge  went  up  from  9% 
before  the  campaign  to  12%  afterwards.  Knowledge  when  prompted  was 
approximately  double  that  of  spontaneous  recall,  and  the  European  average 
increased from 21% before the campaign to 24% after. 

Two  questions  were  asked  only  during  the  autumn  survey  in  order  to  evaluate 
people's awareness of European Cancer Week and to find out from which sources 
they had heard about it. It turned out that  some  one  quarter of Europeans  (24%) 
say  they  had  heard  something  about  European  Cancer  Week  (spontaneous 
knowledge)  -  a  remarkable  result  highlighting  the  fact  that  the  campaign's 
European  origin  is  relatively  well  established.  The replies to  the  second  question 
show  that television  -  whether  in the  form  of  current  affairs  programmes/reports 
(44%)  or  advertising  (41%)  -  was  clearly  the  main  medium  through  which 
Europeans  came  to  hear  about  European  Cancer  Week.  Newspapers  and 
periodicals/magazines came a poor second in this respect. 

III. 1.3 Results per  country 

63 

64 

65 

Analysis of the two performance indices calculated from the Eurobarometer results 
(see  III. 1.1)  gave  rise  to  four  distinct  groups  of  countries  in  terms  of  the 
campaign's overall impact: 

- 
- 
- 
- 

countries where the campaign was a huge success; 
countries where it was a success; 
countries below the European average; 
non-classifiable  countries. 

19 

66 

67 

68 

69 

70 

71 

The campaign was a huge success in Germany,  Austria,  Spain, Greece and  Ireland 
both  as  regards  awareness  of  cancer  preventability  and  knowledge  of  the 
campaign's  European  origin.  In  these  countries  the  two  performance  indices  are 
well above the average and the campaign's two  aims in this regard  were  achieved 
to  a very  large  degree,  i.e.  heightening  European  citizens'  awareness  and  putting 
across  European  messages  so  as  to  make  the  Community's  action  in  this  field 
wider known. Furthermore, these countries benefitted  in general from a strong and 
high-profile  campaign (high rate of media pressure). 

The  second  group  of  countries  consists  of Belgium,  Denmark,  Finland,  Italy  and 
the United Kingdom; here one of the two performance  indices is much higher than 
the  European  average,  while  the  other  is  at  an  acceptable  level.  And  in  most  of 
these  countries  the  rate  of  media  pressure  is  also  above  the  European  average, 
reflecting  the  link  which  exists  between  the  extent  of  the  publicity  drive  and  the 
campaign's  effectiveness. 

The  countries  where the  campaign's  impact  was  below  the European  average  are 
France, Luxembourg  and the Netherlands; in these  countries the two  performance 
indices were at a satisfactory  level overall, although below the average. The media 
pressure in these countries was lower,  due mainly to the difficulties  encountered in 
obtaining free advertising. 

Two  countries  -  Portugal  and  Sweden  -  are  difficult  to  classify  under  the 
evaluation  system used. In Portugal,  despite a very high rate of media pressure and 
the  printing  and  distribution  of  a  very  large  amount  of  campaign  materials,  the 
campaign  performance  indices  are  negative.  It  should  be  recalled  here  that  the 
Eurobarometer  results before  the  campaign were  particularly  positive in Portugal. 
The results for  Sweden may stem from the fact  that i) no materials were printed  or 
distributed  for the campaign and ii) media pressure during it was very low. 

III. 1.4  Conclusions 

The  campaign  undertaken  during  1995  European  Cancer  Week  had  a  significant 
influence  on  the  Union's  citizens'  knowledge  about  cancer  prevention:  after  the 
Week  20  more  million Europeans  believed  they  could  reduce  their  individual  risk 
of  contracting  cancer.  The  campaign's  prime  objective  (see  1.6.1)  was  therefore 
achieved  for  the  most  part,  even  if  the  impact  within  the  15  countries  varies 
considerably  and  the  knock-on  effect  of  this  improved  knowledge  on  Europeans' 
behaviour with regard to the risk factors  is not yet known. 

The  campaign  also  contributed  to  giving  a  higher  profile  to  the  Community's 
activities in the public health field, in particular  in the fight against cancer:  after  the 
Week,  24% of Europeans  knew of the European  Code against  Cancer (see Fig. 4) 
while 24%o also said they had heard of European  Cancer Week. 

20 

72 

73 

74 

m .2  Campaign aimed at general  practitioners 

This  campaign's  aims  were  to  familiarise  GPs  with  the  prevention  messages 
contained  in the European Code  against  Cancer and to  make  them  aware  of the 
importance of including advice on cancer prevention in their medical practice. The 
approach  adopted  to  achieve this involved  production  of  a brochure  (specifically 
adapted  to  this  profession's  information  requirements)  and  its  dispatch  to  every 
general  practitioner  in the  European Union  during European  Cancer Week  (also 
seen.2.1). 

III. 2.1  Evaluation  methodology 

The GP campaign was evaluated by means of a telephone survey undertaken in the 
Union's  15  countries.  During  this  survey  2 050  general  practitioners  were 
contacted21, which is a representative sample of 0.7% of the Union's GPs. The GPs 
approached were chosen by the opinion poll agency from lists which differed from 
the  address  files  used  to  mail  the  brochure  (protection  of  data  entrusted  to  the 
Commission).  The telephone  surveys were  conducted  in November  1995  on the 
basis  of  a  semi-structured  questionnaire  containing  18  questions.  These  did  not 
just  ask  the  GPs'  opinion  about  the  brochure  and  the  European  Code  against 
Cancer's  10 recommendations  but also  covered the other European  materials and 
messages  with  which  general  practitioners  came  into  contact  during  the  whole 
campaign  (press  releases  in  professional  journals,  leaflets  and  posters  distributed 
by  the  anti-cancer  Leagues  and  Associations,  messages  put  across  via  the  mass 
media). 

III. 2.2  Reaction  to and views on the brochure 

GPs  are  literally  deluged  every  day  by  advertising  in  their  post;  the  risk  of  the 
European  Code  against  Cancer brochure  "drowning"  in  this  flood  was  therefore 
relatively  large.  Seen  in  this  light,  the  doctors'  recall  of  the  brochure  is  at  an 
acceptable  level  as regards spontaneous recall (European average22  -  15.3%), and 
is  very  good  (39.4%)  in the  case  of  recall  when  prompted  (also  called  assisted 
recall - see Annex VI. 1, Fig.  5). However, the differences from country to country 
are very large, with the lowest  spontaneous recall rate being 2.9% in Sweden and 
the highest 40% in Luxembourg, and the lowest assisted recall rate being 22.1% in 
Greece and the highest 86% in Luxembourg. 

21 

22 

200  in  Germany,  Belgium,  Spain,  France,  Italy  and  the  United  Kingdom;  100  in  Austria, 
Denmark,  Finland,  Greece, Ireland, Portugal, Sweden and the Netherlands;  50 in  Luxembourg. 
Weighted  European  averages. 

21 

75 

76 

Of the  GPs  recalling  having  received  the  brochure,  87.6%  felt  it  had  been  well 
done and 77.5% considered it to be very useful  or moderately useful  (very useful: 
31.5%,  moderately  useful:  46.5% -  see  Annex VI. 1,  Fig.  6).  It  should  be  noted 
that the worst  results for these two  questions were recorded  in Denmark (46.4% 
for  both  questions),  where  the  GPs'  associations  had  not  adopted  the  approach 
favoured by the "Europe against Cancer" Programme (also see II.2.1). The second 
country  where  a  different  approach  had  been  adopted  (Netherlands)  also  had 
results for  the two  questions very  much below  the  average  (60.4% for  brochure 
design, 57.1% for brochure usefulness). 

Of  the  doctors  who  recalled  having  received  the  brochure,  20%  said  they  had 
learned something from it (lowest rate 3.8% in Italy, highest 38.3% in Spain) while 
10.5%  of  them  stated  that  the  recommendations  contained  in  the  brochure  had 
actually  changed  certain  aspects  of  their  medical  practice  (lowest  rate  0%  in 
Ireland and Sweden, highest  18% in Spain). 

77 

It  should  also  be  noted  that  68.2%  of  doctors  recalling  having  received  the 
brochure considered it useful to repeat the exercise in the future. 

Ill  2.3  Knowledge  of and views on the Code 

78 

79 

80 

The  survey  on  general  practitioners'  recall  of  and views  on the  brochure  sent  to 
them was  also  used  to  determine  GPs' knowledge  of the European  Code  against 
Cancer and their views concerning its usefulness for the general public. Thus, 37% 
of  all  the  doctors  interviewed  (regardless  of  whether  they  remembered  receiving 
the  brochure  or  not)  said  they  knew  the  European  Code  against  Cancer  (see 
Annex VI. 1, Fig.  7).  Of these,  82.7% said the Code was very useful  or useful  for 
providing  the  general  public  with  information  (see  Annex  VI. 1,  Fig.  8),  a  reply 
which vindicates the pride of place accorded to  the Code by the  "Europe  against 
Cancer" Programme in its information drives. 

III. 2.4  Reaction  to and  views on other materials used in the  campaign 

It  was  deemed  useful  to  use  the  same  survey  to  find  out  the  extent  to  which 
general  practitioners  had received,  for  placing  in their waiting  rooms,  the  leaflets 
and  posters  printed  by  the  anti-cancer  Leagues  and  Associations  from  the films 
supplied by the "Europe against Cancer" Programme.  It should be noted  here that 
waiting  rooms were not the only place for  distributing  such materials -  they were 
also  made  available  to  the  general  public  in  pharmacies,  via  direct  mailing  or 
handed out during various events put on during the Week. 

15.9% of  all  the  doctors  interviewed  said  they  had received  leaflets  on the  Code 
for  their  patients; the  corresponding figure for the  posters  was  14%.  Among  the 
doctors  having  received  these  materials,  a very  large  majority  found  them  to  be 
very  interesting  or  moderately  interesting  (81.8% for  the  leaflets,  71.3% for  the 
posters). 

22 

III. 2.5  Conclusions 

81 

82 

83 

GPs  had  clearly  picked  out  the  brochure  specifically  intended  for  them  from 
among  the  flood  of  advertising  mail  they  receive.  The  doctors  recalling  having 
received the brochure judged it extremely positively,  as they did the usefulness  of 
the European Code against Cancer as a tool for informing the general public. 

This positive  evaluation  emerging from the telephone  survey  is  confirmed  by the 
very large number of requests for additional copies of the brochure received by the 
"Europe  against  Cancer"  Programme  from  individual  doctors  (GPs  or  others), 
doctors'  associations,  medical  faculties,  other  medical  profession  training  bodies 
and  various  public  health  and  health  education  institutions.  More  than  21 000 
copies of the brochure will be reprinted in 1996 in order to meet this demand. 

Numerous  statements from individual doctors and official  declarations from many 
GP associations are highly appreciative of the fact that the European  Commission 
approached  doctors directly;  in terms of the telephone  survey,  this is  reflected  in 
the high percentage  of doctors in favour  of a similar venture being undertaken in 
the future. 

IV. 

FOLLOW-UP  ACTIVITIES 

84 

85 

86 

At  its  meeting  on  13  December  1995  the  Advisory  Committee  set  up  for  the 
second  action  plan was  presented  by  the  Commission  with  an  initial  analysis  of 
1995  European  Week's  impact.  The  Committee  members  agreed  that  the  Week 
had gone very well. 

The  Commission  also  informed  the  European  group  of  anti-cancer  Leagues  and 
Associations  (14.11.1995),  the  Committee  of  Cancer  Experts  (23.11.1995)  and 
the  European  Group  of Representatives  of  GPs' Associations  (23.4.1996)  of the 
results  of  the  1995  European  Cancer  Week.  These  three  groups  also  concluded 
that the  1995  Week  had generated  remarkable results.  Furthermore,  the group  of 
Leagues and Associations - the Programme's main partner in organising the Week 
-  recommended  to  the  Commission  that  the  contract  (for  planning  and 
coordinating the Week)  concluded with the EURO-RSCG  media  communications 
agency be renewed for 1996. 

A  number  of  conclusions  were  drawn  from  the  way  the  1995  Week  went  for 
preparing  and  implementing  the  1996  Week.  Thus,  in  order  to  ensure  greater 
synergy  between  the  activities  undertaken  by  all  the  players  involved  in  the 
campaign  at  Member  State  level  (anti-cancer  League(s),  Health  Ministry,  other 
bodies  involved,  Commission  representative's  office,  media  communications 
agency's  local  office),  preparation  meetings  were  organised  in  most  countries 
among  all  the  abovementioned  players  as  well  as  representatives  of  the  "Europe 
against Cancer" Programme and the media communications agency's head office. 

23 

87 

88 

89 

It was decided to decentralise translation for future campaigns in order to improve 
the linguistic  quality of the translated versions  of the materials used  and to  adapt 
them  to  the  particular  circumstances  in  each  country;  henceforth  the  various 
language  versions  will  be  produced  in  cooperation  between  the  contact  person 
named  by  the  League(s)  in  a  given  country  and  the  media  communications 
agency's office  in that country. 

In order to improve the information flow between the Leagues, and in particular to 
those not  represented  in the working group advising the  "Europe against Cancer" 
Programme  on the Week,  the group's minutes  are to  be systematically  distributed 
to  all members  of the European group  of Leagues; furthermore,  each member  of 
the  working  group  will  assume  responsibility  for  informing  the  League(s)  of  a 
country not represented within the group. 

An independent  evaluation  of the  second  action plan (1990-1994)  to  be arranged 
by the Commission will also deal with  1995  - a year which was not covered by an 
action  plan  (also  see  1.1)  -  and will  therefore  include  an  evaluation  of  the  1995 
European Week.  That evaluation will be in addition to the one already undertaken 
by the  Commission  on the basis of the Eurobarometer  surveys  and the  telephone 
survey of GPs used for the qualitative analysis contained in this report. 

24 

V. 

90 

BUDGET 

The budget  allocated  for  implementation  of  1995 European  Cancer  Week  was  as 
follows: 

- 

- 

- 

- 

- 

contract with the EURO-RSCG agency23 24 

ECU  1 170 000 

funding  for  anti-cancer Leagues and Associations 
for printing and distribution of materials: 
14 x ECU  10 000 

ECU  140 000 

fees paid to authors for the "national" part of the 
GP brochure (8 x ECU 5 000): 

ECU 40 000 

cost of project  95/C/45309 (production of the 
common part of the GP brochure) 

ECU 66 341 

printing of GP brochure (322 000 copies, 

16 versions) 

ECU  154 762 

purchase of GPs' addresses for five countries 

ECU  10 000 

TOTAL 

ECU  1581  103 

23 

24 

The  contract  totalling  ECU  1.3 million  also  covers promotion  of  the  "Europe  against  Cancer" 
Programme  in general,  but in  1995 the agency's  activities  concentrated  almost  exclusively  (some 
90%) on the  Week. 

The contract  did not foresee  the buying of advertising  space. However,  free  advertising  space 
amounting  in cash  terms to over  1 MECU  has been obtained  by the agency  (see also II. 1.3 and 
11.2.2) 

25 

ANNEX 

cf  Volume 2 

<2C 

ISSN 0254-1475 

COM(97)  19 final 

DOCUMENTS 

EN 

04  05  16 

Catalogue  number  :  CB-CO-97-015-EN-C 

ISBN  92-78-15102-5 

Office  for  Official  Publications of the European  Communities 

L-2985 Luxembourg 

il