The 12 European commandments for reducing your risk of cancer
It is less well known than the Erasmus program, which enables students to travel throughout Europe. But it has saved thousands of lives and deserves at least as much attention in 2017, when, like Erasmus, it celebrates its30th anniversary. Henri Pujol, University of Montpellier
This is the "Europe Against Cancer" program. An ambitious initiative that continues its prevention work today through its 12 commandments, the "European Code Against Cancer."
“Do not smoke,” says the first commandment in the latest edition of the Code, updated in 2014. And so on until the twelfth.
- Do not smoke.
- Make your home and car smoke-free environments.
- Limit your alcohol consumption.
- Eat a healthy diet rich in fruits, vegetables, and whole grains. Limit red meat, foods high in fat, salt, or sugar, and avoid processed meats.
- Maintain a healthy weight.
- Be physically active in your daily life.
- Avoid excessive exposure to the sun, especially in children. Use sunscreen. Do not use tanning devices.
- Take the necessary steps to reduce your risk of potential radon exposure in your home.
- Follow the safety guidelines at your workplace to protect yourself from carcinogens.
- For women: If possible, breastfeed your children. Limit hormone replacement therapy during menopause.
- Have your children vaccinated against hepatitis B (newborns) and papillomavirus (young girls).
- Participate in screening programs for colorectal cancer (men and women), breast cancer, and cervical cancer (women).
In France, 18,300 lives saved in 2000
Today, research makes it possible to estimate the number of lives saved thanks to the Code. If citizens and public authorities had not changed their behavior, and given the aging population, the annual number of cancer deaths in the EU-12 between 1985 and 2000 would have increased from 850,000 to just over 1,000,000. An impact study carried out in 2003 by the International Agency for Research on Cancer (IARC) shows that the reduction in the number of deaths (adjusted for demographic data) was 9.2% over this period, slightly less than the 15% initially targeted. Thus, the Code prevented 92,500 cancer deaths in 2000 in the European Union of Twelve, including 18,300 in France.
The strength of this public health program, which was highly innovative at the time of its launch, is symbolized by its oversight. The European Commission, then chaired by Jacques Delors, placed it under the authority of Vice President Manuel Marin, who was in charge of social affairs, rather than under the aegis of the Commissioner for Research, as would have been expected for a program with a strong medical dimension. This was a real paradigm shift, driven by the chairman of the Committee of European Cancer Experts, Professor Maurice Tubiana, who died in 2013.
For the first time, all citizens of the Twelve European countries were formally informed that they themselves could reduce their risk of cancer—and mortality from this disease—through proactive behavior, with an impact comparable to that of advances in care and biological research. The aim was to change attitudes among the population, while at the same time the public authorities would adopt appropriate measures to prevent cancer and detect it early enough.
Recommendations that are still relevant 30 years later
It is remarkable that, 30 years later, the twelve recommendations remain as relevant as ever and continue to form the basis not only of the fight against cancer, but also of the fight against chronic and degenerative diseases, which account for around two-thirds of healthcare expenditure in our country.
Let's take a look at the causes of cancer one by one, starting with tobacco, the leading cause of preventable cancer deaths. According to the National Cancer Institute (Inca), tobacco was responsible for 47,000 (31.3%) of the 150,000 cancer deaths recorded in France in 2015. It is never too late to stop smoking and exposing others to secondhand smoke. Passive smoking is responsible for 1,000 cancer deaths each year in France.
Alcohol is the second leading preventable cause of cancer deaths. It causes 15,000 (10%) cancer deaths. If you drink alcohol, you should reduce your consumption to a few days a week and limit the amount you drink to a maximum of two drinks per day for men and one drink per day for women—some recommendations are even stricter.
Diet is also important. Between 20 and 25% of cancers are thought to be caused by our eating habits. Certain foods are proven risk factors if consumed in excess: red meat, processed meat, salt, and high-calorie foods. On the other hand, other foods reduce the risk of cancer. It is therefore advisable to eat five portions of fruit and vegetables every day, as well as other fiber-rich foods such as whole grains (whole grain bread, pasta, and rice) and pulses (lentils and dried beans).
Thirty minutes of brisk walking, five days a week
Being overweight or obese are recognized risk factors, while regular physical activity reduces the risk of cancer. The recommended amount is the equivalent of 30 minutes of brisk walking, 5 to 7 days a week.
Excessive exposure to UV rays, whether from the sun or tanning beds, was responsible for 15,000 cases of melanoma in 2015, resulting in 1,800 deaths. It is therefore important to protect yourself from the sun and avoid tanning devices.
Radon is the second leading risk factor for lung cancer. This naturally occurring radioactive gas, found in the soil in certain regions, can spread into homes. You can find out how to measure the radon levels in your home by contacting your regional health agency. To reduce the concentration of this gas, better soil insulation and ventilation are required.
Occupational cancers are thought to account for 4 to 10% of cancer deaths. Compliance with handling instructions and vigilance on the part of occupational health services are important for their prevention.
Hormone treatments for menopause should be limited
Breastfeeding reduces the risk of breast cancer. However, hormone replacement therapy during menopause increases this risk and should only be prescribed in cases where symptoms significantly impact quality of life, and only for short periods of time, with regular medical monitoring.
Finally, consulting your doctor will enable you to find out how to participate in the vaccination and screening programs offered by the health authorities.
Since 1988, European cancer leagues have been working to raise awareness of these individual cancer prevention measures.
Even today, INCA estimates that 40% of cancers could be prevented if all citizens made the necessary lifestyle changes. The CIRC even estimates this rate at 50%—the difference can be explained by the fact that the causes of the disease are not yet fully understood.
In the EU, 24 countries have launched their cancer plans since 2000. France adopted its plan in 2003. The European fight against cancer continues within the EU's Health Program covering the period 2014-2020, with a budget of €450 million. Its objective is to "reduce the number of new cancer cases in the EU by 15% by 2020." Here again, the widest possible dissemination of the Code is one of the conditions for achieving this new objective.
Michel Richonnier, economist and former lecturer at Sciences Po and the College of Europe in Bruges (Belgium), contributed to this article.
Henri Pujol, Honorary Professor of Medicine at the University of Montpellier, University of Montpellier
The original version of this article was published on The Conversation.