The 12 European Guidelines for Reducing Your Risk of Cancer
It is less well known than the Erasmus program, which enables students to study throughout Europe. But it has saved thousands of lives and deserves at least as much attention in 2017, a year in which it, like Erasmus, is celebrating its30th anniversary. Henri Pujol, University of Montpellier
This is the “Europe Against Cancer” program. An ambitious initiative that continues its prevention efforts to this day through its 12 guidelines, the “European Code Against Cancer.”
“Do not smoke,” reads the first commandment in the latest edition of the Code, updated in 2014. And so on, up to the twelfth.
- Don't smoke.
- Make your home and your car smoke-free.
- Limit your alcohol intake.
- Eat a healthy diet rich in fruits, vegetables, and whole grains. Limit your intake of red meat and foods high in fat, salt, or sugar, and avoid processed meats.
- Maintain a healthy weight.
- Be physically active in your daily life.
- Avoid excessive sun exposure, especially for children. Use sunscreen. Do not use tanning beds.
- 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 the use of hormone replacement therapy during menopause.
- Have your children vaccinated against hepatitis B (newborns) and human papillomavirus (young girls).
- Take part in screening programs for colorectal cancer (men and women), breast cancer, and cervical cancer (women).
In France, 18,300 lives were saved in the year 2000
Today, research makes it possible to estimate the number of lives saved thanks to the Code. If the behavior of citizens and public authorities had remained unchanged, and given the aging of the population, the annual number of cancer deaths in the European Union of Twelve between 1985 and 2000 would have risen from 850,000 to just over 1,000,000. An impact study conducted in 2003 by the International Agency for Research on Cancer (IARC) shows that the reduction in the number of deaths (adjusted for demographic factors) was 9.2% over this period, slightly below the 15% initially targeted. Thus, the Code prevented 92,500 cancer deaths in the year 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, had placed it under the authority of Vice-President Manuel Marin, who was in charge of Social Affairs, rather than under the auspices of the Commissioner for Research, as would typically be expected for a program with a strong medical focus. This was a true paradigm shift, driven by the chairman of the Committee of European Cancer Experts, Professor Maurice Tubiana—who passed away in 2013.
For the first time, all citizens of the Twelve were formally informed that they themselves, through proactive behavior, could reduce their risk of cancer—and cancer-related mortality—with an impact comparable to that of advances in care and biological research. The goal was to change attitudes among the population, while public authorities would simultaneously adopt appropriate measures to prevent cancers and detect them early enough.
Recommendations that remain relevant 30 years later
It is remarkable that, 30 years later, the twelve recommendations have retained their full relevance and remain the foundation not only for the fight against cancer, but also for the fight against chronic and degenerative diseases, which account for approximately two-thirds of healthcare spending in our country.
Let’s review the causes of cancer one by one, starting with tobacco, the leading cause of preventable cancer deaths. It was responsible for 47,000 (31.3%) of the 150,000 cancer deaths recorded in France in 2015, according to the National Cancer Institute (Inca). It’s never too late to quit smoking—and to stop exposing others to secondhand smoke. Passive smoking is estimated to cause 1,000 cancer deaths each year in France.
Alcohol, next, is the second leading preventable cause of cancer mortality. It causes 15,000 (10%) cancer deaths. If you consume alcoholic beverages, you should limit your drinking to a few days a week and restrict intake to a maximum of 2 drinks per day for men and 1 drink per day for women—some guidelines are even stricter.
Diet, too. 20 to 25% of cancers are believed to be due to our dietary habits. Certain foods are proven risk factors if consumed in excess: red meat, processed meats, salt, and high-calorie foods. On the other hand, other foods reduce the risk of cancer. Therefore, it is recommended to eat five servings of fruits and vegetables daily, along with other high-fiber foods such as whole grains (whole-grain bread, pasta, and brown rice) and legumes (lentils, dried beans).
A brisk 30-minute walk, five days a week
Being overweight or obese are recognized risk factors, whereas regular physical activity reduces the risk of cancer. It is recommended to engage in the equivalent of 30 minutes of brisk walking, 5 to 7 days a week.
Excessive UV exposure, 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 essential 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, present in the soil of certain regions, can seep into homes. By contacting your regional health agency, you can find out how to measure the radon levels in your home. To reduce the concentration of this gas, better floor insulation and improved ventilation are essential.
Occupational cancers are estimated to account for 4 to 10% of cancer deaths. Adherence to safety guidelines and vigilance on the part of occupational health professionals are key to preventing them.
Hormone therapy for menopause should be limited
Breastfeeding reduces the risk of breast cancer. On the other hand, hormone replacement therapy for menopause increases this risk and should only be prescribed for symptoms that significantly impair quality of life, and only for short periods, with regular medical monitoring.
Finally, consulting your doctor will help you understand how to participate in the vaccination and screening programs offered by health authorities.
Since 1988, the European Leagues Against Cancer have been working to raise awareness of these individual cancer prevention measures.
Even today, the INCA estimates that 40% of cancers could be prevented if all citizens made the necessary lifestyle changes. The IARC, for its part, estimates this rate at 50%—the difference stems from the fact that not all causes of the disease are yet fully understood.
Within the EU, 24 countries have launched their National Cancer Plans since the year 2000. France adopted its own in 2003. The European fight against cancer continues under the EU’s Health Program covering the 2014–2020 period, with a budget of 450 million euros. Its goal: “To reduce the number of new cancer cases in the EU by 15% by 2020.” Once again, the widest possible dissemination of the Code is one of the conditions for achieving this new objective.
Michel Richonnier, an economist and former professor 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 This article was published on The Conversation.