Primary Prevention: United for Action
Executive Summary
Each year, millions of people across the European region develop cancer, causing a heavy burden on individuals and their families, healthcare systems, governments and wider society, not to mention the impact in terms of lives lost. Yet 40% of all cancers are preventable. 20% of European cancer cases are attributable to tobacco consumption, 8% to alcohol, and further 5% each to an unbalanced diet and being overweight or obese, while another 2%–3% are linked to harmful ultraviolet exposure. Additional cancer causes and risk factors include infections by Human Papillomaviruses (HPV), Hepatitis B and C viruses (HBV & HCV) and Helicobacter pylori; exposure to ionising radiation; air, water and food pollution; and occupational exposure to carcinogens.
There is ample evidence to show not only that tobacco is a leading cause of more than ten types of cancer but also that healthcare policies aimed at smoking cessation are effective at reducing the incidence of the disease. Yet there remain many areas in Europe where much work needs to be done to bring down smoking rates, and where citizens are still exposed to secondhand smoke. Efforts are being undermined by the tactics of the tobacco industry, which is trying to sow confusion around the idea of harm reduction, rather than reducing tobacco use.
Alcohol consumption is associated with seven major cancers, including breast, liver, colorectal, and laryngeal cancers. Research has shown that drinking is associated with risk, and increased consumption increases the risk. Consequently, there appears to be no safe level of alcohol consumption, and effective polices must be introduced to increase taxes on alcohol products, ban or at least restrict alcohol marketing, introduce warning labels and restrict its availability, among other measures. The need for this is underlined by the low levels of knowledge of the harms of alcohol compared with those for tobacco.
The association between diet, lifestyle and cancer mirrors that for cardiovascular disease, with emerging evidence of a shared aetiology between the two diseases. There are a range of known dietary carcinogens but also obesity is a major contributor to cancer risk via patterns of chronic inflammation. Moreover, obesity is itself associated with 13 types of cancer. Controlling dietary habits could help reduce the risk of both cancer and cardiovascular disease, with the healthiest lifestyles associated with an approximate 30% reduction in cancer incidence. Key to this will be the involvement of family physicians and cancer nurses in education and prevention. The role of better treatment of obesity as a means of improving cancer prevention should be emphasised.
Between 75% and 95% of melanomas of the skin are preventable through changes in individual sunseeking behaviour and the provision of shaded environments, protective clothing and sunscreen in at-risk of environments. Another key area is that of sunbeds, which are associated with substantial increases in skin cancer risk, especially in those who start using them at a young age. Yet legislative measures in Europe on sunbed use remain insufficient. Achieving real change in reducing harmful ultraviolet exposure will require harmonised guidelines and communication, prevention policies in communities, schools and companies, and effective policies to limit or ban sunbed use for cosmetic purposes.
The evidence is available and the path is clear. The time is now for action.
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