Overview of the 4th edition of the

European Code Against CancerProfessor Annie S. Anderson

Centre for Public Health Nutrition ResearchCentre for Research into Cancer Prevention and ScreeningNinewells Medical School, University of Dundee a.s.anderson@dundee.ac.uk

Rationale

At least 1/3 of all cancers are preventable

Mortality can be further reduced by early detection (screening)

2.7 million people were diagnosed with cancer in the EU28 in 2012

25% expected increase in EU until 2030 (to 3.3 million cases)

Second most common cause of death (after cardiovascular disease)

Cancer mortality accounts for nearly 20% of all deaths in EU28

WHAT?

• A key prevention tool to reduce cancer risk, and to improve health in general

• Concrete, science-based guidelines• At least 1/3 of cancers are preventable

WHY?

• Science is dynamic• Improvement in communication• 13 new Member States in the EU since 3rd revision (in 2003)

HOW?• Update of the Code (recent scientific data)

1) Confirm existing recommendations

2) Potential additional recommedations

3) Interventions proven to be successful, assessed by scientific evidence

WHO?• Supported by the European Commission• Led by the IARC• Actors

1) Scientific Secretariat (IARC)2) Scientific Committee (external experts from the EU)3) Expert working groups

Update

Update of scientific evidence

Focus on target group (European individual)

Explanations and additional guidance as public health messages

Recommendations on how to implement individual interventions

Added Value

The Code does not aim to replace existing efforts to promote cancer prevention.

It aims to strengthen cancer prevention by:

Encouraging the general public to react more positively when receiving similar messages

Focusing on the key prevention messages relevant to most people

Methods:Target Group

General population

Relevant cancer burden

Not targeted at only high risk group

Methods:Communication

Recommendation can be communicated in a straightforward way

No difficult decisions involved (weighing risks and benefits)

Actions the individuals can take themselves

Expert Working Group on communication of health messages

What can I do to reduce my risk of

cancer?

EUROPEAN CODE AGAINST CANCER

Target group

ECAC

New Structure

CodeQuestions &

Answers Science base

http://cancer-code-europe.iarc.fr

A) Certain cancers may be avoided – and health in general can be improved – by adopting healthier lifestyle:1) Do not smoke; if you smoke, stop doing so. If you fail to stop, do not smoke in the presence of non-smokers.

2) Avoid obesity.

3) Undertake some brisk, physical activity every day.

4) Increase your daily intake and variety of vegetables and fruits: eat at least five servings daily. Limit your intake of foods containing fats from animal sources.

5) If you drink alcohol, whether beer, wine or spirits, moderate your consumption to two drinks per day if you are a man and one drink per day if you are a woman.

6) Care must be taken to avoid excessive sun exposure. It is specifically important to protect children and adolescents. For individuals who have a tendency to burn in the sun active protective measures must be taken throughout life.

7) Apply strictly regulations aimed at preventing any exposure to known carcinogenic substances. Follow all health and safety instructions on substances which may cause cancer. Follow advice of national radiation protection offices.

B) Cancers may be cured, or the prospects of cure greatly increased, if they are detected early:

8) Women from 25 years of age should participate in cervical screening. This should be within programmes with quality control procedures in compliance with European Guidelines for Quality Assurance in Cervical Screening.

9) Women from 50 years of age should participate in breast screening. This should be within programmes with quality control procedures in compliance with European Union Guidelines for Quality Assurance in Mammography Screening.

10) Men and women from 50 years of age should participate in colorectal screening. This should be within programmes with built-in quality assurance procedures.

11) Participate in vaccination programmes against Hepatitis B Virus infection.

European Code against Cancer3rd Edition (2003)

Coordination Group:

Scientific Secretariat:

Carolina Espina, Patricia Villain, Tracy Lignini

Principal Investigators:Joachim Schüz, Lawrence von Karsa

WG CommunicationJane Wardle (Chair)

WG Chairs

Literature GroupSilvia Minozzi (Chair)

Editorial BoardPI (Co-Chairs)

advises & adopts

edits

European Code

Against Cancer

– Collaboration

supports

Scientific Committee

Expert Groups:

WG RadiationJoachim Schüz (Chair)

WG NutritionIsabelle Romieu (Co-Chair)Martin Wiseman (Co-Chair)

WG ScreeningNereo Segnan (Chair)

WG EnvironmentJoachim Schüz (Chair)

WG InfectionsRolando Herrero (Chair)

WG TobaccoMaria Leon Roux (Chair)

prepares

4th Edition of the European Code against Cancer1 12 ways to reduce your cancer risk

(1) Do not smoke. Do not use any form of tobacco.

(2) Make your home smoke-free. Support smoke-free policies in your workplace.

(3) Take action to be a healthy body weight.

4th Edition of the European Code against Cancer1 12 ways to reduce your cancer risk

(4) Be physically active in everyday life. Limit the time you spend sitting.

(5) Have a healthy diet:• Eat plenty of whole grains, pulses,

vegetables and fruits.• Limit high-calorie foods (foods high in

sugar or fat) and avoid sugary drinks.• Avoid processed meat; limit red meat

and foods high in salt.

4th Edition of the European Code against Cancer1 12 ways to reduce your cancer risk

(6) If you drink alcohol of any type, limit your intake. Not drinking alcohol is better for cancer prevention.

(7) Avoid too much sun, especially for children. Use sun protection. Do not use sunbeds.

(8) In the workplace, protect yourself against cancer-causing substances by following health and safety instructions.

4th Edition of the European Code against Cancer1 12 ways to reduce your cancer risk

(9) Find out if you are exposed to radiation from naturally high radon levels in your home.Take action to reduce high radon levels.

(10) For women:• Breastfeeding reduces the mother’s

cancer risk. If you can, breastfeed your baby.

• Hormone replacement therapy (HRT) increases the risk of certain cancers. Limit use of HRT.

(12) Take part in organised cancer screening programmes for:

• Bowel cancer (men and women)

• Breast cancer (women)• Cervical cancer (women).

4th Edition of the European Code against Cancer1 12 ways to reduce your cancer risk

(11) Ensure your children take part in vaccination programmes for:

• Hepatitis B (for new-borns)• Human papillomavirus (HPV)

(for girls).

Healthy diet

• Cancers of upper aerodigestive tract, colorectum

• Plant foods – dietary fibre (colonic flora/microbiome), micronutrients/phytochemicals (glucosinolates), energy density

• High calorie foods/sugary drinks – energy balance, appetite regulation, sugar calories?

• Meat – haem, curing/salt, nitrites

Alcohol

• Cancers of mouth, pharynx, larynx (nb smoking), colorectum (men v women), liver, breast

• Ethanol as carcinogen (IARC) cf smoking• Metabolised to acetaldehyde (carcinogen)• Oestrogen, immunity• Direct irritation• Facilitate other carcinogens as solvent

Alcohol and breast cancer

Alcohol and breast cancer