Every year, 3.5 million people in the EU are diagnosed with cancer and 1.3 million die from it. Over 40% of cancer cases are preventable. Without a reversal in these trends, it will become the leading cause of death in the EU, writes Martin Banks.
The European Parliament’s Special Committee on Beating Cancer is currently working on its own report by way of response to the recommendations contained in the new EU Cancer Plan on prevention.
The EU says Europe needs to stop cancer in its tracks by attacking it at source.
That is why the beginning of 2021 has been marked by a significant milestone: the launch of Europe’s Beating Cancer Plan.
The Cancer Plan is Ursula von der Leyen Commission’s flagship initiative for EU health policy. The European Parliament reciprocated this ambition by setting up a special committee to develop concrete steps to fight cancer.
Key to all this are the measures included in the Cancer Plan’s prevention pillar. The EU says that any potential gaps in terms of prevention must be urgently identified and addressed by actions in terms of legislation.
One measure taken by some Governments across Europe are so-called “sin tax” policies to encourage better choices although some question whether these have actually worked.
Most agree that the success of the Cancer Plan depends on understanding if regulation is working and what more can be done.
The EU Plan was the focus of a special virtual hearing on Wednesday involving MEPs and a range of experts.
A keynote speaker at the online discussion included Deirdre Clune, an EPP member from Ireland and Member of the Committee on the Internal Market and Consumer Protection.
Clune is also a member of parliament’s special beating cancer committee, set up last September which will prepare parliament’s own report and response to the commission cancer plan proposals.
It had hearings last year on lifestyle issues, including tobacco consumption.
She said: “The plan is to cut consumption drastically by 2040 via measures such as taxation, education and plain packaging. The statistics on cancer are stark and these tell their own story but a lot can be done on a practical level, for example, via taxation.
“Yes, we will come up against many pushbacks a lot of the suite of the commission proposals, for example, in cutting down on eating red meat. But the point is that we must focus on preventable cancers.”
Europe’s Beating Cancer Plan seems to propose adopting the sin tax approach, especially for alcohol and diet. Ireland has previously been a driving force with its legislation on this with the Public Health Alcohol Act and now sugar taxes but some argue this seems to have backfired with poorer communities being hit the most.
When asked if she thinks this is the right approach, the MEP said, “A sin tax is always a sensitive issue but education is part of this too. In any case, I am not sure that it is just poorer communities that have been the only ones most affected. But even if you have higher taxes on alcohol you still need to do a lot about thing like low cost selling, for example, the 3 for price of 1 deals which have now been legislated against.
“But it has to be said that all such things at least raise a public awareness around alcohol harm and consumption and serves to maybe stop people in their tracks to think about these things.I accept the jury is still out though (on a sin tax).
She added: “During the crisis there has been more drinking done privately at home and increased taxation can be effective, be it on alcohol or tobacco.”
Tomislav Sokol, an MEP from the EPP and Member of the Committee on the Internal Market and Consumer Protection, said he was “surprised” to learn that up to 40pc of cancers are preventable.
He said: “The biggest problem is tobacco with 27percent of cancer deaths being attributable to tobacco compared to 4 percent due to alcohol.
“This is an enormous amount so this is a top priority for us.
“The European Cancer Plan is the 1st systematic document which tries to cover all this and which also has a strong emphasis on prevention. it is a big step forward.
“The plan is very ambitious, for example, the aim to have less than 1pc tobacco use by 2040.”
The Croatian member said: “But we must have much higher taxation on tobacco and alcohol.This will be the silver bullet. But there will be a big backlash from interest groups in getting everyone on board.
Turning to harm reduction issues, he said alternative tobacco products had “more or less been put in the same basket for increased taxation as cigarettes.
“But this is divisive because the European Commission has taken a generally negative stance towards alternative products.”
He added: “Even so, much of the scientific evidence and the experts does not and do not share such negativity. They say that harm reduction measures can help while the ECJ says there is no certainty about the effects of harm reduction. We must give consumers a real choice but I believe that the plan is a good starting point for these discussions.”
He said the special cancer committee was in process of preparing a report on prevention and a special study on vaping.
German member Michael Gahler, President of the Kangaroo Group which hosted the event, described the cancer plan as “ambitious” but that it was “top health priority”.
The MEP, who moderated the debate, said: “Up to 40% of us are likely to be affected by cancer so this presents a very serious issue. The WHO says 30-40″ of cancers are preventable and there is clear evidence that it can help a lot when people modify their lifestyles. That is why we need to invest in innovations that will help people change their lives and both the public and private sectors need to take joint responsibility here.
“Citizens should be motivated to choose to do regular exercise and avoid substance abuse, be it alcohol or tobacco. This, I believe, is better than,say, introducing a sin tax or just telling people what not to do.
“We should be following a science based approach – that will help us.”
Despina Spanou, Head of Cabinet for commissioner Margaritis Schinas, warned: “This (the cancer plan) is going to be a topic of tensions between governments and the EU but these tensions have eased in recent years because people are more willing to talk about lifestyle changes.But the plan also looks not just at prevention but treatment, diagnose and cancer survivors.
“The ambitious aim is for a tobacco-free Europe and this too will create tensions. There can be many government measures but at the end of the day we need an educated consumer who sees why tobacco consumption is harmful.
“Frankly, tobacco does not makes sense to me: it is an addiction and needs to be fought with a hardline approach. We need to tackle this at its heart: diagnosis and treatment.”
Dr Nuno Sousa, deputy director for the National Programme on Oncological Diseases, Directorate-General for Health in Portugal, said: “Lifestyle changes can promote a significant change in the growth of cancer but this will only become evident in a 5-10 year period. Past and current interventions to control tobacco consumption should be the roadmap for future proposals.
“Taxation is not the only issue and it is important to also explore controlling the marketing of, say, tobacco products. That is the template to be followed. Education is also the key – if we provide the consumer about the pros and cons of different tobacco products we can make a change without the need for increased taxation.”
The Portuguese Tobacco Control Law appears to encourage risk and harm reduction when it comes to smoking and using alternatives when conventional methods do not work. This, though, would seem at odds with the Cancer Plan which looks at regulating vaping (which the UK and France have both said helps with quitting smoking).
The Portuguese plan says that health services, regardless of their legal nature, such as health centers, hospitals, clinics, doctors’ offices and pharmacies, should promote and support information and education for the health of citizens with regard to the harm caused by smoking and the importance of prevention and smoking cessation.
Sousa, in a Q and A session, was asked about Portugal’s response to the Cancer Plan and if it supports the Commission’s approach of sin taxes.
He replied,: “Our approach is going to be in line with the commission recommendation, that is, that there should be no leeway provided for vaping or other forms of tobacco consumption. That is also part of our national tobacco control programme. This also states that tobacco alternatives should not be seen as being any less harmful.”
Another speaker was Thomas Hartung, of the Johns Hopkins University Bloomberg School of Public Health.
Speaking via a link from Baltimore, he was asked about “gaps” in the cancer plan and if there should be more emphasis on harm reduction.
Hartung, who is on leave of absence from the commission, said that comparing the two systems, the EU and US was “interesting”, adding: “I hope the EU plan will also look at what is happening on this in the US and elsewhere.”
He said: “Put simply, people are afraid of chemicals but the good news is that this is starting to change.”
The WHO, he said, says that 40% of cancers are environment caused and tobacco will cause 1 billion early deaths this century. If someone starts smoking at the age of 18 they will live ten years less than those who don’t.
He believes e cigarettes can be a possible “game changer” saying that such products carry only a 3-5% risk of cancer.
“Tobacco is still a risky product but if some, by vaping, can get off cigarette smoking for good as a result that is good.
“A perceived problem is vaping kids although it is better they try e cigs than the real thing. I lost my dad to lung cancer so I am not a fan of any of these products.”
He said flavours of e-cigarettes was “one of the big problems”, not least as there are so many of them – 7,700 different flavours. Another issue is additives, he said: “Therefore we need to test flavours to identify all possible risks.
“There is a strong opportunity with the cancer plan but we need to do it carefully.”