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The need for a progressive discussion on the future of European cancer prevention policy

Ernst Stetter / Mar 2022

Stella Kyriakides, European Commissioner for Health and Food Safety. Photo: European Union, 2022

 

The battle against cancer, including equal access to healthcare, is still a very important societal challenge The European Union is right to address it. As such, the Europe’s Beating Cancer Plan is one of the key pillars of the future envisaged European Health Union. It aims to provide better cancer care and bring about structural improvements across the EU.

On February 16th, 2022 the European Parliament adopted the report on Strengthening Europe in the fight against cancer. This report was the result of the 18 months term of a dedicated European Parliament’s Special Committee on Beating Cancer. With this report, the European Parliament responded to the European Commission’s Europe’s Beating Cancer Plan, as the EU strategy to combat this disease presented already February 2021.

Based on four pillars: (1) prevention; (2) early detection; (3) diagnosis and treatment; and (4) quality of life of cancer patients and survivors, the report by the European Parliament contains a broad range of initiatives including facilitating access to cross-border health care and clinical trials for cancer patients, extending the use of joint procurement procedures, managing shortages of cancer medicines, guaranteeing the “Right to be Forgotten” as well as ensuring equal access to innovative cancer drugs and treatments. However, in the weeks leading up to the vote, the debate in Brussels was completely overshadowed by the topic of prevention. Most prominently, on vaccination and life-style consumption such as alcohol, tobacco and hazardous substances.

Definitely, the COVID-19 pandemic has shown the need to better protect and, above all, prevent diseases. This also applies particularly to cancer, as about 40% of cancer cases are preventable. To prevent cancer in the first place, the European Commission advocates a holistic approach, ranging from education to closer cooperation and new legislation. It also includes specific targets, such as for the elimination of cancers caused by human papillomavirus, with a goal of vaccinating at least 90% of the EU target population of girls by 2030 and significantly increasing vaccination coverage among boys.

The European Parliament underlined in its report the importance of such a holistic and horizontal approach. A majority of the European Parliament also called for this holistic approach, but wanted more differentiation. This differentiation laid bare the fundamental question of how to approach public health. More precisely, the discussions in the European Parliaments’ Special Committee on Beating Cancer and — unusually for a non-legislative report — also in plenary showed a split among parliamentarians on key elements of this issue. The plenary debate was dominated by the discussion how toxic products should be treated, for example if there is a non-harmful level of alcohol, or if there are acceptable levels of toxins, and in particular are some tobacco products more harmful than others.

The debate and the vote have shown that the European Parliament as a whole has chosen the path of differentiation, while the Socialists and Democrats preferred their public health centred approach as the scientific evidence is clear: a safe level of alcohol does not exist, tobacco causes cancer, alternatives are not safe either, and toxins at the workplace are a threat to workers across Europe. Thereby the Socialists & Democrats took a public health approach first.

The conservatives mostly focused on the implications – in particular – of lifestyle choices. This approach became especially clear with regard to alcohol, which generated publicity in the days preceding the final vote. The debate was overshadowed by implications for the industry and jobs and, above all, on culture. The argument was that the so-called Mediterranean diet – including wine – is a way of life and under certain circumstances can be even healthy. Here a cleavage between wine and spirits emerged.

Another area highly debated was the issue of tobacco. The parliamentarians were overwhelmingly in support on stronger measures against tobacco and called for new legislation in this area including higher taxes. The discussions in this area were focused on alternative products such as electronic cigarettes, tobacco heating products and the question of how to treat such products. Are they treated like traditional tobacco products ignoring the evidence provided by some studies that indicate that they are a less risky alternative to classic cigarettes or should these alternatives be embraced in order to reduce the number of smokers? Regrettably, increasing taxes will likely not be enough to achieve this target and further questions need to be asked in exploring new solutions that may not be a perfect or risk free solution but create fewer health risks and promote significantly reduction in smoker-related cancer. Hence such questioning could acknowledge potential benefits as well as respecting the precautionary principle.

For this reason, harm reducing policy solutions should be taken more into consideration as they improve without any doubt individual and general public health. Unfortunately this was not discussed further. Such policies are complementary in the early cancer detection and prevention. They have proven already their efficiency.

These fundamental questions need to be further addressed. The intensive negotiations made clear, that the Europe’s Beating Cancer Plan and the Report of the European Parliament are not the end but the new beginning of the fight against cancer. The next steps should be to shape a comprehensive strategy including the concerns of the progressives and with a definition of tangible and measurable goals as well as specific actions that ensure that the defined goals are reached.

Ernst  Stetter

Ernst Stetter

March 2022

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