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Opinion of the European Economic and Social Committee on the ‘Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions on Action Against Cancer: European Partnership’

On 24 June 2009 the European Commission decided to consult the European Economic and Social Committee, under Article 262 of the Treaty establishing the European Community, on the

Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions on Action Against Cancer: European Partnership

The Section for Employment, Social Affairs and Citizenship, which was responsible for preparing the Committee's work on the subject, adopted its opinion on 10 November 2009. The rapporteur was Ms Kössler.

At its 458th plenary session, held on 16 and 17 December 2009 (meeting of 16 December 2009), the European Economic and Social Committee adopted the following opinion by 176 votes to and one abstention.

1.1 The EESC welcomes the Commission's initiative for a European Partnership for Action against Cancer. Cancer takes an enormous toll on individuals and European society and is the sickness which claims the highest number of victims. After circulatory diseases, cancer was the second most common cause of death in 2006, accounting for two out of ten deaths in women and three out of ten deaths in men. Approximately 3,2 million EU citizens are diagnosed with cancer each year (1).

The EESC highlights the importance of joint EU action, based on information sharing and exchange of expertise and best practice, in helping Member States in their fight against cancer.

1.2.1 The EESC stresses that there are unacceptable differences between Member States in terms of cancer incidence and mortality and supports the objective for all Member States to have integrated cancer plans by the end of the Partnership.

1.2.2 The EESC agrees with the Commission that integrated cancer strategies need to be built on clear objectives which provide a driving force for implementation and make it possible to assess whether the intended effects have been achieved.

1.2.3 The EESC agrees that preventive measures are of great importance and can improve well-being and contribute to healthier and longer life for people in the future.

1.2.4 The EESC considers the Partnership in the period up to 2013 to be an important further step in the process which began in 2003 (2) and recognises the need to continue the Partnership in some form or another after that date, given that several targets have a longer time horizon (2020).

1.2.5 The EESC would emphasise the importance of a healthy lifestyle and believes that the Partnership has an important role to play in convincing national leaders and bodies active in the public health sector to do more in the Member States.

1.2.6 The EESC would stress that the Partnership is in line with Article 152 of the Treaty on public health, which provides that Community action shall be directed towards improving public health.

1.2.7 The EESC is committed to supporting the Partnership and wishes to make an active contribution by working through its contacts with civil society at local and national level.

1.2.8 The EESC would stress the importance of using the Structural Funds that are earmarked for training and infrastructure in the health sector but notes that these funds are not utilised sufficiently in the Member States.

2.1 The EESC would again point out that cancer affects many individuals and their friends and family. It is a major health and social problem and the single most important cause of death among working age people.

2.2 The high number of cancer cases therefore also has many important socio-economic implications in the Member States.

2.3 As the number of cancer cases is expected to increase, this will have further adverse consequences.

2.4 Effective prevention can prevent nearly one third of all cancer cases and through early detection a further third can be treated successfully and often even cured.

2.5 The four most common forms of cancer in the EU are breast cancer, colorectal cancer, lung cancer and prostate cancer.

2.6 The types of cancer which cause the most deaths in the EU-27 are, in order of mortality rates, as follows: lung cancer, colorectal cancer, breast cancer, prostate cancer and stomach cancer (1).

2.7 The number of incidences of and deaths from all these five types of cancer can be reduced by adopting a healthier lifestyle.

2.8 Lung cancer is the form of cancer which causes the most deaths in the EU. Nearly a fifth of all cancer deaths in 2006 were due to lung cancer and the majority of them were caused by smoking. Around 335 000 people die each year from lung cancer in Europe (1).

3.1 The European Commission proposal on European Partnership for Action Against Cancer for the period 2009-2013 is meant to support the Member States in creating integrated cancer plans, which should reduce the burden of cancer in the EU with the target of a 15 % reduction by 2020 (510 000 new cases).

Objective: improved implementation of the Council recommendation on Screening and promotion of large scale information campaigns on cancer screening, directed at the general public and health-care providers.

Objective: to tackle inequalities in cancer mortality by reducing the disparity between the best and worst performing Member States.

Objective: achieving coordination of one third of research from all funding sources by 2013.

4.1 The EESC believes that a horizontal approach is necessary to curb the increasing burden of cancer throughout the European Union.

4.2 Cancer is caused by many factors but can be prevented in some cases. Prevention should therefore address lifestyle, occupational and environmental causes.

4.3 Prevention work should be guided by the principle of Health in All Policies (HIAP) and the Partnership can be strengthened through the mainstreaming of health policy in other fields, such as the environment and agriculture, both at national and EU level, in line with the EU health strategy.

4.4 The EESC believes that it is especially important to focus prevention on lifestyle patterns which increase the risk of getting cancer. In particular, it is important to make the young generation aware that a healthy lifestyle reduces the risk of contracting cancer. Such knowledge among young people, who in due course will become parents, can have a major impact on their children and future generations.

4.5 Knowledge is now available on the factors which increase the risk of contracting cancer. By far the biggest risk factor is smoking.

4.6 Other risk factors are obesity, physical inactivity, excessive sunbathing and high alcohol consumption.

4.7 Countless numbers of people die as a result of tobacco use, obesity, low intake of fruit and vegetables and high exposure to sunlight.

4.8 The EESC believes that it is important for the Partnership to focus on prevention and control.

4.9 The EESC welcomes the proposal to set overarching targets for prevention and screening and therefore highlights the importance of defining indicators to monitor achievement of the targets in the Member States.

4.10 Prevention and early detection (screening) are crucial for successful treatment and recovery.

4.11 The EESC recalls that the EU recommended the use of graphic warning pictures on cigarette packets as from 2001. As it is, only three Member States use them. More Member States should introduce them. Graphic warning pictures are also an effective way of influencing children and even make an impression on those who do not yet know how to read.

4.12 The EESC would draw attention to the importance of taking measures to counter second-hand smoking.

4.13 The EESC believes that it is important to improve the lifestyle of young people by introducing lifestyle training in school systems in the Member States for the early provision and dissemination of information on how to live longer. Information on the risks of smoking, unhealthy eating habits, low fruit intake and the dangers of sunlight should be provided early in life. At least 2 to 3 hours of physical education a week should be introduced in primary and secondary schools in the Member States. Physical activity and an interest in outdoor life and sport can help to reduce overweight in adult life as well.

4.14 The EESC would point out the important role which researchers, public health workers, patient organisations, economists, teachers, healthcare professionals, supervisory authorities, politicians, other decision-makers and civil society have to play in ensuring that the Partnership's goals are given practical effect in Member States.

4.15 The EESC would highlight the importance of patient organisations at European level and the key role they can play for the Partnership. Similarly, other voluntary organisations and networks can play a major role in spreading the message on how to prevent getting cancer and the importance of early detection. The Committee would also draw attention to the role the media can play in raising awareness of a healthy lifestyle and early detection and in improving prevention efforts.

4.16 The EESC would underline that effective prevention efforts can save life 20-30 years in the future and that they bring economic benefits in that the cost of preventive measures is considerably lower than cancer treatment.

4.17 The EESC would emphasise the importance of finding indicators for monitoring primary prevention over time. In order to measure primary prevention efforts in the Member States over time it is proposed that Member States, at regular intervals, measure the number of 15-year olds who smoke and similarly use some indicator of overweight (e.g. the BMI). Prenatal care across the Member States might be one area where overweight among women can be monitored whilst trends over time among men might possibly be monitored in connection with military recruitment.

4.18 The EESC would stress that screening represents an investment for better health and a way for individuals to avoid contracting the sickness.

4.19 The EESC believes that it is important to be able to evaluate the screening programmes that are introduced.

4.20 The EESC agrees that the proposed screening programmes should cover as much of the population as possible in the cases of breast, cervical and colorectal cancer, in accordance with the Council Recommendation on cancer screening by 2013. Explicit goals were already set in 2003 but were never achieved.

4.21 The EESC agrees that Member States should increase their efforts to fully implement the Council Recommendation on cancer screening by 2013. The EESC would welcome seeing all Member States have reasonable, step-by-step goals for working in this direction.

4.22 The EESC believes that it is important to target information and support to vulnerable groups so that they also become aware of the benefits of taking part in screening. It is also important to point out the stress and strain that anxiety about cancer can cause.

4.23 The EESC hopes that any future screening programmes that may be recommended at EU level are based on evidence. It further hopes that the EU recommends the age ranges to be covered in connection with the introduction of programmes by Member States. Having common age ranges and intervals for calls for screening in all Member States would reduce disparities in results and would also benefit research.

4.24 The EESC endorses the idea of a voluntary European pilot accreditation scheme.

5.1 The EESC supports the aim to tackle inequalities in cancer mortality by reducing disparities between Member States.

5.2 The EESC would emphasise that it is important that all the Member States start compiling statistics and establish cancer registries so that this goal can be achieved. Open and accurate comparisons are fundamental in this regard. A minimum requirement for achieving this goal is that each Member State has or establishes a population register, arrangements for registering new cancer cases and a cause of death register. In this way accurate data can be obtained on incidence, prevalence, survival and mortality. The EESC recommends that at a later stage hospital registers also be linked to these arrangements, thus making the strategies more comparable and enabling treatments to be compared.

5.3 The EESC agrees on the need for identification of obstacles in collection of data and recommends that targeted action be taken so that Member States which do not have registries can quickly introduce them.

5.4 The EESC agrees on the importance of collection of data on the cost of cancer to society. This would be beneficial for this issue and reveal the extent of the problem for society.

5.5 The EESC agrees with the proposal to conduct a survey to gauge European opinion on cancer data registration. Here the experience of the Nordic Member States can be cited as good examples.

5.6 The EESC agrees that cancer has many contributory causes, including lifestyle, working conditions and environmental factors, and that prevention work should therefore be conducted on a broad front.

5.7 The EESC would particularly stress the importance of preventive work in the tobacco field. In many Member States, above all the most recent ones, the incidence of smoking is high. Often smoking levels are highest among the most vulnerable socio-economic groups. Even passive smoking is associated with health risks and attention should be drawn to this.

5.8 Like the Commission, the EESC believes that the exchange of knowledge between countries could be improved substantially and that it is important to improve research infrastructures.

5.9 The EESC welcomes the proposal to strengthen public access to information on cancer research and clinical trials in particular.

5.10 Like the Commission, the EESC would highlight the importance of a comprehensive European research initiative on prevention issues, for example lifestyle research, which has been neglected to date and is an important and strategic area for research efforts, in line with the Partnership's aims. There is also a need for research to shed light on the risks of side-effects and subsequent medical errors as well as for research on psycho-social issues.

5.11 The EESC would emphasise the importance of competition in research and believes that it is mainly at the infrastructure level where cooperation in research in general can be improved. The Committee welcomes the initiatives involving shared biobanks, easier exchange of material, exchange of knowledge and clinical studies where material produced by individual Member States is not enough or where things can be taken forward more quickly if many countries work together (European multi-centre studies).

5.12 The EESC would welcome the establishment of an authority to evaluate research and scientific practice from a European perspective. An independent organisation along these lines should be able to evaluate and review the overall body of evidence for a particular medical field in Europe; in other words, compare the research carried out in that area using pre-established criteria for good research.

5.13 The EESC would be pleased if this organisation could, in particular, identify areas where there is a pressing need for strategic EU-wide research projects on cancer but where there are no commercial interests.

5.14 Objective: to ensure accurate and comparable data on cancer necessary for policy and action.

5.15 Like the Commission, the EESC emphasises the importance of comparable data and the need for cancer registries in the Member States.

5.16 The EESC would also point out the need to develop comparable and assessable indicators. A first step would be for all Member States to establish cancer registries and report registry data to a single designated authority. The IARC (International Agency for Research on Cancer) and the UICC (International Union Against Cancer) might be appropriate bodies – both of them operate et European level.

5.17 The EESC believes that open benchmarking has a key role to play in identifying and transferring best practice.

5.18 Comparable data and extensive exchange of such data are also of major importance for research.

5.19 The EESC would point out that all areas of the healthcare supply chain (treatment, rehabilitation and palliative care) are important in reducing the burden of cancer illnesses and the suffering to which cancer victims and their friends and family are exposed. The EESC hopes that, as an initial step, the focus is put on primary prevention and secondary prevention (screening) so that cancer can be detected and treatment begun as soon as possible.

5.20 The EESC believes that it is important that all parts of the healthcare supply chain (treatment, rehabilitation and palliative care) and primary and secondary prevention be included in the integrated national cancer plans.

Brussels, 16 December 2009.

The President of the European Economic and Social Committee

Mario SEPI