Europe’s eye is fixed on mighty things

D. Kerr

This issue of Annals of Oncology sees the publication of the third version of the European Code Against Cancer [1], together with its scientific justification. A product of the Europe Against Cancer program of the European Commission, the Code is a series of recommendations that, if followed, could lead in many instances to reductions in cancer incidence and reductions in cancer mortality. Reducing the constantly growing mountain of public health information on this subject into a set of recommendations that can fit into a leaflet or onto a poster has itself been an ambitious task. The authors are to be commended for that alone, but we should also notice that in making 11 recommendations they have been led by evidence and science and not by any desire to make commandments to be set in stone.

As cancer professionals, we can also learn much about the state of the art from what has been omitted from the Code and why. We should consider carefully their remarks on current data on, amongst other things, chemoprevention, hormone replacement therapy and PSA screening. The authors are also careful to signal developments in our understanding of cancer genetics and to highlight the potential of developing technologies. The Code is not set in stone, and we may reasonably expect that further versions will be developed as evidence in support of new recommendations emerges.

Fundamental to our understanding of, and planning for, the future is our insight into mortality trends across Europe. These are considered in the Code document and, more extensively, in an accompanying article by Quinn et al. [2]. These authors examine projected trends in age-specific and age-standardized cancer mortality rates and numbers of cancer deaths up to 2020 for all cancers and various specific sites. In considering Europe they include not only the existing 15 EU countries, but also the 10 acceding countries, Bulgaria and Romania (currently applicant countries, along with Turkey), and Iceland, Norway and Switzerland of the four EEA countries. The general result from this is that, in most countries, the age standardized rates are predicted to decrease. The demographic shift towards an ageing European population, however, means that, as a best estimate, there will be ~1.25 million cancer deaths in 2015, 135 000 (12%) more than in 2000.

Clearly, we must think big if we are to affect how this prediction is translated into European reality; big in terms of our view of Europe and big in terms of what we can do to reshape the possible outcome. The Code itself, despite its limited number of points, is a big statement of how to affect the future. How Europe has worked against cancer to shape our current reality will be considered shortly in a forthcoming article in Annals of Oncology [3]. The authors of that article contend that the Europe Against Cancer program appears to have been associated with the avoidance of some 92 573 cancer deaths in the year 2000.

My non-European colleagues will forgive me, I hope, for my talking here, and at such length, about Europe. How we, as cancer professionals, can work to achieve public health goals at the trans-national level is something that I believe concerns us all. The current population of the 25 countries considered by Quinn et al. is ~450 million. The European Commission is to be commended for its vision in founding the Europe Against Cancer program back in 1987, and for its continued support of public health initiatives at the pan-European level. As these articles make clear, there is much to be done and much to be learned. But by working together, using science to inform our decisions, and considering the needs of all Europeans, we have the possibility to shape our future for the better.

Editor-in-Chief

D. KerrDepartment of Clinical Pharmacology, University of Oxford, Oxford, UK

References

1. Boyle P, Autier P, Bartelink H et al. European Code Against Cancer and scientific justification: third version (2003). Ann Oncol 2003; 14: 973–1005.[Free Full Text]

2. Quinn MJ, d’Onofrio A, Møller B et al. Cancer mortality trends in the EU and acceding countries up to 2015. Ann Oncol 2003; 14: 1148–1152.[Abstract/Free Full Text]

3. Boyle P, d’Onofrio A, Maisonneuve P et al. Measuring progress against cancer in Europe: has the 15% decline targeted for 2000 come about? Ann Oncol 2003; 14: In press.