Annals of Oncology

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Annals of Oncology 14:973-1005, 2003
© 2003 European Society for Medical Oncology

Original Paper

European Code Against Cancer and scientific justification: third version (2003)

P. Boyle^1,+, P. Autier², H. Bartelink³, J. Baselga⁴, P. Boffetta⁵, J. Burn⁶, H. J. G. Burns⁷, L. Christensen⁸, L. Denis⁹, M. Dicato¹⁰, V. Diehl¹¹, R. Doll¹², S. Franceschi¹³, C. R. Gillis¹⁴, N. Gray¹⁵, L. Griciute¹⁶, A. Hackshaw¹⁷, M. Kasler¹⁸, M. Kogevinas¹⁹, S. Kvinnsland²⁰, C. La Vecchia²¹, F. Levi²², J. G. McVie²³, P. Maisonneuve²⁴, J. M. Martin-Moreno²⁵, J. Newton Bishop²⁶, F. Oleari²⁷, P. Perrin²⁸, M. Quinn²⁹, M. Richards³⁰, U. Ringborg³¹, C. Scully³², E. Siracka³³, H. Storm³⁴, M. Tubiana³⁵, T. Tursz³⁶, U. Veronesi³⁷, N. Wald³⁸, W. Weber³⁹, D. G. Zaridze⁴⁰, W. Zatonski⁴¹ and H. zur Hausen⁴²

¹ Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy; ² Centre for Research on Epidemiology and Health Information Systems (CRESIS), Centre de Recherche Public de la Santé, Luxembourg; ³ Professor and Chairman, Radiotherapy Department, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Huis, Amsterdam, The Netherlands; ⁴ Medical Oncology Service, Vall d"Hebron University Hospital, Vall d"Hebron, Barcelona, Spain; ⁵ Chief, Unit of Environmental Cancer Epidemiology, International Agency for Research on Cancer, Lyon, France; ⁶ Cancer Family Network, CancerResearchUK, University of Newcastle, Newcastle, UK; ⁷ Chief Administrative Medical Officer, Greater Glasgow Health Board, Glasgow, UK; ⁸ President, The Association of European Cancer Leagues, Oslo, Norway; ⁹ Oncology Centre Antwerp, Antwerp, Belgium; ¹⁰ Hematology-Oncology, Centre Hospitalier, Luxembourg; ¹¹ Med. Klinic 1, Universitat zu Koln, Koln, Germany; ¹² Clinical Trial Service Unit, Cancer Research UK Cancer Studies Unit, Radcliffe Infirmary, Oxford, UK; ¹³ Chief, Field and Intervention Studies Unit, IARC, Lyon, France; ¹⁴ Scientific Coordinator, Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy; ¹⁵ Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy; ¹⁶ Lithuanian Oncology Center, Vilnius, Lithuania; ¹⁷ Deputy Director, Cancer Research UK & UCL Cancer Trials Centre, Stephenson House, London, UK; ¹⁸ Director, National Institute of Oncology, Budapest, Hungary; ¹⁹ Department of Epidemiology and Public Health, Institut Municipal d’Investigacio Mèdica (IMIM), Barcelona, Spain; ²⁰ Department of Oncology, Haukaland Hospital, Bergen, Norway; ²¹ Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy; ²² Director, Registre Vaudois des Tumeurs, Institut Universitaire de Médecine Sociale et Préventive, Lausanne, Switzerland; ²³ Scientific Coordinator, Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy; ²⁴ Unit of Clinical Epidemiology, Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy; ²⁵ Director-General of Public Health, Ministerio de Sanidad y Consumo, Madrid, Spain; ²⁶ Genetic Epidemiology Division, Cancer Research UK, St James’s University Hospital, Leeds, UK; ²⁷ Ministero della Sanita’, Roma, Italy; ²⁸ Chairman, Department of Urology, Hopital de l’Antiquaille, Lyon, France; ²⁹ Director, National Cancer Intelligence Centre, Office for National Statistics, B6/02, 1 Drummond Gate, London, UK; ³⁰ National Cancer Director, St Thomas’ Hospital, London, UK; ³¹ Department of Oncology, Radiumhemmet, Karolinska Hospital, Stockholm; ³² Dean and Director of Studies and Research, Eastman Dental Institute for Oral Health Care Sciences and International Centres for Excellence in Dentistry, University of London, Eastman Dental Institute, London, UK; ³³ President, Liga proti rakovine SR, Bratislava, Slovakia; ³⁴ Danish Cancer Society, Director Cancer Prevention and Documentation, Copenhagen, Denmark; ³⁵ President du Centre Antoine Beclere, Centre Antoine Beclere, Faculte’ de Medicine, Paris, France; ³⁶ Director, Institut Gustave Roussy, Villejuif, France; ³⁷ Scientific Director, European Institute of Oncology, Milan, Italy; ³⁸ The Medical College of St Bartholomew’s Hospital, Wolfson Institute of Preventive Medicine, Department of Epidemiology, London, UK; ³⁹ Schweizerische Krebsliga, Berne, Switzerland; ⁴⁰ Director, Institute of Carcinogenesis, Deputy Director, Cancer Research Centre RAMS, Moscow, Russian Federation; ⁴¹ Department of Cancer Epidemiology and Prevention, The Marie-Sklodowska Memorial, Cancer Center and Institute of Oncology, Warsaw, Poland; ⁴² Director, German Cancer Research Center (DKFZ), Heidelberg, Germany

Received 28 April 2003; accepted 7 May 2003

The first 150 words of the full text of this article appear below.

	Introduction

 
Since the previous version of the European Code Against Cancer was created [1], the European Union has expanded its number of Member States and next year (in 2004) will see a further and dramatic expansion as 10 new Member States join (Cyprus, Czech Republic, Hungary, Estonia, Malta, Latvia, Lithuania, Poland, Slovenia and Slovakia). Additionally, it is currently anticipated that Bulgaria and Romania will be admitted in 2007 followed at a later date by Turkey. These expansions enlarge the Union to incorporate a greater diversity of peoples with a much larger degree of heterogeneity present in lifestyle habits and disease risk than previously present. The contrast between the Mediterranean countries, the Nordic countries and those countries of Central and Eastern Europe is considerable. In view of the accession of new States, an important aspect of the revision of this Code was to take into consideration the specific situation in . . . [Full Text of this Article]

European Union cancer burden
Cancer control

	Many aspects of general health can be improved, and many cancer deaths prevented, if we adopt healthier lifestyles

 

	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.

 
Obesity
Physical activity

	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 or 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 cancer-causing substances. Follow all health and safety instructions on substances which may cause cancer. Follow advice of national radiation protection offices.

 
Ionising and non-ionising radiation

	There are public health programmes that could prevent cancers developing or increase the probability that a cancer may be cured

 

	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.

 

	Additional items considered

 
Chemoprevention
Exogenous hormones
Screening for other forms of cancer

	Genetics

 

	Cancer mortality trends

 

	Future directions

 

	Acknowledgements

 

	Suggested reading

 
Introduction
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 or 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 cancer-causing substances. Follow all health and safety instructions on substances which may cause cancer. Follow advice of national radiation protection offices.
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 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
Additional items considered

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