The EU’s Beating Cancer Plan has been heralded as the flagship health initiative and ‘masterplan’ of the European Commission in the fight against cancer, writes Martin Banks.
As the first initiative under this Plan, the Commission has now presented a legislative proposal on occupational safety and health (OSH). The proposed fourth revision of the Carcinogens and Mutagens Directive (CMD) sets new or revised binding occupational exposure limit values for three substances that can cause cancer.
The Commission noted that each year, about 120,000 work-related cancer cases occur because of exposure to carcinogens in the EU, leading to approximately 80,000 fatalities annually, making cancer the cause of half of the deaths linked to work. Estimates showed that more than 1.1 million workers in a wide range of sectors would benefit from improved protection by the proposed changes. With this revision, new or updated limits will have been put on 27 carcinogens since 2014.
The European Trade Union Confederation (ETUC) criticized the EU claiming it has taken no action to limit exposure to 20 more cancer-causing substances, while existing exposure limits for common workplace carcinogens like crystalline silica, diesel emissions and asbestos do not offer sufficient protection and urgently need to be updated. The ETUC has said that its objective is to have binding occupational exposure limits under the CMD for at least 50 priority carcinogens by 2024. It has called for a new coherent and transparent system of setting EU exposure limits based on those of Germany and the Netherlands, noting that up to 12% of all cancer cases are work-related.
However, it welcomed the proposal as a step in the right direction, as it would protect workers particularly in the manufacturing and construction industries. Construction workers will likely be exposed to more insulation products and waste in the coming years, as the European Commission recently stated that the renovation rate in the EU member states must double to reach the 2030 climate target. Today the Commission explained how it wants to achieve this in its Renovation Wave communication.
This begs the question whether workers in the construction sector, from manufacturing to renovation sites and waste management, need additional protection when dealing with mineral wool, a commonly used insulation material. It is manufactured with the carcinogen formaldehyde as binder, which has been on the trade union’s priority list, and was regulated under the CMD in 2019. The EU Regulation on Classification, Labelling and Packaging of substances classifies mineral wool itself in general as a suspected carcinogen. However, certain exemptions apply, and the CMD does not currently protect workers from mineral wool.
A 2009 academic article noted that mineral wool waste shares the properties of the original material. This included “the carcinogenic potential of old mineral wools, secondary components such as binder and lubricant contents”. Earlier this year, Austrian state television ORF called mineral wool waste “as carcinogenic as asbestos”, highlighting problems with its safe management. Experts in the EU institutions are aware of these concerns.
Speaking after an event in the European Parliament, Aurel Laurenţiu Plosceanu from the European Economic and Social Committee, a consultative body of the EU, and the Rapporteur on ‘Working with Hazardous Substances’ said last year: “More needs to be done to make more people aware of the potential dangers of mineral wool. There is a real risk associated with this material and, like asbestos, people need to be made aware of the possible risks.” He called for a range of measures, including an awareness raising campaign, better labelling, more investment in research and safer equipment for people in the construction industry who work with the material. He added: “The particular problem with this material is that any health problems may not actually appear in someone until long after their exposure to it. With something like lung cancer, which, as with asbestos, is a possible health risk associated with this, unfortunately that could be too late."
As with any other ordinary legislative proposal, the European Parliament and the Council will have the opportunity to amend the proposed revision of the CMD before adopting it. The European Commission is expected to adopt the broader Beating Cancer Plan later this year. It remains to be seen whether the EU institutions will also address the concerns surrounding the use of mineral wool.
Lifestyle choices and beating cancer
On 21 October, the Kangaroo Group organized an online debate on Europe’s Beating Cancer Plan, Health Commissioner Stella Kyriakides’ flagship initiative. The webinar, chaired by Michael Gahler MEP, President of the Kangaroo Group, involved a presentation by Professor David Nutt of Imperial College London and featured Deirdre Clune, MEP and Tomislav Sokol, MEP.
The event discussed the potential of harm reduction to help EU citizens make healthier lifestyle choices and how that could help prevent cancer.
The following is a summary of the webinar, from Professor Nutt’s presentation, to the contributions by MEPs Clune and Sokol and the Q&A session.
- Professor David Nutt, Imperial College London
- Deirdre Clune, EPP MEP
- Tomislav Sokol, EPP MEP
- Michael Gahler, EPP MEP
- Michael Gahler introduced the event, saying that 40% of cancers in Europe can be prevented and incentivising European citizens to choose healthier options can go some way towards helping prevent these cancers, such as the ones caused by alcohol and tobacco.
Professor David Nutt
- Professor Nutt presented to the webinar on the principles of harm reduction, particularly in relation to alcohol and tobacco.
- He outlined that preventative measures such as increasing taxation, educating on harms, increasing the age for use of alcohol and tobacco, restricting the locations where they can be bought and the times they can be purchased can all help to reduce the harm caused by alcohol and tobacco.
- He also said that enabling access to safer alternatives such as snus and e-cigarettes for smokers as approaches that can reduce smoking-induced cancers.
- On tobacco, Nutt said: “What causes cancer in smokers, is not the nicotine, but the tar.” He presented an analysis of the level of harms associated with different ways of delivering nicotine showing how very different they were, with cigarettes the most harmful compared with snus and vaping.
- Nutt pointed to Sweden’s experience with snus as an example of how less harmful alternatives to smoking can reduce smoking-induced cancers, saying: “Snus really does reduce cancer.”
- Nutt pointed out that cigarette use in Norway has fallen while consumption of snus has risen, showing that Norwegians are giving up smoking for snus in increasing numbers.
- Nutt also pointed out that: “e-cigarettes are extraordinarily low in carcinogens.” He said that “we can say, almost certainly, that e-cigarettes will reduce mouth and lung cancers compared with smoking.”
- Nutt showed evidence from the USA that tobacco smoking in young people has fallen despite the fact that more are vaping. This, he said, confirms that there is no “gateway effect” from vaping to smoking.
- Nutt said that in heavy drinkers by reducing your alcohol intake by 25 grams a day could be reducing your risk of oral cavity cancer by a third.
- Nutt pointed out that alcohol taxation increases are predicted to reduce the prevalence of alcohol induced cancers.
Deirdre Clune, MEP
- Clune stated that the European Parliament’s Special Committee on Beating Cancer (BECA) recognises that “people have habits, their way of life and their lifestyle,” and that the committee will focus on all areas of cancer, across prevention, early diagnoses, treatment and care
- She stressed that a coordinated approach is needed, with BECA focusing on prevention as a key area as 40% of cancers are preventable.
- Clune pointed out the example of snus in Sweden as something that BECA could “hold on to.” She said that smokers most often start smoking when they’re young, and it is very rare for smokers to take it up later in life.
- Clune said that people need to understand that smoking is an addiction and that safer alternatives can be a way forward. She pointed out that most people associate smoking just with lung cancer, while it in fact causes many others.
- She pointed out a similar fact with alcohol and liver cancer. She recognised that restricting the sale of alcohol can be effective and that the sale of alcohol for young people should be looked at.
- Clune pointed to restrictions on alcohol advertising and particularly restrictions on advertising on television and in sports as having changed changed lifestyle behaviours.
- She said she hopes BECA’s report will be ambitious and recommend action on alcohol and tobacco. She recognises that BECA has a lot to do, and input from experts like Nutt will help them in their work. She stressed that prevention is certainly an area where BECA hope to play a role.
Tomislav Sokol, MEP
- Said Nutt’s presentation was interesting, in terms of the evidence presented. Sokol said that decisions need to be made strictly on the available evidence and that something that is lacking. He pointed out that conversations with academics and researchers is extremely important to the Parliament.
- Sokol referenced the previous court ruling in Europe on snus. He said that often, the European courts rely on impact assessments made by the Commission, as the courts themselves are not equipped in these areas to decide by themselves.
- Sokol stressed the importance of harmonised rules across the EU and said evidence must be fed into the Commission.
- Sokol pointed out that people can often decide for themselves on healthy lifestyle choices, but they need to get the most information possible to do so, and said this is one area where the EU can play an important role.
- He said he hopes that BECA’s report that will be sent to the Commission will be ambitious and evidence based.
Beating cancer: Better protection of workers against cancer-causing chemicals
Europe’s Beating #Cancer Plan
Europe’s Beating Cancer Plan will form a core part of Health Commissioner Stella Kyriakiades’ term in office. A pan-European strategy to combat cancer is long overdue and we welcome Commissioner Kyriakiades’ initiative in tackling what is the second leading cause of death in Europe, write Dr Delon Human and Dr Anders Milton.
On 10 September, the Commission held a town hall on the Beating Cancer Plan. Unfortunately, this town hall did not fill us with hope - it seems that the Commission may be about to miss out on the chance of a lifetime and fail to sufficiently tackle preventable cancers in Europe.
Not only did the town hall fail to pay heed to the most obvious preventable cause of cancer in smoking, it seemed to disregard the opinion of EU citizens. Of the submissions to the Plan’s public consultation, nearly 20% supported the adoption of harm reduction plans for alcohol and tobacco. One in every six recommended policies which encourage the use of reduced risk nicotine products by smokers, such as e-cigarettes.
As stated at the launch of the consultation by the Commission, 3.5 million people in the EU are diagnosed with cancer annually, and 1.3 million die from it, yet over 40% of cancer cases are preventable.
The WHO estimates that one in every two smokers will develop a tobacco-related disease with 700,000 Europeans dying from smoking every year. 90% of lung cancers alone can be prevented by eliminating tobacco use in Europe.
What is often forgotten, however, is that smokers consume cigarettes for nicotine but get cancer from the tobacco, tar and thousands of other additives in cigarettes. Nicotine itself is not a carcinogen. This raises the question; what if there was a way to offer smokers the nicotine they desire while removing carcinogens?
Tobacco harm reduction presents the clear and obvious answer to this question. The use of alternative, potentially reduced risk products, like e-cigarettes, could eliminate smoking induced cancer in Europe within a generation.
A study of the results of the 2014 Eurobarometer survey by several European academics emphasised this point. The study found that the vast majority of EU citizens consuming e-cigarettes on a regular basis were former smokers or smokers attempting to quit.
Countries like Sweden have shown a way forward for Europe to reduce tobacco-induced cancers through the adoption of science-based approaches to reduce smoking prevalence and smoking-related deaths. Sweden offers tobacco alternatives like snus and this has helped them to achieve the lowest tobacco-related mortality rate of all EU countries relative to its population size.
In an attempt to mitigate the devastating effects of the pandemic, which has so far taken the lives of almost 200,000 Europeans, EU institutions and member state governments immediately turned to science and evidence to inform policy. Lockdowns, social distancing and working from home have all become normalised as part of the effort to overcome COVID-19.
This sense of pragmatism and efficiency must be mirrored by the Commission’s Beating Cancer Plan.
Harm reduction policy, particularly tobacco harm reduction, has extraordinary potential to reduce avoidable smoking induced cancers. It can save the lives of countless Europeans. We are calling on the Commission to recognize this potential, to hear the voices of European citizens, and leave no stone unturned in the fight to beat cancer.
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