Every year, 3.5 million people in the EU are diagnosed with cancer and 1.3 million die from it. Over 40% of cancer cases are preventable. Without a reversal in these trends, it will become the leading cause of death in the EU, writes Martin Banks.
The European Parliament’s Special Committee on Beating Cancer is currently working on its own report by way of response to the recommendations contained in the new EU Cancer Plan on prevention.
The EU says Europe needs to stop cancer in its tracks by attacking it at source.
That is why the beginning of 2021 has been marked by a significant milestone: the launch of Europe’s Beating Cancer Plan.
The Cancer Plan is Ursula von der Leyen Commission’s flagship initiative for EU health policy. The European Parliament reciprocated this ambition by setting up a special committee to develop concrete steps to fight cancer.
Key to all this are the measures included in the Cancer Plan’s prevention pillar. The EU says that any potential gaps in terms of prevention must be urgently identified and addressed by actions in terms of legislation.
One measure taken by some Governments across Europe are so-called "sin tax" policies to encourage better choices although some question whether these have actually worked.
Most agree that the success of the Cancer Plan depends on understanding if regulation is working and what more can be done.
The EU Plan was the focus of a special virtual hearing on Wednesday involving MEPs and a range of experts.
A keynote speaker at the online discussion included Deirdre Clune, an EPP member from Ireland and Member of the Committee on the Internal Market and Consumer Protection.
Clune is also a member of parliament’s special beating cancer committee, set up last September which will prepare parliament’s own report and response to the commission cancer plan proposals.
It had hearings last year on lifestyle issues, including tobacco consumption.
She said: “The plan is to cut consumption drastically by 2040 via measures such as taxation, education and plain packaging. The statistics on cancer are stark and these tell their own story but a lot can be done on a practical level, for example, via taxation.
“Yes, we will come up against many pushbacks a lot of the suite of the commission proposals, for example, in cutting down on eating red meat. But the point is that we must focus on preventable cancers.”
Europe’s Beating Cancer Plan seems to propose adopting the sin tax approach, especially for alcohol and diet. Ireland has previously been a driving force with its legislation on this with the Public Health Alcohol Act and now sugar taxes but some argue this seems to have backfired with poorer communities being hit the most.
When asked if she thinks this is the right approach, the MEP said, “A sin tax is always a sensitive issue but education is part of this too. In any case, I am not sure that it is just poorer communities that have been the only ones most affected. But even if you have higher taxes on alcohol you still need to do a lot about thing like low cost selling, for example, the 3 for price of 1 deals which have now been legislated against.
“But it has to be said that all such things at least raise a public awareness around alcohol harm and consumption and serves to maybe stop people in their tracks to think about these things.I accept the jury is still out though (on a sin tax).
She added: “During the crisis there has been more drinking done privately at home and increased taxation can be effective, be it on alcohol or tobacco.”
Tomislav Sokol, an MEP from the EPP and Member of the Committee on the Internal Market and Consumer Protection, said he was “surprised” to learn that up to 40pc of cancers are preventable.
He said: “The biggest problem is tobacco with 27percent of cancer deaths being attributable to tobacco compared to 4 percent due to alcohol.
“This is an enormous amount so this is a top priority for us.
“The European Cancer Plan is the 1st systematic document which tries to cover all this and which also has a strong emphasis on prevention. it is a big step forward.
“The plan is very ambitious, for example, the aim to have less than 1pc tobacco use by 2040.”
The Croatian member said: “But we must have much higher taxation on tobacco and alcohol.This will be the silver bullet. But there will be a big backlash from interest groups in getting everyone on board.
Turning to harm reduction issues, he said alternative tobacco products had “more or less been put in the same basket for increased taxation as cigarettes.
“But this is divisive because the European Commission has taken a generally negative stance towards alternative products.”
He added: “Even so, much of the scientific evidence and the experts does not and do not share such negativity. They say that harm reduction measures can help while the ECJ says there is no certainty about the effects of harm reduction. We must give consumers a real choice but I believe that the plan is a good starting point for these discussions.”
He said the special cancer committee was in process of preparing a report on prevention and a special study on vaping.
German member Michael Gahler, President of the Kangaroo Group which hosted the event, described the cancer plan as “ambitious” but that it was “top health priority”.
The MEP, who moderated the debate, said: “Up to 40% of us are likely to be affected by cancer so this presents a very serious issue. The WHO says 30-40" of cancers are preventable and there is clear evidence that it can help a lot when people modify their lifestyles. That is why we need to invest in innovations that will help people change their lives and both the public and private sectors need to take joint responsibility here.
"Citizens should be motivated to choose to do regular exercise and avoid substance abuse, be it alcohol or tobacco. This, I believe, is better than,say, introducing a sin tax or just telling people what not to do.
“We should be following a science based approach - that will help us.”
Despina Spanou, Head of Cabinet for commissioner Margaritis Schinas, warned: “This (the cancer plan) is going to be a topic of tensions between governments and the EU but these tensions have eased in recent years because people are more willing to talk about lifestyle changes.But the plan also looks not just at prevention but treatment, diagnose and cancer survivors.
“The ambitious aim is for a tobacco-free Europe and this too will create tensions. There can be many government measures but at the end of the day we need an educated consumer who sees why tobacco consumption is harmful.
“Frankly, tobacco does not makes sense to me: it is an addiction and needs to be fought with a hardline approach. We need to tackle this at its heart: diagnosis and treatment.”
Dr Nuno Sousa, deputy director for the National Programme on Oncological Diseases, Directorate-General for Health in Portugal, said: “Lifestyle changes can promote a significant change in the growth of cancer but this will only become evident in a 5-10 year period. Past and current interventions to control tobacco consumption should be the roadmap for future proposals.
"Taxation is not the only issue and it is important to also explore controlling the marketing of, say, tobacco products. That is the template to be followed. Education is also the key – if we provide the consumer about the pros and cons of different tobacco products we can make a change without the need for increased taxation."
The Portuguese Tobacco Control Law appears to encourage risk and harm reduction when it comes to smoking and using alternatives when conventional methods do not work. This, though, would seem at odds with the Cancer Plan which looks at regulating vaping (which the UK and France have both said helps with quitting smoking).
The Portuguese plan says that health services, regardless of their legal nature, such as health centers, hospitals, clinics, doctors’ offices and pharmacies, should promote and support information and education for the health of citizens with regard to the harm caused by smoking and the importance of prevention and smoking cessation.
Sousa, in a Q and A session, was asked about Portugal’s response to the Cancer Plan and if it supports the Commission’s approach of sin taxes.
He replied,: “Our approach is going to be in line with the commission recommendation, that is, that there should be no leeway provided for vaping or other forms of tobacco consumption. That is also part of our national tobacco control programme. This also states that tobacco alternatives should not be seen as being any less harmful.”
Another speaker was Thomas Hartung, of the Johns Hopkins University Bloomberg School of Public Health.
Speaking via a link from Baltimore, he was asked about “gaps” in the cancer plan and if there should be more emphasis on harm reduction.
Hartung, who is on leave of absence from the commission, said that comparing the two systems, the EU and US was “interesting”, adding: “I hope the EU plan will also look at what is happening on this in the US and elsewhere.”
He said: “Put simply, people are afraid of chemicals but the good news is that this is starting to change.”
The WHO, he said, says that 40% of cancers are environment caused and tobacco will cause 1 billion early deaths this century. If someone starts smoking at the age of 18 they will live ten years less than those who don’t.
He believes e cigarettes can be a possible “game changer” saying that such products carry only a 3-5% risk of cancer.
“Tobacco is still a risky product but if some, by vaping, can get off cigarette smoking for good as a result that is good.
“A perceived problem is vaping kids although it is better they try e cigs than the real thing. I lost my dad to lung cancer so I am not a fan of any of these products.”
He said flavours of e-cigarettes was “one of the big problems”, not least as there are so many of them - 7,700 different flavours. Another issue is additives, he said: “Therefore we need to test flavours to identify all possible risks.
“There is a strong opportunity with the cancer plan but we need to do it carefully.”
#EAPM - Climate change is one thing, Mr President - changes in cancer treatments are another…
Love them or loath them, politicians from left, right and centre are an essential part of the landscape in every important arena affecting citizens, writes European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan.
Whatever one may make of the recent news that US President Donald Trump no longer believes that climate change is a ‘hoax’, in the wake of scientists issuing a final call to halt rising temperatures, he still says the experts have a ‘political agenda’.
Well, doesn’t everyone? And that includes in the vast arena of healthcare, although all parties are pushing for ways to imbed innovation and personalised medicine into healthcare systems as they all have a stake in making it work.
Each aspect of related regulation may not always suit everyone, but all are agreed that it is necessary, alongside cooperation, if we are to make the best of the fast-moving science for the benefit of patients.
Against this backdrop, many stakeholders in the field of cancer will come together at the ESMO Congress, which this year takes place in Munich (19-23 October). The European Alliance for Personalised Medicine (EAPM) will once again be on board, and the keynote annual oncology conference comes just a few weeks ahead of EAPM’s own event in Milan in late November. (Please see link to programme.)
The two gatherings will happen at a time when health technology assessment (HTA) is filling everyone’s minds. Indeed, last week, EAPM and its associate the Bulgarian Alliance for Precision and Personalised Medicine (BAPPM), held a key event on the future of HTA.
The conference presented and discussed the specifics of HTA in respect of personalised medicine products as well as target therapies, companion diagnostics, and innovative pharmaceutical products for personalised treatment.
Real-world data and date sharing
One of the many important topics set to be discussed by ESMO in Munich will be the use of real-world data to complement the traditional evidence from randomised clinical trials, and EAPM has already moved forward in this regard when scoring an important victory with its MEGA initiative. MEGA stands for Million European Genomes Alliance, and was adopted by 16 countries in a joint declaration in April 2018. It zooms in on the key goal of engaging EU and national policy makers now, in order that they understand and shape the landscape for the successful implementation of genomics and related technologies throughout healthcare.
MEGA constituted a major commitment on behalf of a coalition of willing Member States, alongside the European Commission, to join genomic databanks at an EU level for medical research.
The signatories agreed to work together “towards building a research cohort of at least one million genomes accessible in the EU by 2022”.
But although genome sequencing is starting to be introduced to clinical care, improving diagnosis and care of patients with rare genetic diseases and starting to impact on cancer diagnosis and stratification of therapies, there remain a number of key challenges to ensure genomics and related technologies are applied such that over the next few years we can fully realise the potential of personalised medicine. These will be discussed at ESMO as well as at the EAPM event a few weeks later.
Real-world data promises to substantially increase the effectiveness and efficiency of all processes in the development and utilization of medicines, from research and development, to regulatory decision-making, pricing and reimbursement decisions to use in medical practice.
However, to realize the full potential of real-world data requires a ‘learning healthcare system’, based on electronic health records and other collected healthcare data. This would allow real-world data to be continuously fed into the system,and would complement the traditional evidence from randomised clinical trials.
However, health-care systems must be ready in terms of technology to collect data, using a methodology that analyses information taking into account aspects such as protection of personal data, consent, ethics and data access.
The Nobel Assembly at Karolinska Institutet this month awarded the 2018 Nobel Prize in Physiology or Medicine jointly to James P. Allison and Tasuku Honjo. The award was given “for their discovery of cancer therapy by inhibition of negative immune regulation”.
By stimulating the inherent ability of immune system to attack tumour cells the pair have established a new principle for cancer therapy.
For more than 100 years scientists attempted to engage the immune system in the fight against cancer, but progress into clinical development was modest.
Immune checkpoint therapy has now revolutionized cancer treatment and fundamentally changed the way cancer can be managed. Allison and Honjo have inspired efforts to combine different strategies to release the brakes on the immune system with the aim of eliminating tumour cells even more efficiently.
A large number of checkpoint therapy trials are currently under way against most types of cancer, and new checkpoint proteins are being tested as targets.
Targeted drugs moving house
Targeted drugs for advanced cancer are moving from specialist units to a more-community setting these days. Almost 25% of patients with advanced cancer, treated at Comprehensive Cancer Care Network centres in the United States, are receiving innovative drugs matched to DNA mutations in their tumours.
This achievement will be reported at the ESMO Congress and will show that “cutting-edge precision medicine is spreading from highly specialist cancer units to other healthcare facilities so more patients can benefit, wherever they are treated”, say the event’s organizers.
EAPM is watching matters closely, and will follow up at its own Congress on the many important developments emerging from ESMO 2018 in Germany. One thing is already clear, the climate is certainly changing in cancer treatment.
Serious failure in English #BreastCancerScreening may have shortened lives - minister
As many as 270 lives might have been shortened after errors in the breast cancer screening programme in England meant 450,000 patients were not notified for appointments, Britain’s health minister said on Wednesday (2 May), write Alistair Smout and Michael Holden.
Health Secretary Jeremy Hunt apologized for the “serious failure,” which he said was the result of a mistake in the computer system’s algorithm, and ordered an independent inquiry.
“Our current best estimate which comes with caveats ... is that there may be between 135 and 270 women who had their lives shortened as a result,” he told parliament.
“Tragically there are likely to be some people in this group who would have been alive today if the failure had not happened.”
#WorldCancerDay European cancer groups urged to take action against glyphosate
The Health and Environment Alliance (HEAL) is calling on Europe’s most influential cancer societies to urge governments to put an immediate ban on glyphosate, a chemical used as a herbicide. In a letter sent on World Cancer Day 4 February from HEAL’s President, Dr Peter van den Hazel, he reminds leading national cancer groups that a ban on glyphosate represents a significant opportunity in cancer prevention.
Glyphosate was classified as a 'probable carcinogen' on the basis of currently available data by the World Health’s Organization’s (WHO) International Agency for Research on Cancer (IARC) in March 2015.
Dr Peter van den Hazel says: “Defining glyphosate as a ‘probable carcinogen’ means that scientists have been able to show that glyphosate causes cancer in mammals. Policy makers in Europe and at national level should listen to the expertise of the leading WHO scientists and now urgently reduce exposure to this herbicide. We must assume that if exposure can produce cancer in animals, it can do the same in people.”
Glyphosate is in widespread use in Europe. It is the active ingredient in most herbicides sold for use in the agricultural sector. It is also sold to consumers as a weed killer for private garden use and to public authorities to keep school grounds, hospitals grounds, public parks, pavements and railway lines clear of unwanted vegetation.
Surveys monitoring the body fluids of Europeans suggest exposure to glyphosate is increasing. Germany’s federal environment agency (UBA) recently published the results of its regular testing of glyphosate in the urine of German residents. It showed that whereas only 10 percent of 400 urine samples taken in the survey in 2001 were contaminated with glyphosate, the percentage had increased to just under 60 percent in 2013 and to 40% in 2015. Biomonitoring by Friends of the Earth Europe (FoEE) in 18 European countries in 2013 showed levels varied widely.
Existing national initiatives
Some national cancer societies in Europe have already taken the action that HEAL is promoting. Last year, the French cancer league (la Ligue contre le cancer with a membership of 700,000) issued a statement calling on the French government to ban glyphosate and four other pesticides included in the IARC classification as soon as possible. A few months later, they launched a petition to prevent renewal of the licence for glyphosate by the European Union authorities. It seems their voice was heard as a few months after the first call, the French Environment Minister required French garden centres to stop sales of glyphosate to individuals unless a qualified vendor provides advice.
In the Netherlands, private sales of herbicides containing glyphosate were banned in 2014. German state consumer protection ministries have called for a ban, and some retailers in Germany have voluntarily taken glyphosate products off their shelves. The Danish Working Environment Authority, which is under the Danish Ministry of Employment, has followed the WHO/IARC decision by declaring glyphosate as a carcinogen. This will imply changes in application practices, including recommendations to use alternative, less toxic chemicals.
Genon Jensen, HEAL’s Executive Director says that she believes national cancer societies could be highly effective in bringing about a policy change that would reduce cancer risk. “We are asking influential cancer organisations to encourage their national authorities to ban this probable carcinogen. Now is the time to do it because the EU is reviewing whether to renew the European licence on glyphosate. So alongside taking national action at home, we are asking national governments to oppose the renewal of glyphosate’s authorisation at the EU level. Cancer leadership within the countries are well-placed to be heard and, in this way, can contribute to avoiding unnecessary cancer diagnoses from this exposure in the future.”
HEAL is a signatory to a petition to the EU Commission, the Food Safety and Health Commissioner Vytenis Andriukaitis, and responsible Ministers of the Member States calling on them not to renew the licence for glyphosate.
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