European Code Against Cancer. 12 Ways to Reduce Your Cancer Risk

There are an estimated 2.64 million new cancer cases and 1.28 million cancer-related deaths every year in the European Union. In Spain, there were an estimated 128 550 new cases of cancer among men and 86 984 among women in 2012 The number of cancer-related deaths in the same year was 63 579 for men and 29 183 for women. These figures make cancer the leading cause of years of life lost (35% of the total), followed by cardiovascular diseases and then accidents. The European Code Against Cancer addresses all European citizens with a powerful message: We know enough to prevent cancer!

In Spain, the most common malignancies among men are prostate, lung and colon cancer and among women are breast and lung cancer. The frequency of many cancers has changed considerably over the years. For example, lung cancer and breast cancer are much more common today than 50 years ago, while stomach cancer has become much less common. External factors play a major role in most cancers, and this changing panorama is a result of radical changes in recent decades in the risks we are exposed to and in living conditions.

Last October, the International Agency for Research on Cancer (IARC) published the fourth edition of the European Code Against Cancer. The code consists of a series of recommendations focused on actions that individuals can take to reduce their risk of cancer by avoiding or reducing exposure to carcinogenic agents, adopting a healthy lifestyle and taking part in organised cancer screening programmes.

The following are the 12 recommended actions:
1. Do not smoke or use any form of tobacco.
2. Avoid passive smoking.
3. Maintain a healthy body weight.
4. Be physically active.
5. Eat a healthy diet.
6. Limit alcohol intake.
7. Avoid excessive exposure to sun and ultraviolet radiation.
8. Avoid cancer-causing substances in the workplace.
9. Reduce exposure to high radon levels.
10. Favour breastfeeding and limit the use of hormone replacement therapy.
11. Vaccinate newborn babies against hepatitis B and girls against human papilloma virus.
12. Take part in organised cancer screening programs for bowel, breast and cervical cancer.

This code is the result of a collaborative effort involving a large group of European researchers. I had the opportunity to participate in both the work of drafting the text and in developing the recommendations relating to environmental and work-related exposures. CREAL, an ISGlobal allied centre, is well known in Europe for its work in the field of environmental health. We have been involved in many WHO/IARC expert committees and have contributed key evidence on the relationship between cancer and environmental risk factors, including air and water pollutants and occupational exposure to carcinogenic agents.

It is not by chance that "do not smoke" is the first recommendation on the list; it is the MOST important of all Can we do anything to prevent cancer? We can do a great deal! If we translated everything currently known about the causes of cancer into preventive action, we could avoid at least 50% of all cases. With this aim in view, the WHO has developed a set of recommendations on the actions individuals should undertake to limit their risk of cancer. All of these recommendations are important, but some are more important than others. It is not by chance that "do not smoke" is the first recommendation on the list; it is the MOST important of all.

However, it should also be said that cancer is a stochastic process; in other words, it also has a random component. Everyone has had an uncle or a grandmother who “smoked every day for 70 years” or “drank five glasses of wine and three brandies every day for 80 years” and never had cancer. Good for them! However, the probability that a person will develop lung cancer or many other types of cancer is at least 10 to 20 times greater in smokers than in non-smokers. That is the important statistic to keep in mind, both for ourselves as individuals and also for the population as a whole. Therefore, if you follow these recommendations, you may not necessarily escape cancer, but you will greatly reduce your potential risk. And if we all followed these recommendations, cancer would be much less common in our society.

The WHO code recommends specific actions that everyone can take to reduce their risk of cancer. However, there are many risk factors that are outside the control of the individual. Air pollution, for instance, is a significant cause of lung cancer; a person who lives in Barcelona or Madrid has a higher risk than someone living elsewhere, and there is nothing they can do about that. Social class is another example of an external risk factor; for example, cancers affecting the stomach or cervix are more common among lower income groups and breast cancer is more common among more affluent women. But people cannot choose whether to be born into a rich or a poor neighbourhood! The place where we live and the type of work we do also depend on our social class. This means that many actions that could reduce cancer risk have to be implemented at the community level.

Finally, although the WHO/IARC recommendations refer to individual actions, it is important to make the point that our personal decisions are never taken in a vacuum. The fact that Spanish people eat a healthier diet than Germans is a product of cultural and socio-economic factors. And an individual’s decision to take up or give up smoking is highly dependent on what is happening around them in their immediate environment. So yes, while the European code is important in terms of individual action, there are many other factors that we do not control ourselves. The important message is that every one of us can and should do something to limit the consequences of this terrible disease. The European Code Against Cancer addresses all European citizens with a powerful message: We know enough to prevent cancer!

More information

European Code Against Cancer

[This text was originally published in Spanish in La Vanguardia]