Cancer: Working together to spread the word, ‘Cancer is
preventable!’
Wendy Yared,a Kevin O’Hagan,b Sabrina Paladini,c Pavel Poc,d Alojz Peterle,d,e Matic Meglič, f Tina Lipušček f, Ana Šinkovec f
Main messages
• The Association of European Cancer Leagues, in collaboration with many different stakeholders including policymakers and the private sector, relaunched the European Week Against Cancer and renewed dissemination of the European Code Against Cancer.
• Engaging policymakers has been important to give visibility to cancer prevention activities. This was done at the European level via the Members of the European Parliament roundtables and at the national level with European Week Against Cancer official conferences.
• Using social media and offering attractive prizes as incentives have been effective ways to encourage young people to reflect on cancer prevention.
• The implementation of these health promotion and prevention activities was possible thanks to the coordinated support and resources of partner leagues and organisations. Only through continued investments in health promotion and cancer prevention research can governments and society curb the rising costs associated with preventable cancers.
a Association of European Cancer Leagues; Brussels, Belgium; b Irish Cancer Society; Dublin, Ireland; c Italian Cancer League; Rome, Italy; d Member of the European Parliament (MEP); Brussels, Belgium; e MEPs Against Cancer (MAC);
Brussels, Belgium; f National Institute of Public Health of the Republic of Slovenia; Ljubljana, Slovenia
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The panorama of cancer prevention in Europe
The opportunities for cancer prevention at a European level hold much promise, with great potential to make a positive impact on individuals and communities across the continent, as illustrated in the past by the success of the Europe Against Cancer Programme in the 1980s and 90s. One of the goals of EPAAC has been to revive that energy, creating the momentum to continue this important public health mission long after the formal conclusion of this Joint Action. To do so, the Association of European Cancer Leagues (ECL) was charged with leading EPAAC’s work on Health Promotion and Prevention, offering a fresh look at the challenges and the possibilities to raise awareness and change behaviours so that collectively, we can prevent cancer in our populations.
Current challenges for cancer prevention and health promotion Despite the existing evidence and knowledge available to help prevent cancer, a number of challenges hinder effective action, including lack of information and awareness among the general public, inadequate funding for public health programmes, limited evidence to inform policymaking, interference from private industry, and insufficient collaboration among stakeholders.
The first challenge is the misinformation surrounding cancer, evident by the quantity of misleading or erroneous sources found on the internet. Studies conducted by the European Society for Medical Oncology (ESMO) presented in 2012 indicate a need to tackle these kinds of myths, such as the belief that more than 50% of cancers are genetic and unavoidable (1). Some cancer control organisations have taken steps to tackle this problem by alerting the public of misconceptions, with organisational web pages devoted specifically to exposing the myths about cancer (2,3). The Union for International Cancer Control (UICC) dedicated the 2013 World Cancer Day theme to dispelling misconceptions about cancer under the tagline, ‘Cancer – did you know?’ (4) However, getting the right information to the public is still a challenge.
Funding is also a major issue. Although the European Commission’s Citizens’
Summary for EPAAC highlighted that ‘prevention is the most cost-effective, long-term cancer strategy’ (5), and the World Health Organization holds that preventing chronic diseases is ‘a vital investment’ (6), prevention is still grossly underfunded, constituting only 2–9% of total funding for cancer research (7).
Correcting this problem is not as straightforward as simply allocating more resources. European cancer societies, key funders of cancer research, have ascribed the lack of funding in this area to the lack of proposals submitted (personal communications with cancer society CEOs 2011–2014). This gap
37 Rejuvenating the European Week Against Cancer
may be partly due to the tradition of cancer research, which tends to have a short-term focus, with research grants extending less than five years. This perspective does not accommodate prevention efforts, which may take decades to yield results (8).
Another challenge to the development of effective health promotion policy is the limited evidence available in some areas, for example in the use of taxation or bans to curb obesity. France has imposed a tax on sugary drinks (9), with some early evidence to support the measure’s effectiveness (10), but aggressive lobbying stalled similar efforts in New York City (11). In Denmark (the first country to implement a tax on foods with saturated fat), taxes were abolished after just one year. Strong opposition from the food industry cited the loss of Danish business and a negative impact on manufacturing jobs, and these claims could only be countered with preliminary evidence from the field of public health to defend the measures (12,13). By extrapolating conclusions from the long public health fight against tobacco, we can surmise that tax levers will eventually prove an effective contribution to a larger and more comprehensive effort to curb obesity (14), but until then, powerful pressure by vested interests will continue to cloud the debate.
Even when evidence strongly supports public health policy, there is a risk of interference by industry, for example in the areas of tobacco control and – to a lesser degree – sunbed standardisation. In Europe, the tobacco industry has most recently been directing its efforts to derail the revision of the EU Tobacco Products Directive, lobbying strongly against larger warnings, standardised packaging, and other measures. In an attempt to delay the process of this Directive, the tobacco industry flooded the EU with 85,000 responses to the consultation round (15), the highest number of responses for any Directive in EU history. On a lower scale, the indoor tanning industry actively influenced the previous EU Joint Action on Sunbeds led by the Product Safety Enforcement Forum of Europe (Prosafe) (16), while an industry representative also holds the Chair of the technical committee of the European Committee for Standardisation for sunbeds (CEN/TC 412 ‘Indoor sun exposure services’) (17).
However, it should be noted that although industry interference in public health matters is a fact in some cases, this is by no means universally true. There are countless examples of responsible corporate actions to promote health (in EPAAC1 and elsewhere), which are above reproach in practice and in intent.
Even as health advocates try to remove the influence of commercial interests in health policy, we must not exclude industry as a partner in the long term.
1 Three industry partners have participated in EPAAC’s actions on health promotion and prevention, donating unrestricted financial support to help offset the implementation cost of being in the Partnership; see ECL website for details.
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Finally, it is worth noting the need for increased collaboration. In general, cancer organisations work on their own rather than in collaboration with others.
Even the UICC, a network of cancer control organisations and individuals, provides themes for World Cancer Day to guide members but usually does not collaborate with them jointly on actions. Rather, the Union makes templates and other downloadable resources available on their site for use, and members then provide information back to UICC on how the event was acknowledged in their countries (4).
The EPAAC approach, then, which pivots on collaboration with a wide range of partners across the EU, represents real innovation. Collaborating to achieve common goals eliminates duplication of efforts and costs, and bolsters complementary aims pursued by partners. In this Partnership, ECL has helped to disseminate research and policy findings by OECD and World Cancer Research Fund (WCRF) during its European Week Against Cancer conferences by organising scientific seminars alongside its Official Conferences; by inviting speakers from WCRF and OECD to present at its Official Conferences; and by sharing links and information from these organisations before, during and after the European Week Against Cancer via social media. Involving a range of diverse stakeholders has also allowed us to tap into the broad well of expertise and knowledge available in Europe. Having partners from different organisations, areas of interest, and geographic locations, we believe, increases the likelihood that our actions and information will be accepted and disseminated.
Protecting our future generations through cancer prevention Studies have concluded that between 33% and 50% of cancers are preventable through behavioural changes alone (18–19). Children and young people are at special risk. Despite advances in medical technology, children today may have a lower life expectancy than their parents due to the obesity epidemic and its associated health risks (20). In part, this is due to the so-called ‘obesogenic environments’ in which they are raised and the contagious nature of social choices such as eating or exercise (21). The National Cancer Institute (USA) attributes as many as 30% of major cancers in the United States to behavioural factors aside from tobacco use, specifically poor diet, physical inactivity and their manifestation in the form of obesity (22).
Since 2007, the European Commission has promoted actions to enhance physical activity levels and promote healthier diets, as set out in the Strategy for Europe on nutrition, overweight and obesity-related health issues (23). Children are among the priority groups. In line with this strategy, one of our major focuses within EPAAC has been to reach out to future generations as part of our strategy to empower individuals to take action to prevent cancer.
39 Rejuvenating the European Week Against Cancer
Spreading the message of cancer prevention: EPAAC activities
The European Week Against Cancer
The original European Week Against Cancer was an annual health promotion campaign widely celebrated in the second week of October. Organised under the Europe Against Cancer programme’s first Action Plan 1987–1989, the Week was managed and partly funded by the Commission in collaboration with European cancer control organisations. Cyprus, the Czech Republic, Slovakia and Slovenia were especially active in planning and implementing the first edition, having organised the Week in their own countries even before funding was made available by the European Commission.
In 1999, ECL was charged with planning and organising the Week through its member leagues because they had been coordinating it at a national level since its inception in 1989. Each year, the Week centred around a specific theme, such as tobacco, nutrition, occupational safety and screening. However, celebration of the Week stopped in 2002, as national leagues lost interest in supporting a mandated theme, specific funding from the Commission ceased, and the ECL Secretariat was transformed, moving from Patagonia to Belgium and hiring new staff, resulting in a loss of continuity.
Reviving the Week through EPAAC
On numerous occasions, discussions between the European Commission and European cancer leagues have discussed the idea of reviving the European Week Against Cancer. The Commission also felt that one of main fruits of the previous Europe Against Cancer programme, the European Code Against Cancer had not been given enough visibility and use. Much effort, collaboration between esteemed cancer experts, and funding had led to the development and revision of the Code, yet it was no longer being disseminated at the European level.
Thus, as the ECL Board and partners discussed the revitalisation of the Week during EPAAC, communicating the European Code Against Cancer emerged as an important aim. Based on feedback from cancer leagues, it was agreed that no specific theme should be aligned with the Week in order to avoid interfering with the actions of the national leagues.
Engaging partner organisations
The European Partnership Action Against Cancer, as the name implies, hinges on actions carried out in partnership with others. This is especially important
40 Boosting Innovation and Cooperation in European Cancer Control
for prevention, since resources are more limited than in other areas, and specific challenges exist which cannot be overcome by isolated measures. At the start of EPAAC, a handful of organisations, mostly regular collaborators of ECL, were approached to join the project. ECL was active from the start in disseminating information related to EPAAC via its monthly newsletter, website, and briefs to other organisations at international meetings. As the word spread, new organisations approached ECL to join its cancer prevention efforts.
European Week Against Cancer 2011 to 2013
In order to relaunch the European Week Against Cancer, the European Cancer Leagues organised Official Conferences for the Week within EPAAC from 2011 to 2013, encouraging countries and other organisations to plan events during 25–31 May each year around cancer prevention messages from the European Code Against Cancer.
The 2011 Official Conference for the revived European Week Against Cancer took place in the EU institutions in Brussels, a location chosen to give international visibility to EPAAC and to the relaunch of the Week. The President of the European Council, Mr Herman Van Rompuy, opened the ceremonies.
The themes for the first day of the Conference were those in the European Code Against Cancer, targeting policymakers and the NGO community. The conference on the second day focused on the scientific evidence on the messages of the Code, targeting a more academic audience. The organisation of the 2011 European Week Against Cancer Conference was only possible due to positive cooperation with EPAAC Collaborating Partners, specifically with EUREGHA (European Regional and Local Health Authorities), and with guidance from the Belgian Cancer Centre.
Rome was chosen for the Official Conference in 2012 to coincide with the EPAAC Open Forum. Jointly organised and funded by the Italian Ministry of Health and the Italian Cancer League, the event provided a good opportunity to convene stakeholders from the Italian national health system to work together on the programme of the Week. The League focused its efforts on Healthy Lifestyles to show support for the prevention activities in its regional chapters, while the Ministry of Health provided the venue for the Official Conference, as well as for the EPAAC Open Forum a few weeks later. While the 2011 Official Conference drew media attention due mainly to the participation of President Van Rompuy, the 2012 Official Conference in Rome had wide media coverage (24,25) due to keynotes from Italian celebrities, including the Vice President of the International Olympic Committee Mario Pescante, volleyball star and cancer survivor Giacomo Sintini, and fashion designers Carla Fendi
41 Rejuvenating the European Week Against Cancer
and Lavinia Biagiotti. Actress Sophia Loren also sent a letter of support, which was presented in the Welcome Session.
In recognition of its EU Presidency and the 50th anniversary of the Irish Cancer Society, Ireland was chosen as the site of the 2013 Official Conference, with themes around Healthy Lifestyles and Tobacco Control. The Irish Cancer Society organised the event, which also served as an important platform in advancing the work and announcing the intention of the Irish Cancer Society to develop its activities in the area of health promotion as part of the Irish Cancer Society’s new Strategy Statement 2013–2017, Towards a future without cancer (26). Reducing the risk of cancer is one of four goals in the strategy, which commits the society to developing policies and programmes to make people aware that they can reduce their risk of developing some forms of cancer through healthy lifestyles choices.
In order to reach out and engage policymakers and practitioners, it was essential that the conference address current relevant issues. Therefore particular consideration was given to the public health policy context and the advocacy work going on in Ireland and Europe. The Dublin Conference gained much media attention thanks to the Minister for Health James Reilly, a consistent advocate for tobacco control measures. He made the key announcement that Ireland would introduce standard packaging on the eve of the Conference kick-off and ahead of World No Tobacco Day. The announcement generated considerable international media interest, since this measure would make Ireland the first European country to introduce standard packaging.
Smart flash mobs for prevention awareness
Combining elements from the popular ‘flash mob’ and ‘smart mob’
phenomena2 crystallised during the first Advisory Council meeting of partners as an innovative idea which could engage children and young adults on the subject of cancer prevention. The result was a choreographed, pre-rehearsed dance meant to gain the attention of the general public and inform them of cancer prevention activities during the European Week Against Cancer. Printed information on the European Code Against Cancer was disseminated after the performance, while videos were posted onto YouTube for dissemination through social media outlets.
The first flash mob for the European Week Against Cancer was made up of dancers from the European School of Brussels and took place in 2011 at a public
2 The online Oxford dictionary defines a flash mob as ‘a public gathering of complete strangers, organised via the Internet or mobile phone, who perform a pointless act and then disperse again’ (oxforddictionaries.com). ‘Smart mobs’ are a closely related concept, defined as a gathering of people with specific similarities for a reason all consider as important, but which does not necessarily involve dancing (27).
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square in Brussels (Place de l’Albertine). The second flash mob, coordinated by the same school, took place on the Spanish Steps in Rome, the venue of the Official 2012 Conference at the Italian Ministry of Health. The second flash mob was much more successful in reaching our goals of engaging youth and the general public, taking place in a very densely populated part of the city and drawing from the lessons learned in 2011 (Box 2.1). There were also more views and distribution of the 2012 flash mob video on social media; this may have been due to the momentum set in place by actions of the previous year.
Youth Competition
The idea of organising a youth competition came in the second year of the project. The view was that the limited involvement by schools and countries in the flash mob activity of the first year could be improved dramatically.
It was unclear whether the flash mob of the first year achieved its goal to reach young people, so partners were consulted to improve youth outreach. The most accepted suggestions included the organisation of contests for young people and the production of content for social media with catchy videos and photos on YouTube and Facebook. Combining these two ideas by organising a competition for young people to create prevention materials in the form of
Box 2.1 Steps to planning a smart flash mob
1. Find a group of enthusiastic young people committed to helping you with your message. It is helpful but not necessary that they can dance – they will learn!
2. Recruit a choreographer to put the dance movements together and to choose music for the dance.
3. Upload videos of the choreography with music, and disseminate the link for dancers to practise before the event day.
4. Get permission from the authorities to use the space for your event. A flash mob should appear spontaneous, but you don’t want the dancers dragged away by the police before it starts. If you will be using copyrighted music, permission may need
4. Get permission from the authorities to use the space for your event. A flash mob should appear spontaneous, but you don’t want the dancers dragged away by the police before it starts. If you will be using copyrighted music, permission may need