Cancer remains the second leading cause of death in Europe and the overall burden continues to rise across the European Union. In the EU27, estimates for 2022 indicated 1.466 million new cancer cases in men and 1.277 million in women, reflecting an increase of around 13% compared with 2012, largely driven by population ageing and longer life expectancy. Breast, colorectal, prostate and lung cancers each affect more than 300,000 people annually, while lung cancer alone accounts for around a quarter of cancer-related premature deaths before the age of 70. These trends underline the importance of prevention strategies that combine clear public guidance with wider policy measures capable of reducing exposure to known cancer risks and supporting healthier choices across diverse populations.
Cancer Prevention Depends on Health Literacy and Enabling Environments
Evidence shows that a substantial proportion of cancers could be prevented through effective action on established risk factors. Current estimates suggest that around 40–50% of cancers and 44% of cancer deaths are preventable, while meeting international targets for major risk factors could prevent 8% of cancer cases, avert 12% of premature cancer deaths and reduce cancer-related health expenditure by 9% in the EU27. Despite this, awareness of cancer prevention recommendations has remained low in many Member States.
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Health literacy is a key determinant of whether individuals can access and act on prevention information, but behaviour change is shaped by social, economic and commercial factors that extend beyond personal knowledge. Misinformation further undermines confidence in effective prevention measures. Evidence indicates that information alone rarely leads to sustained change, but it can raise awareness and build support for policies that reduce risk at population level. As cancer incidence rises and health systems face increasing strain, prevention approaches that integrate individual behaviour with supportive environments have become increasingly important.
A Revised Code Combines Individual Actions with Policy Support
The European Code Against Cancer is a European Commission initiative that provides evidence-based recommendations tailored to EU populations. Since its first release in 1987, the Code has expanded to address a broad range of behavioural, environmental, occupational and infectious cancer risks, as well as early detection. Europe’s Beating Cancer Plan supported the development of the fifth edition, with the aim of harmonising prevention efforts and reaching at least 80% of the EU27 population by 2025.
A defining feature of the fifth edition is the explicit pairing of individual recommendations with corresponding population-level policy measures. This reflects recognition that prevention is more effective when environments support healthier choices and reduce involuntary exposure to carcinogens. Development followed a transparent, stepwise process involving around 80 experts and four key criteria: strength of scientific evidence and epidemiological relevance, suitability for a broad public audience, clarity for lay communication and alignment with authoritative international policies.
Qualitative research across nine EU Member States identified barriers including limited health literacy, restricted access to preventive services, economic constraints and time pressures. These findings informed both the content of the recommendations and their communication, with the aim of improving reach across socioeconomic groups. The resulting fifth edition includes 14 evidence-based actions for individuals, each linked to policy measures intended to reinforce prevention at scale and promote equity.
Updated Recommendations Reflect Emerging Risks and Evidence
Several recommendations were revised to improve clarity and reflect updated evidence. Tobacco guidance now explicitly addresses smoking cessation and includes vaping products, acknowledging evidence that electronic nicotine delivery systems can promote smoking initiation among young people. The recommendation also reflects the growing use of novel nicotine products, particularly among youth.
Second-hand smoke remains a significant concern, with 23% of people in the EU reporting high indoor exposure in 2023 despite smoke-free legislation. Exposure in homes and cars disproportionately affects children and women and contributes to lung cancer in never and former smokers. Updated guidance therefore emphasises keeping both homes and vehicles smoke free.
Advice on overweight and obesity has been strengthened to reflect its complexity as a chronic condition, affecting over half of adults in the EU27. References to ultra-processed foods and high-calorie products highlight their association with weight gain, while physical activity guidance is supported by evidence linking sedentary behaviour, including prolonged sitting, to cancer risk. Dietary recommendations continue to promote whole grains, vegetables, legumes and fruits, while limiting red meat and avoiding processed meat due to associations with colorectal cancer.
Alcohol guidance has been reinforced in light of evidence that even low levels of consumption increase cancer risk and that reducing or stopping intake lowers the risk of certain cancers. Ultraviolet radiation advice reiterates avoiding excessive sun exposure and never using sunbeds. Indoor radon guidance now provides clearer steps for assessment and mitigation, while occupational risk messaging places greater emphasis on employer responsibility and worker protection.
Air pollution has been introduced as a new stand-alone recommendation, reflecting its classification as a human carcinogen and the widespread exposure of EU citizens to levels exceeding WHO guidelines. Infection-related cancer prevention integrates vaccination, testing and treatment for key pathogens, including expanded human papillomavirus vaccination to boys. Organised screening remains central, with established programmes for colorectal, breast and cervical cancers and the addition of lung cancer screening for high-risk groups using low-dose computed tomography.
Rising cancer incidence in Europe highlights the need for prevention strategies that extend beyond individual responsibility to address the wider conditions shaping exposure and behaviour. The fifth edition of the European Code Against Cancer responds by combining 14 evidence-based individual actions with complementary policy recommendations. By integrating updated scientific evidence with clearer communication and an explicit focus on equity, the revised framework aims to support more effective and sustainable cancer prevention across EU Member States, benefiting individuals, health systems and populations alike.
Source: The Lancet Regional Health – Europe
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