EU has a potential Marshall Plan for Oncology and must not let it fail

Hailed as ambitious and holistic, Europe's new plan for beating cancer has met with applause from cancer organisations and civil society. Now, as the pandemic is taking a heavy toll on cancer detection and care, the plan needs to be urgently and properly implemented. So much is at stake – without decisive action, Europe may face a cancer tsunami, with the disease projected to become the leading cause of mortality in just under 15 years.

Thanks to its all-encompassing and innovative approach to cancer prevention, treatment and post-care, the Europe's Beating Cancer Plan is a tremendous opportunity to turn the tide against a disease which only last year took some 1.3 million European lives, making it the second biggest killer after cardiovascular conditions.

The fact that Europeans make up 10% of the world population but account for one quarter of all cancer patients worldwide, with over 2.6 million newly diagnosed each year, makes the case for proper and speedy implementation of the plan.

The new cancer plan took centre stage at the hearing held by the European Economic and Social Committee (EESC), which analysed its strengths and weaknesses.

Taking the floor were representatives of the European institutions, cancer organisations and social partners, whose contributions will feed into an opinion the EESC is preparing on the topic, due to be adopted in June.

Although the new plan is not perfect – fine-tuning and some improvements are considered necessary – participants at the hearing unanimously praised its ambition and potential. They stressed the crucial importance of implementation, which will require cooperation and commitment from all Member States, as well as engagement at all levels.

The EESC applauds the Europe's Beating Cancer Plan as an important step in the fight against the growing problem of cancer incidence. A definite advantage of the Plan, which deserves recognition, is its multifaceted and innovative approach to tackling this disease, said the rapporteur for the EESC's upcoming opinion, Małgorzata Bogusz.

In her view, potentially disastrous consequences of the coronavirus pandemic, which threaten to turn cancer into Europe's deadliest disease by 2035, make the need for an effective cancer plan greater than ever: Massive delays in cancer diagnosis and treatment reduce the chances of recovery. It is therefore necessary to effectively address the Covid-induced disturbances in order to prevent a cancer tsunami. In this context, the plan appears to be nothing short of salvation.



Unveiled by the European Commission in February, the new plan is the first comprehensive strategic document in 30 years that sets the course for the battle against cancer at EU level. The plan places emphasis on research, state-of-the art technologies and equal access to the best possible care for all Europeans, regardless of their geographical location or socio-economic status.

It rests on four key action areas: prevention; early detection; diagnosis and treatment; and quality-of-life of cancer patients and survivors. It is backed by 10 flagship initiatives and multiple supporting actions, for which the EU has earmarked EUR 4 billion, channelled through various EU programmes, such as EU4Health or Horizon Europe.

Presenting the plan at the hearing, the Commission's Stefan Schreck said the plan reflected a political commitment to leave no stone unturned in the campaign against cancer. Although health is primarily a national competence, the Cancer Plan will complement and support efforts of the Member States and those working in the cancer sector.

For example, one of its flagship initiatives is the elimination of cancers caused by human papillomavirus infections, which should be achieved by vaccinating 90% of girls, as well as a large portion of boys, in all Member States by 2030. Awareness-raising about harmful excessive alcohol consumption and achieving a tobacco-free Europe is also planned.

Another flagship initiative, the new EU cancer screening scheme, should ensure that by 2025 90% of the target population across the EU is offered breast, cervical and colorectal screening.

An EU Network of National Comprehensive Cancer Centres in every EU country should enable better cross-border collaboration, reducing current inequalities between Member States in access to care and medicines. Such disparities should be detected and eliminated through another initiative, a Cancer Inequalities Registry, which would compile data on country-specific situations.

This Plan may represent a new starting point to benefit the Member States. The fight against cancer requires bold action from all countries, said Isabel Fernandes from Portugal's Health Ministry, adding that it was essential to take countries' different starting-points into account.



However, participants saw the prospect of unequal implementation of the plan in different Member States and regions as especially worrisome.

In the EESC's view, the reliance of the plan on modern screening and treatment technologies raises hopes, but also concerns about regional infrastructure disparities. The general and non-binding nature of the Plan does not guarantee a more effective and regionalised response to the increasing incidence of cancer. The roadmap should include detailed implementation milestones, performance indicators and realistic timeframes.

There is a striking difference between countries. Today you may not even notice when you physically cross a border inside the EU, but your survival may depend on which side of the border you are. Equitable access to treatment, preventive measures and care are something we, as European citizens, should all be deeply concerned about, said Bettina Ryll of Melanoma Patient Network Europe (MPNE).

It is vital to guarantee equal access to all groups in society, regardless of their social and economic status or vulnerability.

The long-term sustainability of the plan is also a concern, with some issues, such as investment priorities at EU and national level, still not being defined, said Ms Fernandes.

Participants agreed that implementation would require efforts from all parts of society in a bottom-up approach to achieve joint ownership of the plan.

There must be close cooperation between the EU and the Member States, but also between the Commission and entrepreneurs, employers' organisations and trade unions. We just have to make it work, stressed Mario Van Mierlo of SMEunited.



When it comes to cancer exposure at work, the new plan is not ambitious enough, which is quite disappointing, according to the speakers from the European Trade Union Confederation (ETUC) and the European Trade Union Institute (ETUI).

With more than 100 000 occupational deaths per year, or 10% of all annual cancer deaths, there should be a special flagship initiative for that, said ETUC's Per Hilmersson. No one should be placed at risk of cancer when at work. The EU should be bolder in making this a priority. Zero work-related cancer is a political goal that the EU and its Member States should include in the plan.

To that end, more substances, agents or risk factors should be recognised as cancer-inducing, such as asbestos or solar radiation for outdoor workers, for example those employed in the construction sector or agriculture. The role of night work in the occurrence of certain cancers, such as breast cancer, should be explored.

My key message is that these cancers are preventable. The EU should strengthen support for existing research in this area, ETUI's Marian Schaapman said.

Elke Schneider from the European Agency for Safety and Health at Work (OSHA) said that cancer registers should contain information on patients' workplaces to see how these have contributed to every cancer case. OSHA is currently conducting a telephone survey in six countries, which should give an overview of possible exposure to 24 cancer risk factors at work in a broad variety of jobs.

Ms Schneider also said that return-to-work strategies for cancer survivors were limited, and there was a need for better workplace solutions.

Mr Van Mierlo warned that the burden for adapting workplaces and methods should not be placed exclusively on SMEs and companies, but that a joint solution should be found to help them.

Matti Aapro from the European Cancer Organisation objected to the lack of survivorship goals, such as that of doubling survival for poor-prognosis tumours like pancreatic and lung cancer.

There’s a general feeling in the cancer community that the Survivorship and Quality of Life pillar could have been stronger, with firmer commitments provided on achieving the right to be forgotten in all EU countries, Mr Aapro said. Without such a right, cancer survivors may be, for example, denied access to insurance and financial loans.

Antonella Cardone from the European Cancer Patient Coalition (ECPC) agreed and said such a right should be recognised in all the Member States. Some solutions to facilitate cancer patients' and cancer survivors' access to financial services had been considered, but the Commission had failed to promote a legal framework that is coherent and consistent with consumer rights in the EU Treaties. The ECPC would also like to see the creation of a specific reference network addressing cancer-related complications and comorbidities, as there was a lack of connected knowledge on the matter.

Throwing his full support behind the plan, Pekka Pesonen of Copa Cogeca warned against the vilification of products which are proved not to be cancer-inducing if consumed in moderate amounts, when they can even be beneficial to health, such as wine. Let's not stigmatise products enshrined in the European DNA. Let's attack their harmful and excessive consumption. It would be wrong to stop promoting wine!

Concluding the event, Ms Bogusz stressed that the EU could not afford to neglect the fight against cancer. A failure to act will create a snowball effect, leading to the accumulation of problems that could get out of hand in no time. The EU needs a new Marshall Plan for Oncology. The Europe's Beating Cancer Plan is a step in the right direction. We must not waste this potential.

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