EPHA welcomes ECAC5 as it moves cancer prevention beyond personal choice and into the political arena

After more than a decade, the European Code Against Cancer has been updated, a development arriving at a critical moment. Cancer remains a leading cause of premature death in Europe, and preventable risk factors continue to permeate daily life. The 5th edition of the European Code Against Cancer (ECAC5) represents a significant shift in both the framing and potential action surrounding cancer prevention.

A New Focus on Shared Responsibility

The European Public Health Alliance (EPHA) has welcomed ECAC5, praising not only the updated scientific evidence informing cancer prevention strategies, but also its explicit recognition that preventing cancer is a shared responsibility – encompassing societal, political, and individual actions. For the first time, the Code directly addresses policy-makers, acknowledging that individual choices are influenced by policy decisions, commercial influences, and environmental factors.

Did You Know? Previous editions of the Code primarily focused on individual actions to reduce cancer risk.

From Individual Advice to Policy Expectations

While ECAC5 retains the foundational advice for individuals, expanding recommendations from 12 to 14 and strengthening guidance on established risk factors, it also introduces a crucial new element. The updated Code includes a parallel set of recommendations specifically for policy-makers. These recommendations emphasize that effective prevention relies on structural conditions – including regulation, financial measures, public investment, and protection from harmful commercial practices – marking a departure from relying solely on awareness and behavior change.

The updated recommendations address current risk factors, explicitly referencing vaping and emerging nicotine products. They reinforce the need to avoid alcohol entirely, strengthen guidance on diet, obesity, and ultra-processed foods, expand HPV vaccination to all genders, and include lung cancer screening alongside existing programmes. Renewed attention is also given to environmental factors like radon, sun exposure, occupational carcinogens, and, newly, air pollution – a leading risk factor for cancer.

Aligning Cancer Prevention with Broader Health Goals

ECAC5’s strength lies in its alignment with the prevention of other noncommunicable diseases. The Code targets shared risk factors – tobacco and nicotine use, alcohol consumption, unhealthy diets, physical inactivity, and environmental exposures – that contribute to cancer, cardiovascular diseases, respiratory illnesses, and metabolic disorders. This integrated approach could maximize health gains and optimize the use of public resources.

Expert Insight: By explicitly linking cancer prevention to broader public health initiatives, ECAC5 acknowledges the interconnectedness of health challenges and the potential for synergistic benefits from coordinated policy responses.

The Code complements existing commitments from the EU and the World Health Organization (WHO) regarding noncommunicable disease prevention and health promotion, including WHO’s “best buys” and “quick buys” for prevention, and the EU’s new Safe Hearts Plan.

Policy Recommendations as a Key Breakthrough

From EPHA’s perspective, the policy recommendations are the most significant aspect of ECAC5. They translate scientific consensus into clear expectations for governments: to regulate harmful products, limit aggressive marketing, ensure clean air and safe workplaces, invest in vaccination and screening, and design systems that support health. The Code also addresses equity and integrity, acknowledging that cancer risk is socially patterned and that prevention policies must reduce, not exacerbate, health inequalities. It also highlights the need to protect public health policy from commercial interference, particularly in areas like tobacco, alcohol, and ultra-processed foods.

This shift moves cancer prevention from a matter of individual morality to one of public accountability, asserting that preventing cancer is a political priority, not simply a personal choice.

The Role of Civil Society and Implementation

EPHA contributed to the development of ECAC5, with its Director General participating in the expert work coordinated by the International Agency for Research on Cancer (IARC). This underscores the importance of independent public health and civil society voices in shaping evidence-based prevention guidance. The European Cancer League echoes the call for ECAC5 to be used as a practical policy tool, with its value measured by concrete action at EU, national, and local levels.

Frequently Asked Questions

What is the primary shift in focus with ECAC5?

ECAC5 marks a shift from solely focusing on individual behavior change to recognising cancer prevention as a shared societal and political responsibility, with specific recommendations for policy-makers.

What new risk factors are explicitly addressed in ECAC5?

ECAC5 explicitly addresses vaping and emerging nicotine products, reinforces the message to avoid alcohol entirely, strengthens guidance on diet, obesity, and ultra-processed foods, expands HPV vaccination to all genders, and includes lung cancer screening, as well as environmental factors like air pollution.

How does ECAC5 relate to other public health initiatives?

ECAC5 aligns with the prevention of other noncommunicable diseases and complements existing commitments from the EU and WHO regarding NCD prevention and health promotion.

How will governments balance the need for effective cancer prevention measures with potential economic or political considerations?