Update of the recommendation on cancer screening: ECDA position

ECDA fully supports the update of the 2003 guidance, which should allow to improve the early detection of cancer and potential complications across Europe; and support implementation of screening guidelines and cost-effective and evidence-based solutions for early diagnosis.

Improvements in cancer screening and diagnosis are critical to effectively enhance cancer management and survival in Europe; and prevent or address early-on cancer co-morbidities as well as cancer-related complications, which present a significant challenge.

Extension of screening to other types of cancer

The update of the recommendations and extension of screening to other types of cancer should be based on new, solid scientific evidence and good practice screening policies in Europe. The 2020 WHO report on cancer provides related guidance. ECDA supports the extension of screening notably to liver, lung and gastric cancer.

  • Liver cancer is the sixth-most common cancer and the third-most frequent cause of cancer-related death globally. Detection of liver cancer at an early stage could reduce mortality to a maximum of 5 years of life lost relative to the general population. Chronic liver diseases caused by viral hepatitis, alcohol or fatty liver disease are the most important risk factors for developing liver cancer. Extending the Recommendation to liver cancer for high-risk population groups living with chronic liver diseases makes sense and is endorsed by all clinical stakeholders. These patients are identifiable, have a high risk of liver cancer, and can be offered curative treatment if their liver cancer is diagnosed early. Furthermore, liver cancer detection tools are easily available and affordable.
  • Concerning lung cancer, there is compelling international scientific evidence demonstrating that Low Dose Computed Tomography (LDCT) for lung cancer screening is effective, beneficial and feasible. More specifically, evidence shows that national screening programs using LDCT in asymptomatic high-risk Europeans could detect cancer at an early stage when treatment is most likely to be successful. Such screening programmes would save lives and improve the survival and quality of life of Europeans. In addition, LDCT for lung cancer screening satisfies all the criteria on the introduction of screening set out in point 6 of the current Council recommendations on cancer screening and is in accord with the WHO principles of early disease detection.
  • As for gastric cancer, although rates are lower in Europe and tend to decline, around 136,000 Europeans are diagnosed with gastric cancer every year. Approximately 90% of all gastric cancers are related to H. pylori infection. According to latest studies around 40% reduction in mortality is achieved by eradicating H. pylori among healthy individuals. Well-designed H.pylori screen and treat implementation strategies should be recommended with thorough monitoring and outcome data collection. Population-based screening for H. pylori does not seem appropriate for all European countries. However, it should be considered in the countries with higher incidence of gastric cancer and in all other countries in the individuals considered at increased risk for gastric cancer.

Improving participation in screening

The initiative should help improve the participation to screening programmes. Harmonisation of protocols and research on finding the most appropriate target populations would be very beneficial.

Taking a bold vision on cancer screening

Further, other major chronic diseases can be risk factors for certain types of cancer, or enhance disease progression. The interactions between cancer and other chronic diseases require to establish protocols for the screening and management of complications on the long term, as these may occur only after several years in patients. The earlier detection and state-of-the-art management of other major chronic diseases that cause cancer should be integral to strategies to detect and control cancer.

ECDA's response to the public consultation on the update of the cancer screening recommendations is available here.

 


Joint call to MEPs to protect the strength of the BECA report during plenary vote

On the occasion of World Cancer Day and ahead of the plenary vote on the report developed by the BECA committee expected on 15 February, eleven European health organisations call on MEPs to adopt the report with no weakening of its recommendations on cancer prevention

In a joint letter initiated by ECDA, the organisations express again their continued support to the report of the special committee on “Strengthening Europe in the fight against cancer” and ask MEPs to adopt it without compromising its content.

It is of long-term importance that the report maintain its level of ambition and strong language, in particular when it comes to the main, well-known and preventable risk factors of cancer and other major chronic diseases.

Every year in Europe, millions of deaths and lost years of "healthy" life are attributable to alcohol consumption, tobacco use, poor nutrition, lack of physical activity and air pollution, responsible for cancer and other major chronic diseases. There is no safe level of alcohol consumption, exposure to tobacco, nor to poor air quality. It is our shared duty to put in place all measures to ensure that our current and future generations are protected from the dramatic impact of these modifiable risk factors, which present a considerable health and economic challenge; and underlie health inequalities.

One of the key learnings of the COVID-19 pandemic is that it is high time to efficiently promote and protect public health; and put Europeans’ health and wellbeing first and above commercial interests.

Health is a fundamental right embedded in the EU treaties, specifically in article 168 of the Treaty on the Functioning of the European Union, and a collective responsibility within the European Union. It is the backbone of strong and sustainable economies and societies.

The promise of the Europe’s Beating Cancer Plan to reduce suffering caused by cancer and other chronic diseases - including cancer co-morbidities and complications - must not be compromised.

---

Co-signatories:

  • Association of European Coeliac Societies (AOECS)
  • Association of European Cancer Leagues (ECL)
  • European Alcohol Policy Alliance (Eurocare)
  • European Chronic Disease Alliance (ECDA)
  • European Institute of Women's Health (EIWH)
  • European Public Health Alliance (EPHA)
  • European Public Health Association (EUPHA)
  • EuroHealthNet
  • Oral Health Foundation
  • Smoke Free Partnership
  • Safe Food Advocacy Europe (SAFE)

ECDA statement on the new EU NCDs Initiative

A bold move to address one of Europe’s biggest health challenges 

ECDA statement on the new EU NCDs Initiative

The European Chronic Disease Alliance (ECDA) welcomes the announcement by the European Commission of a new strategic approach to address major non-communicable diseases in Europe in a systematic and ambitious way, which includes a focus on health promotion and disease prevention.

Chronic diseases represent a major health challenge across Europe, in every EU country. Their high prevalence has continued to exponentially grow over the past decades, fueled by under-investment in the area of prevention. It is expected to keep growing as a result of an ageing population and increased exposure to the well-known major risk factors and ‘newer’ determinants, without proper political and financial attention.

The COVID-19 pandemic continues to have a significant, unprecedented impact on patients with chronic diseases, while it also affects people without any pre-existing conditions, resulting in the onset of chronic diseases and complications. It has underscored the clinical links between communicable and non-communicable diseases; and the need for holistic responses. In the current situation, a longer term collateral damage at individual, public health and socio-economic levels is no longer questioned. This “syndemic” has further exacerbated the importance of stepping up the prevention and control of chronic diseases and the need for significant commitment in the area with comprehensive strategies.

Against this background and building on the EU4Health programme, the European Commission’s new vision to improve the response to chronic diseases is much welcome. The co-creation element will ensure that the expertise of the medical profession, patients and all other crucial experts helps define a strong and robust roadmap, expected in June 2022. The priority areas identified by the European Commission encompass the key areas of knowledge & data, health promotion and disease prevention including screening, diagnosis and treatment, and quality of life for patients. They have the potential to bring a new impetus across Europe to change the lives of the millions living with a chronic disease while protecting the rest of the population and younger generations.

For this initiative to be successful, the following aspects warrant consideration:

  • an inclusive approach that goes beyond traditional siloes, addressing the interlinks between chronic diseases and fostering integrated, multidisciplinary care
  • emphasis on the specific needs of children with dedicated actions
  • prioritising health economic data collection and analysis efforts, to provide comparable evidence that can inform policymaking at all levels
  • a bold vision and inclusive mindset to add value to other chronic diseases, such as kidney, liver, gastro-intestinal diseases, allergy and auto-immune diseases and the many more

ECDA supports the shift to a comprehensive, structured and pragmatic approach on chronic diseases, which it has favoured since its inception and further encouraged during the 2011 EU Reflection Process. ECDA will remain committed to work with the European Commission and all relevant stakeholders towards a chronic disease-free Europe and making this new initiative and its implementation one of Europe’s greatest achievements in the field of public health.

The full statement is available here.


Joint statement on the new WHO Air Quality Guidelines

To protect public health and the environment from the harmful effects of air pollution, ECDA joined forces with our member the European Respiratory Society in calling on policymakers to engage with the new WHO Global Air Quality Guidelines 2021 and implement ambitious clean air policies without delay.

In a new statement released on 22 September, over 100 organisations - representing public health experts, specialist healthcare professionals and patients - highlight their support for the recently published Guidelines and call on countries to use them as a guide for effective air quality and emission reduction policies around the world.

In particular, to:

  • Revise clean air legislation to lower the limit values for PM2.5 and NO2 in air pollution hot spots and align them closely with the WHO AQGs 2021.
  • Combine fixed limit values with binding policies for a continuous reduction of the average pollution levels in all places, and not only in pollution hot spots, to achieve progressive lowering of exposures of the entire population.
  • Invest, implement, and effectively monitor and enforce clean air policies to protect and improve public health and feed into efforts for climate neutrality.

Air pollution is a major cause of mortality and disability in the EU and globally. It is linked to major chronic diseases including lung and heart diseases, diabetes, cancer; as well as infant mortality, and emerging evidence points to harmful effects on pregnancy, cognitive development in children, dementia and mental health, as well as an increased risk of dying from COVID-19.

There is no safe level of air pollution, as evidence has shown there are harms to human health even at the lowest observable levels of exposure.

Read the full joint statement here.


Implementing Europe’s Beating Cancer Plan means turning goals for improved chronic disease prevention into reality

Today, on the occasion of the last day of the European Week Against Cancer and the World No Tobacco Day, the European Chronic Disease Alliance (ECDA) issues a statement on the implementation of the Europe’s Beating Cancer plan and prevention measures.

The statement emphasises the importance of realising the preventive actions set out in the Plan without delay – to protect millions of Europeans from cancer and other major chronic diseases that share common risk factors. Prevention is central to protecting and improving people’s health and well-being. It is also the most cost-effective way of addressing the growing prevalence of chronic diseases in the EU.

Helping Europeans ‘Commit to Quit’: The EU should strive for reaching the ambition of less than 5% of the EU population using tobacco by 2040. Further, robust EU legislation that enhances tobacco control, but also addresses novel tobacco and emerging products like e-cigarettes and heated tobacco products; and ensures proper enforcement at national level is essential. The review of the EU Tobacco Products Directive is a unique opportunity to embed provisions in that regard.

Reducing alcohol consumption in the EU: Notably, new mandatory requirements for alcoholic beverages (set out in the Europe’s Beating Cancer Plan) to indicate the list of ingredients, and provide nutrition declarations and health information labelling, should be implemented in full and without dilution.  The introduction of excise taxes and other pricing policies, such as Minimum Unit Pricing, is needed to decrease the affordability of alcohol. Increased harmonisation of these rules throughout EU countries should be promoted.

Protecting Europe’s current and future generations: stronger regulatory policy action to tackle the exposure to marketing and advertising of unhealthy food products and drinks is needed on broadcast media, digital media and through the sponsorship of events, particularly those aimed at young people. This should go hand-in-hand with addressing cross border sales challenges and enforcing mandatory harmonised labelling with evidence-based easy-to-understand information.

Implementing the Europe’s Beating Cancer Plan means working in collaboration with all relevant actors within and beyond the cancer community, to maximise the benefits and impact of the Plan in other disease areas and co-morbidities.

Read the full statement here.


Extending the mandate of the ECDC towards an integrated public health approach: Joint letter from health organisations

Organisations from across the health spectrum call on the EU Council to extend the mandate of the EU agency to other areas of public health, as a response to the learnings of the COVID-19 pandemic and a forward-looking approach to improving public health in Europe that enhances multidisciplinary collaboration.

In a letter published today, a group of organisations (representing patients, healthcare professionals and medical societies, industry, public institutes and broader health advocacy groups) calls on the Council to consider the expansion of the mandate of the ECDC to other areas of public health that are linked to the current mission of the Centre, notably to cover the interconnections between communicable and non-communicable diseases. The letter is issued ahead of the Council Working Party on pharmaceuticals and medical devices that will discuss the Commission’s proposal to strengthen the Agency.

The COVID-19 pandemic has further highlighted how interconnected disease areas are and how dismantling silos in healthcare leads to better results.

If Europe is to focus on greater strategic autonomy and be a geopolitical force that remains the healthiest region of the world - yet burdened by large health inequalities, it needs an excellent Centre for preventing and controlling diseases, a more effective ECDC that is all inclusive and that can collect and present information that is decisive for national health authorities, policymakers as well as healthcare professionals and the broader medical and scientific community.

To truly safeguard the health of Europeans, there is a need for an integrated approach to health challenges and threats.

The potential of increasing ECDC’s scope of work to other areas of public health has been highlighted in the 2019 independent evaluation of the Centre. The European Parliament further asked in a resolution of July 2020 that ECDC be empowered to tackle the gaps in chronic disease epidemiology.

The ongoing revision of the ECDC mandate is a unique opportunity to act change. It is time to break siloes, both across medical disciplines and with regards to EU vs national efforts, in order to increase sustainability and efficiency of EU-level activities while protecting public health in Europe.

Read the joint letter here

Co-signatories:

  • All.Can
  • BioMed Alliance
  • European Chronic Disease Alliance (ECDA)
  • EU4Health Civil Society Alliance
  • EU Health Coalition
  • European Health Union Initiative
  • EuroHealthNet
  • European Public Health Alliance (EPHA)
  • European Public Health Association (EUPHA)
  • European Diabetes Forum (EUDF) 
  • Self Care In Europe (SCiE)
  • Senior International Health Association (SIHA)

Europe’s Beating Cancer Plan provides hope for chronic disease prevention

The European Chronic Disease Alliance (ECDA) welcomes the prevention pillar of Europe’s Beating Cancer Plan, published on 3rd February 2021, that places prevention at the heart of the EU’s fight against cancer and other chronic diseases.

ECDA supports the targets and measures set out in the plan, which are expected to significantly help to improve the health of all EU citizens. Goals for a tobacco-free generation, and commitment to action in the areas of food and alcohol labelling are much required. Together they have the potential to unlock enormous progress in Europe’s agenda of disease prevention and should be implemented swiftly.

Cancer and co-morbidities present a significant challenge across Europe. In 2020, 2.7 million EU citizens were diagnosed with cancer and 1.3 million died from it, accounting for the second cause of death in the EU after cardiovascular diseases.

In a statement published today on the occasion of the World Cancer Day, the Alliance particularly emphasizes the importance of:

  • Prevention: a crucial pillar that can have a far-reaching impact
  • Harnessing the benefits of early detection and diagnosis
  • Systemizing multidisciplinary and integrated care for better health outcomes
  • Supporting an improved quality of life for patients and their families

It is ECDA’s view that the plan in its current form is a strong basis to successfully improve the prevention and control of cancer and other chronic diseases in Europe.

While the plan is focused on the response to cancer, ECDA encourages the European Commission and policymakers to keep an inclusive mindset in the implementation and roll out of the plan, in order to maximise its benefits and impact in other disease areas. This will be particularly crucial for all proposed actions and initiatives that are linked to or have consequences on cancer co-morbidities – in all sections of the plan.

ECDA remains committed to supporting the implementation of the plan - in particular the prevention pillar - in cooperation with other stakeholders; and re-emphasizes that it will be important to monitor and track the implementation of the flagship initiatives and supportive actions set out in it.

Read the full statement of the ECDA here.


Extending the mandate of the ECDC to cover non-communicable diseases

The Commission’s legislative proposal to extend the mandate of the ECDC is expected on 11 November.

The European Chronic Disease Alliance recommends the extension of the mandate to chronic diseases, in alignment with the Parliament’s resolution on the “EU’s public health strategy post COVID-19” adopted in July 2020 and the conclusions of the independent external evaluation of the ECDC in 2019.

The evaluation highlighted that the “opportunities stemming from an extension of the mandate to the non-communicable diseases are related to the expected increased sustainability and efficiency of EU-level activities in these areas and the potential for link and synergies with ECDC’s communicable diseases related work, that could also encourage more integration at national level”. The COVID-19 crisis further amplifies how relevant this conclusion is.

There is a critical lack of comparable data and guidance to Member States in the area, responsibilities which ECDC is naturally well placed to take up notably due to its renown expertise, experience and pre-established networks amongst national public health authorities.

ECDA hopes that consideration is given to this recommendation in the context of the Council Working Party on Public Health meeting taking place on the 29th of October to discuss draft Council Conclusions on COVID-19 lessons learned in health; and while the Commission introduces a COVID-19 health response package.

Read the full paper here.

This paper is supported by MEPs Kateřina Konečná (Czechia, GUE/NGL) and Brando Benifei (Italy, S&D). 


EU4Health Civil Society Alliance: 10 Guiding Principles for the new health programme

As the COVID19 pandemic continues to affect individuals, societies and economies worldwide, the need to strengthen healthcare access and disease-prevention, whilst reducing health inequalities and bringing innovation to health systems across Europe persists, and is to-date stronger than ever.

Following recent announcements related to the financial cuts in the Commission’s new health programme, and in view of the upcoming ENVI committee vote on the draft EU4Health programme proposal later this month, the EU4Health Civil Society Alliance, which ECDA is contributing to, have gathered their expertise and carried out a joint analysis of the programme. The Alliance has developed a list of 10 guiding principles, to act as guidelines and help ensure the new programme’s full potential.

The EU4Health CSA believes that the new programme should focus on ensuring long-term health improvements beyond the COVID-19 crisis.

Read the guidelines in the statement available for download here.

About the EU4Health Civil Society Alliance:
The EU4Health Civil Society Alliance (CSA) is a group of patient and public health civil society organisations and advocates, representing many diverse networks of European citizens concerned with health and well-being. You can find more information here.


Paper on COVID-19, chronic diseases and EU health capacity

This paper outlines recommendations to EU institutions, national governments and relevant groups in Europe concerning the COVID-19 response and recovery plans with regard to chronic diseases.

The lessons from this crisis must be learnt. The proposals aim to support reflections on preparedness for potential future pandemics or other crises, which may occur as a result of factors like climate change; but also to reinforce healthcare systems’ capacity to achieve long-term public health objectives.

  • COVID-19 exemplifies the need for better prevention and control of chronic non-communicable diseases (NCDs) across Europe
  • Prevention and optimal management of chronic diseases must be integral to the COVID-19 response and recovery plans
  • Rethinking the EU capacity in healthcare appears more than ever fundamental to better protect citizens and set up a European Health Union

This papers covers: 1) implications of the COVID-19 crisis for chronic disease care and for patients; 2) Lessons learned from COVID-19: needs and solutions to improve chronic disease care; and 3) Implementing these learnings into EU and national policy.

The new EU4Health Programme as well as national-level programmes should dedicate increased and sufficient resources to chronic disease prevention and optimal management, seeing this as long-term public health investment, in parallel with the budget allocated to infectious diseases and future crisis preparedness.

All the actions proposed herewith would pave the way towards a “European Union of Health”, as desired by EU citizens and supported by the European Parliament and several EU Member States.

Read the full paper here.