Europe's Beating Cancer Plan

Europe's Beating

Cancer Plan

Communication from the

commission to the European

Parliament and the Council

TABLE OF CONTENT

1. A CANCER PLAN FOR EUROPE: INTRODUCTION..................................................................................................................... 4

2. A MODERN APPROACH TO CANCER: NEW TECHNOLOGIES, RESEARCH AND INNOVATION AT

THE SERVICE OF PATIENT-CENTRED CANCER PREVENTION AND CARE.................................................................... 6

2.1. Driving change through knowledge and research................................................................................................................ 6

2.2. Making the most of data and digitalisation in cancer prevention and care.......................................................... 7

3. SAVING LIVES THROUGH SUSTAINABLE CANCER PREVENTION.................................................................................... 9

3.1. Improving health literacy on cancer risks and determinants......................................................................................... 9

3.2. Achieving a tobacco-free Europe................................................................................................................................................... 9

3.3. Reducing harmful alcohol consumption..................................................................................................................................... 10

3.4. Improving health promotion through access to healthy diets and physical activity........................................ 11

3.5. Reducing environmental pollution................................................................................................................................................. 12

3.6. Reducing exposure to hazardous substances and radiation.......................................................................................... 12

3.7. Preventing cancers caused by infections.................................................................................................................................. 13

4. IMPROVING EARLY DETECTION OF CANCER............................................................................................................................. 14

5. ENSURING HIGH STANDARDS IN CANCER CARE.................................................................................................................... 15

5.1. Delivering higher-quality care......................................................................................................................................................... 15

5.2. Ensuring a high-quality health workforce................................................................................................................................. 16

5.3. Ensuring access to essential medicines and innovation.................................................................................................. 16

5.4. Building on the promise of personalised medicine for cancer prevention, diagnosis and treatment... 17

6. IMPROVING THE QUALITY OF LIFE FOR CANCER PATIENTS, SURVIVORS, AND CARERS............................ 19

7. REDUCING CANCER INEQUALITIES ACROSS THE EU........................................................................................................... 21

8. PUTTING CHILDHOOD CANCER UNDER THE SPOTLIGHT................................................................................................... 22

9. FUNDING...................................................................................................................................................................................................... 24

10. INTERNATIONAL COLLABORATION AND COORDINATION................................................................................................. 24

11. IMPLEMENTATION AND GOVERNANCE: DELIVERING TOGETHER.................................................................................. 25

12. CONCLUSION............................................................................................................................................................................................ 26

ANNEXES..................................................................................................................................................................................................... 28

1. A CANCER PLAN FOR EUROPE: INTRODUCTION

1 Most recent estimates from the European Cancer Information System (ECIS) for the EU-27 countries. New diagnoses cover all types of cancer, apart

from non-melanoma skin cancer.

2 https://gco.iarc.fr/tomorrow/en/.

3 mRNA (messenger Ribonucleic acid) is the molecule that direct cells in the body to make proteins. It can be used to make vaccines to prevent or treat

specic diseases, such as certain types of cancer or viruses like COVID-19.

4 See Article 168 of the Treaty on the Functioning of the European Union.

Cancer concerns us all in one way or another. In

2020, 2.7 million people in the European Union were

diagnosed with the disease, and another 1.3 million

people lost their lives to it

. Cancer is an individual

diagnosis that has important impacts on patients,

but it also severely aects the lives of their families

and friends.

Today, Europe accounts for a tenth of the world’s

population, but a quarter of the world’s cancer cases.

Unless we take decisive action, lives lost to cancer

in the EU are set to increase by more than 24% by

2035

, making it the leading cause of death in the EU.

The overall economic impact of cancer in Europe is

estimated to exceed €100 billion annually. Moreover,

the COVID-19 pandemic has severely impacted

cancer care, disrupting prevention and treatment,

delaying diagnosis and vaccination, and aecting

access to medicines. Since the pandemic began,

the number of cancer diagnoses has decreased,

foreshadowing a future increase in cases.

The EU has been working to tackle cancer for decades

and its actions, for example on tobacco control and

protection from hazardous substances, have saved

and prolonged lives. However, the last European

action plan against cancer was developed in the

early 1990s and the world has seen major progress

in cancer treatment in the years since. Personalised

medicine – tailored to individual situations and

needs – has radically changed patients’ prognoses.

Meanwhile, research and innovation, such as mRNA

technologies,alongside digital technologies, have

dramatically advanced our understanding of cancer

initiation and progression, prevention and diagnosis.

Europe urgently needs a renewed commitment

to cancer prevention, treatment and care that

recognises the growing challenges, and opportunities

to overcome them, including the developments

in cancer care. We need a whole-of-government

approach that focuses on the patient and maximises

the potential of new technologies and insights;

strengthens cooperation and opportunities for EU

added value; eradicates inequalities in access to

cancer knowledge, prevention, diagnosis and care;

and delivers improved health outcomes to patients.

Europe’s Beating Cancer Plan is the EU’s response

to these needs. It reects a political commitment

to leave no stone unturned to take action against

cancer. Mobilising the collective power of the EU to

drive change to the benet of our citizens, the Cancer

Plan contains concrete, ambitious actions that

will support, coordinate and complement Member

States’ eorts to reduce the suering caused by

cancer. It marks the beginning of a new era in cancer

prevention and care, where patients have access to

high-quality screening, treatments and the latest

state of the art technologies, with support at EU

level that allows scale and specialisation, while

fully respecting Member States’ responsibilities in

health policy

. In doing so, it delivers on the political

guidelines of Commission President von der Leyen. It

is also a direct response to the strong and clear calls

from the European Parliament for action in this area.

The aim of Europe’s Beating Cancer Plan is to

tackle the entire disease pathway. It is structured

around four key action areas where the EU can add

the most value: (1) prevention; (2) early detection;

(3) diagnosis and treatment; and (4) quality of life of

cancer patients and survivors. Over the coming years,

it will focus on research and innovation, tap into the

potential that digitalisation and new technologies

oer, and mobilise nancial instruments to support

Member States.

With its policy objectives, supported by ten agship

initiatives and multiple supporting actions, the

Cancer Plan will help Member States turn the tide

against cancer. It will enable expertise and resources

to be shared across the EU - supporting countries,

regions and cities with less knowledge and capacity.

It will help researchers to exchange ndings between

small and large Member States and to have access

to crucial health data on the potential causes of

cancer and promising treatments for it. Medical sta

and hospitals will be able to tap into a wealth of

shared information. Ultimately it will ensure that

patients across the EU can benet from better care

and treatment.

Europe’s Beating Cancer Plan is a key pillar of a

stronger European Health Union and a more secure,

better-prepared and more resilient EU. It outlines

substantive actions to mitigate the impact of the

COVID-19 pandemic on cancer care and support

structural improvements for a more sustainable

cancer pathway. In addition, the new, ambitious

EU4Health programme and other EU instruments

will provide substantial nancial support with €4

billion to Member States in their eorts to make

their health systems more robust and more able to

address cancer.

The COVID-19 pandemic and the experience with

vaccine development have clearly shown us that

when we come together, when we pool our eorts

and resources, it is possible to make unprecedented

progress. It requires the unique convening power

of the EU, xing goals, setting clear deadlines,

committing the necessary funding and connecting

the main actors through eective partnerships.

Applying this approach to cancer can deliver eective

results. By working as a team and combining

eorts at national and EU level, we can overcome

individual weaknesses, reduce fragmentation, and

deliver a more eective and more equal response to

cancer. The strength and success must also build on

engaging and communicating with the wider public

to support our joint eorts. Recognising the value of

partnerships, the Cancer Plan is based on a ‘Health

in All Policies’ multi-stakeholder approach and is the

result of an extensive consultation process. It reects

the views of stakeholder groups and patients, the

European Parliament and Member States.

A broad array of EU policies will support the Cancer

Plan with digitalisation, research and innovation

as the starting point for a new approach to cancer

care in the EU. Actions will span across policy areas,

from employment, education, social policy and

equality, through marketing, agriculture, energy,

the environment and climate, to transport, cohesion

policy, and taxation. This will enable the Cancer Plan

to tackle cancer drivers in our schools and in the

workplaces, in research labs, in our towns and cities,

and in our rural communities; and to do so using

innovation, healthy choices and improvements to

our environment. Cooperation will also be pursued

internationally within the established cooperation

framework with the World Health Organisation

(WHO) and the long-standing collaboration with its

International Agency for Research on Cancer.

Most importantly of all, Europe’s Beating Cancer

Plan places the interests and well-being of patients,

their families and the wider population at its heart,

every step of the way.

2. A MODERN APPROACH TO CANCER: NEW TECHNOLOGIES,

RESEARCH AND INNOVATION AT THE SERVICE OF

PATIENT-CENTRED CANCER PREVENTION AND CARE

5 The Cancer Mission Board, an independent expert group of the Commission, has prepared an outline with 13 recommendations for consideration

which will serve as basis for the implementation of the Cancer Mission, https://ec.europa.eu/info/publications/conquering-cancer-mission-possible_en.

6 https://ec.europa.eu/research/eic/index.cfm.

7 https://eit.europa.eu.

8 The Marie Skłodowska-Curie Actions (MSCA) are the EU agship programme for researchers’ mobility and training through the development of excellent

doctoral programmes, collaborative research and fellowship schemes, and contribute to excellent research, https://ec.europa.eu/research/mariecurieactions/

node_en.

The more we understand of the biological processes,

risk factors and health determinants driving cancer,

the more eectively we can prevent, detect, diagnose

and treat it. Cancer research, innovation and new

technologies can save lives; but to save as many

lives as possible, new knowledge must be shared

as widely as possible, so that health authorities and

other stakeholders can translate them into concrete

actions. The last 20 years have seen us make

tremendous scientic progress. Our understanding

of the role of genetics and genomics and gender

dierences in cancer has increased enormously,

as has digitalisation and the growing power of

computer-based analytical tools.

The smart combination of health data and new

technologies caters for the exponential development

of personalised medicine, which becomes a

powerful tool to address cancer through tailor-made

prevention and treatment strategies so patients

receive the therapies that work best for them, and

no money is wasted on trial and error treatments.

Building on what the EU, Member States, healthcare

professionals, industry and patient organisations

have already achieved, Europe’s Beating Cancer

Plan will use the remarkable potential of new

technologies and scientic progress, including

insights from comorbidities, social and behavioural

sciences, to better address cancer across the entire

disease pathway through its agships and actions.

The EU is in a unique position to maximise this

potential by pooling scientic expertise, knowledge,

data and computing power to develop innovative

and personalised solutions that will benet cancer

patients.

2.1. Driving change through knowledge and research

Stepping up our research and innovation eorts

will enable us to better understand cancer risk

factors, as well as improving diagnoses, therapies,

treatments and prevention policies. Several key EU-

wide initiatives will contribute to this goal.

The Mission on Cancer

, foreseen under Horizon

Europe, will be a major component of the EU’s

investment in cancer research and innovation. It

will deepen our understanding of the complexity of

cancer. Drawing on research and innovation, public

health and policy development, it will inform many

of the Cancer Plan’s key actions and deliver solutions

for patients, including those with comorbidities.

In addition, Horizon Europe will fund research

infrastructures, cloud computing and European

Innovation Council actions

. This includes

oering researchers access to relevant enabling

infrastructures and tools. Furthermore, the European

Institute of Innovation and Technology

will use its

partnerships for innovation, known as Knowledge and

Innovation Communities, to deliver transformative,

people-centred solutions against cancer. The Marie

Skłodowska-Curie Actions will continue developing

researchers’ skills in cancer prevention, prediction,

detection, diagnosis and treatment

. For the 2021-

2025 period, the Research and Training Programme

of the European Atomic Energy Community

(EURATOM) will support research on the protection

of patients beneting from diagnostic and cancer

therapies involving radiation sources.

Two new partnerships, foreseen under Horizon

Europe, will fully capitalise on investments in

research and deliver tangible benets for patients.

The proposed Innovative Health Initiative will

help create an EU-wide research and innovation

ecosystem. It will promote cooperation between the

health industry, academia and other stakeholders

to translate scientic knowledge into innovations

that address prevention, diagnosis, treatment and

management of diseases, including cancer. The

proposed Partnership on Transforming Health

and Care Systems, bringing together health and

care authorities, regions, patients and healthcare

professionals, will provide insights into how to better

take up research and innovation opportunities.

9 OECD (2019), Health in the 21

Century: Putting Data to Work for Stronger Health Systems, OECD Health Policy Studies, OECD Publishing, Paris,

https://doi.org/10.1787/e3b23f8e-en.

10 https://ec.europa.eu/digital-single-market/en/content/european-digital-strategy.

11 Real-world data is health-related data derived from a diverse human population in real-life settings. Such data can include medical health records,

registries, biobanks, administrative data, health surveys, observational studies, health insurance data, data generated from mobile applications etc.

12 Also known as supercomputing, this refers to computing systems with extremely high computational power that are able to solve hugely complex and

demanding problems. https://ec.europa.eu/digital-single- market/en/policies/high-performance-computing.

13 In this respect the European Interoperability Framework will underpin these eorts, https://eur- lex.europa.eu/legal-content/en/TXT/?uri=CELEX:52017DC0134.

14 Couespel, N., et al., Strengthening Europe in the ght against cancer, study for the Committee on Environment, Public Health and Food Safety, Policy

Department for Economic, Scientic and Quality of Life Policies, European Parliament, Luxembourg, 2020.

15 https://eur-lex.europa.eu/eli/reg/2016/679/oj.

16 An electronic health record is a collection of longitudinal medical records or similar documentation of an individual, in digital form (Commission

Recommendation (EU) 2019/243 of 6 February 2019 on a European Electronic Health Record exchange format).

17 Agarwala, V. et al. (2018), Real-World Evidence In Support Of Precision Medicine: Clinico-Genomic Cancer Data As A Case Study, Health Aairs, Vol. 37/5, pp.

765-772.

Flagship 1: A new Knowledge Centre on Cancer

will be launched in 2021 within the Joint Research

Centre to help coordinate scientic and technical

cancer-related initiatives at EU level. It will act

as a knowledge broker, diusing best practice

implementation and issuing guidelines to feed

the design and roll-out of new actions under the

Cancer Plan. It will, for example, contribute to the

European Cancer Imaging Initiative, the European

Health Data Space and research carried out under

the Cancer Mission.

2.2. Making the most of data and digitalisation in cancer prevention

and care

The digital transformation can bring signicant

benets for the health sector. As much as 30% of

the world’s stored data are currently produced by

health systems. But the health sector lags behind in

exploiting this potential. It is a sector which is ‘data-

rich but information poor’

Cancer care is one of the major disease areas that

will benet from the European Digital Strategy

thanks to better exploitation of real-world data

using powerful tools such as Articial Intelligence

(AI) and High-Performance Computing

. Despite

this, barriers persist around interoperability

, legal

and ethical standards, governance, cybersecurity,

technical requirements

, and compliance with

personal data protection rules

Electronic health records are set to become crucial

tools in cancer prevention and care

. They will ensure

that clinical information is shared eciently between

oncologists, radiologists and surgeons, enhancing

the patients’ treatment and survival chances. Health

records can also better capture the experiences and

outcomes of oncology patients, painting a clearer

picture than the 5% that participatein clinical trials.

Combining health records, always in compliance with

EU data protection rules, with other data sets, such

as genomics, can provide even better insights into

the ecacy of treatments and their optimisation

Europe’s Beating Cancer Plan seeks to make the

most of the potential of data and digitalisation. The

European Health Data Space (EHDS), which will be

proposed in 2021, will enable cancer patients to

securely access and share their health data in an

integrated format in the electronic health records

between healthcare providers and across borders in

the EU. The EHDS should give general practitioners

and specialists access to patients’ clinical data,

ensuring that health and care delivery happens

along the entire patient pathway, and will connect

with the Knowledge Centre on Cancer to ensure that

learnings are shared eciently. In this context, the

Commission will pursue work with Member States

on a common exchange format for electronic health

records and to tackle data security, privacy and

interoperability.

Besides digitalisation of health data, the combined

use of new technologies such as AI and High-

Performance Computing can help rapidly process

large amounts of health data and support

the development of better targeted screening

mechanisms. It can also lead to quicker, better

diagnoses by automating and standardising tasks,

while avoiding potential gender and racial or

ethnic origin bias. In addition, High-Performance

Computing can help us perform complex simulations

of molecular and cellular interactions, such as

virtually testing the eectiveness of new medicines

or repurposed drugs.

Flagship 2: The European Cancer Imaging

Initiative will be set up in 2022 to develop an

EU ‘atlas’ of cancer-related images, making

anonymised images accessible to a wide range of

stakeholders across the ecosystem of hospitals,

researchers and innovators. It will follow on the

proposal to establish the European Health Data

Space, and will involve the planned new Testing

and Experimentation Facilities to link the data

to tools such as High-Performance Computing and

AI, including also benchmarks for cancer screening

algorithms. Supported by Digital Innovation Hubs

the initiative will further improve personalised

medicine and support innovative solutions, thanks

to greater accuracy and reliability in minimally-

invasive diagnostics and follow-up of treatments.

Furthermore, the European Cancer Information

System

, which monitors the burden of cancer in

Europe, will be expanded as of 2021. It will include

new indicators detailed also by cancer staging

, and

a new section on childhood cancers. New features

will also include more detailed data at sub-national

18 The European Cancer Information System (ECIS) will become a part of the Knowledge Centre on Cancer, https://ecis.jrc.ec.europa.eu/.

19 Cancer staging describes the extension of a tumour, and takes into account its size, the invasion of adjacent organs, and the presence in other more

distant organs (metastatic cancer).

20 For example with data from the Human Biomonitoring for EU programme (https://www.hbm4eu.eu/) or environmental data available via the

Information Platform for Chemical Monitoring (https://ipchem.jrc.ec.europa.eu/).

level, thus facilitating linkages with environmental

and socio- economic data. It will help monitor

progress and future needs in addressing cancer at

EU and national level. This information is crucial to

understanding and tackling cancer.

Flagship initiatives on research, innovation and

digitalisation

▶ Create a Knowledge Centre on Cancer to facilitate

the coordination of scientic and technical

cancer-related initiatives at EU level – 2021.

▶ Launch a European Cancer Imaging Initiative

to support the development of new computer-

aided tools to improve personalised medicine and

innovative solutions – 2022.

Other actions

▶ Enable cancer patients to securely access and

share electronic health records for prevention and

treatment across borders through the European

Health Data Space – 2021-2025.

▶ Expand the European Cancer Information System

– 2021-2022.

▶ Launch Horizon Europe Partnerships to translate

scientic knowledge into innovations – 2021.

3. SAVING LIVES THROUGH SUSTAINABLE CANCER

PREVENTION

21 World Health Organization, Regional Oce for Europe, 18.02.2020 at https://www.euro.who.int/en/health- topics/disease-prevention/tobacco/news/

news/2020/2/tobacco-use-causes-almost-one-third-of-cancer-deaths-in- the-who-european-region.

22 For instance: novel tobacco products, e-cigarettes, herbal products for smoking.

Prevention is more eective than any cure. About

40% of cancer cases in the EU are preventable.

Prevention is also the most cost-ecient long-term

cancer control strategy. Benetting from of a whole-

of-government approach, the Cancer Plan aims to

raise awareness of and address key risk factors,

such as cancers caused by smoking, harmful alcohol

consumption, obesity and lack of physical activity,

exposure to pollution, carcinogenic substances and

radiation, as well as cancers triggered by infectious

agents. The Cancer Plan also takes into account

health determinants, including education, socio-

economic status, gender, age, and employment. In

addition, attention should be paid to inequalities in

access to prevention and cancer care, aecting for

example elderly people, people with disabilities, or

minorities.

Support for Member States’ actions will be

complemented by EU initiatives focusing on cancer

genomics, with research to identify the genetic

predisposition of individuals to develop cancers,

opening up new prospects for personalised risk-

assessment and targeted cancer prevention (see

chapter 5.4).

3.1. Improving health literacy on cancer risks and determinants

Improving access to and understanding of risk

factors and health determinants is vital to improve

health outcomes, especially for complex diseases

like cancer. Europe’s Beating Cancer Plan will launch

actions to give people the information and tools

they need to make healthier choices. Promoting

cooperation between health and social services and

the community is an important part of the Cancer

Plan. It will involve social workers, teachers and

nurses – they will educate the public on healthy

behaviour and patients on how to live well aer

cancer treatment.

The European Code against Cancer will be updated

to take into account the latest scientic developments

and will add new evidence-based recommendations

to improve health literacy. The Cancer Plan will aim

to make at least 80% of the population aware of

the Code by 2025. An ‘EU Mobile App for Cancer

Prevention’, to be funded under the EU4Health

programme, will oer individuals information on how

to reduce their cancer risks. In doing so, it will extend

the Code’s coverage and – with information on how

to benet from new developments in personalised

cancer risk-assessment – will empower people to

manage their own health. A new project on ‘Health

Literacy for Cancer Prevention and Care’ will also

be launched to develop and share best practice to

strengthen health literacy in cancer prevention and

care programmes, with a focus on disadvantaged

groups. These measures will be implemented in the

period 2021- 2025.

3.2. Achieving a tobacco-free Europe

Tobacco consumption continues to be the leading

cause of preventable cancer, with 27% of all

cancers attributed to tobacco use

. By eliminating

tobacco use, nine out every ten cases of lung cancer

could be avoided.

Through rigorous enforcement of the EU tobacco

control framework and its adaptation to new

developments and market trends, including stricter

rules on novel products

, Europe’s Beating Cancer

Plan will put forward actions from 2021 to help create

a ‘Tobacco-Free Generation’ where less than 5% of

the population uses tobacco by 2040, compared to

around 25% today. The interim goal is to reach the

WHO target of a 30% relative reduction in tobacco

use by 2025 as compared to 2010, corresponding to

a smoking prevalence of around 20% in the EU. The

Commission will continue to prioritise protecting

young people from the harmful eects of tobacco

and related products.

EU-level regulatory instruments will be strengthened

to achieve these objectives. Tobacco taxation is one

of the most eective instruments to ght tobacco

consumption, particularly in deterring young people

from taking up smoking. Decisive action will be

taken by reviewing the Tobacco Products Directive,

the Tobacco Taxation Directive

and the legal

framework on cross-border purchases of tobacco

by private individuals

. This includes working in

full transparency towards plain packaging and a

full ban on avours, using existing EU agencies to

23 According to Eurobarometer data, the trend has reversed for youth smoking rates (age 15-24) which went down to 20% in 2020, from 25% in 2014,

following a peak of 29% in 2017.

24 Council Directive 2011/64/EU.

25 Article 32 of Directive 2008/118/EC.

26 WHO Framework Convention on Tobacco Control, Article 5(3), https://www.who.int/fctc/text_download/en/.

27 https://ec.europa.eu/transparencyregister/public/homePage.do.

28 For the EU Member States, UK, Norway, and Switzerland: https://www.euro.who.int/ data/assets/pdf_le/0009/386577/fs-alcohol-eng.pdf

29 Between 2010 and 2016 in the European Union only a 1.5% reduction in total consumption has been reached: WHO fact sheet on the SDGs: Alcohol

consumption and sustainable development (2020).

30 https://ec.europa.eu/taxation_customs/sites/taxation/les/ study_assessing_articles_32_and_36_of_council_directive_2008118ec_concerning_the_general_

arrangements_for_excise_duty.pdf.

31 Brief interventions (BI) for alcohol have been shown to be eective in the management of alcohol consumption for harmful alcohol drinkers, who are not

seeking treatment. BI is a discussion aimed at raising an individual's awareness of their risky behaviour as a way of motivating them to change it.

improve the assessment of ingredients, extending

taxation to novel tobacco products, and tackling

tobacco advertising, promotion and sponsorship on

the internet and social media.

By 2023, the Commission will propose to update

the Council Recommendation on Smoke- Free

Environments both extending its coverage to

emerging products, such as e-cigarettes and

heated tobacco products, and expanding smoke-

free environments, including outdoor spaces. The

Cancer Plan will create momentum to better enforce

legislation in Member States’ national tobacco control

strategies, especially as regards sales to minors and

campaigns on giving up smoking. This will make

for better implementation of the WHO Framework

Convention on Tobacco Control, including the

obligations on transparency

and taking fully into

account the principles of the Transparency register

In addition, the EU track and trace system will be

extended to all tobacco products by 2024.

3.3. Reducing harmful alcohol consumption

Alcohol-related harm is a major public health concern in

the EU. In 2016, cancer was the leading cause of alcohol-

attributable deaths with a share of 29%, followed by

liver cirrhosis (20%), cardiovascular diseases (19%) and

injuries (18%)

. The Commission will increase support

for Member States and stakeholders to implement

best practices and capacity-building activities to

reduce harmful alcohol consumption in line with the

targets of the UN Sustainable Development Goals. This

includes a target to achieve a relative reduction of at

least 10% in the harmful use of alcohol by 2025

. In

addition, the Commission will review EU legislation on

the taxation of alcohol and on cross-border purchases

of alcohol by private individuals

, ensuring that it

remains t for purpose to balance the objectives of

public revenue and health protection.

To reduce the exposure of young people to alcohol

marketing, the Commission will closely monitor the

implementation of the Audiovisual Media Service

Directive provisions on commercial communications for

alcoholic beverages, including on online video-sharing

platforms. This will involve work with Member States and

the European Regulators Group for Audiovisual Media

Services (ERGA) and stakeholders to encourage self and

co-regulatory initiatives. Furthermore, the Commission

will review its promotion policy on alcoholic beverages

and in addition propose a mandatory indication of

the list of ingredients and the nutrition declaration on

alcoholic beverage labels before the end of 2022 and

of health warnings on labels before the end 2023.

Support will also be provided to Member States to

implement evidence-based brief interventions

alcohol in primary healthcare, the workplace and social

services.

3.4. Improving health promotion through access to healthy diets and

physical activity

32 Wild CP, Weiderpass E, Stewart BW, editors (2020). World Cancer Report: Cancer Research for Cancer Prevention, Lyon, France: International Agency for

Research on Cancer. http://publications.iarc.fr/586.

33 https://ec.europa.eu/food/farm2fork_en

34 Commission initiative to review promotion policy for EU agricultural food products, Regulation (EU) 1144/2014 https://ec.europa.eu/info/law/better-regulation/

have-your-say/initiatives/12782-Information-and-promotion-measures-for-agricultural-and-food-products-in-the-internal-market-and-in-non-EU-countries.

35 https://monographs.iarc.fr/wp-content/uploads/2018/06/mono114.pdf.

36 https://www.eltis.org/sites/default/les/linking_transport_and_health_in_sumps.pdf.

Cancer risk is heightened by the joint eects of

unhealthy diets and physical inactivity

. On nutrition,

the Commission will further reduce the presence

of carcinogenic contaminants in food. It will set

maximum levels for more of these contaminants,

based on the latest available scientic evidence. The

Cancer Plan will then focus on measures to make

healthy foods more available. At the same time it

will explore with Member States tax incentives to

increase their consumption, along with measures to

improve consumer information and health literacy

and address the marketing and advertising of

products linked to cancer risks.

Addressing obesity and diabetes starts in childhood.

The Commission will evaluate the 2014- 2020

EU Action Plan on Childhood Obesity and propose

a follow-up. As announced in the Farm to Fork

Strategy

, the Commission will also propose a

revision of the EU school fruit, vegetables and milk

scheme in 2023 to make healthy products more

available to children and improve their understanding

of the benets of healthy food, supported by the

‘EU Mobile App for Cancer Prevention’. It will also

propose harmonised, mandatory front-of-pack

nutrition labelling to empower consumers to make

informed, healthy, and sustainable food choices.

Marketing and advertising is designed to inuence

the choices consumers make. The Commission is

planning to prepare an implementation report in

2022 on the Audiovisual Media Service Directive,

including those on commercial communications on

unhealthy food and drinks. The Commission also

supports Member States and stakeholders in their

eort on reformulation of and on implementation of

eective policies to reduce marketing of unhealthy

food products, including through a Joint Action

on Implementation of Validated Best Practices in

Nutrition. The Commission is undertaking a review

of the promotion policy for agricultural products, with

a view to enhancing its contribution to sustainable

production and consumption, and in line with the

shi to a more plant-based diet, with less red and

processed meat and other foods linked to cancer

risks

and more fruit and vegetables.

Taxation measures can also help with health

promotion. The Commission’s proposal on VAT rates

allows Member States to make more targeted use

of rates, for instance to support the availability

and aordability of healthy and nutritious food. In

addition, in 2022, the Commission will publish a

study mapping scal measures and pricing policies

on sugars, so drinks and alcoholic beverages.

Following this, the Commission will look into the

feasibility of proposing new tax measures on sugars

and so drinks.

The ‘HealthyLifestyle4All’ campaign to be

launched in 2021 involving among other key sectors

promoting sport, physical activity and healthy diets

will contribute to the goals of the Cancer Plan.

Member States, regional and local governments and

civil society representatives will be invited to help

promote healthy choices become easy and aordable

choices. To reduce inequalities, HealthyLifestyle4All

will focus on involving people with low socioeconomic

status and disadvantaged groups, such as people

with disabilities or people with a minority racial or

ethnic background, and ensuring gender-balanced

participation. The Commission will promote

investment in active mobility infrastructures,

healthy canteens and develop outreach measures.

These eorts will be channelled through major EU

initiatives such as the European Week of Sport,

the EU School Scheme, the Erasmus programme

and the European Mobility Week, along with the EU

promotion policy for agri-food products.

Other EU actions and initiatives will include the

Sustainable Urban Mobility Planning Guide on linking

transport and health

. In addition, the Commission

will revise the 2013 Urban Mobility Package in 2021

to support sustainable and healthy transport and

mobility.

3.5. Reducing environmental pollution

37 Mortality data for the year 2012 and the WHO European Region high income group of countries; see https://www.eea.europa.eu/publications/healthy-

environment-healthy-lives.

38 https://www.eea.europa.eu/publications/healthy-environment-healthy-lives.

39 At least one in eight European deaths is caused by environmental pollution and in particular poor air quality, EEA Report No 21/2019.

40 Erickson, BE: Linking pollution and infectious disease (2019), c&en – Chemical & Engineering News, Volume 97, Issue 11.

41 Substances such as peruorooctane sulfonate and peruorooctanoic acid are associated with reduced antibody response to vaccination; EFSA, Scientic

opinion on PFAS.

42 Fitness check of the Ambient Air Quality Directives SWD(2019) 427.

43 https://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health.

44 https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A52020PC0571.

45 https://osha.europa.eu/en/facts-and-gures/workers-exposure-survey-cancer-risk-factors-europe.

Europeans rightly expect to live in healthy, sustainable

environments. Yet, despite extensive legislation on

environmental pollution, environmental causes are

thought to be behind over a quarter of a million

cancer deaths in Europe every year

. Environmental

pollution has a particularly harmful eect on young

children.

Air pollution

is a main driver of mortality, with

pollutants from a wide range of sources, including

energy, transport, agriculture and industry -

contributing to 400 000 premature deaths per

year, including from lung cancer, heart disease and

strokes

. Contaminants also remain a signicant

risk. For instance, chemicals with hazardous

properties can be harmful to the environment and

human health, causing cancers, and aecting the

immune, respiratory, endocrine, reproductive and

cardiovascular systems. Weakening of the human

immune system increases vulnerability to diseases

including cancer, and reduces the body’s capacity to

respond to vaccines

Europe’s Beating Cancer Plan will interact closely

with the Green Deal and its Zero Pollution Action

Plan to step up actions on contaminants in surface,

ground and drinking water, soil and air. Drawing on

the evaluation of the current air quality legislation

the EU’s air quality standards will be revised by

2022 to align them more closely with the WHO

recommendations

. Improved monitoring, modelling

and air quality plans will help local authorities to

achieve cleaner air. The revision of the Industrial

Emissions Directive planned towards the end of

2021 is expected to further reduce the entry of

contaminants into water, air and soil. In parallel, the

Commission has recently adopted its Sustainable

and Smart Mobility Strategy, which outlines a

series of measures aimed at supporting the shi to

zero-emission mobility and reducing environmental

pollution from transport.

With the entry into force of the revised Drinking

Water Directive, a stronger risk-based approach will

be taken to keeping contaminants out of drinking

water. Under the Water Framework Directive, the

Commission will propose to introduce or tighten

limits on the concentrations of certain pollutants in

surface or ground waters that could contribute to

cancer incidence, including through the consumption

of sh and shellsh.

3.6. Reducing exposure to hazardous substances and radiation

Reducing exposure to hazardous substances and

radiation will contribute signicantly to cancer

prevention. It is particularly important to improve

safety of products for consumers and professional

users and reduce the exposure to carcinogens in

specic settings like the workplace, where 52%

of annual occupational deaths in the EU can be

attributed to work-related cancers.

The Carcinogens and Mutagens Directive protects

workers from risks arising from exposure at work.

As part of Europe’s Beating Cancer Plan, the

Commission has proposed to update the Directive,

setting new or revised occupational exposure limits

for three important substances: acrylonitrile, nickel

compounds, and benzene

. Subject to the outcome

of the ongoing consultation with the social partners,

the Commission plans to present a legislative

proposal in 2022 to further reduce worker’s

exposure to asbestos to protect them from cancer

risks. The new Occupational Safety and Health

Strategic Framework 2021-2027 will set strong

commitments to reduce occupational exposure to

chemicals. EU-OSHA will also further develop the

workers’ exposure survey on cancer risk factors in

Europe

to help reduce work-related cancer.

The Commission will also explore measures on

exposure to ultraviolet radiation, including from

sunbeds, which increases the risk of melanoma, the

most serious form of skin cancer. The Commission

will support Member States in implementing the

requirements on protection from ionising radiation,

particularly radon

, which causes a substantial

number of lung cancers. EURATOM’s Research and

Training Programme will improve knowledge on

exposure to radon, and countermeasures to reduce

its accumulation in dwellings. Results are expected

in 2025.

Finally, implementing the actions under

the Commission’s Chemicals Strategy for

46 Council Directive 2013/59/Euratom laying down basic safety standards for protection against the dangers arising from exposure to ionising radiation.

47 COM(2020) 667 nal. Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee

and the Committee of the Regions on a “Chemicals Strategy for Sustainability Towards a Toxic-Free Environment”.

48 Based on the three key pillars of the global strategy, the WHO recommends a set of targets or milestones that

each country should meet by 2030 to get on the path to eliminating cervical cancer within the century:

• 90% of girls fully vaccinated with the HPV vaccine by the age of 15;

• 70% of women screened using a high-performance test by the age of 35, and again by the age of 45;

• 90% of women identied with cervical disease to receive treatment (90% of women with pre-cancer treated and 90% of women with invasive cancer

managed).

https://www.who.int/news/item/19-08-2020-world-health-assembly-adopts-global-strategy-to-accelerate- cervical-cancer-elimination.

Sustainability

will make it possible to deal with

hazardous chemicals more rapidly, and eectively

reduce the exposure of consumers and professionals

to carcinogenic substances, or to other hazardous

chemicals that interfere with the endocrine and

immune systems. It will also support a research and

innovation agenda for chemicals for the development

of safe and sustainable alternatives. Lastly, the EU’s

capacities for chemical risk assessment should be

strengthened through the launch of the Horizon

Europe Partnership on Assessment of Risks from

Chemicals.

3.7. Preventing cancers caused by infections

Many cancers can be prevented and lives saved by

vaccination.

Flagship 3: With dedicated funds under the

EU4Health programme and other funding

instruments, Europe’s Beating Cancer Plan will

support Member States’ eorts to extend routine

vaccination against human papillomaviruses of

girls and boys – in order to eliminate cervical

cancer and other cancers caused by human

papillomaviruses. The objective is to vaccinate

at least 90% of the EU target population of girls

and to. signicantly increase the vaccination of

boys by 2030

. Member States will play a critical

role in meeting this target

Furthermore, the Commission will help ensure access

to vaccination against Hepatitis B and to treatments

to prevent liver and gastric cancers associated with

the Hepatitis C virus and Helicobacter pylori infections.

It will also propose a Council Recommendation on

vaccine- preventable cancers to help address cancer

risks associated with Hepatitis B and Human papilloma

virus infections. In parallel, as announced by the

EU Pharmaceutical Strategy, the Commission will

examine the system of incentives and obligations to

boost innovation and ensure better access to rst-line

medicines and vaccines.

Flagship initiatives on prevention

▶ Eliminate cancers caused by human

papillomaviruses through EU support for Member

States on vaccination with the aim to vaccinate

at least 90% of the EU target population of girls

and to signicantly increase the vaccination of

boys by 2030 – 2021-2030

Other actions

▶ Improve health literacy on cancer risk by updating

the European Code against Cancer – 2021-2025.

▶ Create a ‘Tobacco-Free Generation’, including

reviewing the Tobacco Products and the Tobacco

Taxation Directives and the legal framework

on cross-border purchases of tobacco; update

the Council Recommendation on Smoke-Free

Environments, and support implementing the

Framework Convention on Tobacco Control –

2021-2025.

▶ Review EU legislation on alcohol taxation and

cross-border purchases of alcohol products, and

propose mandatory labelling of ingredients and

nutrient content, along with health warnings on

alcoholic beverages – 2021-2023.

▶ Reduce harmful alcohol consumption through

support to capacity-building and best practice;

reduce young people’s exposure to online

marketing and advertising of alcohol products;

implement evidence-based brief interventions –

2021-2025.

▶ Address unhealthy diets, obesity and physical

inactivity by reducing carcinogenic contaminants

in food; addressing childhood obesity and

reviewing the EU school fruit, vegetables and

milk scheme; supporting Member States and

stakeholders on reformulation of and on eective

policies to reduce marketing of unhealthy food

products; propose harmonised, mandatory

front-of-pack nutrition labelling; launch the

‘HealthyLifestyle4All’ political commitment –

2021-2024.

49 https://ec.europa.eu/health/sites/health/les/state/docs/2018_healthatglance_rep_en.pdf.

50 https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX:32003H0878.

51 The three types of cancer addressed by the Council Recommendation on cancer screening which, in 2003, were the only ones to have the prerequisite

to be addressed by population based screening.

52 https://ec.europa.eu/info/research-and-innovation/strategy/support-policy-making/scientic-support-eu-policies/group-chief-scientic-advisors_en.

▶ Align the EU’s air quality standards more closely

with the WHO guidelines and promote sustainable

and smart mobility – 2022-2023.

▶ Reduce exposure to carcinogenic substances

through the amendment to the Carcinogens and

Mutagens Directive – 2021-2025.

▶ Adopt a new Occupational Safety and Health

Strategic Framework to further reduce workers’

exposure to chemicals – 2021-2027.

▶ Launch of the Horizon Europe Partnership on

Assessment of Risks from Chemicals – 2021.

4. IMPROVING EARLY DETECTION OF CANCER

Early detection through screening oers the best chance

of beating cancer and saving lives. As of 2020, 25 EU

Member States had introduced in their National Cancer

Control Plans population- based screening programmes

for breast cancer, 22 for cervical cancer and 20 for

colorectal cancer. However, many programmes have not

been fully implemented, and unacceptable inequalities

persist within and between Member States. For example,

coverage of the target population ranges from 6% to

90% for breast cancer screening, and from about 25%

to 80% for cervical cancer screening

To guide further EU action on cancer screening with the

most recent evidence, the Commission will launch work

in 2021 to prepare a 3

report on the implementation

of the Council recommendation on cancer screening

Alongside this, in the medium term, the upgraded

European Cancer Information System will start to

routinely collect indicators to monitor and assess cancer

screening programmes.

Flagship 4: Europe’s Beating Cancer Plan will put

forward a new EU-supported Cancer Screening

Scheme to help Member States ensure that 90% of

the EU population who qualify for breast, cervical and

colorectal

cancer screenings are oered screening by

2025. The scheme will be supported by EU funding

and focus on making improvements in three key areas:

access, quality and diagnostics.

On access, the Commission will make a proposal

by 2022 to update the Council Recommendation

on cancer screening to ensure it reects the latest

available scientic evidence. Extending targeted

cancer screening beyond breast, colorectal and

cervical cancer to include additional cancers, such as

prostate, lung and gastric cancer, will be considered.

This work will be informed by advice from the

European Commission’s Group of Chief Scientic

Advisors

, prepared by early 2022 at the latest. It will

consider the latest developments in cancer screening

technologies, and assess advances in personalised

medicine, AI, big data and other technologies, as well

as operational quality assurance.

This evidence will also feed into the work of the

Knowledge Centre on Cancer, which will provide

new guidelines and quality assurance schemes

on cancer screening, diagnosis, treatment

rehabilitation, follow-up and palliative care for

colorectal and cervical cancer, in addition to the

ongoing Commission Initiative on Breast Cancer.

These will include voluntary accreditation and

certication programmes for Cancer Centres and

screening programmes, while continuously updating

the existing guidelines on breast cancer.

To enhance diagnostics, the Cancer Screening

Scheme will feed the new European Cancer Imaging

Initiative, by boosting the availability of screening

data and promoting new methods to improve the

quality and speed of screening programmes using

AI.

To bolster the new EU Cancer Screening Scheme, the

foreseen Mission on Cancer will generate evidence

on optimising existing population-based cancer

screening programmes, develop novel approaches

for screening and early detection, and provide options

to extend screening to new cancers. The new scheme

will be rolled out in Member States with funding

from the EU4Health programme, support from the

Technical Support Instrument, and loans from the

European Investment Bank. The European Regional

Development Fund can also support investments

in early detection. The survival rate for cervical,

breast and colorectal cancer is a key indicator of

how eective healthcare systems are in cancer care,

reecting both eciency in early detection and the

eectiveness of treatment

53 The action is expected to help increase the ve-year net survival rate of patients with cervical, breast and colorectal cancer by 2025. It will also reduce existing

inequalities in survival rates between EU Member States.

54 Principle 16 of the European Pillar of Social Rights.

55 https://ec.europa.eu/health/sites/health/les/state/docs/2018_healthatglance_rep_en.pdf.

56 The establishment of national Comprehensive Cancer Centres and their networking at EU level are being recommended by the Horizon Europe Cancer Mission

Board and the EU Joint Action CanCon, https://cancercontrol.eu/.

Flagship initiatives on early detection

▶ Develop a new EU Cancer Screening Scheme to

ensure that by 2025, 90% of the target population

is oered breast, cervical and colorectal cancer

screening – 2021-2025.

Other actions

▶ Update and explore expansion of the Council

Recommendation on cancer screening – 2022.

▶ Develop new guidelines and quality assurance

schemes for screening, diagnosis, treatment,

rehabilitation, follow-up and palliative care

for colorectal and cervical cancer, including

accreditation and certication programmes, while

continuously updating the existing guidelines on

breast cancer – 2021-2025.

▶ Update the European Cancer Information

System to monitor and assess cancer screening

programmes – 2021-2022.

5. ENSURING HIGH STANDARDS IN CANCER CARE

Europe’s Beating Cancer Plan will seek to ensure that

people in the EU have the right to access aordable,

preventive and curative healthcare of good quality,

as called for under the European Pillar of Social

Rights

. High-quality cancer care depends on a

number of factors such as a high- quality workforce

working in multidisciplinary teams, on timely access

to specialised cancer services providing optimal and

quality assured treatment, as well as the availability

of essential medicines and innovation.

5.1. Delivering higher-quality care

When it comes to accessing high-quality cancer care,

and particularly for timely diagnosis and treatment,

patients are still faced with substantial dierences

in the standards of care, leading to unacceptable

disparities across the EU. For instance, survival rates

following treatment for breast cancer vary by 20%

between countries and the ve- year survival for

colon cancer ranges from 49% to 68%

Flagship 5: The Commission will establish, by

2025, an EU Network linking recognised National

Comprehensive Cancer Centres in every

Member State

. It will facilitate the uptake of

quality-assured diagnosis and treatment, including

training, research and clinical trials across the

EU. This cross-border collaboration will improve

patients’ access to high-quality diagnostics and

care and the latest innovative treatments. It can

also help with patient mobility to ensure adequate

treatment for patients with complex conditions. A

new ‘EU Cancer Treatment Capacity and Capability

Mapping’ project will help to map and share the

dierent capabilities and expertise available

across the EU.

This action will help deliver higher-quality care and

reduce inequalities across the EU, while enabling

patients to benet from diagnosis and treatment

close to home. The Cancer Plan aims to ensure

that 90% of eligible patients have access to

such centres by 2030.

The EU Network will be supported by the existing four

rare-cancer focused European Reference Networks

and a group of newly-created Reference Networks.

These new Reference Networks will look at specic,

challenging cancer conditions, which will benet

from cross-border cooperation and EU expertise.

These conditions include metastatic diseases, co-

morbidities in cancer care, complex cancers with poor

57 https://ec.europa.eu/health/ern_en .

58 https://ec.europa.eu/social/main.jsp?catId=1223&langId=en.

prognosis, paediatric cancers and specic conditions

related to genomics in cancer care, palliative care

and survivorship. The networks will connect experts,

share expertise across the EU and provide answers,

certainty and hope to patients where before there

was none.

5.2. Ensuring a high-quality health workforce

High-quality cancer care depends on a high-quality

workforce. Patients deserve the best care possible,

and health professionals need support to ensure

they can receive training and keep updating their

skills during their professional lives. This support

should take into account the strong gender

dimension in the health and care workforce. Europe’s

Beating Cancer Plan will use training and continuous

education, including on digital skills, AI, genomics,

and personalised medicine to build a stronger

multidisciplinary cancer workforce.

The Commission will launch an ‘Inter-specialty

cancer training programme’ in 2021. Focusing on

oncology, surgery and radiology, the programme

will set out to deliver a more skilled and mobile

cancer workforce through cross-border training and

information-sharing. The training will also include

a focus on patients’ quality of life and well-being,

including mental, psychosocial and nutritional

support, along with patient empowerment. It will help

Member States address skills gaps and equip their

health workforce with personnel trained in cancer

prevention, early detection, diagnosis, treatment,

rehabilitation and survivorship.

The programme will help optimise collaboration

among cancer specialists and ultimately benet

diagnosis, treatment and follow-up for cancer

patients. It will feed into the work of the Pact for

Skills large-scale partnership in the health sector

announced in the Skills Agenda for sustainable

competitiveness, social fairness and resilience

which aims at securing training opportunities for

health professionals to up and re-skill. It also

complements ongoing trainings oered through the

European Institute of Innovation and Technology, the

Marie Skłodowska-Curie Actions and the Erasmus+

programme.

5.3. Ensuring access to essential medicines and innovation

Recent developments in cancer diagnosis and

treatment have dramatically improved survival rates

and quality of life for cancer patients. However, the

nancial costs are high, and they vary signicantly

across the EU. Moreover, shortages of cancer

medicines have increased considerably, with serious

consequences for patients. Overcoming these

challenges is an important goal for Europe’s Beating

Cancer Plan, and for the Commission as a whole.

It takes, on average, almost 15 years to develop

new medicines. Repurposing of existing medicinal

products can be a viable strategy to reduce

timeframes, decrease development costs and

improve success rates.

The recently adopted Pharmaceutical Strategy

for Europe, and the announced reform of the basic

pharmaceutical legislation, will propose ways to

improve access to medicinal products, including

to generic and biosimilar medicines. The Strategy

also started initiatives to secure supply chains and

respond to shortages of medicines, and will seek

to boost innovation to address the unmet needs

of patients, while making sure treatments remains

aordable.

In 2021, the Commission will launch an EU platform

to improve access to cancer medicines to support

the repurposing of existing medicines. It will devise

and test models for closer collaboration among

stakeholders and will leverage, pool and share

existing data using new digital tools. Building on

experiences with repurposing of medicines to

treat COVID-19

, an additional project will be

launched that uses High-Performance Computing

to rapidly test existing molecules and new drug

combinations. Starting with cancers with poor

prognosis and rare cancers, this work will involve

analysing and leveraging new innovative, and

promising treatments.

Flagship 6: The new ‘Cancer Diagnostic and

Treatment for All’ initiative, to be launched

by end of 2021, will help improve access to

innovative cancer diagnosis and treatments.

It will use the ‘next generation sequencing’

technology for quick and ecient genetic proles

of tumour cells, allowing Cancer Centres to share

cancer proles and applying the same or similar

diagnostic and therapeutic approaches to patients

with comparable cancer proles. The initiative

will ultimately help optimise cancer diagnosis

and treatment and reduce unequal access to

personalised medicine in cancer care, greatly

benetting patients.

The new legal framework for clinical trials

will apply by the end of 2021. This will introduce a

highly coordinated, robust and agile system for the

59 https://ec.europa.eu/digital-single-market/en/news/using-european-supercomputing-treat-coronavirus.

assessment and oversight of clinical trials in the EU.

Streamlined procedures will facilitate the conduct of

trials helping to bring innovation to patients. Timely

adoption of the proposal for a Regulation on Health

Technology Assessment (HTA) by the Council and

the European Parliament would help ensure speedy

access to innovative cancer diagnosis and treatments.

A permanent framework for EU cooperation on HTA

could provide Member States with high-quality and

timely HTA reports, and would enable them to share

resources, expertise and capacity. This is particularly

relevant to highly specialised cancer diagnostic

procedures and treatments.

To support the security of supply of radioisotopes for

cancer diagnosis and care, and to enhance the quality

and safety of radiation technology in medicine, the

Commission will present a new action plan under the

Strategic Agenda for Medical Ionising Radiation

Applications of nuclear and radiation technology

(SAMIRA). It will further provide guidance on EU

research and innovation, and support the education

of medical professionals in radiology, radiotherapy

and nuclear medicine, in close cooperation with the

‘Inter-specialty training programme’.

5.4. Building on the promise of personalised medicine for cancer

prevention, diagnosis and treatment

Every patient is dierent, and no cancer is the same.

Preventing and treating cancer as eectively as

possible calls for a personalised approach tailored

to the characteristics of the patient and the disease.

Personalised cancer medicines can signicantly

improve prevention, detection and prognosis for

cancer patients and can reduce the risk of adverse

eects. They should be part of the future of cancer

medicines. In addition, the capacity to access

genomic data cross-border in the EU will give

researchers and clinicians the ability to analyse and

compare patients’ genetic and clinical information.

This will help predict the potential development of

cancers, detect the disease earlier, and decide on the

most eective treatments.

The new Partnership on Personalised Medicine,

due to be set up in 2023 and funded under

Horizon Europe, will identify priorities for research

and education in personalised medicine, support

research projects on cancer prevention, diagnosis

and treatment, and make recommendations for

the roll-out of personalised medicine approaches

in daily medical practice. As a preparatory action

to the Partnership, the Commission will establish a

roadmap to personalised prevention, identifying

gaps in research and innovation, and will support

an approach to map all known biological anomalies

leading to cancer susceptibility, including hereditary

cancers.

To support Member States in making the most of the

rapid evolution of genomics in cancer prevention,

diagnosis and treatment, in 2021 the Commission

will launch, the ‘Genomic for Public Health’ project.

The project will complement the 1+ Million Genomes

Initiative

, which has cancer among its main

use cases, and is expected to give secure access

to large amounts of genomic data for research,

prevention and personalised medicine purposes.

Actions under the project, funded by the EU4Health

programme, will also target the identication of

genetic predisposition of individuals to develop

cancers, opening new perspectives to personalised

risk-assessment and targeted cancer prevention.

In addition, it will help Member States develop

guidelines and recommendations to better determine

who and what to test, organise health services to

implement genetic testing, and provide

specic

education and training for health workers to advance

our understanding of cancer control.

Flagship 7: Alongside the ‘Genomic for Public

Health’ project, the European Initiative to

Understand Cancer (UNCAN.eu), planned to be

launched under the foreseen Mission on Cancer

to increase the understanding of how cancers

develop, will also help identify individuals at high

risk from common cancers using the polygenic

risk scores technique

. This should facilitate

personalised approaches to cancer prevention and

care, allowing for actions to be taken to decrease

risk or to detect cancer as early as possible.

Already from 2021, new and existing biomedical

research infrastructures networks will also provide

tailored support to researchers working on

personalised cancer treatments. This will include

free use of advanced methodologies, technologies,

tools and equipment to work on new cancer therapies

ranging from initial discovery to novel advanced

therapy medicinal products and radiotherapy. It will

also include support to further explore and develop

the area of therapeutic and personalised cancer

vaccination, which has taken a massive leap forward

with the recent approval of mRNA-based vaccines

for COVID-19 showing that this new technology is

ready for wider deployment. Patients with advanced

melanoma, and head and neck cancers have for

example already successfully been treated with

mRNA technology.

New platforms, hosted on the European Open Science

Cloud

, will furthermore support interdisciplinary

60 https://ec.europa.eu/digital-single-market/en/european-1-million-genomes-initiative.

61 Policy Paper on Public Health Genomics in Cancer, https://cancercontrol.eu/archived/uploads/PolicyPapers27032017/Policy_Paper_1_Genomics.pdf .

62 Cancer is a disease that can be aected by changes in either one or many genes, frequently coupled with environmental factors. A ‘polygenic risk score’ can

inform people about their risk of developing a disease, based on the total number of genetic changes related to specic diseases, including some types of

cancers.

63 https://ec.europa.eu/info/research-and-innovation/strategy/goals-research-and-innovation-policy/open-science/eosc_en.

cancer research and enable the delivery of advanced

personalised treatments. This collaboration will

allow researchers to access, analyse and process

research data across disciplines and national

borders, including through the European Reference

Networks and the EU Network of Comprehensive

Cancer Centres while fully complying with data

protection laws.

Personalised medicine will also benet from High-

Performance Computing. Combining an individual’s

health data with real-time monitoring through smart

devices and pharmacokinetic will form the basis

to create a digital twin (i.e. virtual representation)

of each person. This will leverage the potential of

personalised medicine approaches, and enhance

targeted screening and prevention strategies, rapid

diagnoses and individualised therapeutic concepts.

To further explore the potential of the innovation

of digital technology on cancer treatment,

the Commission will from 2021 support new

collaborative projects bringing together relevant

stakeholders and expertise to make use of

new approaches to data analytics, using High-

Performance Computing and AI. These projects will

support eorts to advance personalised medicine,

focusing initially on cancers with poor prognosis

such as pancreatic, or head-and- neck cancers. Also in

2021, the Innovative Medicines Initiative will launch

projects on the use of AI to provide data-driven

decision support to health professionals, carers and

patients in prevention, diagnosis and treatment, as

well as projects on overcoming drug resistance in

cancer and on the added value of proton therapy in

oesophageal cancer.

Flagship initiatives on cancer care

▶ Establish an EU Network linking recognised

National Comprehensive Cancer Centres in every

Member State to improve access to high-quality

diagnosis and care – 2021- 2025.

▶ Launch a ‘Cancer Diagnostic and Treatment for

All’ initiative to improve access to innovative

cancer diagnosis and treatment – 2021-2025.

▶ Launch UNCAN.eu to help identify individuals at

high risk from common cancers – 2021-2025.

Other actions

▶ Launch an ‘Inter-specialty training programme’

focusing on oncology, surgery and radiology to

optimise diagnosis and treatment of cancer

patients – 2021-2025.

▶ Establish a group of new Reference Networks on

specic cancer types – 2022-2025.

▶ Create an EU platform to support the repurposing

of existing medicines – 2021-2025.

▶ Adopt the proposal for a Regulation on Health

Technology Assessment – 2021.

▶ Present SAMIRA Action Plan to ensure quality and

safety of radiation technology and the supply

of radioisotopes of medical importance for

diagnostic and treatment – 2021- 2025.

▶ Set up a Partnership on Personalised Medicine -

2023.

▶ Develop a roadmap towards personalised

prevention – 2023-2025

▶ Launch the ‘Genomic for Public Health’ project to

support Member States in making the most of

the rapid evolution of genomics – 2021-2025.

▶ Launch a new project using High-Performance

Computing to rapidly test existing molecules and

new drug combinations – 2023-2025.

▶ Assist researchers working on personalised

cancer treatments through tailored support and

new digital platforms – 2021-2027.

▶ Support collaborative projects on cancer

diagnostics and treatment using High-

Performance Computing and AI – 2021-2027.

6. IMPROVING THE QUALITY OF LIFE FOR CANCER PATIENTS,

SURVIVORS, AND CARERS

Thanks to advances in early detection, eective

therapies and supportive care, survival rates have

increased dramatically. The number of cancer

survivors is growing every year, and is now estimated

at over 12 million in Europe. This gure includes

around 300 000 childhood cancer survivors, a number

which is also expected to rise substantially in the

years to come. While this is a reason for optimism,

survivors, their families and carers can experience

signicant challenges. These challenges could oen

be avoided or mitigated by cooperation between

health and social care systems, and as well as with

employers. In this context, we should no longer

focus on ‘how long’ people live aer diagnosis, but

rather on ‘how well and how long’ they live. Europe’s

Beating Cancer Plan aims not only to ensure that

cancer patients survive their illness, but that they

live long, fullling lives, free from discrimination and

unfair obstacles.

Flagship 8: Funded by the EU4Health programme,

the Commission will launch the ‘Better Life for

Cancer Patients Initiative’. It aims to provide,

by 2022, a ‘Cancer Survivor Smart-Card’ to

summarise their clinical history and facilitate and

monitor follow-up care including the patients’

own experience. This personalised and voluntary

‘Card’, in the form of an interoperable portable

eCard or app will connect the patient with health

professionals to improve communication and

coordination around medical follow-up. It will

be complemented by the creation of a virtual

‘European Cancer Patient Digital Centre’ under

the foreseen Horizon Europe Mission on Cancer, to

support a standardised approach to the voluntary

exchange of patients’ data and monitoring of

survivors’ health conditions by 2023.

The most common issues that survivors face stem

from insucient management of late and long-

term eects of treatment; poor coordination and

lack of communication among healthcare providers;

unmet psychosocial needs, and issues related to

rehabilitation, emotional distress, tumour recurrence,

and metastatic disease. Cancer survivors also face

obstacles to return to work. Studies indicate that

the professional situation of people diagnosed with

cancer oen considerably deteriorate years aer the

diagnosis. Measures to facilitate social integration

and re- integration in the workplace, including

an early assessment and adaptation of working

conditions for cancer patients should be integral

parts of the patient pathway

. In addition, because of

their medical history, many cancer survivors in long-

term remission oen experience an unfair treatment

in accessing to nancial services. They oen face

prohibitively high premiums, although they have

been cured for many years, even decades

The Commission will foster its support to Member

States in promoting re-skilling and up- skilling

programmes to help cancer survivors re-join the

labour market, with possible funding support from

the European Social Fund Plus. In 2022, the

Commission will launch a new study related to

the return to work of cancer survivors, mapping

national employment and social protection policies

and identifying obstacles and remaining challenges.

Gaps in access to social protection can put the

welfare of individuals at risk, increase economic

uncertainty for both patients and survivors, and can

lead to a poorer health outcomes. In the upcoming

Occupational Safety and Health Strategic Framework,

the Commission will look into psycho-social risks and

disadvantaged groups, including cancer survivors. In

addition, the action plan to implement the principles

of the European Pillar of Social Rights

will cover

working conditions, social protection and inclusion,

health and care promotion for all workers, including

those aected by cancer. Furthermore, the recent

Green Paper on Ageing

is launching a wide debate,

including on access, quality and aordability of care

and long-term impacts on social protection systems.

64 Cancer Control Joint Action (CanCon): https://cancercontrol.eu/archived/uploads/images/Guide/042017/CanCon_Guide_7_Survivorship_LR.pdf.

65 Patient organisations refer to this issue as so called “Right to be forgotten”, which however should not be confused with the same terminology used in

the context of the General Data Protection Regulation .

66 https://ec.europa.eu/info/european-pillar-social-rights-0/european-pillar-social-rights-20-principles_en.

67 COM (2021) 50 nal, 27.01.2021.

The role of informal carers, in particular family

members, is crucial to support and provide care to

cancer patients. Such care activities oen come with

sacrices, including diculties in reconciling work

and caring activities, loss of current income due to

reduction of working hours and long-term impacts

on their old age income. This also perpetuates

inequalities between genders. Moreover, carer’s

responsibilities can also aect their physical well-

being - and in particular their mental health.

The Commission will, therefore also ensure that

Member States fully transpose the Directive on

work-life balance for parents and carers, which

introduces leave for carers and the possibility to

request exible working time arrangements. The

forthcoming Strategy on the Rights of Persons

with Disabilities 2021-2030 intends to promote

reasonable accommodation at work for people with

disabilities. In this respect, further support to adapt

work patterns for those cancer patients and survivors

who are considered as people with disabilities will be

important.

Through Europe’s Beating Cancer Plan, the

Commission will closely examine practices in the

area of nancial services (including insurance)

from the point of view of fairness towards cancer

survivors in long term remission. In the short term,

the Commission will work with relevant stakeholders

to address access to nancial products for cancer

survivors. The Commission will also engage in

dialogue with businesses to develop a code of

conduct to ensure that developments in cancer

treatments and their improved eectiveness are

reected in the business practices of nancial

service providers to ensure that only necessary and

proportionate information is used when assessing

the eligibility of applicants for nancial products,

notably credit and insurance linked to credit or loan

agreements.

Flagship initiatives on quality of life for cancer

patients and carers

▶ Launch the ‘Better Life for Cancer Patients

Initiative’, including a ‘Cancer Survivor Smart-

Card’ and the creation of a virtual ‘European

Cancer Patient Digital Centre’ to support the

exchange of patients’ data and monitoring of

survivors’ health conditions – 2021-2023.

68 https://ec.europa.eu/health/sites/health/les/state/docs/2020_healthatglance_rep_en.pdf.

69 This is for instance due to comparatively lower nancial resources women have at their disposal to absorb the monetary consequences of cancer and

less time resources for treatment and recovery, due to the persistent gender pay, earnings, and pension gaps and women’s disproportionate caring

responsibilities, https://eur- lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A52020DC0152.

70 For larger Member States, one Centre per 5 million inhabitants is recommended.

Other initiatives:

▶ Ensure full implementation of the Directive on

work-life balance for parents and carers – 2021-

2022.

▶ Address fair access for cancer survivors to

nancial services (including insurance), via a

code of conduct and a reection on long-term

solutions – 2021-2023.

7. REDUCING CANCER INEQUALITIES ACROSS THE EU

A number of indicators show major dierences in

cancer prevention and care between and within

Member States. These inequalities can be seen in

access to prevention programmes, in rates of early

cancer detection, diagnosis, treatment, survival

and measures to improve quality of life of cancer

patients and survivors. For instance, mortality rates

from colorectal cancer are substantially higher

among men than among women

. Dierences in

survivorship and access to care can be explained by

gender dierences, a combination of lower exposure

to risk factors, better access to screening programmes

and health services, and better capacity to absorb

the social and nancial consequences of cancer.

Furthermore, persistent discrepancies can also be

observed for women

, older people, persons with

disabilities, and disadvantaged and marginalised

groups, like people with a minority racial or ethnic

background and people living in poverty.

These inequalities are unacceptable in a European

Health Union that seeks to protect everyone. There

should be no rst- and second-class cancer patients

in the EU. Europe’s Beating Cancer Plan aims to

address these inequalities across the entire disease

pathway. It will tackle these issues also in conjunction

with the actions under the Pharmaceutical Strategy

for Europe and the forthcoming EU Disability Rights

Strategy.

Flagship 9: In 2021, the Commission will establish

a Cancer Inequalities Registry. It will identify

trends, disparities and inequalities between

Member States and regions. Alongside regular

qualitative assessments of the country-specic

situation, the Registry will identify challenges and

specic areas of action to guide investment and

interventions at EU, national and regional level

under Europe’s Beating Cancer Plan.

Several actions outlined in the Cancer Plan will

address inequalities between and within EU Member

States. The updated Council Recommendations on

cancer screening will advise Member States on the

latest approaches to cancer screening, coupled with

quality assurance schemes and accreditation for

screening and treatment of breast, colorectal and

cervical cancer. The EU Network of Comprehensive

Cancer Centres will support Member States in

establishing at least one National Comprehensive

Cancer Centre by 2025

, ensuring that 90% of

eligible patients have access to such Centres by

2030.

To reduce inequalities in access to healthcare services,

Member States can benet from EU Cohesion Policy

Funds, for instance through the use of mobile

healthcare units for cancer screening, or laboratory

diagnostics. This is particularly important for those

living in the most deprived and isolated communities

with restricted access to large urban centres. These

projects aim to provide healthcare and cancer

services, with an emphasis on disease prevention

and early diagnosis. The mobile units, staed with

a multidisciplinary team, visit communities on a

regular basis and connect with established health

facilities. The Commission will also promote the

use of advanced mobile technologies by healthcare

providers through the future EU4Health and Digital

Europe programmes. Digital Europe supports the

deployment of fast connectivity in line with the

Gigabit Society targets for 2025

. The EU will oer

priority funding to projects involving health facilities

with a public service mission. Finally, by supporting

the delivery of aordable, accessible and fair mobility

for all, the Smart and Sustainable Mobility Strategy

will help to better connect people and patients in

remote areas with hospitals and healthcare hubs.

The COVID-19 pandemic has even further hit the

most disadvantaged groups in our society, including

cancer patients. Isolation and containment measures

due to the COVID-19 pandemic have aected their

follow-up care and quality of life. The EU is working

to ensure continued and equitable access to care,

including in crisis situations, and Europe’s Beating

Cancer Plan is a key part of these eorts.

Actions in this area include strengthening and

integrating telemedicine and remote monitoring

in health and care systems by supporting research,

innovation and deployment actions with EU funds.

This will help to protect immunosuppressed cancer

patients from exposure to infectious diseases such

as COVID-19. These developments can also support

71 ‘Connectivity for a Competitive Digital Single Market - Towards a European Gigabit Society’ (COM(2016) 587 nal).

72 Most recent estimates from the European Cancer Information System (ECIS) for the EU-27 countries.

patients in remote or rural areas. Furthermore,

the virtual consultation model of the European

Reference Networks will be promoted to support

knowledge-sharing among healthcare professionals.

Through the EHDS, the Commission will work to

remove barriers to cross-border provision of digital

health services. Measures will also include training

and continuous education for the cancer workforce.

Flagship initiative on inequalities

▶ Launch a Cancer Inequalities Registry to map

trends in key cancer data identifying inequalities

between Member States and regions– 2021-

2022.

Other actions

▶ Strengthen and integrate telemedicine and

remote monitoring in health and care systems;

promote the virtual consultation model of the

ERNs – 2021-2023.

▶ Improve the overall resilience, accessibility and

eectiveness of European health systems to

safeguard provision of cancer care in future

health crises – 2021-2025.

▶ Mainstream equality action in other areas

addressed by Europe’s Beating Cancer Plan such

as screening and high-quality cancer care –

2021-2025.

8. PUTTING CHILDHOOD CANCER UNDER THE SPOTLIGHT

The European Union can and should do more to

protect our children from cancer. In 2020, over

15,500 children and adolescents were diagnosed

with cancer, with over 2,000 young patients losing

their lives to it

. In fact, cancer is the principal cause

of death by disease in children beyond the age of

one. However, important dierences exist between

childhood and adult cancers in terms of the type

of cancer, how far it spreads, and how it is treated.

For example, by the time they are diagnosed, 80%

of paediatric cancers have already spread to other

parts of the body, compared to about 20% of adult

cancers.

Flagship 10: In 2021, the Commission will launch

the ‘Helping Children with Cancer Initiative’

to ensure that children have access to rapid and

optimal detection, diagnosis, treatment and care.

This initiative will be funded under the future

EU4Health programme to facilitate access to early

diagnosis and quality treatment through the new

Network of Comprehensive Cancer Centres. It will

support training and enable the sharing of best

practice and standards of care for children with

cancer, complementing the actions implemented

by the new European Reference Networks.

Up to 30% of children aected by cancer suer severe

long-term consequences. As the number of childhood

cancer survivors continues to grow, comprehensive

care, treatment and follow-up are essential to help

young patients make a good recovery and enjoy an

optimal quality of life

. The new ‘Cancer Survivor

Smart-Card’ will also address the specicities of

childhood cancer survivors, including long-term

monitoring of outcomes and potential toxicity of

treatments, rehabilitation, psychological support,

educational modules, connectivity with healthcare

sta, and information about past clinical history.

The Card will also help tailor follow-up care for

the child patients, with the input of carers and in

agreement with the family. Beyond the individual

level, the upgraded European Cancer Information

System with a new section, specically tailored

and dedicated to childhood cancers will facilitate

monitoring and further research. In addition, the

revision of the Orphan and Paediatric Regulations

will be reviewed to improve the conditions for

studying and authorising new cancer medicines for

use in children.

The Commission will establish in 2022 a new ‘EU

Network of Youth Cancer Survivors’ to complement

the actions under the ‘Helping Children with Cancer

Initiative’, which will connect young cancer survivors

and their families as well as informal and formal

carers. The Network will help strengthen long-term

follow-up in cancer care plans at national and regional

level. Children, adolescents and young adult survivors

73 https://siope.eu/media/wp-content/uploads/2013/09/European_Standards_nal_2011.pdf.

74 Beside the proposed Cancer Mission, Horizon Europe nances research and pilot projects under the thematic areas in the “Health” cluster with a EUR 8.2 billion

budget.

will be nominated as Network representatives in

Member States. Particular attention should be

given to limit the disruptive impact of cancer on the

education of children and young people aected by

cancer, either as patients or carers.

Young cancer patients will also be supported under

the foreseen Horizon Europe Cancer Mission. For

example, the planned ‘Childhood cancers and

cancers in adolescents and young adults: cure

more and cure better’ initiative could increase

understanding of cancer initiation and progression

and boost the transformation of paediatric cancer

care with evidence based information to advance

diagnostics, treatment and survivorship support.

Flagship initiative on paediatric cancer

▶ Launch the ‘Helping Children with Cancer

Initiative’ to ensure that children have access to

rapid and optimal detection, diagnosis, treatment

and care – 2021.

Other initiatives

▶ Establish an ‘EU Network of Youth Cancer

Survivors’– 2021-2022.

▶ Launch the Childhood cancers and cancers

in adolescents and young adults’ initiative to

increase understanding of paediatric cancer –

2022-2025.

9. FUNDING

Europe’s Beating Cancer Plan will be implemented,

enabled and supported using the whole range of

Commission funding instruments with a total of

€4 billion being earmarked for actions addressing

cancer. A substantial share of the future EU4Health

programme, totalling €1.25 billion, will be used

to support actions and initiatives outlined in the

Cancer Plan. For instance, major initiatives that will

receive support include the ‘EU Mobile App for Cancer

Prevention’, the ‘EU Network of Comprehensive Cancer

Centres’, ‘Helping Children with Cancer’, ‘Better Life

for Cancer Patients’, the ‘Knowledge Centre on Cancer’

and the ‘EU Inter-specialty Training’.

Financial support will also be provided through

other EU funding instruments, reecting the whole-

of-government approach and diversity of actions

coming under Europe’s Beating Cancer Plan. For

example, the Horizon Europe Framework Programme

for Research and Innovation

could provide a total

of up to €2 billion to support the foreseen Mission

on Cancer and other cancer related research

projects including for research infrastructures and

the Partnerships. Erasmus+, the European Institute

for Technology and Marie Skłodowska-Curie actions

could provide up to a total of €500 million for

projects in education, training and research in the

eld of cancer

. The Digital Europe programme

will provide nancial support of up to €250 million

for cancer-related project, and support wider digital

investments, such as relating to electronic data,

cybersecurity and digital skills from which the health

sector will benet.

The Cohesion Policy Funds (European Regional

Development Fund, Cohesion Fund and European

Social Fund Plus) will provide support to Member

States and their regions to improve their health

systems’ resilience, accessibility and eectiveness.

In this context, funding will support actions ranging

from health promotion and disease prevention,

improving access to prevention, early detection

and screening, and treatment, as well as research

and development projects relating to oncology. The

funds could, for example, invest in equipment and

infrastructure in oncology wards and prevention

centres, in the development and implementation of

telemedicine, eHealth applications and tools, or in

health workforce skills for cancer care. While most

interventions will be implemented in national or

regional programmes, in line with state aid rules,

the Interreg programmes under the European

Regional Development Fund also oer cross-border

or transnational funding possibilities

As Cohesion Policy Funds are under shared

management, Member States and their national

and regional authorities will be responsible for

setting priorities on the basis of existing needs, and

carrying out these investments. Member States are

strongly encouraged to make full use of all options

to implement the measures included in the Cancer

Plan.

Under the ‘Next Generation EU’ EU budget and

75 Due to the bottom-up nature of these programmes the funding cannot be provided through dedicated calls. Therefore this indicative amount reects the

budget of previous cancer-related projects in the period 2014- 2020.

76 E.g. under the cross-border cooperation Interreg programme for the Euregio Meuse-Rhine (Aachen-Maastricht- Liège), the university hospitals cooperate on

cancer treatment: https://www.oncocare.eu/ or on rare diseases: https://www.emradi.eu/en/about-emradi.

77 The Technical Support Instrument (TSI) is the successor to the Structural Reform Support Programme (SRSP)

78 Joint Statement of the European Commission and the WHO Regional Oce for Europe “A deeper and result oriented partnership for health in Europe” of 14

September 2020.

recovery plan, an unprecedented Recovery and

Resilience Facility, with a budget of €672.5 billion

in non-repayable support and loans, is being created

to nance reforms and investments. The Facility will

support the recovery from the COVID-19 pandemic

and help overcome its economic and social

impact. Member States are prompted to identify

investments that may include health infrastructure,

equipment, digital transformation of healthcare,

manufacturing capacity for medicines and medical

devices, in particular if they are linked to addressing

the Country Specic Recommendations, which guide

the reforms and investment to be supported by

theFacility, including in cancer care.

In addition, the Commission has put forward a

proposal for a Technical Support Instrument

, to

provide practical support to all EU Member States

who express interest in institutional, administrative

and growth-enhancing reforms.

Cancer-related investments by Member States and

public and private entities could also be mobilised

through EU budget guarantees, for instance through

the InvestEU programme. It will oer loans and

equity nancing for investments in hospitals,

primary care and community care facilities, eHealth,

the healthcare workforce, and in innovative health

products, services and care models. To facilitate the

use of EU funding instruments for cancer investment,

the Commission will set up a knowledge sharing

mechanism to inform Member States about the

dierent EU funding mechanisms and how they can

be utilised.

10. INTERNATIONAL COLLABORATION AND COORDINATION

The Commission has a longstanding collaboration

with international organisations such as WHO

and OECD on health issues including on cancer.

This cooperation will continue to be pursued for

instance with WHO within the recently agreed

framework of collaboration on non- Communicable

diseases

, which has a key focus on cancer. In

addition the Commission will re- inforce its work

with specialised agencies and actors such as WHO’s

International Agency for Research on Cancer

, or

the European Network of Cancer Registries

facilitate collaboration to take action against cancer

also beyond the borders of the EU. Furthermore,

continued EU support to strengthening health

systems in partner countries and advancing

universal health coverage including primary health

care, directly contributes to improving prevention,

detection, treatment and care of cancer.

Third countries will benet from the work and

actions under the Europe’s Beating Cancer Plan,

notably through collaborative research within the

framework of Horizon Europe. To eectively tackle

global challenges such as cancer, international

79 https://www.iarc.who.int/.

80 https://www.encr.eu/.

81 https://healthcare-quality.jrc.ec.europa.eu/european-breast-cancer-guidelines

82 Bahrain, Chile, China, Mexico, Tunisia.

cooperation will be signicantly strengthened

within Horizon Europe to ensure access to talent,

knowledge, know-how, peer to peer experts, facilities

and markets worldwide. In addition, outputs and

evidence generated by the Cancer Plan, notably best

practices, lessons learnt, guidelines or screening

programmes, will be made available and can be

implemented and adapted to the national contexts

of third countries. Accompanying partner countries

in cancer campaigns and outreach associating EU

Delegations, international actors and UN agencies

on the ground is key for an eective impact. For

example, the guidelines, or systematic reviews

produced through the European Commission

Initiative on Breast Cancer

are already, or will be

used in several countries outside of the EU

11. IMPLEMENTATION AND GOVERNANCE: DELIVERING

TOGETHER

The Commission will establish the EU Cancer Plan

Implementation Group, to align actions and policies

across the European Commission and other EU

institutions. The group will meet regularly to discuss

and review implementation of the Cancer Plan and

of the foreseen Horizon Europe Mission on Cancer. It

will work closely with:

• the European Parliament committees that deal

with cancer-related issues;

• Member States (through the Steering Group on

Health Promotion, Disease Prevention and the

Management of Non-Communicable Diseases);

• the Cancer Mission Board functioning as a

scientic advisory group; and

• a stakeholder contact group, in particular

consisting of patient groups, established under

the Commission’s Health Policy Platform.

The Commission will be meeting with representatives

of these institutions and stakeholder groups in regular

intervals, at least twice per year. This approach will

enable EU institutions and stakeholders to work

together more consistently and make ownership of

Europe’s Beating Cancer Plan fully inclusive.

The implementation of the Cancer Plan will be

monitored through an implementation roadmap and

progress indicators. The roadmap and indicators will

reect the actions included in the Cancer Plan and

will undergo regular review by the Implementation

Group. Building on the augmented European

Cancer Information System, the Commission will

also regularly collect and publish relevant data to

monitor trends and feed into the Cancer Inequalities

Registry. This will also help monitor progress for all

actions in the Cancer Plan, including their impact

on competitiveness, the environment, and health

beyond cancer.

Europe’s Beating Cancer Plan will be reviewed by

the end of 2024. The review will assess whether the

action taken is sucient to achieve the objectives, or

whether additional measures are necessary.

12. CONCLUSION

Europe can collectively do more. In a strong European

Health Union, addressing cancer needs to become a

shared political, operational and scientic priority.

Europeans expect and deserve to live in a society

that protects them from avoidable cancers, that

ensures early detection, and that provides equitable,

aordable, high-quality and sustainable cancer care

to those who need it. Europe’s Beating Cancer Plan is

an ambitious strategy that oers specic solutions to

meet these expectations. It aims, rst and foremost,

to prevent cancer, and to ensure cancer patients,

survivors, their families and carers can enjoy a high

quality of life.

The COVID-19 pandemic has challenged the EU, its

Member States and the population in unprecedented

ways. However, of all the lessons learned in 2020,

the clearest is that citizens have put health rst

among their priorities, and that they expect Europe

to do more to protect it. The pandemic has shown

that there is enormous strength in collaboration,

solidarity and unity of purpose. This lesson also

applies strongly to cancer prevention, treatment and

care. The success of Europe’s Beating Cancer Plan

requires a whole-of-society eort that follows the

‘Health in All Policies’ approach.

Cancer care is no longer the responsibility of the

health sector alone. It requires engagement and buy-

in from a wide range of sectors and stakeholders.

With ten agship initiatives and multiple supporting

actions that address the entire disease pathway, this

is a plan for Europe. It is inclusive, giving everyone

concerned a stake in its success; and, above all,

it is people-centred, focusing on patients’ needs

throughout.

The European Commission invites all Member States,

stakeholders and citizens across the EU to come

together and ensure that Europe’s Beating Cancer

Plan delivers. Together, we can reverse the rising

trend of cancer across the EU and secure a healthier,

fairer and more sustainable future for all, in line with

the United Nations Sustainable Development Goals.

Together, we can strip away the fear and uncertainty

that come with a cancer diagnosis – and replace

them with knowledge, determination, dignity and

hope. Together, we can make a dierence and defeat

cancer.

ANNEXES to the Communication from the Commission to the European Parliament

and the Council Europe's Beating Cancer Plan

LIST OF ACTIONS

n° ACTIONS Timetable

A MODERN APPROACH TO CANCER: NEW TECHNOLOGIES, RESEARCH AND INNOVATION

AT THE SERVICE OF PATIENT-CENTRED CANCER PREVENTION AND CARE (2)

Flagship: Create a ‘Knowledge Centre on Cancer’ to facilitate the

coordination of scientic and technical cancer-related initiatives at EU level.

2021

Flagship: Launch a ‘European Cancer Imaging Initiative’ to support

the development of new computer aided tools to improve personalised medicines and

innovative solutions.

2022

Actions supporting cancer prevention and care through new cancer research and an

innovative ecosystem:

(1) Enable cancer patients to securely access and share electronic health records for

prevention and treatment across borders through the European Health Data

Space;

(2) Develop a repository of digital twins in healthcare, including for more individual

cancer treatment;

(3) Expand the European Cancer Information System (ECIS);

(4) Launch Horizon Europe partnerships: the Innovative Health Initiative & the

Partnership on Transforming Health and Care Systems.

2021-2025

SAVING LIVES THROUGH SUSTAINABLE CANCER PREVENTION (3)

Flagship: Vaccinate at least 90% of the EU target population of girls and to

signicantly increase the vaccination of boys and invest in related infrastructures to

pursue the elimination of cancers caused by Human papillomavirus.

2021-2030

Improving health literacy on cancer risks and determinants (3.1)

Update and boost implementation of European Code Against Cancer:

(1) Develop and launch the ‘EU mobile App for Cancer Prevention’;

(2) Support the project ‘Health Literacy for Cancer Prevention and Care’.

2021-2025

Achieving a Tobacco-free Europe (3.2)

Create a ‘Tobacco Free Generation’: by reviewing

(1) Tobacco Products Directive;

(2) Tobacco Taxation Directive; and

(3) the legal framework on cross border purchases of tobacco by private individuals

in view of legislative proposals; and

(4) Update the Council Recommendation on Smoke-Free Environments;

(5) Support Member States in full implementation of the Framework Convention on

Tobacco Control.

2021-2025

Reducing harmful alcohol consumption (3.3)

Intensied EU support to Member States and stakeholders with the implementation of

best practices and capacity building to reduce alcohol related harm:

(1) Review of EU legislation relating to the taxation of alcohol and cross- border

purchase of alcohol products;

(2) Proposal for mandatory labelling of the list of ingredients and nutrition

declarationon alcoholic beverage label, as well as health warnings;

(3) Support Member States in the implementation of evidence-based brief

interventions;

(4) Reduce the exposure of young people to online marketing of alcoholic

beverages through monitoring the implementation of the Audiovisual Media

Service Directive.

2021-2025

1. The measures presented in this action plan will all need to be taken forward in line with the better regulation principles, including evaluations

and impact assessments as appropriate.

Improving health promotion through access to healthy diets and physical activity (3.4)

(1) Review of EU school fruit, vegetables and milk scheme;

(2) Propose mandatory front-of-pack nutrition labelling;

(3) Commission report on the implementation of the provisions of the Audiovisu-

al Media Services Directive (AVMSD) including those on commercial communi-

cations on unhealthy food and drinks;

(4) Develop and implement guidance for codes of practice on reducing unhealthy

food marketing to children, including online marketing through the provisions of

AVMSD and a Joint Action of best practices in nutrition (“Best ReMap”);

(5) Publication of a study mapping scal measures and pricing policies

on sugars, so drinks and alcoholic beverages.

2021-2025

Further reduction of the presence of carcinogenic contaminants in food

by setting maximum level limits for more of these contaminants.

2021-2025

(1) HealthyLifestyle4All support to promotion of healthy lifestyles for all generations;

(2) Initiatives under the Sustainable Urban Mobility Planning Guide on linking

transport and health;

(3) Revision of the Urban Mobility Package to promote and support sustainable and

healthy transport and mobility.

2021-2023

Reducing environmental pollution (3.5)

Align the EU’s air quality standards more closely with the WHO

guidelines.

2021-2023

Measures towards zero-emission mobility and reducing environmental pollution from

transport under the Sustainable and Smart Mobility Strategy.

2021-2025

Reducing exposure to hazardous substances and radiation (3.6)

Adopt a new Occupational Safety and Health Strategic Framework

2021-2027.

2021-2027

Reduce workers’ exposure to carcinogenic substances through the

amendments of the Carcinogens and Mutagens Directive.

2021-2025

Revise EU limits for asbestos to further reduce workers’ exposure.

2022-2024

Survey on exposure of workers to risk factors for cancer.

2021-2024

Support Member States in the implementation of the requirements of Council Directive on

protection from ionising radiation, particularly from Radon.

2021-2025

Explore measures to prevent exposure to ultraviolet radiation including from sunbeds.

2023

Launch Horizon Europe Partnership on Assessment of Risks from

Chemicals to strengthen EU capacities for chemical risk assessment.

2021-2025

Preventing cancers caused by infections (3.7)

(1) Reduce liver cancer caused by Hepatitis B virus (by vaccination and investment

in related infrastructures) and prevention of liver cancer caused by Hepatitis C virus

and gastric cancer caused by Helicobacter pylori (by treatment with antivirals and

antimicrobials respectively);

(2) Propose a Council Recommendation on vaccine preventable cancers.

2021-2030

IMPROVING EARLY DETECTION OF CANCER (4)

Flagship: New ‘EU Cancer Screening Scheme’:

(1) Revision of the Council Recommendation on cancer screening, including its

update and proposal for possible extension to other cancers;

(2) Cancer Imaging Initiative to support the development of new computer-aided

tools to improve personalised medicine and innovative solutions;

(3) Develop Guidelines and Quality Assurance schemes on cancer screening, diag-

nosis, treatment, rehabilitation, follow-up and palliative care for colorectal and

cervical cancer, and updating the existing guidelines on breast cancer, including

accreditation/certication programmes.

2021-2025

Update the European Cancer Information System to monitor and assess

cancer screening programmes.

2021-2022

ENSURING HIGH STANDARDS IN CANCER CARE (5)

Flagship:

(1) Creation of ‘National Comprehensive Cancer Centre(s)’ in all Member States

and EU network by 2025;

(2) New cancer Reference Networks on cancer and cancer conditions in addition to

the four existing ERNs;

(3) EU cancer ‘Treatment Capacity and Capability Digital Mapping’ project.

2021-2025

Flagship: ‘Cancer Diagnostic and Treatment for All’ initiative to

improve access to innovative cancer diagnosis and treatments.

2021-2025

Flagship: Launch the European Initiative to Understand Cancer (UNCAN.eu).

2021-2025

Support the ‘Cancer Workforce’, through the ‘Inter-specialty training’ programme.

2021-2025

Create an ‘EU platform to improve access to cancer medicines’ to support the

repurposing of existing molecules with a harmonized and sustainable EU dimension.

2021-2025

Implementation of the legal framework for clinical trials.

2021-2022

Adoption of the Regulation on ‘Health Technology Assessment’.

2021

Present SAMIRA Action plan to ensure quality and safety of radiation technology

and the supply of radioisotopes of medical importance for diagnostic and treatment.

2021-2025

(1) Set up Partnership on Personalised Medicine to identify priorities for research

and education in personalised medicine, support research projects relevant to can-

cer prevention, diagnosis and treatment;

(2) Development of a roadmap to personalised prevention.

2023-2025

Launch the ‘Genomic for Public Health’ project along with the 1+ Million Genomes

Initiative, to ensure the access to large amounts of genomic data for research, prevention

and personalised medicine.

2021-2025

(1) Launch a new project using High-Performance Computing to rapidly test ex-

isting molecules and new drug combinations;

(2) Support collaborative projects on cancer diagnostics and treatment using

High-Performance Computing and AI;

(3) Assist researchers working on personalised cancer treatments through tailored

support and new digital platforms.

2021 - 2027

IMPROVING THE QUALITY OF LIFE FOR CANCER PATIENTS, SURVIVORS AND CARERS (6)

Flagship: ‘Better life for cancer patients’ initiative:

(1) Create a tailor made ‘Cancer Survivor Smart-Card;

(2) Create the ‘European Cancer Patient Digital Centre’ supporting the exchange of

patients’ data and monitoring of survivors’ health condition.

2021-2023

Address fair access for cancer survivors to nancial services via

development of a Code of Conduct and a reection process on long- term solutions.

2021-2023

(1) Launch a study addressing issues related to the return to work;

(2) Address in the Strategy on the Rights of Persons with Disabilities 2021-

2030 the rights of cancer patients and survivors considered as persons with a

disability;

(3) Ensure full implementation of the Directive on work-life balance for parents

and carers.

2021-2022

REDUCING CANCER INEQUALITIES ACROSS THE EU (7)

Flagship: Establish a Cancer Inequalities Registry to map inequalities

between Member States and regions.

2021-2022

(1) Strengthen e-health, telemedicine and remote monitoring systems;

(2) promote the virtual consultation model of the ERNs.

2021-2023

Improve resilience, accessibility and eectiveness of EU health

systems to safeguard provision of cancer care in future health crises.

2021-2025

Mainstream equality action in areas addressed by Europe’s Beating

Cancer Plan such as screening and high-quality cancer care.

PUTTING CHILDHOOD CANCER UNDER THE SPOTLIGHT (8)

Flagship: ‘Helping Children with Cancer Initiative’:

Create an ‘EU Network of Youth Cancer Survivors’.

2021-2023

Launch the ‘Childhood cancers and cancers in adolescents and young adults: cure

more and cure better’ project to boost the transformation

of paediatric cancer care.

2022-2025