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Fighting Prostate Cancer: a European Union Challenge

Submitted by on 15 Apr 2014 – 15:46

Isabel De la MataBy Isabel De la Mata, Principal Adviser with special interest in Health, European Commission

Male cancer patterns in the European Union are changing; lung cancer is declining but prostate cancer is increasing, affecting around one million men. Despite significant advances in the treatment of prostate cancer, it remains a problem for men’s health. The crude annual incidence of prostate cancer in the European Union is 110.8 per 100,000 men with 360,000 new cases per year. The mortality in the EU is 30.6 per 100,000 men per year. Though the incidence and survival rates vary widely between different EU States, mortality rates are similar.

The Council Recommendation on cancer screening was adopted in 2003, setting out the fundamental principles of best practice in early detection of cancer. Based on the accepted scientific criteria, population-based screening programmes for breast, cervical and colorectal cancer are currently promoted at EU level. In order to be recommended for population-based screening, malignant tumours must meet certain scientific criteria: the disease must be common, sensitive to safe and uncomplicated detection and more easily and effectively treated if diagnosed at an early stage. Breast, cervical and colorectal cancer meets these criteria. Current evidence does not yet point to an appropriate balance between benefit and harm of population-based screening when it comes to prostate cancer. The population-based screening of healthy men between 55 and 69 years old using prostate specific antigen (PSA) would increase the diagnosis of asymptomatic cancers that will not emerge during life. For these reasons the European Commission prefers to continue the scientific discussion on this issue.

In 2014 a new Joint Action CANCON (European Guide on Quality Improvement in Comprehensive Cancer Control), was approved under the Work Plan 2013 for the Implementation of the Second Health Programme and will be in place during the period 2014-2016. The main deliverable of this Joint Action will be the European Guide on Quality Improvement in Comprehensive Cancer Control, as well as a Member States Platform, which will provide space for discussions on cancer topics. The Chapters in this Guideline will provide an extraordinary opportunity to address topics directly related to prostate and other specific cancers: Quality-based cancer screening programmes, Comprehensive Cancer Network organisation, Community-based cancer care and Survivorship. The active participation of prostate cancer stakeholders in these discussions will constitute an extraordinary input to respond to the needs of patients in a broad and co-operative European context. Comprehensive cancer control policy should be organised taking into account the general aspects of cancer control but also those that specifically corresponds to the different cancer sites.

Member States will receive guidance on various aspects of high quality screening programmes in line with the existing European guidelines for quality assurance in cervical, breast and colorectal cancer but also guidance on other potential screening programmes, if the necessary consensus between MemberStates and scientific partners are obtained.

The launch of the 4th version of the European Code Against Cancer is currently being prepared by the European Commission in close collaboration with the IARC (International Agency for Research on Cancer) and will be delivered in 2014. The Code is a key communication tool in the prevention of cancer, addressing the public at large in a citizen-friendly format, and should constitute the major tool for disseminating preventive measures and contributing to change definitively the perception of cancer.

The code promotes two very clear messages: certain cancers may be avoided – and health in general can be improved – by adopting healthier lifestyles; and cancers may be cured, or the prospects of cure greatly increased, if they are detected at an early stage. These messages are also essential to prevent prostate cancer: a healthy diet low in fat and high in fruits and vegetables may reduce your risk of prostate cancer, and a body mass index (BMI) of 30 or higher and a low level of exercise may increase the risk of prostate cancer. The active involvement of prostate cancer stakeholders in the promotion and dissemination of the Code will be essential.

Research is also essential in understanding better the mechanisms of prostate cancer.  The FP7 -the European Union Programme for Research- supports large European initiatives as PROMARK (Genetic prostate cancer variants as biomarkers of disease progression) which permitted, using genome-wide association analysis, to identify 4 distinct common genetic variants that increase the risk of prostate cancer, or PROSPER (Prostate cancer: Profiling and evaluation of ncRNA) proposed to explore the role of ncRNAs (regulators of key cellular mechanisms) in prostate cancer. Project members will also evaluate the potential use of ncRNAs in diagnostic and prognostic tools as well as therapy targets.

Large and ambitious initiatives can only be implemented in a large European co-operation basis and the existing European Programmes offer that framework.

Prostate cancer is a European challenge that should mobilize common resources and expertise of European, national and regional authorities as well as scientific partners and patients’ organizations. To organize the efficient and appropriate co-ordination of these efforts at European level it’s our challenge and our commitment.

Isabel De la Mata is Principal Adviser with special interest in Health, European Commission
DG Health and Consumers, SANCO.C – Public Health