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WEB REPORT
Cancer impacts the lives of many Europeans, with nearly 2.7 million new patients diagnosed and 1.3 million deaths each year in the EU-27 (Dyba et al., 2021). Although Europe represents less than 10% of the world’s population, it reports almost 23% of new cancer cases and 20% of the cancer deaths worldwide (Sung et al., 2021). In Europe, cancer is the most prevalent type of non-communicable disease and the second most common cause of death after circulatory diseases. Adding to the human costs of the disease, the economic costs of cancer are enormous, estimated at around EUR178 billion in 2018 (Hofmarcher et al., 2020). Nearly every European’s life is bound to be affected by cancer in some way, whether themselves or their family, friends or community.
The high prevalence of cancer in Europe can be explained by a variety of causes and factors[1], including lifestyle (notably smoking, alcohol consumption and diet), ageing and chronic exposure to some pharmaceuticals, pollutants and other occupational and environmental carcinogens[2] (Madia et al., 2019). A significant proportion of cancers in Europe are attributable to preventable environmental and occupational risks.
Reducing environmental and occupational risks for cancer requires an understanding of their nature, sources, magnitude, routes of exposure, effect and distribution. Despite the increasing amount and quality of scientific evidence, our understanding is still incomplete (Goodson et al., 2015). However, what we already know about the links between environmental risks and cancers can contribute to better policymaking and empower citizens to act. This report summarises the scientific evidence on the associations between selected known environmental and occupational risks for cancer in Europe, including air pollution, second-hand smoke, chemicals in the environment and environmental radiation (including indoor radon).
Some of the known risk factors for cancer, such as age, sex and family history, are intrinsic to the individual and cannot be modified, whereas others can be partially modified (see Table 1). The risk factors that can be modified account for around 40% of cancer cases in Europe (Couespel and Price, 2020). These exogenous risk factors include lifestyle-related ones (e.g. tobacco use, obesity, diet and alcohol consumption), some infections, environmental and occupational exposure to cancer-causing chemicals, UV radiation, indoor radon and air pollution.
Note: EODCs, environmental and occupational determinants of cancer.
Source: Adapted from Wu et al. (2018).
All environmental and occupational risk factors for cancer are modifiable, and exposure to them can be reduced through evidence-based interventions in behaviours, settings, processes, regulations and policies. The overall impact of environmental and occupational factors on cancer is usually measured in two main ways: (1) the number of cancer cases that can be attributed to those factors; and (2) the number of premature cancer deaths that can be attributed to them. Worldwide, around 20% of premature cancer deaths are estimated to be due to environmental and occupational factors (Prüss-Üstün et al., 2016). Almost 9% of all cancer deaths in Europe in 2019 were estimated to be due to environmental and occupational factors (IHME, 2020). Environmental risks alone caused more than 5% of cancer deaths in several European countries in 2019, as illustrated in Map 1.
Note: The environmental carcinogens included in the source study for this map are air pollution (indoor and outdoor) and indoor radon.
Source: Based on the Global Burden of Disease Study (IHME, 2020)
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In addition, while we do not have consistent national estimates across Europe, national studies indicate that environmental and occupational factors may cause around 10% of the cancer cases in Europe (Parkin et al., 2011; Brown et al., 2018; IARC, 2018; Gredner et al., 2018; Tybjerg et al., 2022). Moreover, these estimates are methodologically conservative because of knowledge gaps and uncertainties, so it is very likely that we are underestimating the actual contribution of exposure to environmental and occupational risks for cancer.
Excessive exposure to UV Radiation is a major cause of skin cancers, including malignant melanoma
Many chemicals are known to cause cancer, while some of them causing cancer in various organs
*Natural radiation: Radiation can originate from anthropogenic or natural sources, and it affects human populations to different extents. This report does not cover anthropogenic sources of radiation, such as ionising radiation used in medical treatments or nuclear facilities or generated by the mining of nuclear materials, or non-ionising such as radio frequency electromagnetic fields. These types of radiation, our exposure to them and their health effects are addressed by other EU institutions[3]. This report addresses the main natural sources of radiation with proven carcinogenic potential, our exposure to them and their health effects.
Various EU-wide cancer prevention plans and initiatives include reducing environmental cancer risks in their prevention strategies. Below are the most relevant current activities.
Europe’s Beating Cancer plan: a political commitment to turn the tide against cancer and the most recent EU response to the urgent need for better cancer prevention, treatment and care. The Beating Cancer plan makes an explicit commitment to reduce exposure to carcinogenic substances. One of its flagship initiatives is the European Cancer Inequalities Registry, tasked with identifying trends, disparities, and inequalities on cancer between Member States and regions.
EU Cancer mission: jointly with Europe’s Beating Cancer plan, the Mission on Cancer aims to improve the lives of more than 3 million people by 2030, through prevention and cure and, for those affected by cancer and their families, the potential to live longer and better. The mission has four specific objectives, one of them specifically on preventing cancer.
European code against cancer: a European Commission initiative to inform people about the action they can take to reduce their risk of cancer by following evidence-based recommendations covering environmental risk factors such as second-hand smoke, UVR and various pollutants.
Roadmap on carcinogens: the European Commission, EU-OSHA, the European social partners and several Member States have committed to a voluntary scheme to raise awareness of the risks arising from exposure to carcinogens in the workplace and to exchange good practices.
Knowledge Centre on Cancer: fosters independent evidence-based scientific coordination of and support for the European Commission’s cancer-related policies and activities.
There are several other EU-wide initiatives and scientific committees and EU-funded research projects related to various aspects of cancer prevention and the role that reducing environmental and occupational cancer risks can play in it. These activities have direct and indirect linkages and synergies, mapped out by the European Commission’s Knowledge for Policy Platform.
Environmental and occupational cancer risks are inherently preventable, and reducing them is key to reducing the burden of cancer in Europe. Moreover, people have limited scope for protecting themselves from most environmental and occupational determinants of cancer, making regulatory intervention and policy implementation especially necessary and relevant. Policy and regulations need to be underpinned by sufficient resources allocated to preventing exposure (including occupational) and reducing pollution.
The decreasing trends in exposure to some environmental and occupational carcinogens are encouraging, but these are not enough and are far from indicating a general trend. In addition, cancer cases tend to reflect past exposure, so decreasing trends in exposure will take years to translate into reduced incidence of cancer.
While data are incomplete and uncertainties are high, the existing scientific evidence solidly supports reducing environmental and occupational exposure as an effective and cost-saving strategy to reduce cancer risks. Moreover, it is likely that we considerably underestimate the actual contribution of environmental and occupational exposure to carcinogens. We do not need to fully understand every step of the causal pathway from environmental risks to cancer cases in order to take decisive action to reduce pollution under a readily justified precautionary principle.
[1]The high numbers are also partly due to the comprehensive records of cancer diagnoses across Europe compared with other world regions.
[2]Carcinogens are factors or substances that cause or contribute to cancer.
[3]For anthropogenic ionising radiation, please refer to the EU website on protection from ionising radiation (https://energy.ec.europa.eu/topics/nuclear-energy/radiation-protection_en). For radio frequency electromagnetic fields, please refer to the latest report from the European Commission Joint Research Centre (Chountala and Baldini, 2021).
Brown, K. F., et al., 2018, ‘The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015’,British Journal of Cancer118(8), pp. 1130-1141 (DOI: 10.1038/s41416-018-0029-6).
Couespel, N. and Price, R., 2020,Strengthening Europe in the fight against cancer, European Parliament, Policy Department of Life Policies (https://www.europarl.europa.eu/thinktank/en/document/IPOL_STU(2020)642388).
Dyba, T., et al., 2021, ‘The European cancer burden in 2020: incidence and mortality estimates for 40 countries and 25 major cancers’,European Journal of Cancer (Oxford, England: 1990)157, pp. 308-347 (DOI: 10.1016/j.ejca.2021.07.039).
EU-OSHA, 2014,Exposure to carcinogens and work-related cancer: a review of assessment method. European Risk Observatory executive summary, European Agency for Safety and Health at Work, Bilbao, Spain.
EU-OSHA, 2022, ‘Work-related cancer’, European Agency for Safety and Health at Work (https://osha.europa.eu/es/themes/work-related-diseases/work-related-cancer).
Goodson, W. H., et al., 2015, ‘Assessing the carcinogenic potential of low-dose exposures to chemical mixtures in the environment: the challenge ahead’,Carcinogenesis36(Suppl 1), pp. S254-S296 (DOI: 10.1093/carcin/bgv039).
Gredner, T., et al., 2018, ‘Cancers due to infection and selected environmental factors’,Deutsches Ärzteblatt International115(35-36), pp. 586-593 (DOI: 10.3238/arztebl.2018.0586).
Hofmarcher, T., et al., 2020, ‘The cost of cancer in Europe 2018’,European Journal of Cancer129, pp. 41-49 (DOI: 10.1016/j.ejca.2020.01.011).
IARC, 2018,Les cancers attribuables au mode de vie et à l’environnement en France métropolitaine, International Agency for Research on Cancer (https://gco.iarc.fr/projects/paf-france-fr).
IHME, 2020, ‘Global Burden of Disease data set’, Institute for Health Metrics and Evaluation (https://ghdx.healthdata.org/gbd-results-tool).
Madia, F., et al., 2019, ‘Carcinogenicity assessment: Addressing the challenges of cancer and chemicals in the environment’,Environment International128, pp. 417-429 (DOI: 10.1016/j.envint.2019.04.067).
Parkin, D. M., et al., 2011, ‘The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010’,British Journal of Cancer105(Suppl 2), pp. S77-S81 (DOI: 10.1038/bjc.2011.489).
Prüss-Üstün, A., et al., 2016,Preventing disease through healthy environments: a global assessment of the burden of disease from environmental risks, World Health Organization, Geneva, Switzerland.
Sung, H., et al., 2021, ‘Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries’,CA: A Cancer Journal for Clinicians71(3), pp. 209-249 (DOI: 10.3322/caac.21660).
Tybjerg, A. J., et al., 2022, ‘Updated fraction of cancer attributable to lifestyle and environmental factors in Denmark in 2018’,Scientific Reports12(1), p. 549 (DOI: 10.1038/s41598-021-04564-2).
Wu, S., et al., 2018, ‘Evaluating intrinsic and non-intrinsic cancer risk factors’, Nature Communications 9(1), p. 3490 (DOI: 10.1038/s41467-018-05467-z).
EEA web report no. 01/2022
Title: Beating cancer — the role of Europe’s environment
EN HTML: TH-09-22-252-EN-Q - ISBN: 978-92-9480-477-8 - doi: 10.2800/086710
The country assessments are the sole responsibility of the EEA member and cooperating countries supported by the EEA through guidance, translation and editing.
For references, please go to https://www.eea.europa.eu/publications/environmental-burden-of-cancer/beating-cancer-the-role-of-europes or scan the QR code.
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