'What Can I Do to Reduce My Risk for Cancer?'

Zosia Chustecka

October 14, 2014

The new European Code Against Cancer, launched today, outlines 12 things that individuals can do to reduce their risk for cancer. Top of the list is tobacco, followed by healthy body weight, avoiding too much sun and alcohol, but there are also several new recommendations — about radon, breast-feeding, and hormone replacement therapy (HRT), and also about vaccinations and organized screening programs.

The code was drawn up by the International Agency for Research on Cancer (IARC), the specialized cancer agency of the World Health Organization, with the participation of the European Commission.

There is a bit of overlap with the World Cancer Report 2014 from the IACR, which came out earlier this year and heavily emphasized prevention strategies, but the aims of the two are quite different, commented Joachim Schüz PhD, head of the section of environment and radiation at the IACR in Lyon, France. The report is a summary of the scientific evidence, while the code is in everyday language and is aimed at individuals, giving guidance on "what I can do to reduce my cancer risk."

This latest (fourth) version updates the last version of the code issued in 2003.

There are several new points in the code because the science of prevention is a dynamic and we now have a better understanding of some of the risk factors, Dr. Schüz commented in an interview.

New in this version of the code is the advice on checking and taking action on high levels of naturally occurring radon in homes (which has been associated with an increased risk for lung cancer) and the avoidance of sunbeds and tanning equipment (to avoid skin cancer).

Also new is the advice to women that breast-feeding reduces the mother's cancer risk, and so should be encouraged, and that HRT increases the risk for certain cancers (breast, endometrial, and ovarian), and so should be limited. "The scientific evidence is there now to support these recommendations," he said.

Also new is the advice to have girls vaccinated against human papillomavirus (HPV) (to prevent cervical cancer), which adds on to the advice already in the code to have newborns vaccinated against hepatitis B (to prevent liver cancer).

There are also changes in the advice in this latest version, Dr. Schüz said. For instance, he points out that previous versions of the code have urged individuals to "avoid obesity," whereas the latest version recommends that they "maintain a healthy bodyweight."

"We have tried to rephrase the advice as a positive recommendation," Dr. Schüz told Medscape Medical News. "But also we have to move away from the yes/no position," he explained, because actually there is a gradual relationship between body weight and cancer, where small increases in body weight are associated with a small increase in the risk for cancer, but larger increases are associated with a larger increase in risk. "The more obese you are, the greater the risk," he said.

Tobacco has been in the code since its earliest version in 1987, but even here there are new adjustments, Dr. Schüz said. "Tobacco is still, unfortunately, the number one cause of cancer, so this has to be re-emphasized over and over again for successful prevention, but for the first time we are emphasizing the importance of a smoke-free environment in the workplace and at home, which contributes to helping people to stop smoking and also, of course, reduces the risk of second-hand smoke."

Regulations governing smoking in public places vary across the various countries in the European Union. For example, in parts of Germany, there is currently a discussion about whether a tent for smokers situated in a beer garden is inside or outside, Dr. Schüz commented. The code is important in that it empowers the individual to demand a smoke-free environment from employers, he said.

Another change in the new code is the emphasis on organized screening programs, for colorectal cancer in both men and women and for breast and cervical cancer screening in women. The new emphasis here is that this screening should be part of organized national programs, because only these can ensure "the high quality of the screening," he said.

One last point that Dr. Schüz emphasized is that everybody can do something to reduce their risk for cancer. The recommendation on exercise is spelled out very simply: "Be physically active in everyday life. Limit the time you spend sitting." People should know that even small amounts of activity are beneficial, climbing the stairs instead of using the elevator, even 15 to 30 minutes of brisk walking every day, all of this adds up to reduce their risk of cancer. "There is no need to run a marathon or go to the gym every day," he commented. "Even these small changes can be beneficial."

The new code is directed at European citizens, but these recommendations would hold equally well for Americans, especially those of European descent, he commented. Indeed, there a lot of similarities with guidelines on prevention of cancer put out by organizations such as the American Cancer Society (ACS), the National Institutes of Health, and the Centers for Disease Control and Prevention, he said. But in other parts of the world, there would need to be an adaptation of the guidelines, rather than just a straight translation, in order to take into account regional factors, he added, highlighting as an example the issue of infectious disease in the sub-Sahara Africa.

In the United States, the ACS has for decades published guidelines for cancer prevention and early detection, which include many of the same recommendations that are in the European code, noted a spokesperson.

"For many years, ACS has funded, conducted, and analyzed research about the best ways people can reduce their risk of cancer. We have long recommended almost every action that the European experts have compiled, and it's easy to see the careful thought that underlies this very practical, readable, preventive health guide. It's a great addition to our public health toolkit," said Richard C. Wender, MD, chief cancer control officer from the ACS.

European Code Against Cancer: 12 Ways to Reduce Your Cancer Risk

1 Do not smoke. Do not use any form of tobacco.
2 Make your home smoke free. Support smoke-free policies in your workplace.
3 Take action to be a healthy body weight.
4 Be physically active in everyday life. Limit the time you spend sitting.
5 Have a healthy diet:
• Eat plenty of whole grains, pulses, vegetables, and fruits.
• Limit high-calorie foods (foods high in sugar or fat) and avoid sugary drinks.
• Avoid processed meat; limit red meat and foods high in salt.
6 If you drink alcohol of any type, limit your intake. Not drinking alcohol is better for cancer prevention.
7 Avoid too much sun, especially for children. Use sun protection. Do not use sunbeds.
8 In the workplace, protect yourself against cancer-causing substances by following health and safety instructions.
9 Find out if you are exposed to radiation from naturally high radon levels in your home. Take action to reduce high radon levels.
10 For women:
• Breast-feeding reduces the mother's cancer risk. If you can, breast-feed your baby.
• HRT increases the risk of certain cancers. Limit use of HRT.
11 Ensure your children take part in vaccination programs for:
• Hepatitis B (for newborns)
• HPV (for girls).
12 Take part in organized cancer screening programs for:
• Bowel cancer (men and women)
• Breast cancer (women)
• Cervical cancer (women).



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