After more than a decade, the European Code Against Cancer has been updated and its timing could not be more consequential. With cancer remaining one of Europe’s leading causes of premature mortality, and with preventable risk factors still deeply embedded in our environments, the 5th edition of the European Code Against Cancer (ECAC5) marks a long-overdue shift in how prevention is framed and acted upon.
EPHA strongly welcomes ECAC5, not only for updating the scientific evidence behind cancer prevention, but for explicitly recognising that cancer prevention is a shared societal and political responsibility. For the first time, the Code speaks directly to policy-makers, alongside citizens, acknowledging that individual choices are shaped – and constrained – by policy decisions, commercial determinants, and environmental exposures.
From advice to accountability – what is new in ECAC5
Previous editions of the Code focused primarily on what individuals could do to reduce their cancer risk. ECAC5 retains this foundation, expanding the recommendations from 12 to 14 and strengthening guidance on key risk factors. But it also marks a broader shift in how cancer prevention is understood and acted upon.
ECAC5 introduces a parallel set of recommendations for policy-makers, clearly stating that prevention depends on structural conditions: regulation, fiscal measures, public investment, and protection from harmful commercial practices. This is a decisive departure from the notion that cancer prevention can be achieved through awareness and behaviour change alone.
Reflecting today’s risk landscape, the updated recommendations explicitly address vaping and emerging nicotine products, reinforce the message to avoid alcohol entirely, strengthen guidance on diet, obesity, and ultra-processed foods, expand HPV vaccination to all genders, and include lung cancer screening alongside established screening programmes. Crucially, they also bring renewed visibility to environmental risk factors, updating recommendations on radon, sun exposure, and occupational carcinogens, as well as introducing a new recommendation on what individuals, and most importantly governments, can do to reduce air pollution, a leading risk factor for cancer.
A win–win for cancer prevention and broader NCD action
One of ECAC5’s greatest strengths is that it aligns cancer prevention with the prevention of other noncommunicable diseases. The Code explicitly targets shared risk factors – tobacco and nicotine use, alcohol consumption, unhealthy diets, physical inactivity, and environmental exposures – that drive not only cancer, but also cardiovascular, respiratory, and metabolic diseases.
This means that acting on ECAC5 is reinforcing integrated NCD prevention efforts, maximising health gains from a single set of policy interventions, and making better use of public resources. In this sense, ECAC5 complements and strengthens EU and WHO commitments on NCD prevention and health promotion – including WHO’s evidence-based “best buys” and “quick buys” for NCD prevention, and the EU’s new Safe Hearts Plan.
The policy recommendations as the real breakthrough
From EPHA’s perspective, the policy recommendations are the most politically consequential element of ECAC5. They translate scientific consensus into clear expectations for governments: to regulate harmful products, curb aggressive marketing, ensure clean air and safe workplaces, invest in vaccination and screening, and design food, transport, and urban systems that support health by default.
Importantly, ECAC5 also addresses equity and integrity. It acknowledges that cancer risk is socially patterned, and that prevention policies must reduce – not reinforce – health inequalities. It also recognises the need to protect public health policy from commercial interference, a prerequisite for effective regulation in areas such as tobacco, alcohol, and ultra-processed foods.
In doing so, ECAC5 shifts prevention from the realm of individual morality to that of public accountability. It makes clear that failure to prevent cancer is not simply a matter of personal choice, but of political priorities.
The role of civil society – from evidence to implementation
EPHA is proud to have contributed to its development. EPHA’s Director General participated in the expert work underpinning the new edition, alongside leading scientists coordinated by IARC. This reflects the essential role that independent public health and civil society voices play in shaping credible, evidence-based prevention guidance.
We also strongly echo the position of the European Cancer League: ECAC5 should now be used as a practical policy tool, not just a communication instrument. Its value will be measured not by downloads or endorsements, but by whether its recommendations are translated into concrete action at EU, national and local level.
From code to action
ECAC5 sends a clear message: cancer prevention cannot be outsourced to individuals. It requires political leadership, regulatory courage, and sustained public investment. At a time when Europe is debating its future health priorities, the Code provides a scientifically robust and politically relevant roadmap for prevention that benefits cancer outcomes, NCD control, and population health more broadly. ECAC5 gives policy-makers fewer excuses – and a clearer responsibility – to act.