Recently-released data from the European Cancer Organisation makes for concerning reading: as the Covid-19 pandemic rocked health systems across the European bloc, 100 million cancer screenings went unperformed, leading experts to believe that up to a million cases of cancer have gone undiagnosed in Europe.
While cancer screenings should pick up again now that the coronavirus vaccine rollout is gathering speed and Covid case rates are dropping everywhere from Rome to Riga, the setback in cancer care only underlines how swiftly the EU must act to prevent a “cancer epidemic” in the wake of the Covid-19 pandemic. Under these circumstances, European policymakers must double down on commitments to tackle major cancer risk factors like tobacco use, and devising a more comprehensive anti-smoking strategy which incorporates every available public health tool, including technologies such as e-cigarettes.
Tobacco smoking a logical first target
For the nearly 4 million Europeans diagnosed with cancer each year, a myriad set of risk factors is to blame. While some are sadly unavoidable, an estimated 40% of cancers in the EU are preventable, meaning that cracking down on avoidable risk factors is essential to curbing cancer rates in the bloc.
The most important of these is tobacco use, which is responsible for the deaths of roughly 700,000 Europeans each year. Between a quarter and a third of all cancer deaths are ultimately linked to smoking; while mainly associated with lung cancer—nine out of ten cases of which could be prevented if smoking was stubbed out—smoking combustible tobacco can also be a factor in the development of liver, bowel, stomach, and several other cancers.
A tobacco-free generation: an impossible dream?
European policymakers are already aware that drastically reducing smoking rates—some of the highest of any region in the world—is an essential element of any plan to tackle cancer.
Medics, politicians, and economists all concur that reducing smoking rates would be a major public health victory for European societies, and the EU has already settled on an ambitious target—the bloc, where 25% of the adult population smokes cigarettes, wants to lower that rate to under 5% by 2040 and create a “tobacco-free generation”.
Lawmakers, however, have had less success settling on the best way to tackle the deadly habit. Higher taxation and plain packaging have been proven to lower smoking rates, but they are not in and of themselves sufficient to achieve the ambitious goals outlined by the EU. A smattering of European politicians have even proposed eliminating the legal sale of tobacco products entirely, in a similar vein to New Zealand which is considering legislation that would ban the sale of tobacco products to anyone born after 2004—even after they reach adulthood. However, as previous real-world experiments with the outright prohibition of alcohol or narcotics demonstrate, blanket bans never achieve their objective.
Alternatives to tobacco: an underused tool?
While banning smoking outright is not a mainstream position in Europe, the EU may unfortunately be making a comparable mistake by focusing only on the affordability and availability of cigarettes, while doing nothing to offer the tens of millions of smokers across the bloc a viable alternative to using combustible tobacco.
This is despite the fact that new ways of reducing the societal cost of smoking, improving smokers’ health and alleviating pressure on European health services, are at Europe’s disposal. E-cigarettes offer particular promise—major public health bodies including Public Health England have found that e-cigarettes are up to 95% less harmful than combustible tobacco products, and that using vaping products is one of the most successful ways for smokers to wean themselves off of their habit. Indeed, in 2017 alone, Public Health England estimated that some 50,000 smokers who would have otherwise continued puffing away successfully quit smoking with the help of vaping devices.
People who quit smoking can, within the span of a few years after their last cigarette, dramatically reduce their added cancer risk—in some cases approaching the risk profile of someone who had never smoked—meaning that any successful cessation method can have significant knock-on public health benefits. With this in mind, a number of countries, such as New Zealand and the UK, have adopted a harm-reduction approach to tobacco policy, incorporating vaping alongside other smoking cessation aids to try and stamp out the habit for good. The EU’s tobacco policies, meanwhile, are moving in the wrong direction, painting tobacco products and e-cigarettes with the same broad brush despite the massive potential for harm reduction offered by the latter.
This missed opportunity is especially tragic given the recent European Cancer Organisation study indicating that the coronavirus pandemic may have led to a dramatic decline in cancer screening—and an ensuing uptick in later-stage cancer cases. The pandemic-induced disruption has shone a fresh spotlight on the importance of taking decisive action to reduce Europeans’ risk of contracting cancer—the first step should be overhauling the bloc’s tobacco policy.