My views on what is good and what still needs to be improved concerning the European Code against Cancer…

Good news came out yesterday for all of us concerned with preventing and reducing the burden of cancer. The International Agency for Research on Cancer and the European Commission published the updated and improved Fourth Edition of the European Code Against Cancer.

The new European Code against Cancer was developed with the best available scientific evidence. It contains recommendations for healthier lifestyles and for strengthening cancer prevention across Europe. The Code prescribes twelve ways to prevent cancer:

Avoiding tobacco, alcohol and excessive sun exposure; maintaining a healthy body weight; and being physically active are among them.

WHO’s specialized cancer agency, the International Agency for Research on Cancer (IARC), developed the Code, which is the outcome of a two-year collaboration between cancer specialists, scientists and other experts.

The message in relation to alcohol consumption is:

If you drink alcohol of any type, limit your intake. Not drinking alcohol is better for cancer prevention.” 

I think this is an important step in the right direction. It does away with the problematic formulation of the third European Code against Cancer (see below) and it puts an end to the myth that different types of alcohol would have different effects. We know that it doesn’t matter whether wine, liquor or beer are consumed – they all are unhealthy and they all increase the risk for cancer from the first drop.

The Code raises awareness of the critical role of prevention in the fight against cancer,” says Dr Christopher Wild, Director of IARC.

By adopting the Code, all European citizens can take concrete action for themselves, their friends and families to significantly reduce their risk of developing cancer.”

I think that this updated and improved European Code against Cancer is indeed good news. It is especially good news when you compare the fourth edition to the third edition of the European Code against Cancer, which stipulated: “If you drink alcohol, whether beer, wine or spirits, moderate your consumption to two drinks per day if you are a man or one drink per day if you are a woman.”

With this prescription the third Code actually contradicted its own evidence-base. Alcohol is a carcinogen and there are no safe amounts of alcohol intake, when it comes to cancer risk. So, why would a code against cancer recommend “moderate consumption”?

Since 1987 scientists conclusively know about the correlation of alcohol use and cancer. It is in this context that I think the fourth edition of the European Code against Cancer is a positive step into the right direction. It offers momentum and impetus for stronger efforts to raise awareness about the correlation between alcohol and cancer. Too few people are aware of the link.

EU citizens' awareness of alcohol-related health harm

EU citizens’ awareness of alcohol-related health harm

The ethanol found in all alcoholic beverages is classified as group 1 carcinogen. As revealed in the report, there is “no doubt” that alcohol can cause cancers of the oral cavity, pharynx, larynx, oesophagus, liver, colorectum and breast.

However, if compared to the awareness people have of alcohol’s correlation with other diseases, such as liver and heart diseases, the awareness about the link between cancer and alcohol is troublingly low. As the Eurobarometer 72.3 “EU CITIZENS’ ATTITUDES TOWARDS ALCOHOL” shows, 1 in 5 European citizens still do not believe that there is connection between alcohol and cancer.

However, I also have two points that are critical of the new, improved code against cancer.

  1. Comparing the wording between alcohol and tobacco, we can see that both substances are still being addressed differently. For consistent messages and for comprehensive approaches to cancer prevention that should change.
  2. The Code addresses individuals and their lifestyle choices. That is important. I am in favour of effective tools to raise awareness. But we must not forget that cancer, like other non-communicable diseases (NCDs), is not driven by the choices of individuals. Cancers are caused and driven by the tactics of corporations, like the tobacco and alcohol industry – their aggressive lobbying, unethical marketing, and other strategies they employ. For this reason, cost-effective and high-impact cancer prevention should primarily be about the so-called Three Best Buys, as well as regulating the industries that profit from and drive these diseases.


In this spirit, our advocacy continues so that the 5th Edition of the European Code against Cancer (and for that matter any other code on cancer prevention) will contain language on alcohol that is unmistakable and a 13th point that empowers citizens to encourage policy makers to put in place the Three Best Buys.

For more information:

Web portal on alcohol and cancer in Europe

Our previous articles on the subject of alcohol and cancer

Press release by the European Public Health Alliance: EPHA encourages policy makers to be braver