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30. RECOMktENDATIONS

Ebbesen P.

The Institute of Cancer Research, The Danish Cancer Society,

Radiumstationen, DK-8000 Aarhus C, Denmark.

Recommendations must be rooted not only in knowledge about

basic cancer biology and cancer epidemiology, but also in

political reality and the concepts about the diseases prevailing

in the populations we want to protect.

In the following short survey of the background for ECP

recommendations I will start with the state of knowledge in the

European population, proceed to discuss the cost-bene

confronting the European governments and end up

arguments for a specific effort with ECP participation.

There is no easy way to get a picture of what is

it probl em

forwardi w

n the mi nd

of a fellow man, but it is safe to say that most Europeans have a

most fragmented idea about human biology and disease. This lack

of coherence is a major reason for unfounded fear and a hindrance

for development of a general consensus about rational cancer

prevention.

A long-term goal for cancer prevention therefore must be to

help the individual countries to formulate a scientific sound

model of general biology and disease which can be learned by a

majority of Western Europeans - and in particular the European

politicians.

The model should contain the concepts of genetically

programmed lifelong biologic development which is assisted in its

continuous modification of the body by the unavoidable deleterious

effects of free radicals and other by-products of oxygen-based

energy production. Cancer and diseases predisposing to cancer

should be understood as "normal biology" only classified in a

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special category because it is unwanted by humans.

It is not trivial and it is necessary. Enlightening of

politicians is important but enlightening policy requires a

population-based consensus which can only be reached if the mental

picture of biology of Europeans is reasonably correct.

The lack of a coherent picture of biology, aging, and cancer

in the minds of most non-professionals is also major reason why a

rational weighing of different prevention strategies is seldom

done.

Cost-benefit analysis of the different possibilities for

cancer prevention open to the European governments has not

influenced policy very much. An example in question is nitrate as

food additive and nitrate in drinking water. Huge sums are now

being used to decrease human exposure to nitrate. The theoretical

basis is sound. Nitrate most likely can contribute to cancer

development, but epidemiology does not equivocally indicate a

measurable effect on cancer incidence. Ventricular cancer is

declining in most European countries. The reason for this most

likely is unrelated to nitrate exposure but it does not support

any oncologic importance of the rising nitrate concentration in

drinking water seen in many places. It is a sad fact that a

driving force in much preventive work is public fear fueled by

sensational newspaper and TV coverage. The same amount of money

spent on antitobacco campaigns would undoubtedly save far more

lives.

Ever since its creation in 1961 ECP has emphasized a balanced

view of what cancer-preventive measures, with a chance of

implementation, would have the biggest effect in Europe right now.

And right now prevention of sexually transmitted cancer is the

area 'where an effort could save the most lives.

Several circumstances cooperate to make this an area ripe for

a major European effort. Firstly, there is now proof of sexual

contacts being instrumental in the spreading of both HIV, HTLV-1,

HPV, and hepatitis S. Secondly, the non-oncologic aspects of

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infection with HIV are so hideous that this in itself demands

preventive measures of exactly the same type as those needed to

prevent spread of the tumor-inducing virus. Thirdly, ECP is now

so entrenched that it is capable of handling the organizational

aspects. Finally, and most important the general public is now

ready to listen. They know about AIDS and fear cancer. Link them

and they will respond.

What are we talking about ? We are suggesting a concerted

promotion of sex habits which will reduce the risk of transmitting

tumorigenic and non-tumorigenic microorganisms. The campaign

could be run under the auspices of WHO with ECP as the work horse

and the European Community financing the effort.

ECP recommendations thus are:

1.

2.

3.

Development of a new intellectual synthesis about human

biology suitable for the increasingly highly educated

population of Europe. This new synthesis should contain a

general principle about normal development and aging

emphasizing the biologic programming and unavoidable

age-related changes. Cancer should appear as a biologic type

characteristic of many - especially old organisms. Life span

and life quality call for a balanced effort against all major

diseases - anticancer efforts included.

A rough quantitation of the external carcinogenic milieu

factors among young women as among men.

An aggressive and coordinated campaign against the spread of

venereal disease. The effort should be carried out as a joint

venture involving ECP, the European and national societies

against AIDS and Cancer as well as other health oriented

international organizations.