Cancer Prevention Awareness: The European Code Against Cancer, 5th Edition

Introduction

Cancer remains a major cause of death in the European Union (EU).  Yet, around 40% of cancer cases can be prevented through behavioural and structural changes. 

The 5^th edition of European Code Against Cancer (ECAC5)[1] is a key EU initiative run by the European Commission (EC) and the World Health Organisation (WHO) aiming at providing actionable recommendations to reduce cancer risk. 

For the first time, ECAC in its 5^th edition[1] addresses not only individuals but also policymakers, with population-level measures that reinforce actions for citizens and communities.

ECAC5 Study Overview

An online randomized study - conducted with 10,027 adults from eight EU countries - tested the optimal formats for communicating the ECAC5’ 14 recommendations to prevent cancer. 

The different proposed message designs varied in content (whether cancer risk factors were listed), length (short or long lists of actions, or absent), and format (text only or text with images).

Key findings:

• Including explicit cancer risk factor information in the message produced the highest recall of avoidable risks, with consistent effects across all education and country groups.
• Adding prevention actions to risk factor information did not further improve recall. Message length and use of images also showed no significant effect on recall.
• Despite delivery improvements, average risk recall remained low, highlighting the complexity of raising awareness and the need for multifaceted interventions.
• Participant comprehension and acceptability remained high for all tested ECAC5 formats.

ECAC5: 14 Evidence-Based Recommendations

The ECAC5 represents a comprehensive set of 14 recommendations of actions for individuals as well as complementary supportive policy level recommendations for policy makers. These recommendations are structured in a way to provide co-benefits for other noncommunicable diseases and broader health promotion initiatives.

14 Recommendations for Individuals

Policy-Level Recommendations

ECAC5 includes complementary guidance for policy makers and governments to:

• Create environments supporting healthy choices by making them accessible and affordable.
• Address socioeconomic barriers to prevention and healthy lifestyles.
• Protect public policy from industry influence and invest in regular monitoring and evaluation.
• Promote screening programmes and expand vaccination to both girls and boys.
• Implement public health campaigns, restrict advertising of substances linked to cancer, and improve food and activity guidelines.

Conclusion

The ECAC5 offers a robust, evidence-based roadmap for cancer prevention, encouraging action at both individual and systemic levels. By following these recommendations and supporting enabling environments, Europe can improve population health, reduce inequalities, and decrease the burden of cancer and related diseases.

EU-OSHA has contributed to European Code Against Cancer, 5^th edition (ECAC5) and the 14 Recommendations. The following articles include work developed by EU-OSHA:

• Article (with focus on the Evaluation Study Results) appear in the special issue of the journal Molecular Oncology  (2026) - targeting Scientific Community (level 3)
• Articles with a separate overview focused on Level 1 of ECAC 5 in the Lancet Regional Health Europe (2026)