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Cancer affects the lives of many Europeans. Environmental and occupational exposure to air pollution, radon, UV radiation, chemical carcinogens, asbestos and other risks contributes significantly to the high burden of cancer in Europe. However, all environmental and occupational cancer risk factors are largely preventable. This web report provides a brief overview of the evidence on the environmental and occupational determinants of cancer in Europe and of EU policy responses.

Key messages

• Exposure to air pollution, carcinogenic chemicals, radon, UV radiation and second-hand smoke together may contribute over 10% of the cancer burden in Europe.
• Environmental and occupational cancer risks can be reduced by cleaning up pollution and changing behaviours: decreasing these risks will lead to a fall in the numbers of cancer cases and deaths.
• The long latency periods of many cancers mean that many future cases will be due to pollution and occupational exposure happening today.
• We need better data on Europe-wide exposure to environmental and occupational cancer risks and need more evidence on the risk arising from low levels of exposure to multiple carcinogens.
• Despite the uncertainties, what is already known about the links between environment and cancer clearly supports implementing ambitious ‘zero pollution’ policies as tools for cancer prevention.
• Reducing environmental and occupational risks is essential if we are to achieve the goals of comprehensive cancer prevention initiatives, such as those in Europe’s Beating Cancer plan.

Understanding the issue

Cancer impacts the lives of many Europeans, with nearly 2.7 million new patients diagnosed and 1.3 million deaths each year in the EU-27 (Dyba et al., 2021). Although Europe represents less than 10% of the world’s population, it reports almost 23% of new cancer cases and 20% of the cancer deaths worldwide (Sung et al., 2021). In Europe, cancer is the most prevalent type of non-communicable disease and the second most common cause of death after circulatory diseases. Adding to the human costs of the disease, the economic costs of cancer are enormous, estimated at around EUR178 billion in 2018 (Hofmarcher et al., 2020). Nearly every European’s life is bound to be affected by cancer in some way, whether themselves or their family, friends or community.

The high prevalence of cancer in Europe can be explained by a variety of causes and factors^[1], including lifestyle (notably smoking, alcohol consumption and diet), ageing and chronic exposure to some pharmaceuticals, pollutants and other occupational and environmental carcinogens^[2] (Madia et al., 2019). A significant proportion of cancers in Europe are attributable to preventable environmental and occupational risks.

Reducing environmental and occupational risks for cancer requires an understanding of their nature, sources, magnitude, routes of exposure, effect and distribution. Despite the increasing amount and quality of scientific evidence, our understanding is still incomplete (Goodson et al., 2015). However, what we already know about the links between environmental risks and cancers can contribute to better policymaking and empower citizens to act. This report summarises the scientific evidence on the associations between selected known environmental and occupational risks for cancer in Europe, including air pollution, second-hand smoke, chemicals in the environment and environmental radiation (including indoor radon).

Environmental contribution to cancer in Europe

Some of the known risk factors for cancer, such as age, sex and family history, are intrinsic to the individual and cannot be modified, whereas others can be partially modified (see Table 1). The risk factors that can be modified account for around 40% of cancer cases in Europe (Couespel and Price, 2020). These exogenous risk factors include lifestyle-related ones (e.g. tobacco use, obesity, diet and alcohol consumption), some infections, environmental and occupational exposure to cancer-causing chemicals, UV radiation, indoor radon and air pollution.

Table 1. Categories of cancer risk factors, according to modifiability

Note: EODCs, environmental and occupational determinants of cancer.
Source: Adapted from Wu et al. (2018).

All environmental and occupational risk factors for cancer are modifiable, and exposure to them can be reduced through evidence-based interventions in behaviours, settings, processes, regulations and policies. The overall impact of environmental and occupational factors on cancer is usually measured in two main ways: (1) the number of cancer cases that can be attributed to those factors; and (2) the number of premature cancer deaths that can be attributed to them. Worldwide, around 20% of premature cancer deaths are estimated to be due to environmental and occupational factors (Prüss-Üstün et al., 2016). Almost 9% of all cancer deaths in Europe in 2019 were estimated to be due to environmental and occupational factors (IHME, 2020). Environmental risks alone caused more than 5% of cancer deaths in several European countries in 2019, as illustrated in Map 1.

Map 1. Percentage of premature cancer deaths attributable to environmental risks in Europe in 2019

Note: The environmental carcinogens included in the source study for this map are air pollution (indoor and outdoor) and indoor radon.
Source: Based on the Global Burden of Disease Study (IHME, 2020)
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In addition, while we do not have consistent national estimates across Europe, national studies indicate that environmental and occupational factors may cause around 10% of the cancer cases in Europe  (Parkin et al., 2011; Brown et al., 2018; IARC, 2018; Gredner et al., 2018; Tybjerg et al., 2022). Moreover, these estimates are methodologically conservative because of knowledge gaps and uncertainties, so it is very likely that we are underestimating the actual contribution of exposure to environmental and occupational risks for cancer.

Environmental risks and their associations with cancer

 Explore the environmental risks and their associations with cancer below:

Air pollution:  Indoor and outdoor air pollution is linked to lung cancer and other types of cancer  At www.eea.europa.eu/publications/environmental-burden-of-cancer/air-pollution

Radon*:  Exposure to indoor radon in buildings is a major cause of lung cancer  At www.eea.europa.eu/publications/environmental-burden-of-cancer/radon

UV Radiation*: Excessive exposure to UV Radiation is a major cause of skin cancers, including malignant melanoma  At www.eea.europa.eu/publications/environmental-burden-of-cancer/uv-radiation

Chemicals:  Many chemicals are known to cause cancer, while some of them causing cancer in various organs   At www.eea.europa.eu/publications/environmental-burden-of-cancer/chemicals

Second hand smoke:  Exposure to second hand smoke increases the risk of cancer even in people who have never smoked themselves  At www.eea.europa.eu/publications/environmental-burden-of-cancer/second-hand-smoke

Asbestos:  Despite being banned since 2005, exposure to asbestos continues to be a major cause of mesothelioma and lung cancer  At www.eea.europa.eu/publications/environmental-burden-of-cancer/asbestos

*Natural radiation: Radiation can originate from anthropogenic or natural sources, and it affects human populations to different extents. This report does not cover anthropogenic sources of radiation, such as ionising radiation used in medical treatments or nuclear facilities or generated by the mining of nuclear materials, or non-ionising such as radio frequency electromagnetic fields. These types of radiation, our exposure to them and their health effects are addressed by other EU institutions[3]. This report addresses the main natural sources of radiation with proven carcinogenic potential, our exposure to them and their health effects.

EU cancer prevention initiatives addressing environmental and occupational risk factors

Various EU-wide cancer prevention plans and initiatives include reducing environmental cancer risks in their prevention strategies. Below are the most relevant current activities.

Europe’s Beating Cancer plan: a political commitment to turn the tide against cancer and the most recent EU response to the urgent need for better cancer prevention, treatment and care. The Beating Cancer plan makes an explicit commitment to reduce exposure to carcinogenic substances. One of its flagship initiatives is the European Cancer Inequalities Registry, tasked with identifying trends, disparities, and inequalities on cancer between Member States and regions.

EU Cancer mission: jointly with Europe’s Beating Cancer plan, the Mission on Cancer aims to improve the lives of more than 3 million people by 2030, through prevention and cure and, for those affected by cancer and their families, the potential to live longer and better. The mission has four specific objectives, one of them specifically on preventing cancer.

European code against cancer: a European Commission initiative to inform people about the action they can take to reduce their risk of cancer by following evidence-based recommendations covering environmental risk factors such as second-hand smoke, UVR and various pollutants.

Roadmap on carcinogens: the European Commission, EU-OSHA, the European social partners and several Member States have committed to a voluntary scheme to raise awareness of the risks arising from exposure to carcinogens in the workplace and to exchange good practices.

Knowledge Centre on Cancer: fosters independent evidence-based scientific coordination of and support for the European Commission’s cancer-related policies and activities.

There are several other EU-wide initiatives and scientific committees and EU-funded research projects related to various aspects of cancer prevention and the role that reducing environmental and occupational cancer risks can play in it. These activities have direct and indirect linkages and synergies, mapped out by the European Commission’s Knowledge for Policy Platform.

Conclusions

Environmental and occupational cancer risks are inherently preventable, and reducing them is key to reducing the burden of cancer in Europe. Moreover, people have limited scope for protecting themselves from most environmental and occupational determinants of cancer, making regulatory intervention and policy implementation especially necessary and relevant. Policy and regulations need to be underpinned by sufficient resources allocated to preventing exposure (including occupational) and reducing pollution.

The decreasing trends in exposure to some environmental and occupational carcinogens are encouraging, but these are not enough and are far from indicating a general trend. In addition, cancer cases tend to reflect past exposure, so decreasing trends in exposure will take years to translate into reduced incidence of cancer.

While data are incomplete and uncertainties are high, the existing scientific evidence solidly supports reducing environmental and occupational exposure as an effective and cost-saving strategy to reduce cancer risks. Moreover, it is likely that we considerably underestimate the actual contribution of environmental and occupational exposure to carcinogens. We do not need to fully understand every step of the causal pathway from environmental risks to cancer cases in order to take decisive action to reduce pollution under a readily justified precautionary principle.

Notes

[1]The high numbers are also partly due to the comprehensive records of cancer diagnoses across Europe compared with other world regions.

[2]Carcinogens are factors or substances that cause or contribute to cancer.

[3]For anthropogenic ionising radiation, please refer to the EU website on protection from ionising radiation (energy.ec.europa.eu/topics/nuclear-energy/radiation-protection_en). For radio frequency electromagnetic fields, please refer to the latest report from the European Commission Joint Research Centre (Chountala and Baldini, 2021).

This report was originally published by the European Environment Agency at bit.ly/3U22U7y (28 June 2022, modified 7 July 2022).