May 2020. ETHRA submitted to Europe’s Beating Cancer Plan public consultation.

What do you think citizens can do to help beat cancer?

Citizens may reduce their chances of getting cancer by making lifestyle changes, of which stopping smoking probably ranks as the most important. Many smokers have successfully stopped smoking using Tobacco Harm Reduction products, such as vapes and snus. These products are more effective than nicotine replacement therapies and are far less harmful to health than using combusted tobacco. Sweden is notable for widespread snus use and has the lowest male lung cancer rates in Europe.

What do you think health professionals can do to help beat cancer?

Quitting smoking can be extremely difficult so health professionals should be advising smokers on all the available ways to quit smoking and should communicate accurate information about all products, and without stigmatising smokers for their lifestyle choices. Vapes, snus, nicotine pouches and heated tobacco products have worked for many smokers, but few health professionals know much about the products or feel confident about discussing them. Many smokers have yet to try safer nicotine products - a huge opportunity is being wasted.

What do you think public authorities/national governments can do to help beat cancer?

Humans are happiest when they have control over their lives and when they have choice, which is why Tobacco Harm Reduction has been so successful at driving down smoking prevalence in countries where safer nicotine products are popular. Authorities need to regulate safer nicotine products sensibly, to keep them affordable, accessible to adults, and versatile. Having a wide variety of flavours is really important, as this variety is intrinsic to the appeal and success of these products.

Which of the actions do you think would have the biggest impact on your lifestyle habits (e.g. diet, physical activity, tobacco, or alcohol consumption)?

In ETHRA’s view the biggest impact will come from avoiding restrictive legislation which reduces choice for smokers wishing to quit. Regulation must always consider the minimal risks of harm reduced products versus the large risks of smoking and ensure that these are reflected. Public Health England's 2018 evidence review found that the cancer potency of e-cigarettes is largely under 0.5% of the risk of smoking and the 2016 Lancet Global Burden of Disease did not find a RR greater than 1 for snus.

Tell us what a successful cancer plan means to you. 10 years after we implement the plan, what should have improved in the lives of European citizens?

Citizens will have access to evidence-based information about Tobacco Harm Reduction and access to all Tobacco Harm Reduction products. A key example of this is that there remains a widespread misconception amongst smokers and health professionals that most of the harm of smoking comes from nicotine, which is deterring many smokers from trying safer nicotine products. Giving good information and access to products will reduce smoking related disease and death and will enable many to live longer and in better health.

How can you (or your organisation) contribute to the EU plan on cancer?

ETHRA has twenty-one Tobacco Harm Reduction (THR) consumer association partners, all of whom work to give accurate information about Tobacco Harm Reduction and to preserve safer nicotine products as an option for smokers who may wish to quit. We are already playing a key role in cancer prevention.

Is there anything else that you would like to add that has not been covered in this consultation?

This survey refers to the avoidance of tobacco as a desirable lifestyle change, however tobacco use per se is not the problem, it is specifically the use of combusted tobacco products which can lead to smoking related disease and premature deaths. Some safer nicotine products are tobacco products, for example: snus is a pasteurised oral tobacco product for which the 2016 Lancet Global Burden of Disease Study did not find a RR (relative risk) greater than one. Conflating “tobacco” with smoking runs counter to the aim of reducing smoking related disease and death.

You can download our submission here (PDF)