Key determinants of the future incidence of cancer across Europe: impact of prevention 2005 - 2009

Objective 2

Assess the potential to reduce exposure to these determinants by reviewing evidence of effectiveness of interventions and policies, assessing the implementation of effective ones, and detecting barriers to a successful implementation.

Work performed:

We provided an overview of the evidence regarding the effectiveness of intervention approaches and policies aimed at smoking cessation, reduced alcohol consumption, improving physical activity levels and intake of fruit and vegetables and preventing obesity. The aim was to identify effectiveness of interventions targeting adults and where possible, to pay specific attention to intervention effects among adults from lower socio-economic backgrounds.

A series of systematic reviews or meta-analyses of original studies or existing reviews was conducted to achieve the objective of this work package. The targeted behaviours were addressed in separate studies. The review for each behaviour started with a scan of the literature to get an impression of the number of systematic reviews already available, to be able to decide whether the approach had to be a review of reviews, an original review, an update of good quality existing reviews, or that the most recent review was good quality, up-to-date and that no additional data collection was needed.


All the systematic reviews or reviews of reviews were conducted using a protocol based on the Cochrane guidelines for systematic reviews.

The following approaches were used for the behaviours under study:

  • Smoking cessation: Review of reviews
  • Obesity prevention: Original review 
    • Lemmens, V.E., et al., A systematic review of the evidence regarding efficacy of obesity prevention interventions among adults. Obes Rev, 2008. 9(5): p. 446-55.
  • Fruit and vegetable consumption: Recent, good quality review was available. A meta-analysis was conducted for worksite interventions.
  • Physical activity: A recent, good quality meta-analysis and systematic review was available.
  • Alcohol consumption: A recent, good quality systematic review was available. 

The study findings of all the studies are described in a report on this objective.


We also aimed to produce a systematic inventory of interventions and policies aimed at smoking cessation, reducing excessive alcohol consumption, preventing obesity and improving physical activity and fruit and vegetable intake that were implemented in Europe in the year 2006.


Two approaches were taken to make the inventory of implemented policies and interventions:

  1. Identification of existing databases with information on implementation of policies and interventions in the EU countries and Norway, Iceland and Switzerland
  2. Asking the national cancer societies of all EU member states, to make an inventory of the policies and interventions aimed at improving the selected risk behaviours that were implemented in their country, by means of structured questionnaires including questions on degree of implementation and barriers to implementation.


There were four main findings in this work package:

  1. Across Europe there are a large number of policies and interventions that have been tried out or put in place, but the effectiveness of these interventions or the degree of implementation of the policies are largely unknown. 
  2. Many countries in Europe have not implemented the effective interventions and policies assessed in this study; thus, there is a potential for more effective cancer prevention in Europe. 
  3. Smoking cessation and alcohol prevention have a stronger focus on policies and are in a more advanced stage than policies and interventions aimed at fruit and vegetable consumption, physical activity and obesity. 
  4. Assessing the degree of implementation of interventions and policies at a national level is methodologically challenging.