Mangesh A. Thorat

European Code Against Cancer, 5th edition – hormone replacement therapy, other common medical therapies and cancer

Several medical therapies modify the risk of developing certain cancers in an individual. The aim of this paper was to provide the scientific justification for the 5th edition of the European Code Against Cancer (ECAC5) recommendation on the use of hormone replacement therapy (HRT) and other drugs used at population scale, such as hormonal contraceptives and aspirin. HRT modifies the risk of developing certain cancers in an individual. Except for vaginal oestrogens, all forms of HRT are associated with an increased breast cancer risk; the risk of serous ovarian cancer and endometrial cancer may also be increased. Despite such an increase in cancer risk, HRT often remains the only option for the management of certain menopausal symptoms for the restoration of quality of life and mental health. Therefore, the ECAC5 recommends using HRT for bothersome menopausal symptoms only after a thorough discussion with a healthcare professional and limiting its use for as short a duration as possible. On review of up‐to‐date evidence for hormonal contraceptives and aspirin, the ECAC5 Working Group elected not to make a recommendation for the average‐risk general population regarding the use of these therapies.

European Code Against Cancer, 5th edition – organised cancer screening programmes

The 5th edition of the European Code Against Cancer (ECAC5) recommends sustainable, organised screening programmes for: (a) colorectal cancer using biennial quantitative faecal immunochemical test (FIT) for individuals aged 50–74 years. As an alternative strategy, once‐only endoscopy may be considered within the same age range; (b) breast cancer using biennial digital mammography for women aged 50–69 years. Implementing this strategy for women aged 45–49 years and 70–74 years can be considered. Other screening strategies or additional examinations could be considered for women with high mammographic density; (c) cervical cancer using human papillomavirus (HPV) screening at intervals no shorter than 5 years for women aged 30–65 years. It is recommended to adapt policies according to vaccination status and screening history; and (d) lung cancer using annual low‐dose computed tomography (LDCT) for individuals considered to be at increased risk of lung cancer based on age, history of smoking or validated risk models, with biennial screening as an alternative. Screening should incorporate smoking cessation interventions.