Marzia Zambon  |  Executive Director, EUROPA DONNA - The European Breast Cancer Coalition

In the middle of Breast Cancer Awareness Month, Europa Donna chose 15 October to celebrate Breast Health Day: since 2008, we have been sending a positive, evidence-based reminder that awareness must lead to action. Breast cancer remains the most commonly diagnosed cancer in women worldwide, with 2.3 million new cases in 2022.

In the EU, 374,800 women were diagnosed that year and one in 8 is estimated to develop the disease within their lifetime. Age remains the most significant risk factor, and that is something none of us can change. But there are risk factors we can change, and we must act now.

Prevention has three interconnected dimensions.

Primary prevention means reducing the chance that breast cancer develops. Research estimates that around one-quarter to one-third of cases could be avoided through modifiable factors, with some estimates reaching approximately 35%. Regular physical activity, maintaining a healthy weight - particularly after menopause - and avoiding or limiting alcohol can reduce risk. Even low alcohol consumption matters, yet this link is still poorly understood. But prevention cannot rest on telling women to make better choices. Governments must address commercial drivers, including gendered marketing of alcohol and tobacco, provide clear cancer-risk labelling, and make healthy food and physical activity accessible.

Biological and clinical factors also need clear, targeted communication to raise awareness. Breastfeeding reduces maternal breast cancer risk and should be enabled through paid maternity leave and workplace protection - never presented as a burden or with judgement. Menopausal hormone therapy can improve quality of life, but combined oestrogen-progestogen treatment is associated with increased risk, which declines after treatment stops. Women deserve an individual assessment of benefits, risks, dose and duration with a specialised clinician.

Social inequality runs through prevention. Advice is ineffective when women lack health literacy, time, income, safe places to exercise or primary care. Policies should be co-designed with the communities they intend to reach and evaluated by socioeconomic status, disability, geography, ethnicity and migration background.

Secondary prevention means detecting disease before symptoms appear, when treatment is generally less aggressive and outcomes are better. Quality-assured, population-based mammography screening reduces breast cancer mortality: trials show an approximate 20% reduction among women invited, with a larger benefit among those who attend. The roughly 35% decline in EU mortality rates over recent decades reflects screening, earlier diagnosis, and better treatment. Women outside screening age groups must be aware of their own normal and have prompt access to diagnosis when they report changes.

Europe's Beating Cancer Plan set the goal of offering breast, cervical and colorectal screening to 90% of eligible people. Offering is not enough. Invitations must be understandable; programmes must be affordable, accessible and connected to timely diagnosis and quality-assured specialist care. Coverage, participation, waiting times, stage at diagnosis and outcomes must be publicly monitored and programmes must be properly funded, not merely promised on paper.

Most importantly, women invited to screening programmes must attend them. The OECD's Health at a Glance 2025, using 2023 data, shows a nearly threefold difference in breast cancer screening rates: 29.8% in Cyprus compared with 83.3% in Denmark. Why do so many women not attend when they are offered a free, potentially lifesaving service?

Tertiary prevention begins after diagnosis: preventing recurrence, second cancers and avoidable long-term illness. It includes completing treatment, support for adherence to endocrine therapy, appropriate follow-up, rehabilitation, physical activity, weight management, limiting alcohol and quitting smoking. These services belong in survivorship care, yet they are often not even addressed at consultations.

And what about GLP-1 medicines, are they the new frontier of substantial weight loss and metabolic improvements? May they contribute to prevention and better survivorship for breast cancer patients? Observational findings are encouraging, but do not yet prove prevention of breast cancer or recurrence; prospective trials, long-term safety data and equitable access planning are essential.

Part of the job of patient organisations is to turn evidence into accountability. Across Europa Donna's network in all 27 EU Member States and 20 other affiliated European countries, we can challenge harmful marketing, increase health literacy, identify barriers to screening, demand comparable data and hold governments to their commitments. Europa Donna is working for the European Parliament to declare 15 October European Breast Health Day: not another awareness day, but an annual institutional checkpoint within Pink October. It would demonstrate that European institutions stand behind prevention and give advocates leverage to follow progress from European commitments to national implementation.

One final, important point to get across: prevention is not pointing the finger, and it is not a slogan. It is a continuum of informed personal choices, supportive public policy, equitable screening and high-quality survivorship care. Europe already knows much of what works. Now it must fund it, implement it and measure it.