Test Green Paper Webpage
Optimising EU Investment in Cancer Research: A Strategic Framework for Better Impact (Green paper, July 2025)
Introduction
EU cancer research policy is at an inflection point.
4 years into the delivery of the landmark Europe’s Beating Cancer Plan and the EU Research Mission on Cancer, decisions on the continuity and direction of future EU cooperation on combatting cancer lie ahead. Preliminary discussions are already commencing on the next 7-year EU budget to commence in 2028, known as “the multiannual financial framework”. A new European Commission has taken office after European Parliament elections, with pledged commitments to macro themes such as ‘Competitiveness’ and European security, guided by informative reports such as those recently led by Mario Draghi, Manuel Heitor, and Enrico Letta.
It is in this context that the Research Policy Network of the European Cancer Organisation, led by Professor Christine Chomienne, has identified a need to promote debate and discussion on the best forms by which to deliver future high impact cancer research supported by EU funding.
The purpose of this ‘Green Paper’ is to promote an opportunity for input from stakeholders from across Europe’s community of cancer researchers, health professionals, patients and patient advocates, carers, interested citizens and many more. Based on responses received, a subsequent ‘White Paper’, to present the final conclusions of the consultative exercise, will be presented at the European Cancer Summit, 19-20 November, in Brussels, Belgium.
The premise of the Green Paper is that Europe has achieved many highly significant achievements in cancer research by working together across borders, aided by European Union mechanisms and frameworks for cooperation. But that improvements to how EU-supported cancer research is conducted are open to be achieved.
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We invite all who have interest in achieving the highest possible performance of EU cancer research to review the following Green Paper and provide your inputs by end of day Friday 5 September. Inputs can be received in any format although a questionnaire is provided at the end of the Green Paper to help guide comments. |
In order to foster and encourage open debate, respondents are invited to indicate if their input may be made public on the Green Paper consultation website. However respondents may also indicate if they would prefer their input not to be distributed in this way.
We thank in advance all stakeholders for their time and expertise in formulating fresh recommendations to the decision-makers of the European Union on achieving the best future for cancer research in Europe.
Where we have come from – a brief history of EU involvement in cancer research
1967-2019. Getting started. Proving concepts and setting new paradigms
Up until the 1960s, the great majority of cancer research in Europe was conducted at the national level through universities, hospitals, and national cancer societies. The foundation of the European Organisation for Research and Treatment of Cancer (EORTC) in 1967 began to signal a new future in which clinical trials and cancer treatment research could be conducted to a greater extent across countries.
As European convergence and integration grew during the 1980s, the foundation of the first European ‘framework programme’ for research and technological development marked a further significant landmark, cementing the concept that health and biomedical research should be considered a key, and high value, area of shared investment by the member state governments of the, then, European Community.
Some early fruits of this new form of cancer research investment included the EUROCARE (European Cancer Registry–Based Study on Survival and Care of Cancer Patients) programme which commenced in 1989. By compiling standardised survival data and study care processes in cancer patients using population-based registries, it enabled, for the first time, meaningful multinational comparisons. The EUROCARE Atlas of Cancer Survival in Europe continues to be the benchmark for assessing survival variability across Europe, and guiding policy interventions in response.
Through the 1990s a variety of important cancer research collaborations and platforms for cooperation continued to be created by successor framework programmes.
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Framework Programme |
Notable Cancer Research Project |
Focus |
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FP1 - FP4 |
Europe Against Cancer[1] |
The “Europe Against Cancer” Programme was a pioneering European initiative that launched coordinated action plans to reduce cancer incidence and mortality through prevention, early detection, data collection, public health research, and professional training, laying the groundwork for EU-wide cancer policy. |
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FP5 |
Eurocare-3[2] |
EUROCARE-3 was a major European study that analysed cancer survival data from over 1.8 million patients across 22 countries, revealing significant regional disparities in outcomes and highlighting how factors like tumour stage, diagnostic practices, and healthcare system quality influence survival. |
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FP6 |
Eurocan+Plus[3] |
The EUROCAN+PLUS Project was a landmark Europe-wide feasibility study launched in 2005 to coordinate national cancer research efforts, addressing fragmentation and duplication by recommending the immediate creation of a permanent, independent European Cancer Initiative (ECI) to foster collaboration across basic, clinical, and epidemiological research, integrate comprehensive cancer centres, and unify stakeholders including patients, funders, and industry to accelerate innovative cancer treatments and prevention strategies. |
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FP7 |
EUROCANPLATFORM[4] |
The EurocanPlatform was a collaborative network of 28 leading European cancer institutions that structured and integrated translational cancer research across prevention, early detection, therapeutics, and outcomes, achieving major milestones such as establishing Cancer Core Europe, advancing biomarker discovery, creating a designation methodology for Comprehensive Cancer Centres of Excellence, and fostering sustainable training programmes to accelerate innovations that improve patient outcomes and reduce cancer mortality. |
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Horizon 2020 |
CHAIMELEON[5] |
CHAIMELEON aimed to set up an EU-wide structured repository for health imaging data to be openly reused in Artificial Intelligence (AI) experimentation for cancer management. It will be built as a distributed infrastructure and populated with multimodality imaging and related clinical data for historic and newly diagnosed lung, prostate and colorectal cancer patients. |
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Horizon Europe |
UNCAN.eu[6] |
UNCAN.eu (Understanding Cancer) is a European initiative under the Cancer Mission that aims to accelerate cancer research by enabling access to high-quality, interoperable data through a European Federated Cancer Research Data Hub, promoting FAIR data principles, open science, and collaboration among existing infrastructures, with the ultimate goal of improving cancer prevention, diagnosis, and treatment for patients across Europe. |
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ECHoS[7] |
ECHoS (Establishing Cancer Mission Hubs: Networks and Synergies) is a European project supporting the implementation of the EU Cancer Mission by creating national and regional cancer mission hubs across Europe, aimed at coordinating stakeholders, aligning national actions, and ensuring that Europe's cancer-related research and innovation efforts are inclusive, patient-centred, and effectively translated into policy and practice. |
2019-2025 – A new era of EU research cooperation on cancer. Thinking bigger.
The European Parliament elections of 2019 had the impact of establishing a new level of vision for European cooperation on cancer research. Election pledges for a European masterplan on cancer were honoured by the bringing forward of both Europe’s Beating Cancer Plan and an EU Research Mission on Cancer.
Both initiatives have established bold statements of intent by the European Union on cancer. More lives can be saved and improved through coordination across countries. New foundations for the future have been established by the creation of fresh networks and infrastructures for cooperation on a range of research and practice areas and needs.
Now, as we collectively look to the next phase of EU action under the forthcoming budget period 2028-2035, it is opportune to reflect on both the strengths of EU cancer research cooperation that can be built upon, but to also invite reflections on areas where improvement, efficiency and higher impact may be realisable with reform of approach.
2025. Europe looks out to a world in flux
At the mid-point of our current decade, one can already imagine that the accounts of the past 5 years of geopolitical activity will fill many shelves in the history section of libraries in the future.
The impacts of the Covid-19 pandemic continue to reverberate, with varying degrees of lesson learnt. The requirement for Europe to re-shore production of essential health and medicinal products has been recognised and responded to through significant legislative and administrative response. The need to further empower agencies of the EU such as the European Medicines Agency and the European Centre for Disease Prevention and Control has been met to a large degree. It is the view of the European Cancer Organisation that more lessons may yet still be applied in respect to: the value of access to near real time health data; the opportunities to lighten regulatory burden in some areas of research; and, the need to address shortages in health workforce capacity with the same energy and intent as now being directed towards medicines shortages.
The shock of Russia’s military invasion of Ukraine is still acutely felt. Once again, the collective muscle of cross-border cooperation that the EU can exercise has been important in the response to both the security and humanitarian needs of the country. Ukraine’s subsequent admission to EU cooperation mechanisms such as Horizon Europe and the EU4Health programme, while now well established, have not undone the damage to clinical trial activity caused by the invasion, in a country that was previously exemplar in this field.
Tariff battles with the USA and other countries are impacting all economic sectors in Europe, inclusive of the health sector, where too often key medicinal and diagnostic products are not being exempted from the threats and counter-threats of tariff introduction and increase.
Meanwhile, in aggregate, the European Union has continued to experience slow and uneven economic growth over recent decades, especially when compared to global peers like the United States and emerging economies. Amongst factors attributed to this include weaker productivity, slower rates of uptake on digitalisation opportunities, and a poorer record of capitalising on the science base available in Europe through its world-leading academic centres. In recognition of these issues, the European Commission has sought out expert advice and recommendations from a number of sources.
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Align, Act, Accelerate (Heitor) |
Much more than a market (Letta) |
The future of European competitiveness (Draghi) |
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Make Europe more globally competitive, secure, sustainable and resilient through a stronger framework programme (Recommendation 2) |
[…] moving away from traditional, siloed approaches, which will be crucial for ensuring research is relevant. (p. 22) |
The report recommends reforming the EU's next Framework Programme for R&I in terms of its focus, budget allocation, governance and financial capacity (part B, p. 245) |
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Deliver European added value through a portfolio of four interrelated and interdependent "spheres of action", with a budget of at least EUR 220 billion (Recommendation 3) |
A coordinated and comprehensive European technology policy (p. 19) |
Europe must profoundly refocus its collective efforts on closing the innovation gap with the US and China, especially in advanced technologies.” (part A, p 19) […] refocus the next Framework Programme (FP10) on selected priorities (new ‘EU Competitiveness Priorities’) and increase the budget to EUR 200 billion. (part B, p. 247) |
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Promote Competitive Excellence throughout the FP, strengthening the ERC, EIC and MSCA. Launch “Choose Europe” to foster research careers in Europe (Recommendation 5) |
Retaining talents is critical for Europe's economic resilience, innovation capacity, strategic independence, and societal welfare and should be one of the most urgent priorities. (p. 21) |
Double the support to ground-breaking fundamental research through the European Research Council (ERC) (part B, p. 250) The existing EIC Pathfinder should be reformed to improve its governance and then endowed with substantially greater resources to become a genuinely new ‘ARPA-type agency’ [..] (part B, p.248) |
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Strengthen the European RD&I ecosystem (Recommendation 8) |
[…] the necessary skills, infrastructures, and investments, to enable widespread prosperity and industrial leadership. (p. 19) |
[…] ERC-I should build on the high number of well-established European research institutions that rank in the middle to high tiers of the global distribution and propel some of them to the very top of academic excellence. (part B, p 251) […] a new EU framework for private funding to enable public universities and research centres to design more competitive compensation policies for top talents and to provide additional support for research. (part B, p. 253) |
It is in these contexts and more that the new European Commission 2024-29 is making Competitiveness and Security major themes of the administration. Accordingly, both policy imperatives will likely form a significant backdrop to the next EU multiannual financial framework 2028-35.
Aligning policy agendas. Cancer research as part of a competitive and secure Europe.
While the over-riding concern of ECO Research Policy Network is the means to achieve the most productive cancer research landscape in Europe for purposes of improving and saving lives, this Green Paper also recognises the existence, and need for Europe to respond to, major policy needs on competitiveness and security.
It is our consideration that a competitive Europe is a Europe which leads the world in research, including in cancer research. Where the promise offered by research conducted can be duly translated to tangible improvements to patient care and treatment. Where burdens and obstacles to research productivity are rapidly identified and overcome. Where the full strength represented by the 793 million citizens represented within the countries of the EU Horizon Europe is capitalised upon.
It is our consideration that a secure Europe is a Europe that integrated through joint endeavour. That responds to grand and shared societal challenges together and effectively. That provides a beacon for other regions of the globe for what can be achieved by mutual cooperation across borders.
It is our intent, by bringing forward fresh suggestions on the future of European cancer research cooperation, to make some contribution towards the achievement of these major areas of present EU policy focus.
[Room for some pull-out boxes (potentially developed further in the final white paper) along the lines of “What has the EU ever done for….cancer prevention research.” “What has the EU ever done for…cancer screening research” etc. Would need to be guided by discussions with relevant experts]
Analysing the strengths and weaknesses of present European cooperation mechanisms on cancer research
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STRENGTHS
· SCALE: Horizon Europe research programme with a value of 95.5 billion euro in value · SCALE: 793 million citizens represented by 37 countries within Horizon Europe · INFRASTRUCTURES: Framework Research Programme with 40 years of successful operation · EXPERTISE: ≈7,000–8,000 universities and equivalent higher-education institutions across all Horizon Europe countries. · REGULATION: Library of pan-European regulation designed to assist pan-European research such as the Clinical Trials Regulation and General Data Protection Regulation. |
WEAKNESSES
· CONTINUITY: Criticism that there are too many ‘stop-start’ projects that are not given the duration needed to achieve maximum impact. · REGULATION: Criticism that EU regulation is interpreted diversely across countries, is rigid and hard to change after problems identified, and can result in added burden for clinicians, researchers and trial sponsors. · COMMERCIALISATION: Europe behind other regions in turning research promise into innovative product that enhances patient outcome. · EXPERTISE: Criticism that funding calls may fall victim to ‘design by committee’, lacking a strong sense of overall coherence and inter-connection. · SCALE: Suggestion that greater productivity could be achieved by having less research projects but conducted at greater scale. · ACCOUNTABILITY: Not always clear who is in overall charge of Europe’s cancer research effort. Targets and goals (e.g. in spreading research productivity and activity across more European countries) not always present and reported on. · INEQUALITIES: Too many countries in Europe remain left behind in terms of cancer research activity and productivity
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OPPORTUNITIES
· New EU Multiannual Financial Framework 2028-35: Chance to restructure approach to EU supported cancer research. · EU Competitiveness Agenda: Chance to unblock long-existing regulatory problems. · EU Security Agenda: Stimulus for deepening integration of efforts in fields such as health and cancer research. · Continuity: Europe’s Beating Cancer Plan and EU Research Mission on Cancer have created solid foundations on which to build in the future. · Scale: Enhancing innovation capacity by exploring alternative funding and evaluation frameworks (e.g. high-risk high-reward projects; ARPA model) · Expertise: Involving leading experts early in the design process ensures funding calls are strategically coherent, better aligned, and mutually reinforcing.
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THREATS
· Geopolitical competition: Europe falls further behind other regions in research productivity. · Political prioritisation: A long-term approach to EU investment in cancer research is somewhat hostage to the political cycle and shifting priorities of each Commission. · Uncertainty: Not known at the present time if the EU Cancer Mission and Beating Cancer Plan will be sustained during the next EU multiannual financial framework period.
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Considering examples from elsewhere.
USA: The National Cancer Institute
In the United States, federal support for cancer research is primarily funded through government grants, particularly from the National Institutes of Health (NIH) and the National Cancer Institute (NCI).
Originally signed into being by President Franklin D Roosevelt in 1937, the NCI became the first disease-specific federal agency for medical research in the U.S.A. Its relatively humble work programme was then greatly boosted by the 1971 National Cancer Act which, as part of President Richard Nixon’s ‘War on Cancer’, gave NCI significant autonomy and additional funding, and established the SEER (Surveillance, Epidemiology, and End Results) programme for population-based cancer data. Through the 1980s, the NCI helped the USA to lead the field in the application of molecular biology, oncogenes, genetics, and tumour immunology. This included its support for the Human Genome Project and the eventual launch in 2005 of the Cancer Genome Atlas (TCGA), a landmark project that mapped genetic mutations in 30+ types of cancer.
As the leader of the cancer research enterprise, collectively known as the National Cancer Program, and the largest funder of cancer research in the world, NCI manages a broad range of research, training, and information dissemination activities that reach across the entire country, meeting the needs of all demographics—rich and poor, urban and rural, and all racial/ethnic populations. The main source of funding for NCI is the US Congress.
Private foundations like the American Cancer Society and pharmaceutical companies also contribute significantly to funding, often focusing on specific types of cancer or treatment innovations. Additionally, academic institutions, biotech companies, and venture capital firms support research through institutional grants, partnerships, and investments in promising cancer therapies.
The NCI has an annual budget of $7.3 billion.
FRANCE: Institut national du cancer (INCa)
The Institut national du cancer (INCa) was created by law on 9 August 2004, as part of France’s first national cancer plan (2003–2007), and officially established as a groupement d’intérêt public in May 2005. The institute is co‑sponsored (“cotutelle”) by the Ministère de la Santé and the Ministère de la Recherche, uniting public and private sector stakeholders.
The Institut is governed by a Board of Administrators (27 members) from government, civil society, patient groups, and health research, plus an international Scientific Council, an ethics committee, and a patient/users committee.
Amongst the roles performed by the Institut national du cancer (INCa) includes:
- Overseeing the ongoing Ten-Year Cancer Strategy (2021–2030) and previous national cancer plans;
- Constructing and operating regional cancer poles (cancéropôles) across seven regions to bring together research centres, hospitals, and industry
Additionally, INCa issues competitive calls for projects spanning scientific, clinical, public‑health, and organizational research and funds clinical and translational research through programs like PHRC‑K, PRME‑K, and PRT‑K.
INCa also:
- Produces evidence-based recommendations, reference frameworks, professional labels, and national expertise;
- Collects, analyses, publishes and disseminates data on cancer incidence, mortality, and risk factors, underpinning French cancer surveillance;
- Runs information campaigns, organises symposiums, publishes resources for professionals and the general public .
INCa has an annual budget of between €120–147 million, funded mainly from public subsidies by the Health and Research ministries. Over 50% of the budget is dedicated to research funding, with the remainder covering public health, communications, operations, and personnel.
JAPAN: The National Cancer Center of Japan (NCC)
Japan’s National Cancer Center, established in 1962, plays a vital role in coordinating nationwide cancer research and data collection. It manages the country’s national cancer registry and runs multi-institutional clinical trials and precision medicine initiatives. The institute also leads formation and implementation of Japan’s Basic Plan to Promote Cancer Control (since 2007), setting priorities in prevention, diagnosis, treatment, and survivorship. The institute is at the forefront of genomics research, coordinating important research collaborations in this field such as C-CAT, SCRUM-Japan, NCC Oncopanel, and the Rare Cancer Center.
Countries such as Brazil, South Korea and India also have national cancer institute, or highly similar style coordinating mechanisms, in place.
A European Cancer Institute: An idea whose time has come?
Clearly, the concept of a centralising cancer institute is not entirely novel, with a raft of countries already embracing the concept of a centralising agency to guide and coordinate research efforts, and also ensure coherence with national strategies on cancer control.
Nor too is the idea of a European Cancer Institute freshly made via this Green Paper. In 2001 clinical researchers were already publishing views and ideas related to the need for such a coordinating mechanism. Notably, the European Academy of Cancer Sciences (EACS) has also championed the concept over a number of years.
In 2008 the European Journal of Cancer led published debate on the topic, with leading cancer policy commentator Professor Richard Sullivan remarking: “[..] there should be a virtual institute, which brings major funders, and key opinion leaders round the table. It could be a discussion forum which keeps the spotlight on one of the biggest health issues for Europe over the next decades.”
The full weight of the European Parliament was also given to the concept through the 2022 Report “strengthening Europe in the fight against cancer – towards a comprehensive and coordinated strategy”. Championed by Report rapporteur and medical oncologist Véronique Trillet‑Lenoir MEP, the Parliament voted in support of the concept of a “European Knowledge Centre on Cancer”, with special coordinating tasks on European level cancer policy implementation. Hailing the cross-party support for her report, Trillet-Lenoir remarked at the time “The articulation of prevention, care and research actions will be ensured by a European Knowledge Center constituting a virtual "European Cancer Institute".
In view of the above described Strengths, Weaknesses, Opportunities, and Threats present within the current EU landscape of cancer research, and taking account of experiences and practices from elsewhere, ECO’s Research Policy Network sees merit in considering again the merits (and demerits) of establishing a European Cancer Institute within the next EU multiannual financial framework period.
What would a European Cancer Institute do?
Although coordinating cancer institutes exist in many countries across the globe, the nature and means by which they operate, their scope, their budgetary arrangements, all differ.
What would appear critical though, in order for any European Cancer Institute to add value to the cancer research landscape in Europe would be to ensure that it contributes towards:
- More long-term approaches to EU supported cancer research
- Greater accountability for the decision-making and performance of EU supported cancer research
- Placing EU supported cancer research in a place of greater security and certainty apart from the rapid changes otherwise often delivered by the political cycle
- Speaking ‘truth to power’ on major policy needs for cancer research productivity in Europe, be they regulatory matters, or of an infrastructural nature (e.g. workforce, data needs)
- Achieving the full potential of Europe’s scalability in terms of population size and breadth of universities and high standard cancer centres.
- Addressing persistent and chronic inequalities in Europe in respect to patient access to clinical trials and uneven trial activity and productivity between countries.
As noted above, among proponents of a European Cancer Institute, some suggestions have been made that it could be a “virtual institute”, that helps to coordinate the existing principal cancer research efforts in Europe e.g. through exchange and close partnership with cancer centres and national cancer institutes.
Alternatively, a ‘bricks and mortar’ institute could also be considered, headquartered in an EU member state city, similar to an EU agency basing, and with a remit more in tune with those established for agencies such as the NCI in the USA and INCa in France.
Still further, a ‘virtual institute’ may be envisaged to be developed as an interim measure, through the terms of the next Horizon research framework period, perhaps building upon the foundations of the EU research mission on cancer. Dependent on experience and development, further decisions on its long-term operation, and mode of working, might be made at a future date.
For the purposes of consultation, this Green Paper initially suggests that a European Cancer Institute should be tasked with:
- Leading EU-wide efforts to improve prevention, detection, diagnosis, and treatment of cancer, being the long-term successor vehicle for the full promises of Europe’s Beating Cancer Plan to be delivered.
- Supporting a goal of all cancer centres in Europe being active in research.
- Supporting the conduct of major EU funded pan-European cancer research projects across countries
- Partnering with industry, philanthropic organisations, civil society organisations, and global institutions to tackle complex research challenges
- Directing investment in cancer research infrastructure across EU member states, and in so doing, helping to ensure better geographical balance in funding and expertise in cancer research across Europe
- Ensuring overall excellence in Europe’s conduct of cancer research and restoring and enhancing its role as a world leader in cancer research.
To lead long-term enhancement of EU cancer research efforts, ECI should:
- Conduct and commission high-quality research to provide data-driven policy proposals that address cancer research, prevention, treatment, and survivorship across the EU
- Establish strong partnerships with patient organisations, healthcare professionals, policymakers, and research institutions to ensure diverse perspective shape policy priorities. Wide stakeholder representation should be achieved in its governances, similar to the European Medicines Agency (EMA) and the French national cancer institute (INCa)
- Support the European Union in responding to regulatory and infrastructural challenges to high quality cancer research across Europe.
- Promote EU-wide cooperation on cancer care, research, and data sharing to reduce disparities in access to high-quality treatment and innovation across member states.
We invite views from any and all with interest in the matters laid out and discussed in this Green Paper. All comments returned will help to inform a final ‘White Paper’ to be presented at the European Cancer Summit, 19-20 November 2025, in Brussels, Belgium.
Responses should be sent to ….. by a deadline of end of day Friday 5 September 2025.
https://www.ejcancer.com/article/0959-8049(95)95354-9/abstract
https://pubmed.ncbi.nlm.nih.gov/14684501/
https://pubmed.ncbi.nlm.nih.gov/22274749/
https://cordis.europa.eu/project/id/260791/reporting
https://chaimeleon.eu/#about-project
https://cancermissionhubs.eu/the-project
https://pmc.ncbi.nlm.nih.gov/articles/PMC5528571/#mol22014871161-bib-0005
https://pmc.ncbi.nlm.nih.gov/articles/PMC5528571/#mol22014871161-bib-0005
