The rising cancer burden in Europe, mainly due to a rapidly ageing population, demands a clear and coordinated response from researchers, oncologists and other physicians, public health professionals and policy-makers. Primary and secondary prevention is the front line in the complex battle against cancer in Europe. To formulate the best strategies in this fight, the major determinants of cancer are summarised in the order of their relative importance in Europe, including tobacco smoking, alcohol, diet, physical activity, occupational factors, environmental factors, infectious agents and genetic and hormonal factors. Furthermore, this paper offers explicit recommendations on individual behaviour modification and possible public policies. It also details the numerous examples of European policies and programmes already in effect which aim to reduce the impact of these risk factors on cancer. Although there are still pending questions, which need further epidemiologic research, it is also true that we have more operational knowledge for cancer prevention than ever before. The prompt implementation of prevention programmes such as those detailed here should be applied with determination to maximise the prevention results. (C) 2008 Elsevier Ltd. All rights reserved.