Youth and Zero Incidence, Zero Prevalence of Cancer in India- An Achievable Goal?
Correspondence Address :
Dr. HS Sreeshyla,
Assistant Professor, Department of Oral Pathology and Microbiology, JSS Dental College and Hospital, JSSAHER, Mysuru, Karnataka, India.
E-mail: dr.sreeshylahs@jssuni.edu.in
Cancer is one of the main leading causes of high mortality and morbidity. It is also one of the preventable diseases with known risk factors in many of the cases. Youth are like double edged sword, by being the highly vulnerable group as well as the group with strong potential for disease prevention. Health education, creating strong awareness on the known avoidable risk factors among the young adults can prevent the occurrence of cancer. Simultaneously, using the educated young group to dissipate their knowledge to curb the cancer is the need of hour. Thought of zero incidence and prevalence of cancer in India looks unachievable. However, with the youth centred programmes, by the youth, for the youth and to the general public, such goals can be achieved.
Deaddiction, Health education, Morbidity, Mortality, Tobacco
Cancer has entangled the world with its vicious cradle and has become a great global concern. The associated socio-economic psychological encumbrance and high mortality-morbidity poor quality of life calls for immediate action to tackle this burden (1),(2),(3). There is an increased literacy rate in the country, an abundance of research added to the cancer literature every day, availability of highly advanced early diagnostic modalities and praiseworthy attempts made by government bodies, private organisations, educational institutions, healthcare units, Non Government Organisation (NGO) and various other officialdoms to increase awareness on cancer among the general public (4),(5),(6). Public awareness messages in the cinema halls and through social media are reaching wider audience (7). Inspite of all the persistent efforts, the cancer still remains a major health issue.
The update from Globocan 2020, International Agency for Research on Cancer (IARC) estimated 19.3 million new cancer cases and 10 million cancer deaths in 2020. If nothing is done about this now, IARC has estimated global cancer burden to rise by 47%, a total of 28.4 million cases by 2040 (8),(9). The projected incidence of cancer occurrence in India was 679,421 among males and 712,758 among females for the year 2020. The cancer registry data has estimated that there will be about 800,000 new cancer cases in India every year (10),(11). In 2019, an estimated 1,335,100 new cancer cases and 397,583 cancer-related deaths occurred among Adolescents and Young Adults (AYAs) worldwide (12). These cancer statistics in India from Globocan survey, Indian cancer registry and National Cancer Control Programme are highly distressing. The continuation of the present trend can lead to highly alarming statistics in next 20-50 years, especially with more youth succumbing to cancer death (8),(13). These darker stats force us at thriving towards its suppression at the earliest. Well-planned short-term projects with good outcomes, spread over longer duration, aiming to achieve zero incidence and zero prevalence of cancer, are essential and crucial.
YOUTH- THE DELIVERERS AND THE BENEFICIARIES
The possibility of creating a cancer-free future by facilitating awareness and sensitising the adolescent-youth population about cancer, its causes, prevention and detrimental effects can aid India in lessening the competition for resource allocation between prevention of communicable diseases and cancer. As important as it is to help and support those with cancer and those with loved ones suffering from cancer, going forward, it is more important to promote its prevention.
The National Youth Policy of India-2014 has defined youth as persons in the age group 15-29 years (14). Youth comprises the major potential section of the society. Youth force is dynamic in nature and the youth of the nation are trustees of prosperity. They can play the dual role of being the participants as well as the deliverers. Globally, India has the largest youth population and will continue to do so for the next 20 years, as estimated by the National Statistical Commission of India (15). The present challenge is to channel this dynamic potential and resource for the welfare of people.
“The world’s biggest power is the youth” (Chanakya) and “We cannot always build the future for our youth, but we can build our youth for the future” (Franklin D Roosevelt). Quotes like these reinforce that youngster are energetic, enthusiastic, creative, innovative and challenge seekers. Youth are identified as both the key beneficiaries as well as deliverers (16). Therefore, it is time we develop youth centred programmes with the involvement of youth, for both youth and the other population (17).
PREVENTIVE MEASURES AND THEIR IMPLEMENTATION
Major areas where World Health Organisation contribute to cancer prevention are Tobacco Control, Palliative Care and Human Resource Development (10),(13). Human resource section should include youth as the major segment. Young trained personnel in various specialities, at various levels should play the key changers.
HEALTH EDUCATION
Education and health are interdependent. While the health status impacts the academic achievement, the academic status will have an impact on health. When combined, health education can have a great bearing (18). Adolescence provides a great window of opportunity for cancer education and intervention. Such an education should be targeted at this group, as they are in an age of active learning as well as in a stage where risky behaviours, such as smoking, begins (19),(20).
Primary prevention is the most effective mode of combating this situation. Health education is an important tool for prevention and early detection of cancers. The cancer associated risk factors are highly preventable. Hence, risk factor modification should be the prime facade. This health education should be provided to children when they are still impressionable, when the new habits they develop or the knowledge they obtain about health and diseases will have an impact on their future health. The best places to introduce this shift are in schools and universities. Teenagers and young adults encountering peer pressure in these settings try out new behaviours. It is necessary to train and equip college and high school professors to spread information about oral cancer and its simple prevention. Risk factors, healthy lifestyles, preventative actions, and advice about the negative consequences of alcohol and cigarettes should be added to the curricula of schools and universities. Also, strict measures to engage the youth in any kind of activity- be it sport or cultural, be made mandatory. This will keep them healthy, busy and away from the unwanted habits (10),(20),(21). This has to be approached together as lifestyle modification should be adopted in young age, for proficient results. Public health officials and education department must collaborate to sustenance quality school health programs that meet the changing needs of today’s youth (10),(18). Educational interventions and platforms should address obstacles to preventative behaviour and target specific areas of cancer prevention, such as avoiding tobacco products, maintaining healthy diet and limiting sun exposure. Educating adolescents on cancer prevention is essential to lower their risk of cancer in the future (19),(20).
Just like ‘Red Ribbon Clubs’ that are formed in schools and colleges to tackle Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS), schools and colleges should also have groups formed by the youth, for the youth wherein students are the mentors as well as the counsellors. When any valuable health information is given by peers, it is well accepted by youth. The participation of the youth not only as the receiver but also as the contributor is a powerful psychological boost for the youths (22). Regular discussions, Interactions, question and answer sessions will keep the information fresh. Freshers’ introduction program should include briefly about tobacco and its ill-effects. This should be followed by an interaction program regularly to keep reminding the youth about the ill-effects of tobacco and its future, i.e., cancer.
Anti-tobacco Programmes
A 50% of all cancers in males are tobacco related and teen age is the most sensitive, vulnerable and easily tangled state (10),(13),(23). Anti-tobacco programs targeting the young are the need of the hour. There are legislations to enforce anti-tobacco laws and sale restrictions (23). However, their strict enforcement is possible with the involvement of the beneficiaries. Student committee’s at all educational institutes should be mandated to monitor strict enforcement of these regulations to yield better outputs. Counselling and deaddiction centres should work towards zero youth tobacco registries at their centres and the counselled youth should be employed and encouraged to take up the responsibility of further counselling the needy. This prevents them from re-addiction and the experience makes them the expert counsellors. Government level inventiveness for development of youth wing, employing the youth dedicated for cancer prevention will be a great initiative.
Media Education
Health magazines that are led by and contributed by youth about cancer facts and experiences should be initiated at national and regional levels with focus on local language. Educative materials in the form of audio-videos, posters, leaflets, flipcharts etc., has to be developed and advertised in the leading dailies for creating awareness about cancer among the general public. Interactive programme which provides an interface to the people with experts on cancer issues and moderated by youth should be conducted to educate the public. This in turn, becomes self-educative too. At every interaction each of us will learn something new as a take home message. Conducting campaigns and parades for cancer awareness will be more effective if conducted in Adolescent and Young Adult (AYA) hotspots like malls, multiplexes and academic institutions rather than conducting them on a busy road on a busy and hot day. Sensitising the youth on a consistent basis will help them generate an innate memory of the shortcomings and create a sense of consciousness and responsibility towards this malady. To effectuate, giving out brochures about cancer awareness along with movie tickets, gift hampers, purchase bills will prove helpful (24),(25).
Information, Education and Communication (IEC) is the key to tackle cancer. Social media can be a remarkable tool in achieving this. Discussion forums, YouTube, Facebook page, Twitter, Instagram to name a few, are all at our finger tips. Using this social media, general public and youth in particular can be targeted. Authentic information about anything related, from tobacco, its side-effects, need for healthy lifestyles, risk factors for cancer should be made available. This information should be advertised while visiting the social media site. Just like other product ads which pop up while we watch a video or visit a site, information about ill-effects of tobacco, its relation to cancer, how to quit tobacco, helpline numbers, contact of tobacco intervention centres should also be displayed which cannot be skipped, but need to be viewed. Personalised, interactive educational program using already established resources will allow for the promotion of cancer prevention.
Social media platforms like “Know Your Lemons”, awareness for breast cancer, Caped India, for cervical cancer and many other Non Profit Organisations (NPOs) promote awareness and provide facilities for early detection and prevention of certain cancers. This has made cancer education accessible and easy. Certain months of the year have been allocated specifically for cancer awareness, like Oral Cancer awareness month (April), Breast Cancer awareness month (October), where campaigns and screening camps are installed to access people who cannot be accessed otherwise through the internet (5),(6).
Since youth are a reservoir of creativity, new ideas, energy and volunteering in NPOs will prove beneficial. Youth should be involved to spread awareness on importance of practising genital hygiene and safe sexual practices. Messages by youth icons in this regard will have a great impact. Celebration of Cancer Awareness Days, No Tobacco Day, Specific Cancer Days/weeks/months and such Cancer specific programmes can be made more fruitful if they are youth centred. Health melas, dramas, street acts, rallies, competitive events and theatre plays by the youth at large public gatherings and educational institutions will be great motivators (13),(16),(17). Well planned strategies, keeping targets, monitoring the implementation, and usefulness of these programme by the youth and finally recognising the outstanding efforts of the youth is necessary to streamline these endeavours.
These youth centred strategies can be distributed and implemented for now, worked upon for better tomorrow to achieve the goal of zero incidence and prevalence of cancer. It should initially begin with modifying the lifestyles of the current youth, deaddicting the habituated youth, improving the quality of cancer affected youth, educating the school children and the AYA comprehensively regarding cancer, involving the youth to percolate the message to all other sections of the society and ensuring continuous monitoring, revisiting and evaluation.
Reduction of once upon a time dreadful diseases like tuberculosis, leprosy, plague should be the driving motive at achieving the zero incidence and zero prevalence of cancer in the future, which even though appeared unachievable, has been made possible with involvement of youth. The measures adopted for cancer control in the developed countries may not be applicable to the Indian context. Under such situations, acting locally and youthfully will be the best solution. Employing and nourishing youth oriented community programs, workshops to prevent substance use and develop sportsmanship, can educate and reduce the exposure to cancer risk factors, improving the healthy lifestyle and social wellbeing of the society.
Authors contribution: Dr. Sreeshyla- literature search, Concept, manuscript preparation, editing, final proof; Dr. Jaishankar- Concept, literature search, editing, final proof; Dr. Shashidara- Concept, Design, final proof; Dr. Usha Hegde- manuscript preparation, final proof; Dr. Priyanka Nitin- literature search, final proof.
DOI: 10.7860/JCDR/2022/57748.17320
Date of Submission: May 13, 2022
Date of Peer Review: Jun 06, 2022
Date of Acceptance: Oct 14, 2022
Date of Publishing: Dec 01, 2022
Author declaration:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 16, 2022
• Manual Googling: Aug 23, 2022
• iThenticate Software: Oct 11, 2022 (4%)
ETYMOLOGY: Author Origin
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com