Children should play key cancer control role

About 100 volunteers, including staff from the National Cancer Centre, showed their heartfelt commitment to promoting public education on cancer by distributing free bags of apples.

Prevention, screening, treatment and palliative care are the four common pillars of the global fight against cancer. Yet, advanced cancers require highly complex treatments that are usually burdensome on patients and family members. Such therapies often yield disappointing outcomes despite entailing huge medical expenses.

To optimize the anticancer fight, we need to place more emphasis on prevention and screening. As part of this approach, cancer education has already been developed exclusively for adults. However, contrary to all expectations, such education has not resulted in a significant decrease in the number of smokers and a sufficient increase in screening rates.

In general, adults are aware of the hazards of smoking and the importance of cancer screening, but a large number of them still shy away from dealing seriously with cancer prevention on their own. They often find it hard to stop smoking and are negligent about being screened, saying, "I'm too busy," "I'm healthy" or "I will go to the hospital when I have to." When actually diagnosed with cancer, they are stunned. This is terrible for society in which one in two people becomes a victim of the disease.

Alarmed by the situation, an increasing number of people now think it is too late for us to learn about cancer only after we become adults. In other words, it is time to provide children with cancer education. I was once asked to give three days of extensive cancer education to middle and high school students, who showed an astonishing level of understanding about the importance of cancer prevention.

The Education, Culture, Sports, Science and Technology Ministry aims to educate middle and high school students about cancer. In fact, the relationship between lifestyle behaviour and diseases is referred to in the Courses of Study, a series of official guidelines for school education set by the ministry. But some people say cancer education at the middle and high school level is not sufficient or pervasive. Therefore, I want to touch on cancer education for children, including primary school students.

In this connection, the March 28, 2014, issue of the US journal Science published an interesting dissertation on quality early child development that was based on more than three decades of data. In the research, children up to the age of 5 were initially divided into two groups - those who received special treatment and those who did not. The former group was offered special curriculum programs, from high-quality early child education to support for good-quality play, to target language, social-emotional and cognitive development. The other group did not receive such intervention.

When the children reached ages 6 to 8, the two groups were divided again with the recipients of special curriculum programs being offered further courses, based on home-school resources, to improve mathematics skills and cognitive functioning, while the other group received ordinary school education. In the project, the health of the subjects when they became adults were observed and analysed.

The project's findings showed that the blood pressure of those who had participated in the intervention group was significantly lower that the nonintervention group when they were in their mid-30s. In addition, the same group had far fewer cases of obesity as measured by body mass index (BMI). The findings show that the benefits of early educational intervention in childhood persist into the mid-30s in regard to health.

In the past, it was recognised that such intervention was effective in making young people less prone to turn to crime and more positive toward continuing their education, leading to a better living standard. As far as I know, the findings published in Science may be the first evidence about the effects of early educational intervention on health.

'Why not children?'

Cancer education involving children also is known to have positive effects on adults. This has been proved, for example, by years of public health campaigns in Sri Lanka by cancer pathologist Hiroshi Kobayashi, a professor emeritus of Hokkaido University. In Sri Lanka, there was a high rate of patients with oral cavity and esophageal cancers and the local people were aware that the widespread habit of chewing tobacco was to blame. Kobayashi initially called on the Sri Lankan government to appeal to adults to change their traditional lifestyle behaviour. The government did so but its campaign was a failure. When Kobayashi was on the verge of giving up, he suddenly had a brainstorm. "If it's no use talking to adults, why not children?" he thought. His new approach has been successful.

Choosing four schools in southern Sri Lanka, Kobayashi offered a programme in which primary and middle school students repeatedly discussed health-related themes, such as cancer prevention and healthy day-to-day livelihoods. The students were encouraged to regularly publish newsletters summarizing their discussions.

Within three to four years of the project, school attendance rates improved from 60 per cent to 80 per cent to 80 per cent to 90 per cent. The improvement was coupled with a sharp decline in the smoking rate among adults from 50 per cent to 60 per cent to 20 per cent to 30 per cent.

In the project, parents are reported to have listened carefully to their children talk about not only the hazards of chewing tobacco but also the adverse effects of smoking on health. The adults apparently became sufficiently aware of the danger of smoking and decided to quit. Furthermore, the number of adults who became careful about obesity and excessive salt consumption increased.

In Japan, the promotion of cancer education was cited in the 2012 edition of the government's Basic Plan to Promote Cancer Control Programs. Pursuant to the plan, the education ministry in 2014 picked 18 prefectures and three major cities as "model municipalities" to provide cancer education.

Preceding the education ministry's selection of "model municipalities," Tokyo's Toshima Ward embarked on cancer education for sixth-year students at primary schools and third-year students at middle schools in fiscal 2012. In fiscal 2013, Kyoto Prefecture, which is not among the prefectures designated by the ministry, invited cancer doctors and people who have experienced cancer to give special sessions at 20 primary, middle and high schools.

Those special lessons have clearly had a positive impact on even primary school students. Many of them said afterward, "We know now that cancer is a common disease. We want our parents to receive checkups to make sure they don't have cancer."

Child-to-parent interaction

For its part, the Japan Cancer Society, of which I serve as president, has provided cancer class programs for schools since 2011. Students participating in such classes have said they would ask their parents to stop smoking and would like to have their families talk about cancer. My society has thus far targeted middle and high schools, but now we are preparing programs for primary school students.

Our society also distributes an illustrated book titled "What is Cancer?" It was produced in 2013 by Toshiyasu Yoshida, head of the At Home Hospice nonprofit organisation in Kansai. So far, we have presented more than 1,000 copies of the book to various entities.

The book contains easy-to-understand narratives and heartwarming pictures to show that humans are mortal; that humans, animals and plants are composed of cells; and that cancer starts when a cell's DNA is damaged.

According to Yoshida, many small children who see the book for the first time tend to repeatedly look at the illustrations even though they are unable to comprehend what it is all about. In the case of children who have been at the deathbed of a grandparent, they seem to be receptive to the book's content.

The Union for International Cancer Control (UICC) designated Feb. 4 as World Cancer Day to hold various events to promote the global fight against cancer. The Japan National Committee for UICC organised a symposium on Feb. 7 under the title "Cancer Education for Children." It was the fourth symposium focusing on that theme.

To expand the depth and scope of cancer education for children, members of the Japan National Committee for UICC, schoolteachers and people at large with cancer experience need to visit as many schools as possible across the country.

At the same time, I would like schoolteachers to have many opportunities to learn systematically about cancer. At school, it is important to make students conscious of our life's limitations and the relationship between lifestyle behaviour and disease, including cancer, instead of simply cramming knowledge into their heads.

I hope cancer education for children will evolve into a pervasive part of child discipline to the extent that children learn about cancer and life, talk about these topics with their families and recommend that their parents have cancer screening. I am looking forward to creating a social environment in which parents will be willing to follow children's advice - something rarely seen in society.