Our Children’s Future Is Our Responsibility

Cancer prevention is a child-care issue. With many of cancer’s instigators planting their seeds during childhood, we—as a profession and as a nation—must seize this important window of opportunity to protect the health and well-being of future generations.

Current estimates suggest that up to one-half of cancers in Western populations can be prevented by adopting a healthy lifestyle during childhood and maintaining it across one’s life­span. Yet, in America today, most adolescents who do smoke initiate smoking before age 18, childhood obesity rates remain high, vaccination rates for human papillomavirus (HPV) are low, and more states need to pass laws restricting tanning bed use to protect our youth from harmful ultraviolet (UV) radiation exposure and an increased risk of melanoma. These are serious issues to overcome.

The Centers for Disease Control and Prevention has worked diligently to educate Americans about cancer risks and prevention. The same is true for numerous other groups, including comprehensive cancer centers, hospitals and health-care systems, K-12 schools, advocacy groups, insurance companies, and the pharmaceutical industry. And when it comes to making prevention services more accessible, the Patient Protection and Affordable Care Act has created a framework to make a difference for millions of people, particularly the underserved.

However, much more is needed to ensure the conversion of knowledge into cultural transformation. Consider our efforts with traffic safety and the use of seat belts, where a comprehensive, decades-long strategy of policy, education, and technology services has led to permanent societal change that saves lives. We need to do the same for cancer prevention, emphasizing its value through new public policies to protect children, comprehensive educational initiatives to impart knowledge during captive K-12 years, and preventive services that are accessible and affordable.

Making Cancer Prevention a National Priority

At The University of Texas MD Anderson Cancer Center, we focus on offering diverse clinical preventive and therapeutic services aimed at reducing risk, identifying disease early, and making a measurable reduction in the cancer burden. Our cross-functional professional teams are charged with executing goal-oriented, milestone-driven efforts to convert current knowledge into drugs, tests, devices, public policies, and educational campaigns that quickly benefit society. These efforts go beyond prevention—they demonstrate cancer control.

Legislative efforts offer significant opportunities to reduce cancer incidence. One prime example is youth tanning and UV exposure. Research shows that tanning bed use starting between the ages of 18 and 24 increases a person’s risk of melanoma by 91%.¹ To help protect its young citizens from tanning bed–related UV exposure, California took a bold step and, in 2011, became the first state to prohibit tanning bed use for minors under the age of 18.

Sensing an opportunity in our home state to raise public awareness of the dangers of indoor tanning, our multidisciplinary team of legislative experts, prevention specialists, and melanoma researchers worked with numerous organizations to educate Texas legislators about tanning bed risks and, in 2013, Texas became the fourth state to enact such a law. To keep the momentum going, we worked with MD Anderson Cancer Network sites around the country and advocacy groups like the American Cancer Society Cancer Action Network to help educate elected officials in other states about the dangers of tanning beds. At present, nine additional states have passed similar legislation, and many others are considering it. Together, through education and action, we can decrease future cancer risk for our children.

To accelerate that process, we partnered with the Coordinated Approach to Child Health (CATCH), an evidence-based multifaceted program devoted to improving children’s lives through healthy eating and physical activity, and we are working to expand its offerings targeting UV light protection to reduce skin cancer risk and tobacco use prevention to reduce the risks of multiple cancer types.

We can all be proud of this public/private investment in our children, which will save many lives across generations, but because CATCH currently is available in so few elementary and middle schools across the country, we are missing an opportunity to reach even more children. Cost-effective, proven programs like CATCH should be available in all schools because knowledge is cancer’s greatest vulnerability and education is the essential foundation for success.

As Nelson Mandela once said, “Education is the most powerful weapon, which you can use to change the world.” I could not  agree more.

Reducing the Incidence of Smoking

While great strides have been made over the past 50 years to reduce tobacco use, more than 40 million Americans continue to smoke today. What’s even more troubling is that more than 88% of adult smokers report starting their habitual use of tobacco as children or adolescents.²

Educational efforts have made a difference, but more state and local governments need to explore effective evidence-based policy options like increasing taxes on tobacco products, mandating more smoke-free areas, and raising the minimum legal age to purchase tobacco products. In 2013, lawmakers in New York City passed legislation raising the purchasing age of tobacco products from 18 to 21, which also includes the sale of electronic cigarettes. The state of Hawaii also recently raised the minimum tobacco purchasing age to 21. To the legislative leaders in Hawaii and New York, I say, “Way to go!”

But those efforts are not enough. We need to spread antitobacco messages where our youth live, work, and play, which means harnessing all available communication mechanisms from video games to social media. We have an obligation to surround them with evidence-based strategies and accurate information to reduce their likelihood of taking that first puff.

Increasing HPV Vaccination Rates

Each year in America, HPV is estimated to cause 26,000 cases of cancer, including cervical, anal, throat, and tonsil cancers, among others. This brings us to a very important subject: HPV vaccination for the prevention of cervical cancer and other cancers resulting from HPV infection. As the father of young children, I can tell you my two daughters and one son received this cancer vaccine.

We have a safe and effective vaccine to protect our children from the merciless pain and suffering caused by these cancers, and we need significant education strategies to ensure parents insist that their pediatricians administer all three doses of the vaccine. Our researchers at MD Anderson have developed programs to support that education, but more must be done.

Other countries have made education about the importance of HPV vaccination a national priority. For example, in 2007, the Australian government launched a major campaign to inform parents about the need to vaccinate, which has been an overwhelming success, with more than 71% of children receiving the vaccine. Mexico also has had tremendous success in getting 67% of its population to vaccinate. That’s a remarkable figure, considering Mexico’s health-care infrastructure is much less developed than ours. With U.S. vaccination rates for women at 32% and those for young men much lower, it’s time for our health-care and policy leaders to stand up for our children and protect them from HPV-related cancers.

Closing Thoughts

I have outlined several major public and private efforts, but more needs to be done on an individual level to ensure that children are protected from getting cancer as they age. A daycare teacher who covers kids in sunscreen before sending them outside to play is making a difference. A religious leader who educates his congregation about how the HPV vaccine protects against cancer and has nothing to do with promoting promiscuity is making a difference. A politician who votes to support a bill banning the sale of e-cigarettes to children is making a difference.

We can all make a difference in our everyday lives, and we should challenge ourselves to consider actions we can take across policy, education, and services to empower our children and—to borrow MD Anderson’s tagline here—help in Making Cancer History®. ■

Disclosure: Dr. DePinho reported no potential conflicts of interest.

References

1. Lazovich D, Vogel RI, Berwick M, et al: Indoor tanning and risk of melanoma: A case-control study in a highly exposed population. Cancer Epidemiol Biomarkers Prev 19:1557-1568, 2010.

2. Centers for Disease Control and Prevention: Youth and tobacco use. Available at cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use. Accessed September 3, 2015.

Disclaimer: This commentary represents the views of the author and may not necessarily reflect the views of ASCO.