Meaning and burden of adolescent and youth cancer in India

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An adolescent and young adult (AYA) with cancer is someone who is 15 to 39 years old at the time of initial cancer diagnosis.

Epidemiology: 1.2 million cancer cases and 4,000,000 deaths were recorded in the 15-39 age group worldwide in 2018, according to GLOBOCAN data. According to the National Cancer Registry Program of India, the incidence of new cancer cases in this age group per 1 lac population was 22.2 among men and 29.2 among women. These numbers are comparable to those of developed countries like the United States. The most common cancers among the 15 to 19 and 20 to 24 age groups were leukemias and lymphomas.

Breast, thyroid, mouth and tongue cancers were the most common among people aged 30 to 39 years. By 2025, the projected number of cancer cases in both sexes is expected to increase to 178,617. Brain and other nervous system cancers, testicular germ cell tumors (GCTs), and skin melanoma are also common sites of cancer. Cancer and its treatment can cause significant school and career disruptions, as well as changes in functioning and appearance, leading to additional challenges in resuming activities of daily living in this age group. Fertility problems, sexual dysfunction and body image issues, particularly among women, are common among AYA cancer survivors.

Risk factors

  1. Hematolymphoid malignancies: Most cases are believed to be due to random cell mutations without a

(eg BRCA1/BRCA2) or some other genetic syndromes.

  1. Breast cancer: The risk of developing the disease at a young age is higher in women with a family history of the disease, particularly in relatives younger than 50 and those with inherited mutations in cancer susceptibility genes.
  2. Colorectal Cancer: A Family History of Early Diagnosis and Certain Hereditary Diseases
  3. Lymphomas, including Hodgkin’s and non-Hodgkin’s lymphomas (eg, Burkitt’s lymphoma), include prior Epstein-Barr virus (EBV) infection, as well as immunocompromised conditions such as HIV infection and immunosuppression following organ transplantation.
  4. Melanoma and other skin cancers appear to occur in teenagers as a result of genetic interactions with childhood ultraviolet light exposure. Indoor tanning is especially important for AYAs because people who start using it before age 35 have a 60% higher risk of developing melanoma, and the risk increases with duration and intensity of use.
  5. Thyroid cancers: although the increase in their incidence rate has been attributed to increased detection, it is increasingly recognized that there can be a true increase in papillary thyroid burden at an advanced stage
  1. Cervical cancer is the second leading cause of death in women ages 30 to 39, as well as AYA women in general. All cases of cervical cancer are caused by persistent human papillomavirus infection, although susceptibility can be increased by smoking and immunocompromised factors.
  2. Other reasons: may be associated with obesity and changes in dietary factors; Lack of physical activity; Exposure to ionizing radiation; etc
  3. Genetic syndromes associated with high carcinogenesis: Down syndrome, Li-Fraumeni syndrome, Beckwith-Wiedemann syndrome
  4. Tobacco consumption: it is quite high in this age group. According to the National NCD Monitoring Survey (2017–18), more than half (50.8%) of adults aged 18–44 reported using tobacco in any form. The average age of onset of any form of tobacco use in adults was 21.1 years. This includes both non-smoking[Tobacco, Khaini, pan masala] and smoke[ Cigarettes, Vaping]

Signs and symptoms: Symptoms are often nonspecific and shared by common childhood conditions, making timely diagnosis difficult. Parents or other caregivers should ensure regular medical checkups and be on the lookout for unusual and/or persistent symptoms, such as an unusual mass or swelling; unexplained pallor or loss of energy; a sudden increase in the tendency to bruise or bleed; persistent localized pain or lameness; prolonged, unexplained fever or illness; frequent headaches, often accompanied by vomiting; sudden changes in eyes or vision; and rapid weight loss.

Prevention and screening

  1. Awareness of the possibility that there is a high risk of cancer among children and adolescents is key. All caregivers including parents, teachers and primary care providers should be aware. Identification of unusual signs and symptoms and prompt medical attention will lead to early diagnosis and
  2. Prevention: The goal of prevention is to reduce or eliminate exposure to carcinogens. Some examples include:
  • Effective tobacco control measures and reducing tobacco use among youth
  • Promotion of a healthy and balanced diet and increased physical activity at school level
  • Vaccinations against cancer-causing pathogens should be initiated and adopted in immunization programs. Examples for these are Hepatitis B and HPV
  • Avoid excessive exposure to the sun and artificial tanning; adoption of sun protection practices, including the use of sunscreens with an SPF higher than
  1. Screening and early detection: The goal is to diagnose cancer as early as possible using simple tests. Cancers of the mouth, tongue, breast and cervix can be detected early using screening tests that are already available.
  2. Cancer in the Family: In certain syndromic cancers, such as breast, colon, uterus and ovary, the presence of a young relative with cancer is expected to increase the risk.

The author is Consultant – Radiation and Clinical Oncology, Ruby Hall Clinic. The opinions expressed are personal.

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Meaning and burden of adolescent and youth cancer in India

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