Every September, a global movement takes place to highlight the importance of childhood cancer. Founded in 1990 and officially proclaimed by Barack Obama in 2010, Childhood Cancer Awareness Month is symbolized by a gold ribbon, which represents all forms of pediatric cancer.
Cancer is a devastating diagnosis for anyone, but when it happens to a child, the grief and shock can be unbearable. At a time when children should be focused on socializing, play and school, attention is instead centered on hospital visits, medications, operations and survival.
The Prevalence and Reality of Childhood Cancer
While we may think childhood cancer is rare, cancer is actually the leading cause of death by disease in children in the United States. In 2023, it was estimated that 9,620 children (aged birth to 14 years) and 5,290 adolescents (aged 15 to 19 years) were diagnosed with cancer in the United States. Each day, 47 children in the U.S. are diagnosed with cancer, and 1 in 7 of these children will not survive past five years.
Over the past 16 years, there has been an increase in the incidence of pediatric cancer, as revealed in a 2023 study conducted by the Centers for Disease Control and Prevention (CDC). Another study, which used data from the CDC Control Wonder Database and was presented earlier this year at Digestive Disease Week 2024, shows a significant rise in cancer rates: from 1999 to 2020, rates of colorectal cancers grew 500 percent among children ages 10 to 14, 333 percent among adolescents ages 15 to 19 and 185 percent among young adults ages 20 to 24. These results may be alarming but are not surprising.
Link Between Obesity and Cancer
There is a clear correlation between obesity and cancer. Being overweight or obese is associated with a higher risk of 13 types of cancer, and six of these cancers involve the gastrointestinal tract: colorectal cancer, hepatocellular carcinoma (due to metabolic dysfunction-associated fatty liver disease or metabolic dysfunction-associated steatohepatitis), and adenocarcinoma of the esophagus, gallbladder, upper stomach and pancreas.
The prevalence of obesity in children in the United States is currently 20 percent and is expected to rise to 30 percent by 2030. Obesity is characterized by a state of chronic low-grade inflammation. Adipose tissue, especially visceral fat, secretes inflammatory cytokines that gradually cause DNA damage, promote tumor growth and enhance cancer cell survival. Obesity also leads to insulin resistance, which causes higher levels of circulating insulin and insulin-like growth factor-1. These conditions promote cell proliferation and inhibit apoptosis, creating an environment conducive to cancer development. Excess adipose tissue alters the metabolism of sex hormones and increases the production of estrogen, which is linked to the development of hormone-sensitive cancers.
Strategies for Preventing Childhood Obesity
Preventing childhood obesity from an early age is crucial in reducing the risk of cancers later in life. These strategies include:
- Healthy diet: Encouraging a balanced diet rich in fruits, vegetables, whole grains and lean proteins while eliminating the intake of sugary beverages, processed foods and high-fat snacks
- Physical activity: Engaging in at least 60 minutes of moderate to vigorous physical activity daily
- Behavioral interventions: Practicing family-based behavioral interventions that promote setting realistic goals, monitoring progress and providing positive reinforcement
- Public health policies: Implementing policies that promote healthy environments, such as restricting the marketing of unhealthy foods to children, improving access to healthy foods and creating safe spaces for physical activity
The Gastroenterologist’s Role in Childhood Cancer Detection
As a gastroenterologist, it is important to be aware that even young patients are at risk for cancer. Do not assume that rectal bleeding in the 20-year-old male is due to hemorrhoids or that the low energy and mild anemia in the 19-year-old female is due to menstrual bleeding. Take the time to listen to the patient, ask questions and explore the possible causes. On a personal note, as a private-practice pediatric gastroenterologist, I have seen several children referred for abdominal pain whom I ended up diagnosing with cancer. Each of these cases was not obvious on the surface, but through carefully listening to the family’s story, an accurate diagnosis was made.
Supporting Childhood Cancer Awareness Month
This September, help support Childhood Cancer Awareness Month by wearing a gold ribbon, applying a gold filter to your social media profile photos, and sharing your stories, photos and messages of support on social media.
Mona Dave, MD, FASGE, is a pediatric gastroenterologist with GI Alliance and Texas Digestive Disease Consultants.