# Cancer awareness through school curriculum: evidence and recommendations from a quasi-experimental study among school children in the State of Kerala, India

## TL;DR

This study shows that teaching cancer awareness in schools improves students' knowledge of cancer warning signs and risk factors.

## Contribution

The study introduces a school-based cancer awareness program and demonstrates its effectiveness in improving adolescent understanding.

## Key findings

- Students in intervention schools showed significant improvements in recognizing cancer warning signs like unexplained lumps and persistent cough.
- The program also improved understanding of risk factors such as poor diet and physical inactivity.
- The study highlights the role of schools and teachers in promoting cancer prevention education.

## Abstract

Cancer is emerging as a leading cause of morbidity and mortality in India and other countries worldwide. Preventable risk factors for cancer, such as the use of tobacco and alcohol, unhealthy diets and physical inactivity, are often initiated and established during adolescence. Identifying effective strategies for engaging adolescents in cancer-protective behaviours is essential. The current study investigates the potential of schools as settings and school curricula as tools for raising cancer awareness among teenagers.

Consultative meetings and workshops were conducted with education, health and social services experts to develop a primer for cancer control in the school curriculum. Textbooks were scanned to determine the extent of cancer-related topics for standards five to ten. The study participants’ awareness at baseline was assessed using the Cancer Awareness Measure toolkit (version 2.1). Based on these findings, a study package was developed and implemented through trained teachers. A quasi-experimental study design was used to assess the impact of the study package in improving cancer awareness.

In the post-intervention survey, the participants from the intervention schools demonstrated significant improvements in their understanding of cancer warning signs (unexplained lump or swelling (p = 0.0001), unexplained bleeding (p = 0.007), persistent cough or hoarseness (p = 0.0001), non-healing ulcers (p = 0.0001) and risk factors (consumption of fewer quantities of fruit and vegetables (p = 0.010), eating red or processed meat (p = 0.0001) and physical inactivity (p = 0.01)).

Implementing the cancer awareness study package through classroom teaching improved students’ understanding of warning signs and risk factors for cancer. The study emphasised the role of the school as a setting, the school curriculum as a tool and teachers as promoters of cancer prevention education. However, there is no guarantee that this program will work if the learners’ environment is not improved through the concurrent teaching of parents. Children learn what they live.