Keun-Young Yoo
Professor Seoul National University College of Medicine (SNUCM)
H. President National Cancer Center, Korea (NCC-K)
Secretary-General Asian Pacific Organization for Cancer Prevention (APOCP)
The Supercourse Dec., 2010
Cancer Epidemiology in Korea
http://www.korea.net
Republic of Korea (KOR)
A Land of Morning CalmRabindranath Tagore (1861ㅡ1941)
land area
222,154 km2 (=Britain)
99,000 km2 (south)
147,000 km2 (Nepal)
5000 years of Korean History
World Cultural Heritage
by
UNESCO
What Do You Know About Korea?
Korean war (1950-1951)
poverty and starvation
What Do You Know About Korea?
Export-Driven Economic Development since 1960s
urbanization
industrialization
westernization
What Do You Know About Korea?
Semiconductors, automobiles
What Do You Know About Korea?
Semiconductors, automobiles, ships, mobile telecoms,
What Do You Know About Korea?
Semiconductors, automobiles, ships, mobile telecoms, chemicals, steels, consumer electronics
What Do You Know About Korea?
World Cup (2002)
Seoul Olympiad (1988)
population: 49 M (south)(ranked 18th in the world) 23 M (north) as of 2007
life expectancy: 75.7 yrs (M) / 82.4 yrs (F)
aging (65+): 9.0% (2005)20.0% (2026)
population IR: 0.33% (2007)
health insurance: universal coverage
per capita GNI: USD 20,045 (2007)
major industries: semiconductors, automobiles, ships, mobile telecoms, chemicals, steels, consumer electronics
.
Health and Welfare StatisticsRepublic of Korea
20091911
Cause of death = infections Cause of death = cancer
Life expectancy < 45 yrs
Per capita GNI < US$20
Life expectancy = 78 yrs
Per capita GNI = US$20,000
Traditional medicine Universal health insurance
Korea
Incredible Changes in Korean Society fromAgricultural to Highly Advanced Industrial Country
(%)
Source: Korea National Statistical Office, 2008
Causes of Deaths in Korea
11.3%
28.0%Cancer
CVA
Heart Disease
Liver Disease
DM
Trend in Age-standardized Incidence Rates of Cancer
Korea Central Cancer Registry, 1999-2007
Sex
Annual
Percent
Change
(%)
Total 2.9 *
Male 1.3 *
Female 4.9 *
* P < .05
Relative Frequency of Incident Cancer Cases in Korea 2003~2005
Unit : %
Source: Korea Central Cancer Registry, 2008
Ten Major Sites of Cancer in Korea1999-2002
0 10 20 30 40 50 600102030405060
Stomach (59.8)
Liver (42.5)
Lung (43.0)
Colorectal (26.2)
Bladder (7.7)
Esophagus (7.2)
Gallbladder, etc (6.8)
Pancreas (6.8)
Prostate (6.6)
Lip, oral cavity, pharynx (5.9)
Stomach (31.4)
Colorectal (20.7)
Breast (27.8)
Cervix uteri (18.5)
Lung (15.5)
Thyroid (14.5)
Liver (14.0)
Gallbladder, etc (6.9)
Ovary (5.6)
Pancreas (5.0)
crude incidence rate /100,000
Male Female
The Korea Central Cancer Registry, 2007
Trend in Major Cancer Mortality Rates
Male Female
Age-standardized rate per 100,000
Year of Death
Source: Annual Report of Causes of Death, Korea National Statistical Office(age-standardized rates on the 2000 Korea registration population )
lung
liver
stomach
colorectum
stomach
liver
breastcolorectum
* P < .05
Site
Year Annual
percent
change
(%)1999 2007
Stomach 68.4 62.8 -0.7 *
Lung 51.9 48.1 -0.6 *
Colon and
rectum27.0 44.5 7.0 *
Liver 48.5 39.6 -2.2 *
Prostate 8.5 20.1 13.2 *
Thyroid 2.3 11.6 24.5 *
Trend in Age-standardized Incidence Rates of Cancer
Male, Korea Central Cancer Registry, 1999-2007
* P < .05
Site
Year Annual
percent
change
(%)1999 2007
Thyroid 11.9 64.8 26.0 *
Breast 24.5 39.9 6.6 *
Stomach 28.3 25.7 -0.7 *
Colon and
Rectum17.1 24.3 5.3 *
Lung 12.9 13.7 1.2 *
Cervix uteri 18.6 12.2 -4.9 *
Liver 12.6 10.9 -1.6 *
Trend in Age-standardized Incidence Rates of Cancer
Female, Korea Central Cancer Registry, 1999-2007
Cumulative Risk of Cancer in Korea
28.9%34.4% Cumulative risk
83 years76 yearsLife expectancy(2007)
FemaleMale
1 out of 3 1 out of 4
Source: Korea National Statistical Office, 2009
Lung Cancer
increase in tax on cigarettes
ban on smoking in public places, health education, etc.
limit cigarette advertising
prohibit promoting the sale of tobacco
warning on cigarette packets
expand public anti-smoking campaign & education
limit sales to minors
Anti-Smoking Program of Korea
0
10
20
30
40
50
60
%
Males 25 31 29.8 19.4 30 16.7 28 48.3 25.7 49.3
Females 25 25 19.1 15.7 25 18.3 24 13.6 19.3 4.8
Newziland Denmark Germany USA Belgium Sweden UK Japan Finland Korea
Source: OECD health data,2005
Smoking Rate in OECD Countries
Initiatives to Reduce the Tobacco Use
• Major TVs, Newspapers Banish Tobacco 2002-2004
KBSSBSMBC
• Increase in Tax on Cigarettes
• Ban on smoking in public places, health education, etc.
• Ban by legislation on the manufacture and sale of tobacco products
(Tobacco Free World Alliance: ToFWA)
Quitline Service for Smoking Cessationat NCC
since April 2006 by telephone & website
providing smoking cessation coaching
releasing knowledge on hazards of smoking
collaboration with 248 Health Centers
for pharmacotherapy : NRT and bupropion
by all the health centers charge free
Smoking Prevalence : Adults
79.3
43.4
45.950.3
57.8
56.7
60.5
69.9
67.6
64.969.8
72.9
75.1
75.3
71.2
3.72.83.143.56
3.134.45.33.55.1
7.7812.6
0
10
20
30
40
50
60
70
80
90
1980 1985 1990 1992 1994 1996 1999 2000 2001 2002 2003 2004 2005 2006 2007
Male
Female
Source: Ministry of Health & Welfare, Korean Association of Smoking & Health
MNNG
Post MNNG 37wks
nitrite (salts, foods, additives, etc.)
enzymatic blockage (비타민C, 냉장고)
nitrate nitrosamine(carcinogenic)
+
amine(foods, drugs)
Stomach Cancer
Helicobactor pylori2-7mm X 5,300
癌! 바로 알기
Gwack et al. Brit J Cancer 2006
CagA-producing Helicobacter pylori Increased Risk of Stomach Cancer in Korea
Codes of Conduct for Cancer Prevention
Cancer is Preventable
& Avoidable!!
國民癌豫防守則
Intake of Vegetables/Fruits, Use of Refrigerator and Stomach Cancer Mortality in Korea, 1973-2005
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
0
50
100
150
200
250
300
350
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
vegetables intake(g/day) fruits intake(g/day) mortality rates of gastric cancer(per a hundred thousand persons) refrigerator(per house)
(Mortality) Korea National Statistical Office. Annual Report of Causes of Death.(Nutrition) Ministry for Health, Welfare and Family Affairs. The Third Korea National Health and Nutrition Examination Survey(Refrigerator) Korea Power Exchange. The number of refrigerators in use in Korea.
refrigeratorsfruits
vegetables
stomach cancer mortality rates
Chronic carrier
Chronic cirrhosis
Liver cancer
HBV HCV
80-90%1-10%adults
Acute hepatitis
90%Vertical
transmission
30-40%
1.5-4%/yr
20-30%
3-6.5%/yr
Liver Cancer癌! 바로 알기
Korea Center for Disease Control & Prevention
Se
rop
ositiv
ity o
f H
BsA
g(%
)HBsAg seropositivity
year
<HBsAg seropositivity among blood donors>
HBV vaccination
introduced in Korea
National vaccination program for
infants and children
Vaccination against
vertical transmission
Liver Cancer Mortality Ratesin Young Koreans
0
0.1
0.2
0.3
0.4
0.5
0.6
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
year
mo
rta
lity
ra
te p
er
10
0,0
00
0-9yr
10-19yr
National
vaccination
program for infants
and children
Vaccination
against vertical
transmission
Korea National Statistical Office 2008
Change in Breast Cancer Mortality Ages 25-49, % Change during 1985-87 to 1995-97
Bray et al. Breast Cancer Res 2004
Source: WHO Mortality database
http://www-depdb.iarc.fr/
Republic of KoreaChina: rural areas
Japan
Age-Incidence Curves of Breast Cancer in selected Asian Countries
Source: Globocan 2002
Countries All ages ASR (World)
Pakistan 35.6 50.1
Singapore 58.9 48.7
Philippines 33.5 46.6
Japan 49.6 32.7
Malaysia 26.2 30.8
Indonesia 23.3 26.1
Turkey 19.9 22.0
Nepal 15.6 21.8
Korea 23.5 20.4
India 16.5 19.1
China 20.1 18.7
Iran 13.4 17.1
Thailand 16.3 16.6
Viet Nam 13.1 16.2
Mongolia 4.9 6.6
Trend of Age-standardized Incidence Rate by Site Female, 1999-2005, Korea
28.3
24.5
18.6
17.1
Lung : 12.9
Liver : 12.6
Thyroid : 11.9
40.8
35.5
28.1
23.0
Lung : 13.6
Cervix uteri : 13.1
Liver : 11.4
breast
* ASR (standardized by Korean population in 2000)
Selected Food Intake in Korea(1969-2005)
grain
animal foods
fishery
vegetables
meats
gra
m p
er
da
y p
er
ca
pita
Source: National Health and Nutrition Survey Report, 2007
Lifestyle Changes in Korea
mean age at first marriage 24.9 (1990) 27.3 (2003) 28.1 (2007)
total fertility rate 2.0 (1980) 1.19 (2003) 1.26 (2007)
age at menarche*
13.5 (1988) 12.7 (1998)
total calorie supply (per capita per day) 2,622 (1983) 2,927 Kcal (2006)
Source: National Statistical Office. 2007
* Cho et al. 1999
Breastfeeding Trend AmongKorean Women
0%
20%
40%
60%
80%
1985 1988 1994 1997 2000
breast feeding combined milk
Source: Korea Institute for Health & Social Affairs. 2000National Health and Nutrition Survey, 2003
Projection of Breast Cancer Mortality Korea, all ages, 2005-2020
Mort
alit
y ra
tes,
per
a h
undre
d t
housa
nd
FEMALE BREAST CANCER
4.18
2.83
3.81
2.34National Cancer Screening Program
5.12
9.19
7.61
0
2
4
6
8
10
12
14
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2005
2010
2015
2020
based on Poisson regression model
6.30
3.9
times
2.8 times
Source : National Statistical Office 2002Choi et al. Asian Pacific J Cancer Prev 2005
자궁 질 세포검사 (Pap smear)
• 1928, George N. Papanicolaou
• 자궁경부에서 세포를 채취, 도말 후 현미경으로 관찰
• 민감도 50 – 70%, 특이도 60 – 90%
National Action against Cancer in Korea
1996 1st Term 10-year Plan for Cancer Control 第1期 癌征服推進事業
1999 National Cancer Screening Program 國家癌檢診事業
2000 Cancer Control Division, Health Promotion Bureau,
Ministry of Health & Welfare 保健福祉部 健康增進局 癌管理課
2001 National Cancer Center 國立癌센터(中心)
2003 National Cancer Act 癌管理法
2004 Regional Cancer Centers 地域癌센터(中心)
2006 2nd Term 10-year Plan for Cancer Control 第2期 癌征服推進事業
National Cancer Information Center at NCC
NCIC provides a comprehensive cancer information services through website, telephone, and on-site education.
NCIC provides some booklets and leaflets on various aspect of cancer.
NCIC have supported health professionals with information on cancer research relates and have developed educational booklets and leaflets on most aspects of cancer.
http://www.cancer.go.kr/
Cancer Eligible Frequency Test /Procedure
Stomach40 & over
adultsevery 2 yrs endoscopy or UGI
Breast40 & overwomen
every 2 yrs mammography & CBE
Cervix30 & overwomen
every 2 yrs Pap smear
Liver40 & over
high risk group* every 6 mo sonography & AFP
Colorectal 50 & over
adultsevery 1 yr
FOBT colonoscopy or barium enema
* 40 & over with HBsAg positive or anti-HCV positive or liver cirrhosis
Screening Guideline of NCSP
Performance of NCSP by Cancer Type
No. of participants(1,000)
No. of cancer detected(detection rate, %)
2005 2006 2007 2005 2006 2007
Stomach 1,150 1,525 1,724 1,383 (0.12) 1,717 (0.11) 1,784 (0.10)
Breast 729 946 1,064 112 (0.02) 124 (0.01) 104 (0.01)
Cervix 73 70 80 28 (0.04) 27 (0.04) 28 (0.03)
Liver 100 117 111 145 (0.15) 152 (0.13) 122 (0.11)
Colorectum 537 692 783 207 (0.04) 289 (0.04) 350 (0.04)
Total 2,589 3,350 3,750 1,875 (0.07) 2,309 (0.07) 2,388 (0.06)
Cancers 2004 2005 2006 2007 2008
Stomach 39.2 39.4 43.3 45.6 53.5
Liver 20.0 16.3 16.5 22.7 19.7
Colon 19.9 25.4 29.4 34.1 39.7
Breast 33.2 38.4 40.6 45.8 49.3
U. cervix 58.3 38.4 54.9 57.0 59.9
unit: %
Source: National Cancer Center. Nationwide Survey for Health Screening Performance Rate, 2004~2007
Note: Cancer screening performance rate by any programs in a given year under the screening guideline recommended by the National Cancer Center and the Ministry of Health & Welfare
Screening rates, All Combined, Korea
Stage Frequency of Breast Cancer
Source: Korea Central Cancer Registry,Korean Breast Cancer Society
36.9%
26.9%
22.7%
49.6%
57.0%
58.7%
11.7%
13.1%
14.8%
1.9%
3.0%
3.8%
Five Year Survival of Cancer Sites of National Screening Program
MEN
WOMEN
1) Ries LAG, et al (eds). SEER Cancer Statistics Review, 1975-2005, National Cancer Institute, 2008
2) National Cancer Center in Japan. Cancer Statistics in Japan, 2008
(Unit: %)
International Comparison of Five Year Relative survival
Korea (‘01-’05)
USA 1)
(’96-’04)Japan 2)
(‘97-’99)Eurocare 2)
(‘95-’99)
Stomach 56.4 24.7 62.1 24.1
Lung 15.5 15.2 25.6 12.6
Colorectum 64.8 64.4 65.2 53.5
Liver 18.9 11.7 23.1 8.6
Thyroid 98.1 96.9 92.4 86.5
Breast 87.3 88.7 85.5 81.1
Cervix uteri 81.1 71.2 71.5 66.5
Prostate 76.9 98.9 75.5 77.0
All Cancers 52.2 65.3 54.3 51.9
National R&D Program for Cancer Control (since 1996~)
Causes and Mechanisms of Common Cancers
Cancer etiology
Cancer metastasis and progression
Tumor immunology
Functions of tumor suppressors
Cancer Therapeutic Technologies
Surgical, radiological chemo-therapeutics
Anticancer drug candidates
Bone marrow transplantation
Molecular/cellular therapeutics for cancer
Alternative medicine for cancer
Multi-institutional clinical trials for cancers
Cancer Diagnostic Technologies
Diagnosis of precancerous lesions
Discovery of new tumor markers
Development of new diagnostic technologies
using novel targets or tools
Studies on the movement, storage and reproduction of diagnostic media
Cancer Prevention and Control
Intervention studies on risk factors for
cancer prevention
Cancer education, awareness, and information
Enhancing the quality of cancer screening
Improving of life for cancer patients and
palliative care
Cancer control policies
Cancer Facts in Korea, Today
United StatesWar against Cancer, 1971Decline in cancer mortality, 1991
KoreaNCC, 20011st NCCP, 1996NCSP, 1999(stomach)-04(colon)
0
30
60
90
120
150
180
210
'95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 07
Male
Female
Annual % change male : -1.13%female : -0.80%
Overall Cancer Mortality Rates
JapanNCC, 1962NCCP, 1965NCSP, 1966(stomach)-92(colon)
0.0
50.0
100.0
150.0
200.0
250.0
300.0
350.0
1950
1955
1960
1965
1970
1975
1980
1985
1990
1995
2000
Year
Death
rate
per
100,0
00 p
op.
Crude(M)
Crude(F)
AgeAdj(M)
AgeAdj(F)
Data: Vital Statistics of Japan (1950-2000)
Death rate from all sites of cancer in Japan
Cancer Incidence, 2003~2005
Numbers of Cancer cases Crude Rates
Age-standardized Rates
(Unit : Rate per 100,000)
(Unit : Rate per 100,000)
Five Year Survival of Ten Major Cancer Sites(2001-2005)
Economic Burden of CancerKorea, 2005
Million Won
Total : 14 billion USD (1.7% of GDP)
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
Liver Stomach Lung Colorectum Breast Leukemia Pancreas
Productivity loss cost of early death
Productivity loss cost of disability
Non-Medical Cost
Medical Cost
Source: Kim et al. Eu J Cancer Care 2007
Total(10,000 persons)
15~64 years(10,000 persons)
65+ years(10,000 persons)
Old Dependency
Ratio
4,2343,812 4,814 4,934 4,863
2,372
146
6.2
3,598
707
19.6
3,123
1,181
37.8
2,242
1,616
72.1
3,453
437
12.7
20302018 20501980 2005
Age 15
Age 65
Age Tsunami: Baby Boomer born 1953-1958
Estimated Cancer Incidences andCancer Deaths by 2015
45.8% increase in cancer incidences
127,716
154,851
186,244
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
200000
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
2015
Cancer Cases
69,154
80,281
89,934
0
10000
20000
30000
40000
50000
60000
70000
80000
90000
100000
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
2015
Cancer Death
30.0% increase in cancer deaths
2nd 10-Year Plan for Cancer ControlKorea, 2006-2015
40000
45000
50000
55000
60000
65000
70000
75000
80000
85000
90000
1995 2000 2005 2010 2015
Expected Objective
69,154(2005)
89,934(2015)
30.0% ↑
116.7/100,000 94.1
/100,000
19.4% ↓
Cancer mortality reduction
Improvement in 5-years survival rate
2nd 10-Year Plan for Cancer ControlKorea, 2006-2015
17.6% ↑
National Budget for 1st Term NCSP (1996-2005)
Total budget : 579.7 million USD
0
20
40
60
80
100
120
140
160
1995 1997 1999 2001 2003 2005
Prevention
Supportive & Palliative care
Research
Regional Cancer Center
National Cancer Center
20.8 22.9 21.9
33.4
53
40.5
58
45.5
64.269.3
150
USD, million
USD, million
Year
2nd Term Ten-year Plan for National Cancer Control (2006-15)
Total budget : 5.81 billion USD
National budget : 3.48 billion USDHealth promotion fund : 2.33 billion USD
Cancer Prevention for All in Asia
감사합니다!
Thank You for
Your Attention!