Japanese Journal of Clinical Oncology 32:S32-S36 (2002)
© 2002 Foundation for Promotion of Cancer Research
Cancer in Korea: Present Features
Yoon-Ok Ahn+
Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
 |
ABSTRACT
|
|---|
In 1995, more than 50 000 persons died in Korea due to
cancers and around 230 000 cancer patients were under medical
treatment. Cancer patients accounted for 8.3% of all inpatients.
The medical care expenditure for cancer patients accounted for
15–18% of all expenditure for inpatients. The age standardized
annual incidence rate of all cancers in the period 1992–95
was 290.8 per 100 000 in males and 173.4 in females. The
cumulative rates for the age span 0–74 years were 35.8%
in males and 20% in females. Four cancer sites, stomach, liver,
lung and colorectum, comprise two-thirds of all new cancers
in males. For females, the major sites include uterine cervix
and breast in addition to the above four sites. The age adjusted
cancer death rate in 1995 was 179.0 in males and 73.5 in females,
which accounted for 24.1 and 17.7% of all deaths in males and
females, respectively. Some changing patterns of major cancers
were observed, especially in the older age group. Early detection
programs for specific cancer sites such as stomach, liver, colorectum,
breast and uterine cervix have been adopted and conducted since
1992 by several medical insurance companies. However, it was
not until 1995 that the Korean government considered a national
cancer control program. In 1995, the ‘Ten Year Plan for
Cancer Control, Korea’ was formulated and the government
adopted the plan as a national policy in 1996. The economic
crisis in Korea in 1997, however, hindered carrying out the
plan.
|
INTRODUCTION
|
|---|
The total area of Korea (South) is about 99 394 km
2, with
seven metropolitan cities and nine provinces as administrative
units. In 1995, the total population was 44 551 183
(22 365 520 males and 22 185 663 females).
Seoul is the capital city of Korea with a population of about
11 million, one quarter of the total population.
Cancer is one of the most common diseases for Koreans. Cancer annually affects nearly 80 000 people and causes 50 000 deaths. It is estimated that about 230 000 people are suffering from cancerous disease.
This paper gives a brief presentation of the present features of cancerous diseases in Korea, in terms of incidence and mortality, burden of cancer patient care and government efforts at cancer control.
|
BURDEN OF CANCER PATIENT CARE IN KOREA
|
|---|
Of all inpatients for medical care in Korea in 1995, cancer
patients accounted for 8.3%, represented by 9.5% in males and
7.9% in females. However, medical care expenditure for cancer
patients accounted for 15–18% of all expenditure for inpatients
(
1). The total amount for medical care expenditure for cancer
patients was estimated as 400 billion Korean Won (~US$460 million)
as of 1995 (Table
1).
|
INCIDENCE PATTERNS
|
|---|
With reference to the Seoul cancer registry data, 1992–95,
the crude annual incidence rate of cancer for males was 184.4
and for females 158.4 per 100 000 (
2). The age standardized
rate (ASR) for the world population was 290.8 in males and 173.4
in females. The cumulative rates for the age span 0–74
years were 35.8% in males and 20% in females (Table
2).
Of all the new cancers, the five leading sites of cancer in
males were stomach (24.7%), liver (18.5%), lung (15.3%), colorectum
(8.5%) and urinary bladder (3.2%). The first four cancer sites,
stomach, liver, lung and colorectum, accounted for two-thirds
of all new cancers in males. For Korean women, the five leading
cancer sites in all age groups were stomach (17.3%), uterine
cervix (13.5%), breast (12.3%), colorectum (9%) and liver (7.2%).
They accounted for 59.3% of all new cancers. In the older age
group, over 65 years of age, they were stomach (22%), lung (12.3%),
colorectum (11.7%), liver (9%) and uterine cervix (7.2%), however.
In the age group 35–64 years, they were uterine cervix
(17.5%), breast (17%), stomach (15.5%), colorectum (8.6%) and
liver (7.4%). They accounted for 66% (Table
3).
Japan and some parts of eastern Asia including Korea have the
highest incidence of gastric cancer in the world. A comparison
of the age incidence curves for males in Seoul in Korea, Osaka
in Japan and Los Angeles in the USA is shown in Fig.
1. The
ASR of gastric cancer was 71.1 per 100 000 in Seoul, 65.0
in Osaka and 7.6 for white males in Los Angeles (
3). The curve
for Seoul parallels that for Los Angeles, in other words, it
has the same difference ratios, about 9.3–9.4, across
the age. This parallel suggests that additional or particular
factors, which are common across the age, are involved in the
risk of gastric cancer in Korea. However, the curve for Osaka
is not parallel to that of Seoul along with all the age group.
Under the age of 40 years, the incidence in Osaka was relatively
reduced. This suggests that the risk of gastric cancer is changing
in Japan, especially in younger populations (Fig.
1).
View larger version (12K):
[in this window]
[in a new window]
|
Figure 1. Incidence curve of stomach cancer by age among males in Seoul (1992–95), Osaka (1988–92) and Los Angeles (whites) (1988–92).
|
|
The age incidence curves for liver cancer for males in three
populations, Korean, Japanese and US whites, are shown in Fig.
2. As seen in Fig.
2, the curve for Seoul parallels on the whole
that for Los Angeles. It has nearly the same difference ratios
along with all the age group. However, comparing the curves
for Seoul and Osaka, the incidence patterns according to age
are different, although the ASRs in two areas were nearly the
same, around 47. Under the age of 60 years, the incidence was
higher in Seoul, but in contrast, in the older age group, it
was higher in Osaka. This suggests that the major risk factors
for liver cancer in these areas are not the same.
View larger version (11K):
[in this window]
[in a new window]
|
Figure 2. Incidence curve of liver cancer by age among males in Seoul (1992–95), Osaka (1988–92) and Los Angeles (whites) (1988–92).
|
|
In the case of colorectal cancer, the age incidence curves
in three populations show a peculiar pattern, as seen in Fig.
3. The ASR of colorectal cancer among males was 24.9 in Seoul,
34.2 in Osaka and 42.5 in Los Angeles (whites). However, the
differences in incidence between the three populations were
observed only in age groups, over 50 years of age. This might
simply reflect the risk accumulated since earlier life. Otherwise,
certain factors, either xenobiotics or autobiotics, seem to
play roles in the increasing risk later in life.
View larger version (11K):
[in this window]
[in a new window]
|
Figure 3. Incidence curve of colorectal cancer by age among males in Seoul (1992–95), Osaka (1988–92) and Los Angeles (whites) (1988–92).
|
|
|
MORTALITY PATTERNS
|
|---|
Cancer is the leading cause of death for Koreans (
4). The crude
annual death rate from cancer in 1995 was 143.6 per 100 000
for males and 82.1 for females in Korea. The ASR was 179.0 in
males and 73.5 in females. Cancer deaths accounted for 24.1%
of all deaths in males and 17.7% in females (Table
4).
Looking at the cancer mortality trend according to age group
separately, with reference to the Annual Reports on the Cause
of Death Statistics for ten years, 1987–96 (
4), different
patterns between age groups could be observed. In the 35–64
years group, there was no marked change in mortality trend.
In the older age group, however, the cancer mortality increased,
from around ASR 800 in 1987 to 1400 in 1996 in males, a 75%
increase (Fig.
4). In females, nearly the same trend was seen
as in males, from around ASR 300 in 1987 to 520 in 1996, a 73%
increase in the age group of 65 years and over (Fig.
5).
Major cancer sites among cancer deaths in males were stomach
(23.3%), liver (23.5%), lung (19.7%) and colorectum, etc. Deaths
due to stomach, liver and lung cancer accounted for two-thirds
of all cancer deaths in males. In females, stomach (24.4%),
liver (12.8%), colorectum (6.9%), breast (4.9%) and uterine
cervix (4.7%) were the major sites among cancer deaths.
Gastric cancer mortality has decreased gradually on the whole during the last 10 years. This decreasing trend was marked in the middle-aged, 35–64 years, group, not in the older age group (Fig. 6). There was no change in the trend of liver cancer mortality during 10 years in both sexes, while lung cancer mortality increased in both genders and all age groups (Fig. 7). Colorectal cancer mortality has increased during 10 years in both genders and more markedly in the older age group (Fig. 8). Female breast cancer mortality has also increased during the last 10 years. It increased more rapidly in the older age group and finally it exceeded the mortality of the middle-aged group.
|
CANCER CONTROL PROGRAMS
|
|---|
Medical insurance, either public or private, covers almost all
Koreans. Most medical insurance companies provide a free health
check-up program biennially to selected beneficiaries. At the
biennial health check-up, beneficiaries, mostly aged over 40
years, are offered participation in early detection or mass
screening programs for specific cancer sites such as stomach,
liver, colorectum, breast and uterine cervix, paying half of
the charge. However, up to now, less than 10% of the target
population on the whole participate in the program. In addition
to the low participation rate in early detection programs, public
education and publicity also are not active. Consequently, the
early detection rate of cancer is relatively low. For instance,
among gastric cancer patients, only about 15% are diagnosed
at stage 1 or less (
5).
It was not until 1995 that the Korean government considered a national cancer control program. There are five population-based cancer registries in Korea, which are financially supported in part by the government, as of 1998. All of them are in metropolitan cities, Seoul, Pusan, Daegu, Kwangju and Incheon. Most of them were launched recently, after 1995, except the Seoul cancer registry.
In 1995, the ‘Ten Year Plan for Cancer Control, Korea’ was formulated by a task force initiated by government (6). The plan includes governmental support financially for various cancer control programs and research. The Government adopted the plan as a national policy in 1996 and established the Planning Council for Cancer Control as a steering committee for forwarding the programs. The economic crisis in Korea in 1997, however, hindered carrying out the plan. The Government has a difficult situation in drawing up a budget and in setting down original programs in the budget. During the three years 1996–98, budgetary measures of only 4 billion Korean Won, 4.3% of that necessary in the plan, were made.
|
FOOTNOTES
|
|---|
+ For reprints and all correspondence: Yoon-Ok Ahn, Department
of Preventive Medicine, Seoul National University College of
Medicine, 28 Yongon-dong Chongno-gu, Seoul 110-799, Korea. E-mail:
yoahn@plaza.snu.ac.kr
|
REFERENCES
|
|---|
1
’95 Medical Insurance Statistical Yearbook for Government Employees and Private School Teachers and Staffs. Seoul: Korea Medical Insurance Corporation 1995.
2
Kim JP, Ahn YO, Shin MH, Ahn DH. Cancer Facts and Estimates in Seoul, Korea, 1992–1995. Seoul: Seoul Cancer Registry 1998.
3
Parkin DM, Whelan SL, Ferlay J, Raymond L, Young J, editors. Cancer Incidence in Five Continents, Vol. VII. IARC Scientific Publication No. 193. Lyon: IARC 1997.
4
Annual Reports on the Cause of Death Statistics – Based on Vital Registration. Seoul: National Statistical Office 1987–96.
5
Ahn YO, Shin MH, Kim JP. Epidemiology of gastric cancer in Korea. In: Nishi M, Sugano H, Takahashi T, editors. 1st International Gastric Cancer Congress, Kyoto (Japan), March 29–April 1, 1995. Bologna: Monduzzi Editore 1995.
6
Ten Year Plan for Cancer Control, 1996–2005. Seoul: Korea Cancer Control Task Force 1995.
Received February 22, 2001; accepted February 27, 2001.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
|
|
 
J.-P. Kim
Surgery in Korea
Arch Surg,
March 1, 2004;
139(3):
336 - 340.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Jang, S. Lee, Y. Jung, K. Song, M. Fukumoto, V. E. Gould, and I. Lee
Malgun (Clear) Cell Change in Helicobacter pylori Gastritis Reflects Epithelial Genomic Damage and Repair
Am. J. Pathol.,
April 1, 2003;
162(4):
1203 - 1211.
[Abstract]
[Full Text]
[PDF]
|
|
|
TOP
ABSTRACT
INTRODUCTION
