Japanese Journal of Clinical Oncology 32:S66-S81 (2002)
© 2002 Foundation for Promotion of Cancer Research
Cancer Epidemiology and Control in Taiwan: a Brief Review
Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan
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ABSTRACT |
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 TOP ABSTRACT INTRODUCTIONCANCER MORTALITY AND INCIDENCE...CANCER INCIDENCE IN TAIWAN...ETHNIC AND MIGRANT VARIATIONS...GEOGRAPHICAL CLUSTERING OF MAJOR...MAJOR RISK FACTORS FOR...CANCER PREVENTION PROGRAMS IN...CANCER SCREENING PROGRAMS IN...MEDICAL CARE FOR CANCER...CANCER RESEARCHCOMPREHENSIVE CANCER CONTROL IN...PROMOTION OF PRIMARY PREVENTION...PROMOTION OF SECONDARY...PROMOTION OF TERTIARY PREVENTION...IMPLEMENTATION OF CANCER...REFERENCES |
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Malignant neoplasm has become the leading cause of death in Taiwan since 1982. There has been a decreasing trend for cancers of the stomach and cervix uteri, while an increasing trend has been observed for cancers of the lung, liver, oral cavity, colon and rectum, breast and prostate. International comparison and migrant studies have shown an elevated risk of hepatocellular carcinoma, nasopharyngeal carcinoma and cervical neoplasia in Taiwan. The national hepatitis B vaccination program, started in July 1984, has resulted in a significant decrease in childhood hepatocellular carcinoma in Taiwan. A decrease in prevalence of cigarette smoking has been observed among middle-aged men since the control of tobacco hazards was enacted in 1997. Free mass screening of cervical neoplasia and colorectal cancer has been implemented in the national health insurance program since 1995. Project-based screening for hepatocellular carcinoma, nasopharyngeal carcinoma and breast cancer among high-risk groups was started in 1994. Most cancer patients are diagnosed by pathological examinations and treated by surgical operation, chemotherapy and radiotherapy in major teaching hospitals in Taiwan. The Taiwan Collaborative Oncology Group has been organized to assess the efficacy of various treatment modalities through multicentric clinical trials. There has been a striking increase in expenditure for medical care of cancer patients. Cancer researchers mainly sponsored by the National Science Council and Department of Health are engaged in basic, epidemiological and clinical studies on major cancers in Taiwan. Major fields of the research include cancer genomics, gene therapy, molecular epidemiology and DNA vaccine.
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INTRODUCTION |
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TOPABSTRACTINTRODUCTIONCANCER MORTALITY AND INCIDENCE...CANCER INCIDENCE IN TAIWAN...ETHNIC AND MIGRANT VARIATIONS...GEOGRAPHICAL CLUSTERING OF MAJOR...MAJOR RISK FACTORS FOR...CANCER PREVENTION PROGRAMS IN...CANCER SCREENING PROGRAMS IN...MEDICAL CARE FOR CANCER...CANCER RESEARCHCOMPREHENSIVE CANCER CONTROL IN...PROMOTION OF PRIMARY PREVENTION...PROMOTION OF SECONDARY...PROMOTION OF TERTIARY PREVENTION...IMPLEMENTATION OF CANCER...REFERENCES |
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The causes of death have changed drastically along with the economic boom and public health development in Taiwan since the early 1950s. Malignant neoplasm has become the leading cause of death in Taiwan since 1982 (1). It has brought a significant medical expenditure and socioeconomic impact to patients, their families and even the entire society. The major cancer sites and their epidemiological characteristics and risk factors vary from nation to nation. The cancer control programs in different countries have their own emphasis and uniqueness. It is worthwhile to compare the epidemiology of various cancers in different countries and to share the experiences in a national control program. This paper aims to describe (1) epidemiology and risk factors of major cancers, (2) cancer prevention programs, (3) cancer screening programs, (4) medical care for cancer patients and (5) cancer research in Taiwan.
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CANCER MORTALITY AND INCIDENCE IN TAIWAN |
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TOPABSTRACTINTRODUCTIONCANCER MORTALITY AND INCIDENCE...CANCER INCIDENCE IN TAIWAN...ETHNIC AND MIGRANT VARIATIONS...GEOGRAPHICAL CLUSTERING OF MAJOR...MAJOR RISK FACTORS FOR...CANCER PREVENTION PROGRAMS IN...CANCER SCREENING PROGRAMS IN...MEDICAL CARE FOR CANCER...CANCER RESEARCHCOMPREHENSIVE CANCER CONTROL IN...PROMOTION OF PRIMARY PREVENTION...PROMOTION OF SECONDARY...PROMOTION OF TERTIARY PREVENTION...IMPLEMENTATION OF CANCER...REFERENCES |
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In the analysis of cancer mortality and incidence rates in Taiwan from 1971 to 1996, the data were derived from the national death certification system (1) and national cancer registration system (2) in Taiwan. The world standard population (3) was used for age adjustment in all the analyses. Secular trends of mortality from major diseases in Taiwan are shown in Figs 1 and 2 for males and females, respectively, from 1971 to 1997. There has been an increasing trend in age-adjusted mortality from cancer, but it was more striking for males than females. While an increasing age-adjusted mortality from diabetes mellitus was observed, there was a rather constant age-adjusted mortality from chronic liver disease and cirrhosis. During the same period there has been a decreasing trend for age-adjusted mortality from cerebrovascular diseases, accidents, heart diseases, nephritis, nephrotic syndrome and nephrosis, hypertensive diseases, bronchitis, emphysema and asthma, as well as gastric and duodenal ulcer.
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Proportions of deaths from major diseases by age in Taiwan in 1996 are shown in Figs 3 and 4, respectively, for males and females. There was a bimodal age pattern for the proportion of cancer deaths in total deaths. The first peak was observed at age 5–9 years for both males and females and the second peak was at age 55–59 years for males and 40–44 years for females. Accidents accounted for the largest proportion of deaths for age groups from 5 to 39 years for males and from 5 to 29 years for females. The proportion of deaths from cerebrovascular diseases and heart diseases increased with age for both males and females.
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Age-adjusted mortality rates of major cancers in Taiwan from 1971 to 1996 are shown in Figs 5 and 6, respectively, for males and females. The age-adjusted mortality from cancers of all sites combined increased from 115 per 100 000 in 1971 to 156 per 100 000 in 1996 for males and from 80 per 100 000 in 1971 to 94 per 100 000 in 1996 for females. The five leading cancer deaths for males were cancers of the liver, lung, stomach, colon and oral cavity; while cancers of the lung, liver, cervix uteri, breast and stomach were the five leading cancer deaths for females.
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Age-specific mortality rates of major cancers in Taiwan in 1996 for males and females are shown in Figs 7 and 8, respectively. Most cancers had an increasing mortality with age except for oral cancer and nasopharyngeal cancer of males and breast cancer of females. There was a bimodal age pattern for male oral cancer and female breast cancer. The three leading cancers before age 50 years were liver, oral and lung cancer for males and cancers of the breast, lung and cervix uteri for females. Leading cancer deaths after age 60 years were cancers of the liver, lung, stomach and colon and rectum for males and cancers of the liver, lung, colon and rectum, stomach and cervix uteri for females.
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Age-specific incidence rates of major cancers in Taiwan in 1995 for males and females are shown in Figs 9 and 10, respectively. Most cancers showed an increasing mortality with age except for oral cancer and nasopharyngeal cancer in males and breast cancer in females. The peak age varied from cancer to cancer. It was 55–59 years for male oral cancer and nasopharyngeal cancer and >70 years for other male cancers. A plateau of male liver cancer incidence was observed between ages 60–64 and 80–84 years. The peak age was 45–49 years for cervical cancer and 60–64 years for female breast cancer. All other female cancers had a peak incidence after age 70 years.
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Secular trends of age-adjusted mortality rates of major cancers in Taiwan from 1971 to 1996 are shown in Figs 1 and 12 for males and females, respectively. There has been an increasing age-adjusted mortality from cancers of the lung, liver, colon and rectum and pancreas and also non-Hodgkin’s lymphoma for both males and females. Males also had an increasing trend of age-adjusted mortality from oral cancer and prostate cancer; females had an increasing trend of age-adjusted mortality from cancers of the breast and gallbladder and extrahepatic bile ducts. A decreasing trend of age-adjusted mortality was observed for stomach cancer of both males and females, cervical cancer of females and cancers of the esophagus and nasopharynx of males.
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CANCER INCIDENCE IN TAIWAN AND ASIAN COUNTRIES |
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TOPABSTRACTINTRODUCTIONCANCER MORTALITY AND INCIDENCE...CANCER INCIDENCE IN TAIWAN...ETHNIC AND MIGRANT VARIATIONS...GEOGRAPHICAL CLUSTERING OF MAJOR...MAJOR RISK FACTORS FOR...CANCER PREVENTION PROGRAMS IN...CANCER SCREENING PROGRAMS IN...MEDICAL CARE FOR CANCER...CANCER RESEARCHCOMPREHENSIVE CANCER CONTROL IN...PROMOTION OF PRIMARY PREVENTION...PROMOTION OF SECONDARY...PROMOTION OF TERTIARY PREVENTION...IMPLEMENTATION OF CANCER...REFERENCES |
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In the comparison of international variations in cancer incidence in Taiwan and Asian countries, the data were derived from Cancer Incidence in Five Continents published by the International Agency for Research on Cancer (3). Age-adjusted incidence rates of cancers of all sites combined, nasopharynx, liver, stomach, colon, lung, cervix uteri and female breast in Asian countries were compared. The highest age-adjusted mortality from cancers of all sites combined was observed among the Maori of New Zealand for both males and females, while the lowest for males was observed for Kuwaitis and the lowest for females in Hanoi, Vietnam, as shown in Fig. 3. As shown in Fig. 4, the highest age-adjusted incidence rate of nasopharyngeal cancer was observed for both males and females in Hong Kong, Singapore (Chinese) and Hanoi. The male lowest age-adjusted incidence rate of nasopharyngeal cancer was observed in Japan and the lowest for females in non-Kuwaitis in Kuwait.
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Figure 5 shows the highest age-adjusted incidence rates of liver cancer in Khon Kaen, Qidong and Osaka and the lowest in Israel, Victoria and New Zealand (non-Maori) for males and females. The highest age-adjusted incidence rates of stomach cancer were observed in Nagasaki, Kangwha and Osaka and the lowest in Koen Kaen, as shown in Fig. 6. Figure 7 shows the highest age-adjusted incidence rates of colon cancer in New Zealand (non-Maori) and Victoria and the lowest in Qidong. The highest age-adjusted incidence rates of lung cancer were observed in New Zealand (Maori) and the lowest in Bombay and Khon Kaen, as shown in Fig. 8. Figure 9 shows the highest age-adjusted incidence rates of cervical cancer in New Zealand (Maori), Chiang Mai and Taiwan and the lowest in Qidong, Shanghai, Tianjin and Israel (Jews). The highest age-adjusted incidence rate of female breast cancer was observed in Israel (Jews), New Zealand (Maori and non-Maori) and Victoria and the lowest in Kangwha, Khon Kaen and Qidong, as shown in Fig. 0
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ETHNIC AND MIGRANT VARIATIONS IN CANCER INCIDENCE IN ASIAN COUNTRIES |
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TOPABSTRACTINTRODUCTIONCANCER MORTALITY AND INCIDENCE...CANCER INCIDENCE IN TAIWAN...ETHNIC AND MIGRANT VARIATIONS...GEOGRAPHICAL CLUSTERING OF MAJOR...MAJOR RISK FACTORS FOR...CANCER PREVENTION PROGRAMS IN...CANCER SCREENING PROGRAMS IN...MEDICAL CARE FOR CANCER...CANCER RESEARCHCOMPREHENSIVE CANCER CONTROL IN...PROMOTION OF PRIMARY PREVENTION...PROMOTION OF SECONDARY...PROMOTION OF TERTIARY PREVENTION...IMPLEMENTATION OF CANCER...REFERENCES |
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In the comparison of ethnic and migrant variation in cancer incidence in Asia and western North America, the data were derived from Cancer Incidence in Five Continents published by the International Agency for Research on Cancer (3). Age-adjusted incidence rates of cancers of all sites combined, nasopharynx, liver, stomach, colon, lung, cervix uteri and female breast in different ethnic groups in selected Asian and western North American cities were compared. As shown in Fig. 1, there was a striking ethnic variation in age-adjusted incidence rates of all cancer sites combined in Singapore, San Francisco and Los Angeles. There was also a significant variation in cancer incidence among Chinese and Japanese in different cities. The Japanese in Japan had higher incidence rates of all cancer sites combined than the Japanese in Hawaii, San Francisco and Los Angeles.
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The age-adjusted incidence rate of nasopharyngeal cancer was much higher in Chinese, Malay and Filipino than in Indian, Black, White, Korean and Japanese, as shown in Fig. 2. There was also a striking variation in incidence rate of nasopharyngeal cancer among Chinese in different cities, with the highest in Hong Kong and the lowest in Tianjin. As shown in Fig. 3, there were significant ethnic and migrant variations in age-adjusted incidence rates of liver cancer. Chinese had higher liver cancer incidence rates than other ethnic groups in Singapore, San Francisco, Los Angeles and Hawaii. Japanese in Japan and Chinese in Asian cities had much higher liver cancer incidence rates than Japanese and Chinese in San Francisco, Los Angeles and Hawaii.
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Figure 4 shows striking ethnic and migrant variations in age-adjusted incidence rates of stomach cancer. Japanese in Japan and Chinese in Asian cities had much higher age-adjusted incidence rates of stomach cancer than Japanese and Chinese in Hawaii, Los Angeles and San Francisco. Japanese and Korean in American cities had higher incidence rates of stomach cancer than other ethnic groups. In contrast, age-adjusted incidence rates of colon cancer were higher among Japanese and Chinese in Hawaii, San Francisco and Los Angeles than Japanese in Japan and Chinese in China and Taiwan, as shown in Fig. 5.
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Figure 6 shows ethnic and migrant variations in age-adjusted incidence rates of lung cancer. There was a striking difference in age-adjusted incidence rates of lung cancer among Chinese in various cities. There was also ethnic variation in the incidence rates in Singapore, San Francisco, Hawaii and Los Angeles. Figure 7 illustrates striking ethnic and migrant variations in age-adjusted incidence rates of cervical cancer. Chinese in Taiwan, Singapore and Hong Kong had much higher age-adjusted incidence rates of cervical cancer than Chinese in Los Angeles, San Francisco, Hawaii and China. Similarly, Japanese in Japan had higher age-adjusted incidence rates of cervical cancer than Japanese in American cities. The ethnic and migrant variations in age-adjusted incidence rates of breast cancer are shown in Fig. 8. In contrast to cervical cancer, Chinese and Japanese in Asian cities had lower age-adjusted incidence rates of breast cancer than those in American cities.
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GEOGRAPHICAL CLUSTERING OF MAJOR CANCERS IN TAIWAN |
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TOPABSTRACTINTRODUCTIONCANCER MORTALITY AND INCIDENCE...CANCER INCIDENCE IN TAIWAN...ETHNIC AND MIGRANT VARIATIONS...GEOGRAPHICAL CLUSTERING OF MAJOR...MAJOR RISK FACTORS FOR...CANCER PREVENTION PROGRAMS IN...CANCER SCREENING PROGRAMS IN...MEDICAL CARE FOR CANCER...CANCER RESEARCHCOMPREHENSIVE CANCER CONTROL IN...PROMOTION OF PRIMARY PREVENTION...PROMOTION OF SECONDARY...PROMOTION OF TERTIARY PREVENTION...IMPLEMENTATION OF CANCER...REFERENCES |
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According to the Atlas of Cancer Mortality in Taiwan, 1982–1991 (4), there was significant geographical clustering of high mortality areas of major cancers in Taiwan. The most striking cluster was in the arseniasis-endemic area along the southwest coast of Taiwan, where significantly elevated mortality rates of cancers of the liver, lung, skin, prostate, urinary bladder and kidney were observed. Consistent with the observation, ecological studies (5–8), case-control studies (9) and cohort studies (10) all showed a dose–response relationship between arsenic exposure and cancer risk. Patients affected with blackfoot disease, a unique peripheral vascular disease related to long-term arsenic exposure, had an increased risk of cancers of the lung, liver, skin, urinary bladder, kidney and prostate, showing no organotropism of the arsenic-induced carcinogenicity (11,12).
Areas showing an elevated mortality from oral cancer for females were clustered in aboriginal townships in eastern Taiwan. Aboriginal women in eastern Taiwan had a much higher prevalence of habits of cigarette smoking, alcohol drinking and betel nut chewing than women in other areas. High stomach cancer mortality areas were clustered in aboriginal townships where the prevalence of Helicobacter pylori was high (13). Areas of high liver cancer mortality were clustered in offshore Penghu Islets where residents had a high exposure to aflatoxin (14).
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MAJOR RISK FACTORS FOR COMMON CANCERS IN TAIWAN |
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TOPABSTRACTINTRODUCTIONCANCER MORTALITY AND INCIDENCE...CANCER INCIDENCE IN TAIWAN...ETHNIC AND MIGRANT VARIATIONS...GEOGRAPHICAL CLUSTERING OF MAJOR...MAJOR RISK FACTORS FOR...CANCER PREVENTION PROGRAMS IN...CANCER SCREENING PROGRAMS IN...MEDICAL CARE FOR CANCER...CANCER RESEARCHCOMPREHENSIVE CANCER CONTROL IN...PROMOTION OF PRIMARY PREVENTION...PROMOTION OF SECONDARY...PROMOTION OF TERTIARY PREVENTION...IMPLEMENTATION OF CANCER...REFERENCES |
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A series of epidemiological studies on major risk factors for various common cancers in Taiwan have been carried out. These cancer risk factors may be classified as infectious agents, lifestyle variables, dietary factors and susceptibility factors. Both hepatitis B virus (HBV) and hepatitis C virus (HCV) are major risk factors for liver cancer, mainly HCC, in Taiwan (15–22). The relative risk of developing HCC was similar for chronic HBV carrier status and HCV infection, but the population attributable risk percentage was much higher for HBV carrier status than for HCV infection (22). Elevated serological titers of antibodies against Epstein–Barr virus (EBV)-specific DNase (anti-EBV DNase) and IgA antibodies against EBV-specific viral capsid antigen (anti-EBV VCA IgA) were associated with an increased risk of NPC (23–26). Human papillomavirus (HPV) has been documented as a major risk factor for cervical cancer in Taiwan (27,28). However, the association between stomach cancer and seropositivity of antibodies against Helicobacter pylori was less striking (29–31).
Major lifestyle variables associated with an increased cancer risk in Taiwan include habits of cigarette smoking, alcohol drinking and betel nut chewing. Cigarette smoking habit has been found to increase the risk of lung cancer, HCC, oral cavity, NPC, esophageal, urinary bladder and cervical cancer in a dose–response relationship (17,19,22,23,25,26,32–35). Alcohol drinking habit has been documented as a risk factor for oral cavity cancer and HCC in Taiwan (17,19,34), while the habit of betel nut chewing is also associated with an increased risk of oral cavity cancer (34).
Consumption of preserved food has been associated with an increased risk of HCC (19), NPC (26) and stomach cancer (36). Frequent consumption of preserved soy beans was found to increase the risk of HCC (19) and NPC (26). Molecular epidemiological studies have shown an increased HCC risk associated with an elevated urinary (37,38) or serum level of aflatoxin (14,38). There was a dose–response relationship between risk of HCC and serum level of albumin adducts of aflatoxin B1 (39). Frequent consumption of salted food has been found to be associated with an increased risk of stomach cancer in Taiwan (36). Low consumption of vegetables and low serum levels of ß-carotene/retinol have been documented as risk factors for lung cancer (33), HCC (19, 40), stomach cancer (36), NPC (26) and arsenic-induced skin cancer (41). Similarly, low serum selenium level has also been found to be a risk factor for HCC (42).
Genetic polymorphisms of phase I and phase II enzymes involved in the metabolism of xenobiotics have been documented to be susceptibility biomarkers of major cancers in Taiwan. The c2/c2 genotype of cytochrome P450 2E1 was found to be associated with an increased risk of NPC (43) and stomach cancer (44), but with a decreased risk of HCC (45). The null genotypes of glutathione-S-transferase (GST) M1 and T1 were found to modify the biological gradient between aflatoxin exposure and HCC risk. There was a significant dose–response relationship between serum level of albumin adducts of aflatoxin B1 and HCC risk among chronic HBV carriers with null genotypes of GSTM1 or GSTT1, but not among those with non-null genotypes (39). GST M1 genetic polymorphism was also reported to interact with serum carotenoids level in the development of HCC (46). Genotypes of N-acetyl transferase (NAT) 1 and NAT2 were found to modify the urinary bladder cancer risk associated with cigarette smoking (47). A recent study has reported an association between cytochrome P450 1A1 polymorphism and risk of HCC (48). Human leukocyte antigen (HLA) A2 and B16 were found to be associated with an increased risk of HCC, whereas HLA A13 was associated with a decreased NPC risk (49).
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CANCER PREVENTION PROGRAMS IN TAIWAN |
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TOPABSTRACTINTRODUCTIONCANCER MORTALITY AND INCIDENCE...CANCER INCIDENCE IN TAIWAN...ETHNIC AND MIGRANT VARIATIONS...GEOGRAPHICAL CLUSTERING OF MAJOR...MAJOR RISK FACTORS FOR...CANCER PREVENTION PROGRAMS IN...CANCER SCREENING PROGRAMS IN...MEDICAL CARE FOR CANCER...CANCER RESEARCHCOMPREHENSIVE CANCER CONTROL IN...PROMOTION OF PRIMARY PREVENTION...PROMOTION OF SECONDARY...PROMOTION OF TERTIARY PREVENTION...IMPLEMENTATION OF CANCER...REFERENCES |
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There are several governmental and non-governmental agencies involved in the cancer prevention programs in Taiwan. The governmental organizations include the National Department of Health, Taiwan Provincial Health Department, Taipei City Health Department, Kaohsiung City Health Department, health departments at county level and health centers at township level. The non-governmental organizations include academic societies, Tung’s Foundation, S. Y. Dao Memorial Foundation, Taiwan Cancer Foundation, Liver Disease Control Foundation, Breast Cancer Foundation and Nan-Hai Foundation.
The nationwide HBV vaccination program has been a very successful cancer prevention program in Taiwan since 1984. Both the chronic HBV carrier rate and HCC incidence rate have declined significantly among birth cohorts born after the vaccination program was implemented (50). The Tobacco Hazards Control Act in Taiwan was enacted in 1997. The tobacco control program includes mandatory warning labels in cigarette packages and advertisements, prohibition of cigarette smoking in public places and transportation vehicles, promotion of anti-smoking education, implementation of smoking cessation clinics and international collaboration in tobacco control. The prevalence of cigarette smoking has declined among middle-aged men, but increased in young women and adolescents. The rapid increase in the incidence of oral cavity cancer is attributable to the increase in betel nut consumption. Both governmental and non-governmental agencies have been active in the control of betel nut hazards, but the prevalence of betel nut chewing remains high among adult men.
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CANCER SCREENING PROGRAMS IN TAIWAN |
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TOPABSTRACTINTRODUCTIONCANCER MORTALITY AND INCIDENCE...CANCER INCIDENCE IN TAIWAN...ETHNIC AND MIGRANT VARIATIONS...GEOGRAPHICAL CLUSTERING OF MAJOR...MAJOR RISK FACTORS FOR...CANCER PREVENTION PROGRAMS IN...CANCER SCREENING PROGRAMS IN...MEDICAL CARE FOR CANCER...CANCER RESEARCHCOMPREHENSIVE CANCER CONTROL IN...PROMOTION OF PRIMARY PREVENTION...PROMOTION OF SECONDARY...PROMOTION OF TERTIARY PREVENTION...IMPLEMENTATION OF CANCER...REFERENCES |
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A program of free mass screening for cervical neoplasia and colorectal cancer has been implemented in the national health insurance which was established in 1995. Project-based free screening for HCC, NPC and breast cancer among high-risk groups was started in 1994. These programs were implemented by the National Department of Health. In addition, several hospitals and clinics also provide self-paid screening for cancers of the nasopharynx, liver, colon and rectum, breast, stomach and prostate.
In Taiwan, NPC is screened by serological tests for multiple anti-EBV antibodies (51,52) and also nasopharyngoscopy. HCC is screened by serological tests for 
-fetoprotein, HBV surface and e antigens and anti-HCV as well as abdominal ultrasonography. Colorectal cancer is screened by tests for occult blood in stool and sigmoidoscopy or colonoscopy. Breast cancer is screened by self-examination, mammography or ultrasonography. Stomach cancer is screened by gastroscopy, while prostate cancer is screened by digital examination, prostate-specific antigen test and ultrasonography.
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MEDICAL CARE FOR CANCER PATIENTS |
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TOPABSTRACTINTRODUCTIONCANCER MORTALITY AND INCIDENCE...CANCER INCIDENCE IN TAIWAN...ETHNIC AND MIGRANT VARIATIONS...GEOGRAPHICAL CLUSTERING OF MAJOR...MAJOR RISK FACTORS FOR...CANCER PREVENTION PROGRAMS IN...CANCER SCREENING PROGRAMS IN...MEDICAL CARE FOR CANCER...CANCER RESEARCHCOMPREHENSIVE CANCER CONTROL IN...PROMOTION OF PRIMARY PREVENTION...PROMOTION OF SECONDARY...PROMOTION OF TERTIARY PREVENTION...IMPLEMENTATION OF CANCER...REFERENCES |
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The medical care delivery system involved in the medical care of cancer patients in Taiwan included one comprehensive cancer hospital, 10 university medical centers and also hundreds of regional and district general hospitals. Among 24 465 physicians and surgeons in Taiwan, there are 110 medical oncologists. According to the Cancer Registry Annual Report in 1995 in Taiwan, 81% of reported cancers were confirmed by pathological examinations, 13% by imaging diagnosis and 6% by other methods.
Major treatments of cancers in Taiwan included surgical treatment, radiotherapy and chemotherapy; immunotherapy and herbal medicine were also used. There has been a striking increase in expenditure for medical care of cancer patients.
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CANCER RESEARCH |
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TOPABSTRACTINTRODUCTIONCANCER MORTALITY AND INCIDENCE...CANCER INCIDENCE IN TAIWAN...ETHNIC AND MIGRANT VARIATIONS...GEOGRAPHICAL CLUSTERING OF MAJOR...MAJOR RISK FACTORS FOR...CANCER PREVENTION PROGRAMS IN...CANCER SCREENING PROGRAMS IN...MEDICAL CARE FOR CANCER...CANCER RESEARCHCOMPREHENSIVE CANCER CONTROL IN...PROMOTION OF PRIMARY PREVENTION...PROMOTION OF SECONDARY...PROMOTION OF TERTIARY PREVENTION...IMPLEMENTATION OF CANCER...REFERENCES |
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There are very active cancer research studies ongoing in Taiwan. Research on basic sciences of cancer include biochemistry and biophysics, carcinogenesis, endocrinology, pharmacology and experimental therapeutics, immunology, molecular biology and genetics as well as tumor biology. Epidemiological studies on cancers are focused on epidemiological characteristics, multiple environmental risk factors, acquired and genetic susceptibility, molecular biomarkers and risk assessment for major environmental carcinogens. Clinical research on cancer diagnosis and treatment is also active in Taiwan. The Taiwan Cooperative Oncology Group (TCOG) has been organized and coordinated by National Health Research Institutes to assess the efficacy of various treatment modalities. There are 12 disease committees and 20 major medical centers in TCOG to carry out clinical trials on cancer treatment protocols.
Major governmental support for cancer research in 1998 included US$5 000 000 from the National Science Council and US$4 500 000 from the National Department of Health. Academia Sinica, university medical centers and governmental and non-governmental hospitals also had budgets for cancer research. However, grants for cancer research from industry were relatively small in Taiwan.
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COMPREHENSIVE CANCER CONTROL IN 2000 |
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TOPABSTRACTINTRODUCTIONCANCER MORTALITY AND INCIDENCE...CANCER INCIDENCE IN TAIWAN...ETHNIC AND MIGRANT VARIATIONS...GEOGRAPHICAL CLUSTERING OF MAJOR...MAJOR RISK FACTORS FOR...CANCER PREVENTION PROGRAMS IN...CANCER SCREENING PROGRAMS IN...MEDICAL CARE FOR CANCER...CANCER RESEARCHCOMPREHENSIVE CANCER CONTROL IN...PROMOTION OF PRIMARY PREVENTION...PROMOTION OF SECONDARY...PROMOTION OF TERTIARY PREVENTION...IMPLEMENTATION OF CANCER...REFERENCES |
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The National Department of Health recently inaugurated a comprehensive cancer control program for year 2000. There are nine program goals: (1) a three-year cervical neoplasia screening rate of 40% among women aged 30 years or older with an age-adjusted mortality from cervical cancer <6.0 per 100 000 women; (2) an age-adjusted mortality from breast cancer <8.5 per 100 000 women; (3) a prevalence of betel nut chewing <15% among men aged 18 years or older; (4) an age-adjusted mortality from oral cancer <5.0 per 100 000; (5) a prevalence of cigarette smoking <27% for the population aged 18 years or older; (6) a prevalence of cigarette smoking <15% for the population aged from 12 to 17 years; (7) an HBV carrier rate <2% for children aged 10 years or younger; (8) a total of 320 beds for hospice care of cancer patients and at least one institution in each county or city to provide hospice care; and (9) a comprehensive cancer center in each of northern, central, southern and eastern Taiwan.
The strategies and programs to reach above-mentioned goals include the following.
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PROMOTION OF PRIMARY PREVENTION OF CANCER THROUGH HEALTH EDUCATION ON HEALTHY LIFESTYLES |
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TOPABSTRACTINTRODUCTIONCANCER MORTALITY AND INCIDENCE...CANCER INCIDENCE IN TAIWAN...ETHNIC AND MIGRANT VARIATIONS...GEOGRAPHICAL CLUSTERING OF MAJOR...MAJOR RISK FACTORS FOR...CANCER PREVENTION PROGRAMS IN...CANCER SCREENING PROGRAMS IN...MEDICAL CARE FOR CANCER...CANCER RESEARCHCOMPREHENSIVE CANCER CONTROL IN...PROMOTION OF PRIMARY PREVENTION...PROMOTION OF SECONDARY...PROMOTION OF TERTIARY PREVENTION...IMPLEMENTATION OF CANCER...REFERENCES |
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It will need integrated efforts by the health administration, the medical care system and non-governmental organizations to promote knowledge of cancer control among the general public. The control of cancers related to tobacco smoking and betel nut chewing will be the major task for the promotion of healthy lifestyles. The new HBV vaccination program, the assurance of safety in blood transfusions and the quality control of diagnostics for hepatitis viruses will be continued to prevent HCC.
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PROMOTION OF SECONDARY PREVENTION OF CANCER THROUGH EARLY DETECTION AND PROMPT TREATMENT |
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TOPABSTRACTINTRODUCTIONCANCER MORTALITY AND INCIDENCE...CANCER INCIDENCE IN TAIWAN...ETHNIC AND MIGRANT VARIATIONS...GEOGRAPHICAL CLUSTERING OF MAJOR...MAJOR RISK FACTORS FOR...CANCER PREVENTION PROGRAMS IN...CANCER SCREENING PROGRAMS IN...MEDICAL CARE FOR CANCER...CANCER RESEARCHCOMPREHENSIVE CANCER CONTROL IN...PROMOTION OF PRIMARY PREVENTION...PROMOTION OF SECONDARY...PROMOTION OF TERTIARY PREVENTION...IMPLEMENTATION OF CANCER...REFERENCES |
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The mass cervical neoplasia screening program will be continued through integrated efforts of the medical care system and special outreach units in underdeveloped areas where the medical facilities are inadequate. A hospital-based intensive screening program will be continued for women with a high risk of breast cancer, while an outreach program will be implemented for screening of breast cancer in underdeveloped areas where the medical facilities are inadequate. Training courses will be provided for pathologists, cytological technicians and radiologists to meet the increasing workload in cancer screening. Lung cancer screening will be included in regular chest X-ray surveys on pulmonary tuberculosis. Annual free oral cancer screening will be implemented in the Activities of the Month for Betel Nut Hazards Control. High-risk group screening programs will be implemented for cancers of the liver, colon and rectum and stomach, while outreach screening programs for these cancers will also be implemented in underdeveloped areas where the medical facilities are inadequate.
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PROMOTION OF TERTIARY PREVENTION OF CANCER THROUGH THE IMPROVEMENT OF QUALITY OF MEDICAL CARE OF CANCER PATIENTS |
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TOPABSTRACTINTRODUCTIONCANCER MORTALITY AND INCIDENCE...CANCER INCIDENCE IN TAIWAN...ETHNIC AND MIGRANT VARIATIONS...GEOGRAPHICAL CLUSTERING OF MAJOR...MAJOR RISK FACTORS FOR...CANCER PREVENTION PROGRAMS IN...CANCER SCREENING PROGRAMS IN...MEDICAL CARE FOR CANCER...CANCER RESEARCHCOMPREHENSIVE CANCER CONTROL IN...PROMOTION OF PRIMARY PREVENTION...PROMOTION OF SECONDARY...PROMOTION OF TERTIARY PREVENTION...IMPLEMENTATION OF CANCER...REFERENCES |
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Comprehensive cancer centers will be established in northern, central, southern and eastern Taiwan to carry out cancer prevention and intervention programs and related research. Diagnostic and treatment protocols for common cancers in Taiwan will be standardized to promote the quantity and quality of hospice care for cancer patients.
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IMPLEMENTATION OF CANCER MONITORING AND RESEARCH SYSTEM |
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TOPABSTRACTINTRODUCTIONCANCER MORTALITY AND INCIDENCE...CANCER INCIDENCE IN TAIWAN...ETHNIC AND MIGRANT VARIATIONS...GEOGRAPHICAL CLUSTERING OF MAJOR...MAJOR RISK FACTORS FOR...CANCER PREVENTION PROGRAMS IN...CANCER SCREENING PROGRAMS IN...MEDICAL CARE FOR CANCER...CANCER RESEARCHCOMPREHENSIVE CANCER CONTROL IN...PROMOTION OF PRIMARY PREVENTION...PROMOTION OF SECONDARY...PROMOTION OF TERTIARY PREVENTION...IMPLEMENTATION OF CANCER...REFERENCES |
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The national cancer registry system will be continued to monitor cancer incidence. The reporting system for cervical neoplasia screening will be improved to provide surveillance on cervical neoplasia. The cost-effectiveness of various cancer screening protocols will be analyzed to select the most appropriate screening programs. Five-year survival rates for various cancers will be used to examine the efficacy of medical care for cancer patients. National research programs will be implemented to study genetic diagnosis and gene therapy of cancer. National health surveys will be carried out to assess the efficacy of programs for tobacco hazards control and betel nut hazards control. Special studies on occupational and environmental cancers will also be started.
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Acknowledgements |
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This work was supported by grants from the Department of Health, Executive Yuan, Republic of China.
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FOOTNOTES |
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+ For reprints and all correspondence: Chien-Jen Chen, Graduate Institute of Epidemiology, National Taiwan University, Jen-Ai Road Section 1, Taipei 10018, Taiwan. E-mail: cjchen@ha.mc.ntu.edu.tw.
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REFERENCES |
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TOPABSTRACTINTRODUCTIONCANCER MORTALITY AND INCIDENCE...CANCER INCIDENCE IN TAIWAN...ETHNIC AND MIGRANT VARIATIONS...GEOGRAPHICAL CLUSTERING OF MAJOR...MAJOR RISK FACTORS FOR...CANCER PREVENTION PROGRAMS IN...CANCER SCREENING PROGRAMS IN...MEDICAL CARE FOR CANCER...CANCER RESEARCHCOMPREHENSIVE CANCER CONTROL IN...PROMOTION OF PRIMARY PREVENTION...PROMOTION OF SECONDARY...PROMOTION OF TERTIARY PREVENTION...IMPLEMENTATION OF CANCER...REFERENCES |
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Received September 11, 2000; accepted September 5, 2001.
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