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Cancer Burden in Japan Based on the Latest Cancer Statistics: Need for Evidence-Based Cancer Control Programs

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Cancer Burden in Japan Based on the Latest Cancer Statistics: Need for Evidence-Based Cancer Control Programs Review Article Page 1 of 15 Cancer burden in Japan based on the latest cancer statistics: need for evidence-based cancer control programs Tomohiro Matsuda, Kumiko Saika Center for Cancer Registries, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan Contributions: (I) Conception and design: T Matsuda; (II) Administrative support: None; (III) Provision of study material or patients: None; (IV) Collection and assembly of data: T Matsuda; (V) Data analysis and interpretation: All authors; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Tomohiro Matsuda. Center for Cancer Control and Information Services, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. Email: [email protected]. Abstract: Cancer as a cause of death has been constantly increasing in Japan, and it became the leading cause of death in 1981. As for incidence and survival, the research groups financed by the Health, Labour and Welfare Ministry have estimated the national cancer incidence in Japan based on high-quality data from several cancer registries over a long period. With the enactment of the Act on Promotion of Cancer Registries in 2013, cancer became a reportable disease; this allows us to establish a cancer control program based on reliable statistics. Cancer mortality and incidence in 2014 describe the cancer burden in the country precisely. Age-standardized mortality rates (world population) for males and females were 114.8 and 63.0/100,000, respectively. Age-standardized incidence rates for males and females were 303.1 and 224.8/100,000, respectively. According to the results of an international collaborative study, CONCORD-3, Japan demonstrated good results, such as net survival of 60.3% for stomach cancer. The 5-year prevalence for all cancers was 1,734,060 in males and 1,399,380 in females. The recent trends of cancer mortality and incidence showed that no increase of mortality was observed in any primary sites in males. However in females, uterine cancer, both of the cervix and the uterine body, showed increasing mortality. Mortality in all the other primary sites is decreasing or at least leveling off. As for incidence, cancers of the pancreas, prostate, and thyroid and malignant lymphoma were increasing in males, and cancers of the esophagus, colon and rectum, lung, breast, uterus, ovary, and thyroid and malignant lymphoma were increasing in females. Geographical disparities at these sites were associated with well-known risk factors, such as smoking, salt intake, hepatitis C virus infection, and Helicobacter pylori infection. Given its hyper-aging society, Japan will likely face a substantial increase in the number of elderly cancer patients. This heavy cancer burden will be compounded by the functional limitations and co-morbidities that often present in older cancer patients. Cancer statistics and cancer registration in Japan in accordance with legislation are the keys to performing effective evidence-based cancer control. Keywords: Cancer; statistics; cancer registry; cancer control; Japan Received: 14 May 2018; Accepted: 15 August 2018; Published: 05 September 2018. doi: 10.21037/ace.2018.08.01 View this article at: http://dx.doi.org/10.21037/ace.2018.08.01 Introduction a second generation of baby boomers. The first generation of baby boomers is now in their mid-70s, an age when Cancer as a cause of death has been constantly increasing in Japan, and it became the leading cause of death in 1981 cancers occur frequently. Accordingly, the number of cancer (Figure 1). Japan had a baby boomer generation, namely patients is increasing, and the cancer burden on society is those born in 1947–1948 just after World War II, as well as becoming increasingly heavier. © Annals of Cancer Epidemiology. All rights reserved. ace.amegroups.com Ann Cancer Epidemiol 2018;2:2 Page 2 of 15 Annals of Cancer Epidemiology, 2018 400 350 300 250 Tuberculosis 200 Cancers Heart diseases Cerebrovascular diseases 150 Pneumonia Crude death rate (per 100,000) Senility 100 50 0 1899 1902 1905 1908 1911 1914 1917 1920 1923 1926 1929 1932 1935 1938 1941 1947 1950 1953 1956 1959 1962 1965 1968 1971 1974 1977 1980 1983 1986 1089 1992 1995 1998 2001 2004 2007 2010 2013 Year Figure 1 Changes in causes of death in Japan. Table 1 Transition of quality indicators of PBCR data The first population-based cancer registry (PBCR) Year of incidence DCN% DCO% M/I MV% started in Miyagi Prefecture in 1951. However, data were 2003 22.8 16.8 0.50 68.1 collected and data quality was evaluated only for several selected regions since the 1970s (1). The Cancer Control 2004 23.6 17.1 0.51 67.2 Act, approved in 2006, mentioned that the PBCR system 2005 20.1 14.9 0.50 74.9 needed to be developed to determine cancer incidence 2006 20.8 13.4 0.49 74.2 throughout Japan. Development of hospital-based cancer 2007 20.6 14.6 0.49 74.3 registries (HBCRs, in the 434 designated cancer treating 2008 20.2 13.6 0.47 75.5 hospitals, as of 2018) has clearly supported infrastructure development of cancer registries and led to improvement 2009 20.1 13.4 0.45 76.0 in the completeness of data after 2010 (Table 1). The Act 2010 18.1 11.8 0.45 78.0 on Promoting Cancer Registries was finally enacted in 2011 11.9 5.3 0.43 83.1 Japan on December 6th, 2013. This Act provides for 2012 13.1 5.6 0.43 82.2 the implementation of a National Cancer Registry in accordance with the purpose of the Cancer Control Act 2013 8.3 5.0 0.43 83.7 (2,3). The National Cancer Registry provides accurate and 2014 9.1 6.4 0.42 82.3 immediate cancer statistics. According to the Act, hospitals PBCR, population-based cancer registry; DCN%, report to the prefectural governors information on any proportion of death certificate notification cases; DCO%, primary cancer that was first diagnosed from January 1st, proportion of death certificate only cases; M/I, ratio of mortality to incidence; MV%, proportion of microscopically 2016, when cancer became a reportable disease. verified cases. The purpose of this article was to determine and © Annals of Cancer Epidemiology. All rights reserved. ace.amegroups.com Ann Cancer Epidemiol 2018;2:2 Annals of Cancer Epidemiology, 2018 Page 3 of 15 summarize the current status of cancer burden in this hyper- population, were used. aging country using up-to-date cancer statistics. A further aim was to introduce the major change in cancer registry Results according to the Act on Promoting Cancer Registries. Cancer mortality in 2014 Methods The mortality, crude rates, and age-standardized rates in 2014 are presented in Table 2. The total cancer mortality in Vital statistics in Japan are used for population prediction, Japan in 2014 was 368,103 (C00–C96), including 218,397 and cancer mortality statistics as a reliable data source males and 149,706 females. The age-standardized mortality since 1898 provide further relevant information. Yearly rates (world population) for males and females were 114.8 publication of mortality data in Japan is done in the and 63.0/100,000, respectively. Among males, in 2014, the following year. According to the death certificates issued leading cancer site was the lung (24.0%), followed by the by medical doctors, the city halls publish a form for vital statistics. The Ministry of Health, Labour and Welfare stomach (14.4%), colon and rectum (12.0%), liver (8.8%), (MHLW) collects all the forms from the city halls via the and pancreas (7.5%). In 2014, the leading cancer site in prefectures, and then the causes of death are coded using females was the colon and rectum (14.9%), followed by ICD-10. The ministry uses the world standard format for the lung (14.0%), stomach (11.0%), pancreas (10.0%), and death certificates and follows the rules for selection of cause breast (8.8%). of death. The data for the year 2014 were obtained from the ministry website and used for this article in accordance Cancer incidence in 2014 with the incidence date, but the latest data are those for the year 2016. Almost all aggregated mortality data are publicly The total cancer incidence in Japan in 2014 was estimated available online (4). to be 867,408 (C00–C96), with 501,527 males and 365,881 Availability of incidence data varies according to females affected (Table 3) (6). The age-standardized prefecture. In several prefectures, such as Miyagi, Fukui, incidence rates (world population) for males and females and Osaka, the data are available from the 1970s. Half were 303.1 and 224.8 /100,000, respectively. Regarding of the prefectures have data since the early 1990s, and the quality and completeness of reporting, the overall the other half have data since the late 2000s. Data for all proportion of death certificate-only cases in all cancer cases 47 prefectures exist since 2013, and the latest fixed data (DCO%) and the ratio of mortality to incidence (M/I) were as of July 2018 are for the year 2014. In 2005, the Japan 6.4% and 0.42, respectively. For accuracy of diagnosis, Cancer Surveillance Research Group (JCSRG), which the overall ratio of morphologically verified diagnosis was initiated under the Third Ten-year Comprehensive (cases diagnosed based on histological and cytological Strategy for Cancer Control Program [2004–2013], took examination) in all cancer cases (MV%) was 82.3%. Among over the research group in Osaka to perform national males, the leading cancer site was the stomach (17.3%), estimates of cancer incidence from 2000 (5), which is called followed by the lung (15.3%), colon and rectum (15.3%), the Monitoring of Cancer Incidence in Japan (MCIJ) and prostate (14.7%).
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