Overview of Cancer in Asia

Men		Women
Site	Percent	Site	Percent
Skin Nasopharynx Lymph node Unknown primary Rectum Prostate Soft tissue Colon Lung Bladder	11.59 11.27 10.40 7.50 7.07 4.85 4.19 4.17 3.99 3.97	Cervix Breast Ovary Skin Thyroid Unknown primary Lymph node Rectum Nasopharynx Uterus	28.66 17.77 7.77 5.89 4.61 3.73 3.40 3.20 3.03 3.00

 

Korea

Cancer is one of the most common diseases in Korea, with 50,000 deaths and 80,000 new cases annually. Cancer accounts for 8.3% of all hospital admissions, represented by 9.5% for men and 7.9% for women. According to the Seoul cancer registry data for 1992 to 1995, the crude annual incidence rates for men and women was 184.4 per 100,000 and 158.4 per 100,000, respectively, while the age standardised rate (ASR) for the world population was 290.8 per 100,000 for men and 173.4 per 100,000 for women.

The main cancer site for men and women is the stomach (Table 5). For men, the 4 leading cancer sites of stomach, liver, lung, and colorectum account for two-thirds of all new male cancers. Among women, approximately 60% of all new cancers are accounted for by those of the stomach, cervix, breast, colorectum, and liver. Interestingly, while the leading cancer sites remain relatively similar for men regardless of age, there are differences between older and younger women, notably that middle-aged women (35 to 64 years) are more likely to develop breast cancer than older women, while older women have more lung cancer (Table 6).

Table 5 . Five leading cancer sites in Korea by gender

Table 6 . Five leading cancer sites in Korea by age.

 

Of note, is that some parts of Asia, including Korea, have the highest incidence of gastric cancer in the world. A comparison of age incidence curves found that the ASR of gastric cancer for men in Seoul was 10-fold that of men in Los Angeles, USA (71.1 per 100,000 population vs 7.6 per 100,000 population).

Cancer is the leading cause of death in Korea, accounting for 24.1% of all deaths for men and 17.7% for women. There is a marked increase in death rates for people older than 65 years (73% to 75% increase). Gastric cancer mortality has gradually decreased during the past decade, particularly for middle-aged people, while lung cancer mortality is increasing for all age groups. Interestingly, female breast cancer mortality has also increased during the past 10 years.

Early detection or mass screening programmes are available for a fee for specific cancer sites such as stomach, liver, colorectum, breast, and cervix. However, the uptake is less than 10% of the target population and public education is not active. Consequently the early detection rate is low. While there is a plan for cancer control, this has been hindered by the economic crisis of 1997.

 

Malaysia

There is no nationwide population-based cancer registry in Malaysia, so the burden of cancer is estimated by extrapolating from regional surveys. The likely incidence of cancer is approaching 150 per 100,000 population, with an annual incidence of 30,000 and a prevalence of 90,000. There is an increasing ageing population, so the incidence of cancer is expected to rise. Cancer constitutes 10.3% of medically-certified deaths and is the fourth leading cause of death. The 10 leading cancers among men, women, and children are shown in (Table 7). In 1998, the most common sites for cancer mortality were lung, liver, breast, leukaemia, and stomach.

Malaysia is a multiethnic country, home to people of Chinese, Indian and Malayan origins. Some racial differences have been noted in cancer incidence. For example, the incidence of nasopharyngeal cancer in Chinese is far greater than in Indians or Malays (15.9 per 100,000 population, 1.1 per 100,000 population, and 0.79 per 100,000 population, respectively), and the incidence is greater among men.

Table 7. Ten leading cancer sites in Malaysia.

 

Indian		Chinese		Malay
Site	Percent	Site	Percent	Site	Percent
Men
Lung Prostate Colorectum Stomach Liver Larynx Bladder Leukaemia Mouth Skin	10.4 9.8 9.5 8.6 7.4 5.1 5.1 4.8 3.6 3.2	Lung Colorectum Stomach Liver Nasopharynx Prostate Skin Lymphoma Bladder Leukaemia	20.1 16.5 9.4 7.9 7.5 5.1 4.3 3.1 2.8 2.7	Lung Colorectum Liver Prostate Lymphoma Leukaemia Nasopharynx Stomach Bladder Skin	19.2 12.9 9.8 7.2 6.8 6.1 4.9 4.2 3.6 3.1
Women
Breast Colorectum Ovary Cervix Uterus Stomach Thyroid Mouth Lung Skin	29.9 9.9 8.7 6.2 5.3 4.2 3.9 3.2 2.9 2.5	Breast Colorectum Lung Cervix Stomach Ovary Skin Uterus Thyroid Nasopharynx	22.0 15.6 9.8 7.3 6.3 5.2 4.5 3.7 2.9 2.8	Breast Colorectum Ovary Cervix Lung Uterus Leukaemia Thyroid Lymphoma Skin	26.8 9.9 8.3 6.7 6.5 5.1 4.0 4.0 3.4 3.4

A national concerted cancer control programme is targeted at prevention, early detection, and integrated management. For example, there is a strong campaign against smoking and a national vaccination programme against hepatitis is in place. Nationwide screening programmes focus on breast and cervical cancer, while awareness clinics for gastric, lung, and colorectal cancers also play a role in the early detection of cancer.

Singapore has several specialised cancer centres, where oncologists work to improve the treatment of cancer. Cancer management and rehabilitation is an important focus of this work. In addition, Singapore has 3 hospices for the care of patients in the terminal stages of the disease.

 

Taiwan

The causes of death have dramatically changed in Taiwan since the economic boom and public health development of the 1950s. Cancer has been the leading cause of death in Taiwan for the past 2 decades. The 5 leading cancers causing mortality are shown in (Table 9). Most cancers have an increasing mortality rate with increasing age. The exceptions are oral and nasopharyngeal cancer for men and breast cancer for females.