[Kim Jaeho's Life Story]<210> The Uncomfortable Truth About Cancer

Since last year, the coronavirus disease (COVID-19) has immobilized not only our country but the entire world. However, if we were to name the most frightening disease in Korea, cancer would undoubtedly take the top spot. Infectious diseases may cause global turmoil for a while, but as time passes, they gradually fade from people's memories. In contrast, the status of cancer, which has long dominated the world, seems unlikely to be shaken.

In the United States, during President Nixon's administration in 1971, the National Cancer Act was enacted, and a war on cancer was declared, investing significant money and effort to conquer it. Yet, even after half a century, the power of cancer does not seem to have diminished much. In 2019, cancer deaths in the U.S. accounted for 21.0% of all deaths, second only to heart disease, which accounted for 23.1%.

The situation in Korea is not much different. The government has significantly reduced the financial burden on citizens related to cancer by increasing health insurance support for early screening and treatment costs. The achievements of new cancer treatment technologies frequently reported in the media and the increased 5-year survival rate of cancer patients have likely contributed considerably to reducing the fear of cancer. But how accurately do we really understand cancer?

According to the 2018 National Cancer Registry statistics released at the end of 2020, new cancer cases have been increasing annually?from 103,000 in 2000 to 218,000 in 2015, and 244,000 in 2018. The probability of Koreans developing cancer if they live to their life expectancy is 37.4%. The 5-year relative survival rate for cancer patients diagnosed in the recent five years is 70.3%, which is 1.3 times higher than 54.1% ten years ago and generally higher than in the U.S. or the U.K.

As these statistics show, the annual increase in new cancer patients is a serious problem. Currently, the probability of developing cancer if living to life expectancy is 39.8% for men and 34.2% for women. If this rate rises further, how many people will be free from cancer? Moreover, cancers with relatively low 5-year survival rates below 40%, such as lung cancer, gallbladder and bile duct cancer, and pancreatic cancer, are increasing, while liver cancer is neither increasing nor decreasing.

It is fortunate that the overall 5-year survival rate for cancer is rising, but it remains at an unsatisfactory level, so it is not something to boast about. Many cancers still have a 5-year relative survival rate below 40%. The 5-year relative survival rate for pancreatic cancer is only 12.6%, meaning that only about one in eight patients survive five years after diagnosis.

The 5-year relative survival rates for gallbladder and bile duct cancer, lung cancer, and liver cancer remain low at 28.8%, 32.4%, and 37.0%, respectively. While policies encourage early cancer screening, leading to more cases being detected early compared to the past, survival times are naturally longer for those detected early than for those diagnosed at intermediate or late stages, regardless of advances in treatment technology. Therefore, treatment effects may be somewhat exaggerated.

Although not reflected in cancer registry statistics, the steady increase in annual cancer deaths is also problematic. According to the Statistics Korea cause-of-death statistics, cancer deaths rose from 58,000 in 2000 to 72,000 in 2010, 77,000 in 2015, and 81,000 in 2019. The proportion of cancer deaths among total deaths has remained around 27-28% since 2010.

The relatively young age of cancer deaths is also concerning. In 2019, among 81,000 cancer deaths, 5.9% were under 50 years old, 18.5% under 60, and 39.4% under 70, indicating many premature deaths. By gender, among those under 50, men and women accounted for 4.9% and 7.6%, respectively; under 60, 17.7% and 19.8%; and under 70, 41.3% and 36.5%, showing a high number of deaths at young ages.

In terms of causes of death by age group, cancer overwhelmingly ranks first in almost all age groups. Only in the teens, twenties, and thirties does cancer rank second after suicide; in all other age groups, it is the leading cause of death.

The government may not want to publicize these uncomfortable truths about cancer deaths, but it is insufficient to merely promote early screening and boast about rising 5-year relative survival rates. While advancements in cancer treatment should be left to scientists, the government must actively inform the public that total cancer deaths are steadily increasing and that many young people die from cancer. Policies should shift their focus toward proactive prevention. If curing cancer after diagnosis is difficult, shouldn't we strive to prevent it in the first place?

Jaeho Kim, Independent Researcher