[Asia Exclusive] Seo Hong-gwan "Most Cancer Diagnostic Tools and New Drugs Are Imported... Need to Strengthen Cancer Sovereignty"

Interview with Seo Hong-gwan, Director of National Cancer Center

Early Diagnosis and Prevention Must Accompany Treatment
for Cancer Conquest

World's Highest Cancer Survival and Cure Rates in Korea
Smoking Is the Biggest Cause of Cancer
Lung Cancer Is the Leading Cause of Cancer Death in Koreans

Though Treatment, Diagnosis, and Prevention Are in Place,
No New Drugs Surpassing Overseas Technology Yet
The Government Must Support and Provide Opportunities
for New Drugs to Emerge in 10 Years

Seo Hong-gwan, director of the National Cancer Center, is being interviewed at the National Cancer Center in Goyang-si, Gyeonggi Province on the 23rd of last month. Photo by Kang Jin-hyung aymsdream@

[Interview with Jo In-kyung, Deputy Head of Biohealth Department at Asia Economy, Summary by Reporter Lee Chun-hee] "One-third of cancers are preventable, one-third can be completely cured through early diagnosis, and the remaining one-third cannot be cured but quality of life can be improved through palliative care."

2.15 million. This is the number of 'cancer survivors' in South Korea, meaning those diagnosed with cancer and currently undergoing treatment or cured, according to the 2019 National Cancer Registry statistics. This accounts for about 4 out of every 100 people. Especially, in 2019 alone, 255,000 new cancer patients were diagnosed. This number has been steadily increasing since 2015.

Seo Hong-kwan, Director of the National Cancer Center, emphasized that conquering cancer requires not only effective treatment but also rapid early diagnosis and cancer prevention. On the occasion of the World Cancer Prevention Day (March 21), designated by the World Health Organization (WHO), we met him last month on the 23rd at his office in the National Cancer Center in Goyang, Gyeonggi Province.

National Cancer Center Exterior (Photo by National Cancer Center)

- In South Korea, national cancer screenings are conducted for stomach cancer, breast cancer, colorectal cancer, liver cancer, cervical cancer, lung cancer, etc. Do you think these are effective?

▲ The national cancer screening system is one of the best in the world. Our 5-year cancer survival rate and cure rate are among the highest globally. People often think that high survival rates are due to good surgery, but that is not the case. Survival rates improve because early diagnosis is achieved through screening. Prevention, early screening, and treatment must all work together.

- Many people say that the recent increase in cancer patients is due to stress. What are the actual causes of cancer?

▲ To prevent cancer, we need to know what causes it and take preventive measures. The most common cause of cancer is smoking. According to the International Agency for Research on Cancer under WHO, 30% of cancers are caused by smoking, 30% by diet, and 18% by chronic infections. Obviously, smoking must be avoided. The exact dietary factors causing cancer are not yet clearly identified. However, generally, carcinogens such as benzo[a]pyrene can form when meat is charred, and high salt intake is also reported to cause cancer. Hepatitis B and C can cause liver cancer, and human papillomavirus (HPV) can cause cervical cancer, so vaccinations for hepatitis B and HPV are necessary. Helicobacter pylori, recently identified as a major cause of stomach cancer, should also be eradicated.

- What is your view on alcohol consumption?

▲ Many people seem unaware that alcohol is a carcinogen. Both alcohol and acetaldehyde are classified as Group 1 carcinogens, yet this is not widely known. As the director of the Cancer Center, I want to raise awareness about this. This is why I believe toasts should be eliminated. Drinking alone and smoking are personal choices, but encouraging others to drink together is akin to promoting carcinogens like smoking.

- Lung cancer, which is highly associated with smoking, surpassed stomach cancer for the first time in the 2019 National Cancer Registry statistics, becoming the most common cancer. It also has a high risk with a 5-year survival rate below 50%.

▲ Cancer is the leading cause of death in South Korea. Among these, lung cancer has the highest fatality rate, causing the most deaths. South Korea provides world-class smoking cessation support services, including free medication and medical fees for three months. People should use these services to quit smoking. Recently, many have switched to e-cigarettes believing they are less harmful. However, e-cigarettes also contain carcinogens. Although their toxicity is lower than traditional cigarettes, carcinogens remain.

- The phrase "effectively the most common" lung cancer is used because thyroid cancer ranks above it. There have been claims of 'overdiagnosis' regarding thyroid cancer. What is your opinion?

▲ The screening itself is flawed. South Korea is the only country that performs ultrasound screening without symptoms. This is hard for the public to understand because the idea of early diagnosis and cure is firmly established. But thyroid cancer is different. It detects "cancers that do not need to be found." The 5-year survival rate for thyroid cancer is 100%, meaning survival rates are the same whether or not one has thyroid cancer. Even if symptoms appear, treatment can be delayed without harm, and survival rates remain high. The U.S. Preventive Services Task Force (USPSTF) gave thyroid cancer early screening a 'D grade,' recommending against it due to more harm than benefit. This is why the 'Alliance of Physicians Against Overdiagnosis' was formed in 2014.

- There are calls for urgent development and localization of new drugs and treatment technologies related to cancer sovereignty. What is your view on this?

▲ South Korea's world-class 5-year cancer survival rate is due not only to early diagnosis but also to well-equipped treatment centers, including the National Cancer Center and major hospitals. However, most related tools are developed overseas. While it is advantageous to quickly adopt new technologies presented at international conferences, I believe it is time for us to develop our own technologies. As the world's 10th largest economy, we cannot keep following what other countries develop.

Of course, this is not easy. But we should not think it is too late and must build from the ground up. We need to invest today so that new drugs can be developed in 10 years. High-priced anticancer drugs like Kymriah and Keytruda represent an outflow of national wealth and impose a heavy financial burden on patients. We lack global pharmaceutical companies, so our pharmaceutical industry is still weak. Initially, investments may seem wasteful, but overseas countries have all gone through this process to succeed in new drug development. The government should support opportunities to develop new drugs.

- What contributions can the National Cancer Center make in this regard?

▲ We operate the Anticancer New Drug and New Treatment Development Project Group. This national project supports early clinical trials by linking promising anticancer drug candidates held by domestic pharmaceutical companies and ventures with domestic and international institutions. Currently, we are developing three clinical development projects and supporting six technology transfer projects for promising anticancer drugs. The U.S. National Cancer Institute (NCI) leads various cancer treatment development projects, from lead compound development to coordinating and supporting public multi-center clinical trials. Especially for rare cancers and new clinical treatments, where private sector interest is lacking, public funding is necessary to support clinical trials. The National Cancer Center is jointly developing treatments with domestic pharmaceutical companies and bio-ventures for rare and intractable cancers, which lack national investment.

We are also steadily collecting cancer-related big data. Cancer can be hereditary but also caused by exposure to carcinogens. To verify this, genetic information, personal lifestyle data, and clinical information are all needed. Last year, the National Cancer Center was designated as a cancer data center and is collecting related data. We gather information on how cancer patients are diagnosed, their clinical course, and their genomic data from multiple hospitals. Integrating these data will yield significant research results. The data will not be monopolized by the National Cancer Center; all personally identifiable information such as names and resident registration numbers will be removed, and the data will be made accessible to domestic companies and researchers.

Seo Hong-gwan, Director of the National Cancer Center, is being interviewed at the National Cancer Center in Goyang, Gyeonggi Province on the 23rd of last month. Photo by Jin-hyeong Kang aymsdream@

- What are your goals for the remaining two years of your term?

▲ As the National Cancer Center is not a private hospital, it should not focus solely on cancer treatment like other medical institutions. It must undertake tasks that private medical institutions cannot but are essential for public health. That is 'cancer prevention' activities. We will promote smoking cessation policies, encourage healthy dietary habits for cancer prevention, and raise awareness about alcohol as a carcinogen. We will widely inform the public that even small amounts of alcohol can cause various cancers.

We plan to establish a research platform for rare and intractable cancers, which have been neglected so far, and implement the 'National Hope Project to Overcome Rare and Intractable Cancers' to improve survival rates through comprehensive management from research to treatment and post-care. Building an open integrated platform that connects and integrates various research resources for new drug development is also urgently needed.