Ministry of Health and Welfare Releases Cancer Incidence Data in 2018
Year-end reminder: Please follow the doctor’s recommendation to attend regular cancer checkups
According to the latest annual cancer registry report in 2018 released by the Ministry of Health and Welfare (MOHW), the number of new cancer cases was 116,131, a 4,447 increase from the previous year. Due to the rapid aging of the population and unhealthy lifestyles, the number of cancer cases is expected to rise continually.
The median age of a cancer diagnosis was 63 years in 2018, same as in 2017; however, the median age of some cancer diagnosis were earlier, such as breast cancer (56 years old), cervical cancer (58 years old), oral cancer (57 years old), esophageal cancer (59 years old), thyroid cancer (50 years old), and corpus uteri cancer (55 years old). With the exception of breast cancer, esophageal cancer, and skin cancer (whose median age of cancer diagnosis were 1 year later) and lung cancer, prostate cancer, and corpus uteri cancer (whose median age of cancer diagnosis were 1 year earlier), the remaining cancer types had the same median age of onset in 2017 and 2018. As for the new cases of cancer, the top ten cancers among men and women are (1) colorectal cancer, (2) lung cancer, (3) female breast cancer, (4) liver cancer, (5) oral cancer (including oropharyngeal and hypopharyngeal cancer), (6) prostate cancer, (7) thyroid cancer, (8) skin cancer, (9) gastric cancer, and (10) corpus uteri cancer. With the exception of corpus uteri cancer (10) and esophageal cancer (11), the rankings of which swapped in 2017 and 2018, the rankings of the remaining types of cancer remained the same in these 2 years.
Top 10 Cancer Rankings: The Rankings of Liver Cancer and Lung Cancer Swapped, Whereas the Ranking of Bladder Cancer Dropped Two Positions Among Men; the Rankings of Colorectal Cancer and Lung Cancer Among Women Were Reversed
The number of new cases of cancers among men was 61,779. In 2018, the age-standardized cancer incidence rate was 341.3 per 100,000 population, an increase of 5.6 from 2017. In terms of incidence, the top 10 major cancers were, in order, colorectal cancer, lung cancer, liver cancer, oral cancer (including oropharyngeal and hypopharyngeal cancer), prostate cancer, esophageal cancer, stomach cancer, skin cancer, leukemia, and non-Hodgkin’s lymphoma. Compared with the statistics of the standardized incidence rate of cancer in 2017, the rankings of lung cancer and liver cancer swapped, whereas bladder cancer dropped to 11th place. Moreover, leukemia and non-Hodgkin’s lymphoma, which ranked 10th and 11th in 2017, respectively, both rose in ranking by one position in 2018.
The number of new cases of cancers among women was 54,352, and the age-standardized cancer incidence rate was 284.7 per 100,000 population, an increase of 3.7 from 2017. Compared with the rankings of the standardized incidence rate for women in 2017, the ranking of lung cancer and colorectal cancer swapped, whereas that of the remaining types of cancer remained the same. According to the standardized incidence rate of cancer, the top 10 cancers among women in 2018 were, in order, breast cancer, lung cancer, colorectal cancer, thyroid cancer, liver cancer, corpus uteri cancer, ovarian cancer, skin cancer, cervical cancer, and stomach cancer.
Incidence of Oral Cancer and Esophageal Cancer in Men is 10–15 Times Higher Than That in Women
A comparison of the top 10 cancers with considerable differences between men and women revealed that the standardized incidence rates of oral cancer (including oropharyngeal and hypopharyngeal cancer) and esophageal cancer in men are respectively 10.8 and 14.8 times higher than those in women. Studies have shown that individuals with the habit of chewing betel nut are 28 times more likely to develop oral cancer and are at a higher risk (5 times) of developing upper gastrointestinal tract (oral cavity, pharynx, throat, and esophagus) cancer. For individuals that have the habit of chewing betel nut, smoking, and drinking alcohol, their risk of developing respiratory and digestive tract cancer increases by up to 10.5 times. The Health Promotion Administration (HPA) reminds the public that quitting betel nut chewing, smoking, and alcohol consumption can reduce the risk of oral precancerous lesions and oral cancer. In addition, regular oral mucosa examinations can detect oral precancerous lesions at an early stage, and timely biopsy diagnosis and treatment can effectively prevent them from developing into cancer. Studies have also found that regular screening can reduce the risk of death from oral cancer by 26%.
Standardized Incidence Rate of Colorectal Cancer Decreased Most Significantly: the Age-standardized Incidence Rates of Colorectal Cancer were All Declined across All Age Groups Between 50 and 84 Years for the First Time
In terms of age-standardized incidence rate, 309.8 people per 100,000 population were diagnosed with cancer in 2018, an increase of 4.4 compared with that in 2017. However, colorectal cancer and liver cancer exhibited the largest decline, dropping by 1.1 and 0.7 per 100,000 population compared with that in 2017. For the first time, a decline in the incidence rate of colorectal cancer across all age groups between 50 and 84 years was observed, indicating that the government’s promotion of colorectal cancer prevention and treatment since 2004 has gradually produced results. Specifically, the fecal occult blood test is administered to people aged 50–74 years once every 2 years, enabling the early detection and treatment of precancerous lesions to prevent the occurrence of cancer. The incidence rates of prostate cancer and lung cancer have increased by 3 and 1.8 per 100,000 population, respectively; these two cancers had the highest increase in incidence.
Early Lung Cancer Rate is 2.1 Times that of 2009
In 2018, lung cancer was found to have the highest growth in terms of the number of cases of early-stage cancer (stages 0 and 1), showing an increase of 551 new cases. Data analysis indicated that 4,524 people were diagnosed as having early-stage lung cancer in 2018, accounting for 31.1% of lung cancer cases in that year and demonstrating an early-stage lung cancer rate 2.1 times higher than that of 10 years previously (1,384 people were diagnosed as having early lung cancer in 2009, which accounted for 14.7% of lung cancer cases that year). This may be attributed to the publication of the article in the internationally renowned New England Journal of Medicine in 2011, which concluded that compared with X-ray, lung cancer mortality among heavy smokers between 55–74 years old can be reduced by them undergoing low-dose computerized tomography (LDCT) screening three times in 2 years. Other factors behind this reduction include the promotion of lung cancer screening research into risk factors other than smoking by the MOHW since 2014 and the increase in the public’s self-paid medical examinations and participation in LDCT-related research projects.
However, according to the Taiwan LDCT Screening Consensus Declaration jointly issued by some of Taiwan’s professional societies (the Taiwan Lung Cancer Society, the Taiwan Society of Pulmonary and Critical Care Medicine, the Taiwan Radiological Society, and the Taiwan Society of Thoracic Surgeons), the following populations are recommended to undergo screening: (1) heavy smokers aged between 50 and 80 years (individuals with a smoking history of more than 30 pack-years and who are still smoking or who have quit smoking in the previous 15 years) and (2) individuals with a family history of lung cancer.
LDCT screening may lead to risks of false warnings, overdiagnosis and overtreatment, radiation exposure, and psychological stress. Therefore, the HPA reminds the public to discuss the advantages and disadvantages of screening with their physicians before any decision is made to initiate LDCT lung cancer screening.
HPA Urges the Public to Attend Regular Health Checkups for Health Benefits
HPA director-general Wang Ying-Wei urged the public to undergo regular screening at medical institutions for the early detection of precancerous lesions or cancers, pointing to the fact that the occurrence of cancer may be caused by decades of unfavorable long-term habits and lifestyles. The World Health Organization noted that 30%–50% of cancers are avoidable. Evidence-based medicine has also proven that four types of cancer screening (Pap test, mammography, fecal occult blood test, and oral mucosa test) can effectively reduce cancer mortality and increase survival rates. Statistical analysis results from the HPA are as follows:
- Undergoing a fecal occult blood test once every 2 years can reduce the mortality rate of colorectal cancer by 35%.
- Regular oral mucosa examinations can reduce the risk of oral cancer mortality by 26% in men with a habit of chewing betel nut or smoking.
- Undergoing mammography once every 2 years can reduce breast cancer mortality by 41%.
- A Pap test can reduce cervical cancer mortality by approximately 70%.
The HPA has urged the public not to panic or be afraid if their screening results are positive, advising them to visit medical institutions for diagnosis as soon as possible to identify abnormalities and ensure early diagnosis and treatment to improve their survival rate. Amidst the global fight against the COVID-19 pandemic, the HPA recommends that the public should still undergo regular health examinations to receive necessary diagnosis and treatment and eliminate the threat of cancer. It has also urgeed the public to wear medical facemasks while undergoing screening at medical institutions to protect themselves and others.