Korea National Cancer Incidence Database Research Articles

Data Resource Profile: The Cancer Public Library Database in South Korea.

This paper provides a comprehensive overview of the Cancer Public Library Database (CPLD), established under the Korean Clinical Data Utilization for Research Excellence project (K-CURE). The CPLD links data from four major population-based public sources: the Korea National Cancer Incidence Database in the Korea Central Cancer Registry, cause-of-death data in Statistics Korea, the National Health Information Database in the National Health Insurance Service, and the National Health Insurance Research Database in the Health Insurance Review & Assessment Service. These databases are linked using an encrypted resident registration number. The CPLD, established in 2022 and updated annually, comprises 1,983,499 men and women newly diagnosed with cancer between 2012 and 2019. It contains data on cancer registration and death, demographics, medical claims, general health checkups, and national cancer screening. The most common cancers among men in the CPLD were stomach (16.1%), lung (14.0%), colorectal (13.3%), prostate (9.6%), and liver (9.3%) cancers. The most common cancers among women were thyroid (20.4%), breast (16.6%), colorectal (9.0%), stomach (7.8%), and lung (6.2%) cancers. Among them, 571,285 died between 2012 and 2020 owing to cancer (89.2%) or other causes (10.8%). Upon approval, the CPLD is accessible to researchers through the K-CURE portal. The CPLD is a unique resource for diverse cancer research to investigate medical use before a cancer diagnosis, during initial diagnosis and treatment, and long-term follow-up. This offers expanded insight into healthcare delivery across the cancer continuum, from screening to end-of-life care.

Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2021.

The current study provides national cancer statistics and their secular trends in Korea, including incidence, mortality, survival, and prevalence in 2021. Incidence, survival, and prevalence rates of cancer were calculated using the Korea National Cancer Incidence Database, from 1999 to 2021, with survival follow-up until December 31, 2022. Deaths from cancer were assessed using causes-of-death data obtained from Statistics Korea. The number of new cancer diagnoses in 2021 increased by 27,002 cases (10.8%) compared to 2020. In 2021, newly diagnosed cancer cases and deaths from cancer were reported as 277,523 (age-standardized rate [ASR], 289.3 per 100,000) and 82,688 (ASR, 67.6 per 100,000), respectively. The overall cancer incidence rates increased by 3.3% annually from 1999 to 2012, and decreased by 5.3% from 2012 to 2015, thereafter, followed by non-significant changes. Cancer mortality rates have been decreasing since 2002, with more rapid decline in recent years (annual decrease of 2.8% from 2002 to 2013; 3.2% from 2013 to 2021). The 5-year relative survival between 2017 and 2021 was 72.1%, which contributed to prevalent cases reaching over 2.4 million in 2021. In 2021, the number of newly diagnosed cancer patients increased as healthcare utilization recovered from the coronavirus disease 2019-related declines of 2020. Revised cancer registration guidelines expanded the registration scope, particularly for stomach and colorectal cancer. Survival rates have improved over the years, leading to a growing population of cancer survivors, necessitating a comprehensive cancer control strategy. The long-term impact of the pandemic on cancer statistics requires future investigation.

Prediction of Cancer Incidence and Mortality in Korea, 2024.

This study aimed to report the projected cancer incidence and mortality for the year 2024 to estimate Korea's current cancer burden. Cancer incidence data from 1999 to 2021 were obtained from the Korea National Cancer Incidence Database, and cancer mortality data from 1993 to 2022 were acquired from Statistics Korea. Cancer incidence and mortality were projected by fitting a linear regression model to observed age-specific cancer rates against their respective years and multiplying the projected age-specific rates by the anticipated age-specific population for 2024. A joinpoint regression model was used to determine the year in which the linear trend changed significantly; we only used the data of the latest trend for prediction. In total, 292,221 new cancer cases and 83,770 cancer deaths are expected to occur in Korea in 2024. The most common cancer site is expected to be the thyroid, followed by the colon and rectum, lung, breast, and stomach. These five cancers are expected to represent 55.7% of the overall burden of cancer in Korea. The most common type of cancer leading to death is expected to be lung cancer, followed by liver, colorectal, pancreatic, and stomach cancers. The age-standardized incidence rates for female breast and prostate cancers are estimated to continue to increase. These up-to-date estimates of the cancer burden in Korea could be an important resource for planning and evaluating cancer-control programs.

Regional disparities in major cancer incidence in Korea, 1999-2018.

This study investigated regional disparities in the incidence of 8 major cancers at the municipal level in Korea during 1999-2018 and evaluated the presence or absence of hot spots of cancer clusters during 2014-2018. The Korea National Cancer Incidence Database was used. Age-standardized incidence rates were calculated by gender and region at the municipal level for 4 periods of 5 years and 8 cancer types. Regional disparities were calculated as both absolute and relative measures. The possibility of clusters was examined using global Moran's I with a spatial weight matrix based on adjacency or distance. Regional disparities varied depending on cancer type and gender during the 20-year study period. For men, the regional disparities of stomach, colon and rectum, lung, and liver cancer declined, and those of thyroid and prostate cancer recently decreased, despite an overall increasing incidence. For women, regional disparities in stomach, colon and rectum, lung, liver, and cervical cancer declined, that of thyroid cancer recently decreased, despite an overall increasing incidence, and that of breast cancer steadily increased. In 2014-2018, breast cancer (I, 0.61; 95% confidence interval [CI], 0.53 to 0.70) showed a high probability of cancer clusters in women, and liver cancer (I, 0.48; 95% CI, 0.40 to 0.56) showed a high probability of cancer clusters in men. Disparities in cancer incidence that were not seen at the national level were discovered at the municipal level. These results could provide important directions for planning and implementing local cancer policies.

Relationship between breast cancer and hormone therapy in reproductive age women in South Korea

Objective: According to the Korea National Cancer Incidence Database (KNCID), the incidence rate of breast cancer is expected to increase sharply within the next decade as the proportion of the elderly in the population increases and westernized lifestyles continue to be adopted. However, unlike Western countries, in Korea, the age of onset is about 20 years earlier. Although many research results on breast cancer have been published, it is difficult to apply the above results as they are considering the differences between Korea and other countries.

Epidemiology of Urologic Cancer in Korea: Nationwide Trends in the Last 2 Decades

Purpose: This study assessed recent trends in the incidence of urologic cancer and patient survival in Korea.Materials and Methods: The incidence of urologic cancer in Korea was calculated based on the Korea National Cancer Incidence Database and the South Korean Statistical Information Service Database. Data from 2000 to 2020 were used to determine the incidence, death, prevalence, and survival rates of urologic cancer.Results: Urologic cancer was diagnosed in 27,514 cases, accounting for 11.1% of the total cancer incidence. In 2020, there were 16,815 prostate cancer cases, 5,946 kidney cancer cases, and 4,753 bladder cancer cases. The age-standardized rate (ASR) for the incidence of prostate, kidney, and bladder cancer increased from 2000 to 2020. The overall ASR was 56 per 100,000 in 2020. In 2000, the ASRs for prostate, kidney, and bladder cancer were 2.9, 3.1, and 4.8 per 100,000, respectively, whereas they were 32.7, 11.6, and 9.3 per 100,000, respectively, in 2020. Urologic cancer has also seen a steady increase in the death rate, prevalence rate, and relative survival rate over the past 20 years. The 5-year relative survival rates for patients diagnosed with prostate cancer, kidney cancer, and bladder cancer during the 5-year period from 2015 to 2019 were 94.4%, 84.7%, and 76.5%, respectively. Among urologic cancers, prostate cancer had the highest survival rate, and bladder cancer had the lowest.Conclusions: The survival rate for urologic cancer is increasing; however, the incidence and prevalence rates continue to rise.

Prediction of Cancer Incidence and Mortality in Korea, 2023.

This study aimed to report the projected cancer incidence and mortality for the year 2023 to estimate Korea's current cancer burden. Cancer incidence data from 1999 to 2020 were obtained from the Korea National Cancer Incidence Database, and cancer mortality data from 1993 to 2021 were acquired from Statistics Korea. Cancer incidence and mortality were projected by fitting a linear regression model to observed age-specific cancer rates against their respective years and then by multiplying the projected age-specific rates by the anticipated age-specific population for 2023. A joinpoint regression model was used to determine the year in which the linear trend changed significantly; we only used the data of the latest trend. In total, 273,076 new cancer cases and 81,818 cancer deaths are expected to occur in Korea in 2023. The most common cancer site is expected to be the lung, followed by the thyroid, breast, colon and rectum, and stomach. These five cancers are expected to represent half of the overall burden of cancer in Korea. The most common type of cancer leading to death is expected to be lung cancer, followed by liver, colorectal, pancreatic, and gallbladder cancers. The incidence rates for all types of cancer in Korea are estimated to gradually decrease. These up-to-date estimates of the cancer burden in Korea could be an important resource for planning and evaluating cancer-control programs.

Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2020.

The current study provides national cancer statistics and their secular trends in Korea, including incidence, mortality, survival, and prevalence in 2020. Incidence, survival, and prevalence rates of cancer were calculated using the Korea National Cancer Incidence Database, from 1999 to 2020, with survival follow-up until December 31, 2021. Deaths from cancer were assessed using causes-of-death data obtained from Statistics Korea. The number of new cancer diagnoses in 2020 decreased by 9,218 cases (3.6%) compared to 2019. In 2020, newly diagnosed cancer cases and deaths from cancer were reported as 247,952 (age-standardized rate [ASR], 262.2 per 100,000) and 82,204 (ASR, 69.9 per 100,000), respectively. The overall cancer incidence rates increased by 3.3% annually from 1999 to 2012, and decreased by 5.0% annually from 2012 to 2015, thereafter, followed by nonsignificant changes. Cancer mortality rates have been decreasing since 2002, with more rapid decline in recent years. The 5-year relative survival between 2016 and 2020 was 71.5%, which contributed to prevalent cases reaching over 2.2 million in 2020. In 2020, the number of newly diagnosed cancer patients decreased due to the coronavirus disease 2019 pandemic, but the overall trend is on the rise. Cancer survival rates have improved over the past decades. As the number of cancer survivors increases, a comprehensive cancer control strategy should be implemented in line with the changing aspects of cancer statistics. The long-term impact of the coronavirus disease 2019 pandemic on cancer statistics needs to be investigated in the future.

Incidence, mortality, and survival of liver cancer using Korea central cancer registry database: 1999-2019.

Backgrounds/AimsHistorically, incidence and survival analysis and annual traits for primary liver cancer (LC) has not been investigated in a population-based study in Korea. The purpose of the current study is to determine incidence, survival rate of patients with primary LC in Korea.MethodsWe conducted a retrospective cohort study using Korea Central Cancer Registry based on the Korea National Cancer Incidence Database. Statistical analysis including crude rate and age-standadized rate (ASR) of incidence and mortality was performed for LC patients registered with C22 code in International Classification of Diseases, tenth revision from 1999 to 2019. Subgroup analysis was performed for hepatocellular carcinoma (HCC, C22.0) and intrahepatic cholangiocarcinoma (IHCC, C22.1).ResultsThe crude incidence rate of HCC (21.0 to 22.8 per 100,000) and IHCC (2.3 to 5.6 per 100,000) increased in the observed period from 1999 to 2019. The ASR decreased in HCC (20.7 to 11.9 per 100,000) but remained unchanged in IHCC (2.4 to 2.7 per 100,000). The proportion of HCC patients diagnosed in early stages (localized or regional Surveillance, Epidemiology, and End Results or SEER stage) increased significantly over time. As expected, 5-yeat survival rate of HCC was greatly improved, reaching 42.4% in the period between 2013 and 2019. This trait was more prominent in localized SEER stage. On the other hand, the proportion of IHCC patients diagnosed in localized stage remained unchanged (22.9% between 2013 and 2019), although ASR and 5-year survival rate showed minor improvements.ConclusionsA great improvement in survival rate was observed in patients with newly diagnosed HCCs. It was estimated to be due to an increase in early detection rate. On the contrary, detection rate of an early IHCC was stagnant with a minor improvement in prognosis.

Prediction of Cancer Incidence and Mortality in Korea, 2022.

PurposeThis study aimed to report the projected cancer incidence and mortality for the year 2022 to estimate Korea’s current cancer burden.Materials and MethodsCancer incidence data from 1999 to 2019 were obtained from the Korea National Cancer Incidence Database, and cancer mortality data from 1993 to 2020 were acquired from Statistics Korea. Cancer incidence and mortality were projected by fitting a linear regression model to observed age-specific cancer rates against their respective years and then by multiplying the projected age-specific rates by the anticipated age-specific population for 2022. A joinpoint regression model was used to determine the year in which the linear trend changed significantly; we only used the data of the latest trend.ResultsIn total, 274,488 new cancer cases and 81,277 cancer deaths are expected to occur in Korea in 2022. The most common cancer site is expected to be the thyroid, followed by the lung, colon and rectum, breast, and stomach. These five cancers are expected to represent half of the overall burden of cancer in Korea. The most common type of cancer leading to death is expected to be lung cancer, followed by liver, colorectal, pancreatic, and gallbladder cancers.ConclusionThe incidence rates for all types of cancer in Korea are estimated to gradually decrease. These up-to-date estimates of the cancer burden in Korea could be an important resource for planning and evaluating cancer-control programs.

Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2019

PurposeThe current study provides national cancer statistics and their secular trends in Korea, including incidence, mortality, survival, and prevalence in 2019.Materials and MethodsIncidence, survival, and prevalence rates of cancer were calculated using the Korea National Cancer Incidence Database, from 1999 to 2019, with survival follow-up until December 31, 2020. Deaths from cancer were assessed using causes-of-death data obtained from Statistics Korea.ResultsIn 2019, newly diagnosed cancer cases and deaths from cancer were reported as 254,718 (age-standardized rate [ASR], 275.4 per 100,000) and 81,203 (ASR, 72.2 per 100,000), respectively. For the first time, lung cancer (n=29,960) became the most frequent cancer in Korea, excluding thyroid cancer. The overall cancer incidence rates increased by 3.3% annually from 1999 to 2012, and decreased by 5.3% annually from 2012 to 2015, thereafter, followed by nonsignificant changes. The incidence of thyroid cancer increased again from 2016 (annual percentage change, 6.2%). Cancer mortality rates have been decreasing since 2002, with more rapid decline in recent years (annual decrease of 2.7% from 2002 to 2013; 3.3% from 2013 to 2019). The 5-year relative survival between 2015 and 2019 was 70.7%, which contributed to prevalent cases reaching over 2 million in 2019.ConclusionCancer survival rates have improved over the past decades, but the number of newly diagnosed cancers is still increasing, with some cancers showing only marginal improvement in survival outcomes. As the number of cancer survivors increases, a comprehensive cancer control strategy should be implemented in line with the changing aspects of cancer statistics.

Incidence and mortality projections for major cancers among Korean men until 2034, with a focus on prostate cancer.

PurposeThe Korean population is rapidly aging, and the cancer burden is expected to change significantly. This study aimed to generate projections of incidence and mortality of major cancers among men in Korea until 2034, with a special focus on prostate cancer.Materials and MethodsCancer incidence data from 1999 to 2016 were obtained from the Korea National Cancer Incidence Database. Mortality data were obtained from Statistics Korea. The most common cancers among Korean men (stomach, colorectum, liver, lung and prostate) were analyzed. To predict the future trends of these cancers, the age-period-cohort method was conducted and extrapolated up to 2034.ResultsIn Korean men, prostate cancer was the fourth most commonly diagnosed cancer in 2016. Based on newly diagnosed cases, the leading cancer site in the year 2034 is expected to be the lung, and the prostate is expected to be the second most frequently diagnosed cancer among Korean men. Age-standardized incidence rates of the most common cancers in men, except prostate cancer, are expected to decrease until 2034. Lung cancer is projected to remain the most common cause of cancer-related mortality until 2034, and the highest estimated change in cancer deaths is expected to be for prostate cancer.ConclusionsIn Korea, the incidence and mortality of prostate cancer is expected to increase markedly in the period up to 2034, particularly in older men. Concerted efforts in screening, diagnosis, and treatment strategies should be considered by healthcare planners and providers.

Trend Analysis and Prediction of Hepatobiliary Pancreatic Cancer Incidence and Mortality in Korea.

BackgroundThis study aimed to analyze the current trends and predict the epidemiologic features of hepatobiliary and pancreatic (HBP) cancers according to the Korea Central Cancer Registry to provide insights into health policy.MethodsIncidence data from 1999 to 2017 and mortality data from 2002 to 2018 were obtained from the Korea National Cancer Incidence Database and Statistics Korea, respectively. The future incidence rate from 2018 to 2040 and mortality rate from 2019 to 2040 of each HBP cancer were predicted using an age-period-cohort model. All analyses, including incidence and mortality, were stratified by sex.ResultsFrom 1999 to 2017, the age-standardized incidence rate (ASIR) of HBP cancers per 100,000 population had changed (liver, 25.8 to 13.5; gallbladder [GB], 2.9 to 2.6; bile ducts, 5.1 to 5.9; ampulla of Vater [AoV], 0.9 to 0.9; and pancreatic, 5.6 to 7.3). The age-standardized mortality rate (ASMR) per 100,000 population from 2002 to 2018 of each cancer had declined, excluding pancreatic cancer (5.5 to 5.6). The predicted ASIR of pancreatic cancer per 100,000 population from 2018 to 2040 increased (7.5 to 8.2), but that of other cancers decreased. Furthermore, the predicted ASMR per 100,000 population from 2019 to 2040 decreased in all types of cancers: liver (6.5 to 3.2), GB (1.4 to 0.9), bile ducts (4.3 to 2.9), AoV (0.3 to 0.2), and pancreas (5.4 to 4.7). However, in terms of sex, the predicted ASMR of pancreatic cancer per 100,000 population in females increased (3.8 to 4.9).ConclusionThe annual incidence and mortality cases of HBP cancers are generally predicted to increase. Especially, pancreatic cancer has an increasing incidence and will be the leading cause of cancer-related death among HBP cancers.

Prediction of Cancer Incidence and Mortality in Korea, 2021.

PurposeThis study aimed to report the projected cancer incidence and mortality for the year 2021 to estimate Korea’s current cancer burden.Materials and MethodsCancer incidence data from 1999 to 2018 were obtained from the Korea National Cancer Incidence Database, and cancer mortality data from 1993 to 2019 were acquired from Statistics Korea. Cancer incidence and mortality were projected by fitting a linear regression model to observed age-specific cancer rates against their respective years and then by multiplying the projected age-specific rates by the anticipated age-specific population for 2021. A joinpoint regression model was used to determine the year in which the linear trend changed significantly; we only used the data of the latest trend.ResultsIn total, 259,999 new cancer cases and 81,567 cancer deaths are expected to occur in Korea in 2021. The most common cancer site is expected to be the lung, followed by the thyroid, colon and rectum, breast, and stomach. These five cancers are expected to represent half of the overall burden of cancer in Korea. The most common type of cancer leading to death is expected to be lung cancer, followed by liver, colorectal, pancreatic, and stomach cancers.ConclusionThe incidence rates for all types of cancer in Korea are estimated to gradually decrease. These up-to-date estimates of the cancer burden in Korea could be an important resource for planning and evaluating cancer-control programs.

Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2018.

PurposeThe current study provides national cancer statistics and their secular trends in Korea, including incidence, mortality, survival, and prevalence in 2018.Materials and MethodsIncidence, survival, and prevalence rates of cancer were calculated using the Korea National Cancer Incidence Database, from 1999 to 2018, with survival follow-up until December 31, 2019. Deaths from cancer were assessed using causes-of-death data obtained from Statistics Korea. Crude and age-standardized rates (ASRs) for incidence, mortality, prevalence, and 5-year relative survival rates were calculated, and temporal trends for incidence and mortality rates were evaluated, with annual percentage changes.ResultsIn 2018, newly diagnosed cancer cases and deaths from cancer were reported as 243,837 (ASR, 270.4 per 100,000) and 79,153 (ASR, 73.3 per 100,000), respectively. The overall cancer incidence rates increased by 3.3% annually from 1999 to 2012, and decreased by 5.4% annually from 2012 to 2015, thereafter, followed by nonsignificant changes. Cancer mortality rates have been decreasing since 2002, with more rapid decline in recent years (annual decrease of 2.7% from 2007 to 2014; 3.7% from 2014 to 2018). The 5-year relative survival between 2014 and 2018 was 70.3%, which contributed to prevalent cases reaching over 2 million by the end of 2018.ConclusionCancer statistics have improved significantly during the past two decades. However, there remain important challenges to be solved, such as controlling cancers with low survival rates. Cancer statistics can be used to discover blind spots in cancer control, and as evidence for developing and implementing future cancer control strategies.

Analysis of the tumor characteristics in young age breast cancer patients using collaborative stage data of the Korea Central Cancer Registry.

This study aimed to evaluate tumor characteristics in young age (20-39years old) breast cancer (YABC) patients in Korea. We identified 10,897 breast cancer patients from 2010 to 2015. The data were collected through 10% systematic sampling of the Korea National Cancer Incidence Database (KNCI DB). Tumor size, lymph node status, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status were collected according to the Collaborative Stage version 2 (CSv2) Data Collection System. Of the 10,897 patients, 1245 (11.4%) were YABC patients. They were found to have larger tumors (T2: 41.6% in 20-39 age group vs 36.4% in 40-49 age group vs 36.5% in 50-59 age group vs 38.4% in ≥ 60 age group; T3: 10.1% vs 7.3% vs 6.5% vs 6.2%, P < .0001), greater rates of lymph node involvement (41.2% vs 32.7% vs 35.7% vs 32.5%, P < .0001), higher tumor grade (High grade: 26.8% vs 19.4% vs 23.5% vs 22.1%, P < .0001), and a larger proportion of triple-negative subtype (18.2% vs 11.0% vs 12.2% vs 13.5%, P < .0001). Compared to the 40-49 age group, breast cancer-related survival (BCRS) rates were worse (91.74% vs 95.04%, P < .0001), and the characteristics of YABC patients were associated with higher risk of death from breast cancer. YABC patients have more aggressive tumor characteristics and worse survival rates. Therefore, we need to identify high-risk groups among YABC patients and support active surveillance in them. These findings from a national cohort provide important information for establishing a national cancer care strategy to manage YABC patients.

Time trends of colorectal cancer incidence and associated lifestyle factors in South Korea

Worldwide, South Korea had the second highest incidence rates of colorectal cancer (CRC) in 2018. To inform public health policy to prevent CRC, we aimed to identify major modifiable lifestyle factors underlying the alarming increase in CRC incidence. We obtained information on CRC statistics from the Korea National Cancer Incidence Database and on the distribution of dietary and lifestyle factors known to modify CRC risk from the Korea National Health and Nutrition Examination Survey. To examine time trends between 2001 and 2013, we calculated annual percent changes of CRC incidence rates and of prevalence of etiologic factors by sex and age. Across all sex and age groups, the most commonly diagnosed cancer was rectal cancer while the most rapidly increasing cancer was distal colon cancer. For the lifestyle factors examined, decreases in exercise were observed across all age groups of both sexes. Yet, obesity and alcoholic drinks appear more relevant CRC contributor to men, smoking to women aged 30–49 years, and processed meat intake to adults aged 30–49 years. The heterogeneous results suggest that dietary and lifestyle target to prevent CRC be tailored by sex and age.

A Summary of the 2020 Gastric Cancer Summit at Stanford University

There exists no coherent national strategy for the early detection or prevention of gastric cancer in the United States, even among identified high-risk groups such as Asian Americans, African Americans, Hispanic Americans, and Alaska Native/American Indian peoples. As a result, patients with gastric cancer in the United States are diagnosed at later stages and demonstrate worse overall survival compared to nations of East Asia with established screening programs (Table 1). The under-recognition of gastric cancer risk within minority communities is a significant unaddressed health care disparity.Table 1Comparison of Gastric Cancer Stage of Diagnosis and SurvivalCountrySouth KoreaJapanUnited StatesYears2006–20102006–20082010–2014ScreeningBiennial radiography or endoscopyBiennial radiography or endoscopyNo screening programStage at diagnosisDistribution (%)5-Year survival (%)Distribution (%)5-Year survival (%)Distribution (%)5-Year survival (%)Localized5192.44895.92870.3Regional2655.72250.02632.0Distant125.5165.7375.8Unknown1149.214—921.8All stages10067.010064.610032.1South Korean data adapted from the Korea National Cancer Incidence Database. Japanese data derived from the Center from the National Cancer Center of Japan. United States data derived from Surveillance, Epidemiology, and End Results Program (SEER) of the National Cancer Institute. 5-year relative survival rates are presented. Summary stages defined by SEER criteria. Open table in a new tab South Korean data adapted from the Korea National Cancer Incidence Database. Japanese data derived from the Center from the National Cancer Center of Japan. United States data derived from Surveillance, Epidemiology, and End Results Program (SEER) of the National Cancer Institute. 5-year relative survival rates are presented. Summary stages defined by SEER criteria. To address this disparity, the Division of Gastroenterology and Hepatology and the Center for Asian Health Research and Education at Stanford University hosted the inaugural Gastric Cancer Summit on March 5–6, 2020. This summit brought together academic physicians, researchers, policy leaders, and patient advocates to identify strategies to combat gastric cancer in high-risk US populations through prevention and early detection. The first day of the Summit consisted of health policy- and advocacy-oriented presentations, and the second day consisted of scientific presentations on advances in early detection and prevention. Dr Joo Ha Hwang began the summit by offering an overview of gastric cancer in the United States, with a focus on the burden faced by Asian Americans. Dr Hwang discussed that Asian Americans have a higher incidence (rate 15 cases per 100,000) of gastric cancer compared with non-Hispanic Whites (6 per 100,000). Certain Asian subgroups such as Koreans Americans (40 per 100,000) and Japanese Americans (30 per 100,000) face a particularly high risk.1Huang R.J. Ende A.R. Singla A. et al.Prevalence, risk factors, and surveillance patterns for gastric intestinal metaplasia among patients undergoing upper endoscopy with biopsy.Gastrointest Endosc. 2020; 91: 70-77 e1Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar Dr Dennis Deapen presented gastric cancer incidence data from Los Angeles County over the period 1976 to 2012, and showed that although Asian Americans have demonstrated secular decreases in incidence over time, certain groups such as Korean Americans remain at heightened risk. Dr Eunjung Lee expanded on this using the California Cancer Registry, and showed that persistent disparities in gastric cancer incidence between Korean Americans and other groups warrant additional preventative strategies.2Lee E. Liu L. Zhang J. et al.Stomach cancer disparity among korean americans by tumor characteristics: comparison with non-Hispanic Whites, Japanese Americans, South Koreans, and Japanese.Cancer Epidemiol Biomarkers Prev. 2017; 26: 587-596Crossref PubMed Scopus (17) Google Scholar Dr Yanghee Woo discussed the advanced stage of diagnosis of most gastric cancers in the United States, reasons for delays in diagnosis, and the curative role of surgery if early diagnosis can be achieved. Dr Woo also reviewed the role of robotic gastrectomy.3Woo Y. Hyung W.J. Pak K.H. et al.Robotic gastrectomy as an oncologically sound alternative to laparoscopic resections for the treatment of early-stage gastric cancers.Arch Surg. 2011; 146: 1086-1092Crossref PubMed Scopus (151) Google Scholar Using a decision analytic Markov model, Dr Shailja Shah demonstrated that endoscopic noncardia gastric cancer screening for high-risk races and ethnicities could be cost effective in the United States, with a cost of $71,451 per quality-adjusted life year for Asian Americans.4Saumoy M. Schneider Y. Shen N. et al.Cost effectiveness of gastric cancer screening according to race and ethnicity.Gastroenterology. 2018; 155: 648-660Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar Dr Shah further showed that, when disaggregated by subgroups, this strategy remained cost effective for all Asian American populations. During the discussion panel, Dr Woo and Dr Shah discussed the need for additional risk factors (eg, smoking status) as inputs for modeling studies. South Korea, a nation of high Helicobacter pylori prevalence and high gastric cancer incidence (34 per 100,000), initiated a biennial screening program for adults ≥40 years old in 2002. Since the initiation of the national screening program, the proportion of gastric cancers diagnosed at an early stage (defined as tumor with invasion limited to mucosa or submucosa) has increased from 39% in 2001 to 73% in 2016 (Figure 1). Dr Il Ju Choi demonstrated in a nested case-control study that receipt of endoscopic screening was associated with a roughly 50% decrease in risk for gastric cancer death among 40- to 74-year-olds (odds ratio, 0.51; confidence interval [CI], 0.49–0.54).5Jun J.K. Choi K.S. Lee H.Y. et al.Effectiveness of the Korean National Cancer Screening Program in reducing gastric cancer mortality.Gastroenterology. 2017; 152: 1319-1328 e7Abstract Full Text Full Text PDF PubMed Scopus (165) Google Scholar Dr Choi also showed in a randomized controlled trial that testing and treating for H pylori decrease gastric cancer incidence in first-degree relatives of gastric cancer patients, with a hazard ratio of 0.45 (95% CI, 0.21–0.94) in the test and treat group.6Choi I.J. Kim C.G. Lee J.Y. et al.Family History of gastric cancer and Helicobacter pylori treatment.N Engl J Med. 2020; 382: 427-436Crossref PubMed Scopus (91) Google Scholar Dr Hwoon-Yong Jung reported that H pylori seropositivity in the South Korean population has fallen across all age groups, decreasing from 75% in 1992 to 51% in 2015. Dr Jung further discussed that improvements in survival in South Korea are attributed in large part to earlier diagnosis, allowing for less morbid endoscopic therapies such as endoscopic submucosal dissection.7Ahn J.Y. Nam S.H. Jung H.Y. et al.Endoscopic surveillance can increase the chance of resectability and endoscopic treatment in gastric cancer.Hepatogastroenterology. 2014; 61: 1465-1471PubMed Google Scholar Japan (incidence rate 28 per 100,000) initiated a national radiography-based screening program for adults ≥40 years old in 1983, with endoscopy reserved for abnormal radiographic examinations. In practice, participation in this program was low and many residents have sought direct outpatient endoscopy in private clinics. The national screening program was amended in 2016 to recommend either endoscopic or radiographic screening for adults ≥50 years old. Dr Chisato Hamashima reviewed the evidence used by the Japanese Guideline Development Group to develop these guidelines,8Hamashima C. Update version of the Japanese Guidelines for Gastric Cancer Screening.Jpn J Clin Oncol. 2018; 48: 673-683Crossref PubMed Scopus (89) Google Scholar which included case-control studies (pooled odds ratio, 0.77; 95% CI, 0.69–0.86) and a community cohort study (hazard ratio, 0.58; 95% CI, 0.36–0.94) suggesting gastric cancer mortality benefits from having received endoscopic screening. Dr Hamashima also reviewed testing characteristics including sensitivity and specificity of endoscopic screening,9Hamashima C. Okamoto M. Shabana M. et al.Sensitivity of endoscopic screening for gastric cancer by the incidence method.Int J Cancer. 2013; 133: 653-659Crossref PubMed Scopus (45) Google Scholar and discussed quality measures adopted in Japan such as the Double Check System of reviewing endoscopic images by a local committee. In the panel discussion, speakers discussed the lack of gold standard randomized controlled trial data for assessing the mortality benefit of screening, and the difficulties in conducting such a study. In the keynote address, Dr Howard Koh discussed a framework to address health care disparities in the United States. Dr Koh reviewed his own experiences in government, first as the Commissioner of Public Health for Massachusetts and later as the US Assistant Secretary for Health under President Barack Obama. Dr Koh emphasized that there is a striking degree of heterogeneity between Asian subgroups that must be accounted for in research studies and policy decisions. Dr Koh also discussed his experience of promoting federal initiatives to increase preventative health care and screening for Asian Americans, such as for hepatitis B. Drawing examples from modeling studies performed for esophageal adenocarcinoma, Dr Chin Hur emphasized how combining multiple known gastric cancer risk factors (such as race, ethnicity, H pylori infection status, diet, sex, and foreign born status) into a comprehensive multivariable risk model could allow for the identification of high-risk subpopulations who could benefit from risk-attenuation programs.10Laszkowska M. Oh A. Hur C. Screening for upper gastrointestinal malignancies in the United States-which immigrant groups should be considered high-risk?.Gastroenterology. 2020; 158: 4-8Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Dr Hur further noted the need to develop better molecular and genetic markers for risk stratification. Pooling data from several US regional cohorts, Dr Meira Epplein demonstrated that H pylori prevalence has not decreased over time among African Americans. Dr Epplein further reviewed data from eradication trials showing a 35%–50% decrease in gastric cancer incidence with H pylori eradication,11Li W.Q. Zhang J.Y. Ma J.L. et al.Effects of Helicobacter pylori treatment and vitamin and garlic supplementation on gastric cancer incidence and mortality: follow-up of a randomized intervention trial.BMJ. 2019; 366: l5016Crossref PubMed Scopus (59) Google Scholar highlighting the need to reduce disparities in H pylori testing and treatment. Dr Epplein also introduced an exciting community-based program to determine the prevalence of H pylori and other gastric cancer risk factors in partnership with community leaders in Durham, North Carolina (the Durham Initiative for Stomach Health). Dr Asad Umar discussed ongoing National Cancer Institute efforts at gastric cancer prevention. Dr Umar highlighted primary prevention studies currently funded by the National Cancer Institute, including international trials of the polyamine synthesis inhibitor difluoromethylornithine in patients with gastric precancerous lesions, curcumin as chemoprevention of carcinogenesis, and Epstein–Barr virus vaccine development. Dr Samuel So described his experience in advocating for hepatitis B screening in high–risk populations. Previously, there was no comprehensive national strategy to screen for hepatitis B in the United States. Because of the efforts of Dr So and others, a recommendation for hepatitis B screening in high-risk populations was adopted by the US Preventative Services Task Force in 2014.12LeFevre M.L. Force USPST Screening for hepatitis B virus infection in nonpregnant adolescents and adults: U.S. Preventive Services Task Force recommendation statement.Ann Intern Med. 2014; 161: 58-66Crossref PubMed Scopus (91) Google Scholar Dr John Inadomi reviewed the process of turning evidence into recommendations using the Grading of Recommendations, Assessment, Development and Evaluations framework. This framework is used by the American Gastroenterological Association, of which Dr Inadomi is the incoming president-elect. Dr David Greenwald discussed the critical role of professional societies in addressing health care disparities through diverse avenues including symposia, white papers, and committees. Dr Greenwald further discussed the national advocacy work of the American College of Gastroenterology, of which he is president-elect. Ms Aki Smith delivered a deeply motivating and personal message about the need to improve awareness of gastric cancer among high-risk groups. In response to the gastric cancer diagnoses of both her father and close friend, Ms Smith founded Hope for Stomach Cancer, a nonprofit organization that promotes early detection of gastric cancer and provides critical resources to patients and families. Dr Andrew Chan began this session with a presentation describing the international team and proposal selected for the 2020 Stand Up To Cancer Gastric Cancer Interception Grant. Dr Chan’s proposal will focus on improving early detection of both intestinal and diffuse gastric cancers using biomarkers such as circulating cell-free DNA. Dr Khay Guan Yeoh focused his talk on molecular risk stratification of gastric precancerous lesions such as intestinal metaplasia (IM). Leveraging a large cohort of high-risk Singaporean patients with IM, Dr Yeoh and colleagues identified several molecular markers for progression onto dysplasia or cancer, including telomere shortening and somatic copy number alterations.13Huang K.K. Ramnarayanan K. Zhu F. et al.Genomic and epigenomic profiling of high-risk intestinal metaplasia reveals molecular determinants of progression to gastric cancer.Cancer Cell. 2018; 33: 137-150 e5Abstract Full Text Full Text PDF PubMed Scopus (103) Google Scholar Dr Alejandro Corvalan discussed ongoing gastric cancer endoscopic screening campaigns in high-risk areas of Chile (incidence rate 18 per 100,000). This campaign has resulted in >3700 patients being screened between 2016 and 2019, and included biospecimen collection for use in future research studies. Dr Richard Peek demonstrated that H pylori strains harvested from gerbils grown under iron-limited conditions exhibited enhanced virulence and inflammatory factors in a CagA-dependent manner.14Noto J.M. Gaddy J.A. Lee J.Y. et al.Iron deficiency accelerates Helicobacter pylori-induced carcinogenesis in rodents and humans.J Clin Invest. 2013; 123: 479-492Crossref PubMed Scopus (120) Google Scholar Moreover, iron depletion accelerated the development of H pylori-induced premalignant and malignant lesions in gerbils. Translating these findings to humans from a high-incidence area of Colombia, Dr Peek and colleagues discovered that serum ferritin concentrations decreased with increasing severity of gastric premalignant lesions.14Noto J.M. Gaddy J.A. Lee J.Y. et al.Iron deficiency accelerates Helicobacter pylori-induced carcinogenesis in rodents and humans.J Clin Invest. 2013; 123: 479-492Crossref PubMed Scopus (120) Google Scholar Dr Manuel Amieva emphasized the importance of tissue location of H pylori with regard to its virulence and ability to cause human pathology. Using quantitative confocal microscopy, Dr Amieva’s group demonstrated that H pylori grows as distinct microcolonies deep in stomach glands, where they accelerate Lgr5(+) stem cell proliferation, and up-regulate the expression of stem cell-related genes.15Sigal M. Rothenberg M.E. Logan C.Y. et al.Helicobacter pylori activates and expands Lgr5(+) stem cells through direct colonization of the gastric glands.Gastroenterology. 2015; 148: 1392-1404 e21Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar Dr Keith Wilson discussed the critical role of spermine oxidase in mediating CagA-induced oxidative DNA damage16Chaturvedi R. Asim M. Romero-Gallo J. et al.Spermine oxidase mediates the gastric cancer risk associated with Helicobacter pylori CagA.Gastroenterology. 2011; 141: 1696-1708 e1–2Abstract Full Text Full Text PDF PubMed Scopus (111) Google Scholar and premalignant changes.17Chaturvedi R. de Sablet T. Asim M. et al.Increased Helicobacter pylori-associated gastric cancer risk in the Andean region of Colombia is mediated by spermine oxidase.Oncogene. 2015; 34: 3429-3440Crossref PubMed Scopus (56) Google Scholar Dr Wilson then overviewed an ongoing randomized chemoprevention trial of difluoromethylornithine (an inhibitor of ornithine decarboxylase upstream of spermine oxidase) in high-risk Honduran and Puerto Rican populations. Dr Charles Rabkin discussed the epidemiology of Epstein–Barr virus–associated gastric cancers including clinical features, risk factors, and immune profiling.18Camargo M.C. Sivins A. Isajevs S. et al.Associations of Epstein-Barr virus-positive gastric adenocarcinoma with circulating mediators of inflammation and immune response.Cancers (Basel). 2018; 10Crossref PubMed Scopus (6) Google Scholar Dr Rabkin also reviewed the distinct hypermethylation profile of Epstein–Barr virus–associated gastric cancers derived from the Cancer Genome Atlas. Using an H pylori transmission model for Mexico that includes treatment resistance,19Alarid-Escudero F. Enns E.A. MacLehose R.F. et al.Force of infection of Helicobacter pylori in Mexico: evidence from a national survey using a hierarchical Bayesian model.Epidemiol Infect. 2018; 146: 961-969Crossref PubMed Scopus (5) Google Scholar Dr Fernando Alarid-Escudero demonstrated a population-wide screen-and-treat strategy with concomitant antibiotic susceptibility testing was the most cost-effective strategy for gastric cancer prevention. Dr Constanza Camargo discussed changes in the epidemiology of gastric cancer. Using cancer registration data covering approximately 80% of the US population, Dr Camargo and colleagues reported an unexpected increase in incidence of noncardia gastric cancer among young (age <50 years) non-Hispanic Whites.20Anderson W.F. Rabkin C.S. Turner N. et al.The changing face of noncardia gastric cancer incidence among US non-Hispanic Whites.J Natl Cancer Inst. 2018; 110: 608-615Crossref PubMed Scopus (81) Google Scholar These data highlight the need for studies addressing novel factors related to major societal transitions that may provide clues to understanding re-emergence of gastric cancer. Dr Christian Abnet demonstrated that H pylori seropositivity is inversely associated with cardia cancers in Western populations, yet positively associated with cardia cancers in Asian populations.21Kamangar F. Qiao Y.L. Blaser M.J. et al.Helicobacter pylori and oesophageal and gastric cancers in a prospective study in China.Br J Cancer. 2007; 96: 172-176Crossref PubMed Scopus (113) Google Scholar These dichotomous findings emphasize the need for personalized approaches to risk stratification across populations. Dr Michael Bruce discussed steps he and colleagues at the Alaska Native Tribal Health Consortium have recently implemented to address the high burden of gastric cancer among Alaska Native/American Indian persons, including endoscopic screening and H pylori testing for persons with a first-degree family history, working toward standardization of endoscopic biopsy protocols statewide, and plans to develop a clinical registry for high-risk individuals.22Nolen L.D. Vindigni S.M. Parsonnet J. et al.Combating gastric cancer in Alaska Native People: an expert and community symposium.Gastroenterology. 2020; 158: 1197-1201Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar The Alaskan approach provides a model by which to improve early detection and prevention in a targeted, high-risk population. Dr Elena Martinez Stoffel discussed the management of patients with pathogenic or likely pathogenic CDH1 variants found on multi-gene panel testing. Dr Stoffel and colleagues discovered that a high percentage of patients with no family history of gastric cancer but incidentally diagnosed pathogenic or likely pathogenic CDH1 variants harbored signet ring cell carcinomas.23Jacobs M.F. Dust H. Koeppe E. et al.Outcomes of endoscopic surveillance in individuals with genetic predisposition to hereditary diffuse gastric cancer.Gastroenterology. 2019; 157: 87-96Abstract Full Text Full Text PDF PubMed Scopus (21) Google Scholar Dr Jeremy Davis further demonstrated that 94% of patients who underwent prophylactic total gastrectomy for pathogenic variants of CDH1 demonstrated signet ring cell carcinomas in gastrectomy explants. These data suggest that pathogenic variants of CDH1 represent a highly penetrant genetic defect. Dr Hanlee Ji discussed his work characterizing the gastric cancer tumor microenvironment with single-cell genomic sequencing.24Sathe A. Grimes S.M. Lau B.T. et al.Single cell genomic characterization reveals the cellular reprogramming of the gastric tumor microenvironment.Clin Cancer Res. 2020; 26: 2640-2653Crossref PubMed Scopus (45) Google Scholar Dr Ji and colleagues revealed widespread immune reprogramming of the tumor microenvironment, data which allow for identification of novel targets for immunotherapy. Dr Blanca Piazuelo provided an expert review of interpreting gastric biopsies using Operative Link scoring systems for IM and atrophy. Dr Piazuelo further discussed the critical importance of distinguishing incomplete phenotypes of IM, as incomplete IM confers a much higher risk for subsequent gastric cancer.25Shah S.C. Gawron A.J. Mustafa R.A. et al.Histologic subtyping of gastric intestinal metaplasia: overview and considerations for clinical practice.Gastroenterology. 2020; 158: 745-750Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar The 2020 Stanford Gastric Cancer Summit highlighted the high burden of gastric cancer among certain racial and ethnic groups, the evidence of a mortality benefit of prevention and screening strategies in East Asia, and the projections that gastric cancer will remain a disease of high burden into the twenty-first century. Based on these data, a broad consensus emerged among Summit participants that strategies of primary prevention (H pylori testing and treatment) and secondary prevention (endoscopic screening) should be be considered for adoption in the United States for targeted, high-risk populations. The summit participants also acknowledged remaining knowledge gaps, including:1.A need for randomized trial data to show the mortality benefit of endoscopic screening in high-risk populations;2.An improved understanding of H pylori prevalence and resistance patterns across ethnic and racial groups in the United States;3.Clinical and biological markers to risk stratify patients with precancerous lesions (such as IM) for cancer progression across diverse US populations; and4.A need for clinical trials to evaluate potential chemoprevention agents in high-risk individuals.

Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2017.

PurposeThis study reports the cancer statistics and temporal trends in Korea on a nationwide scale, including incidence, survival, prevalence, and mortality in 2017.Materials and MethodsThe incidence, survival, and prevalence rates of cancer were evaluated using data from the Korea National Cancer Incidence Database from 1999 to 2017 with follow-up until December 31, 2018. Deaths from cancer were assessed using cause-of-death data from 1983 to 2017, obtained from Statistics Korea. Crude and age-standardized rates (ASRs) for incidence, mortality, and prevalence, and 5-year relative survival rates were calculated and trend analysis was performed.ResultsIn 2017, newly diagnosed cancer cases and deaths from cancer numbered 232,255 (ASR, 264.4 per 100,000) and 78,863 (ASR, 76.6 per 100,000), respectively. The overall cancer incidence rates increased annually by 3.5% from 1999 to 2011 and decreased by 2.7% annually thereafter. Cancer mortality rates have been decreasing since 2002, by 2.8% annually. The 5-year relative survival rate for all patients diagnosed with cancer between 2013 and 2017 was 70.4%, which contributed to a prevalence of approximately 1.87 million cases by the end of 2017.ConclusionThe burden of cancer measured by incidence and mortality rates have improved in Korea, with the exception of a few particular cancers that are associated with increasing incidence or mortality rates. However, cancer prevalence is increasing rapidly, with the dramatic improvement in survival during the past several years. Comprehensive cancer control strategies and efforts should continue, based on the changes of cancer statistics.

Prediction of Cancer Incidence and Mortality in Korea, 2020

PurposeThis study aimed to report the projected cancer incidence and mortality for the year 2020 to estimate Korea’s current cancer burden.Materials and MethodsCancer incidence data from 1999 to 2017 were obtained from the Korea National Cancer Incidence Database, and cancer mortality data from 1993 to 2018 were acquired from Statistics Korea. Cancer incidence and mortality were projected by fitting a linear regression model to observed age-specific cancer rates against observed years and then by multiplying the projected age-specific rates by the age-specific population. A Joinpoint regression model was used to determine the year in which the linear trend changed significantly; we only used the data of the latest trend.ResultsIn total, 243,263 new cancer cases and 80,546 cancer deaths are expected to occur in Korea in 2020. The most common cancer site is expected to be the lung, followed by the stomach, thyroid, colon/rectum, and breast. These five cancers types are expected to represent half of the overall burden of cancer in Korea. The most common type of cancer among people who die is expected to be lung cancer, followed by liver, colon/rectal, pancreatic, and stomach cancers.ConclusionThe incidence rates for all types of cancer in Korea are estimated to decrease gradually. These up-to-date estimates of the cancer burden in Korea could be an important resource for planning and evaluating cancer-control programs.