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The 7th Meeting of Asian National Cancer Centers Alliance (ANCCA)

Jakarta, Indonesia on 25-26 October, 2018

Hitoshi Nakagama
President

1
History and Current Situation
in Japan

2
Trends in Crude Mortality Rate for Leading
Causes of Death (1947-2016)

Cancer

1981

3
Expected Cancer Deaths by Site (2017)

4
Expected Cancer Incidence by Site (2017)

5
Why cancer control in Japan?
~ attributable causes of cancer ~
≈ 55% of cancer among men
Passive was attributable to preventable
smoking risk factors in Japan. The
corresponding figure was lower
Infection among women, being nearly 30%.
( H. pylori, HCV,
Smoking HBV, HPV, EBV, Salt intake (6g and over / day)
HTLV-1)
BMI
(25 and over)
Alcohol
drinking Fruit intake
(Lowest intake group) Annals of Oncology, 2011,
Attributable causes of
Others Vegetable intake cancer in Japan in 2005—
systematic assessment to
(Lowest intake group) estimate current burden of
Physical inactivity cancer attributable to
known preventable risk
Exogenous hormone factors in Japan
(M. Inoue, N. Sawada, T.
use (current use) Matsuda, et al.)

6
History of Promote Cancer
Control Programs
1984 Comprehensive Ten-Year Strategy for Cancer
Control
Research on… 1. Human oncogene, 2. Viral oncogenesis, 3. Control of oncogenesis, 4.
Development of new early checkup technology, 5. Development of the treatments by a
new theory, 6. Control mechanism and control substance of immunity

1994 New Comprehensive Ten-Year Strategy for Cancer


Control
Research on… 1. Molecular mechanism of oncogenesis, 2. Metastasis, infiltration, and the
characteristic of a cancer cell, 3. Cancer predisposition and immunity, 4. Cancer prevention,
5. Development of a new diagnostic technic, 6. Development of a new treatment, 7.
Patient's QOL

2004 3rd –term Ten-Year Strategy for Cancer Control


Dramatic reduction in cancer morbidity and mortality

7
Cancer Control ACT (June, 2006)

(2007)

8
Cancer Control Act (2006)
• The Cancer Control Act, the first comprehensive national
cancer control plan, was approved in 2006 in response to
cancer patient groups’ advocacy for cancer research
promotion, and for ensuring nationwide availability of
cancer care.
• The Basic Plan to Promote Cancer Control Program in
conformity to the Act was drawn up in 2007, in which both
HBCR (hospital-based cancer registry) and PBCR
(population-based cancer registry) were recognized as a
central component of cancer control.
– The Basic Plan made hospital-based registries (HBCR) in
designated cancer care hospitals compulsory = Indirect
involvement of the national government in cancer registration

9
1st Basic Plan to Promote Cancer
Control Programs (2007-11)
Focus areas
Relief of all cancer patients and their families
Reduction of Reduction of burden
cancer death (-20%) Improvement of QOL
5 1 3
Early Chemotherapy & Cancer
Palliative
Detection Radiotherapy, education care
of medical specialists care
6 support &
Cancer 4 Cancer Registry Information
Prevention service
2 Development of medical facilities
7 Cancer Research

9
10% add. decrease of mortality
Goals of the Basic Plan (2007)
Evidence- Mortality
Strategic
based Scenario reduction in
objectives
Methods 2015 (%)
Tobacco (1) 50% reduction -1.6
Smoking rate
control (2) 75% reduction -2.9
(3) Increase to 50% -3.9
Screening Participating rate
(4) Increase to 70% -6.0
Equalize 5 year survival (5) 5 major sites -3.2
quality in rate: improve to (6) All sites (10 years) -4.9
cancer care current ideal level (7) All sites (7 years) -6.8
(1)+(3)+(5) -8.7
Total (1)+(3)+(6) -10.4
(2)+(4)+(7) -15.7

Estimated with a sim. model


10
2nd Basic Plan to Promote Cancer
Control Programs (2012-16)

Specific goals 1. Cancer treatment


2. Cancer care support and information services
3. Cancer registry
4. Cancer prevention
5. Early detection of cancer
6. Cancer research
7. Pediatric cancer
new 8. Cancer education and awareness
9. Social issues including cancer patients’ employment

12
3rd Basic Plan to Promote Cancer
Control Programs (2017-22)
1 We, incl. patients, aim at overcoming cancer, by knowing cancer
1. Evidence-based prevention and screening, 2. Patient-oriented treatment,
3. Building a secure society where patients live with dignity

2
2. Fulfilling treatment 3. Living with cancer
1. Genomic Medicine, 2. Surgery, Radiotherapy, 1. Palliative care from
1. Prevention Chemotherapy and Immunotherapy, 3. Team diagnosis, 2. Patient
1.Prevention medical care, 4. Rehabilitation, 5. Supportive consultation, 3. Social
2. Early detection/ care, 6. Rare cancer, 7. Childhood and AYA network, cancer control and
Screening cancer, 8. Pathology, 9. Cancer registry, 10. patient support, 4.
Early development and introduction of drugs Employment of patient, 5. Life
and devices stages and cancer control

4. Development of infrastructure
3
Related affairs for comprehensive cancer control (budget etc.)

13
Challenges and Solutions
in Cancer Control Program

- Solutions and Achievements –


1. Planning and Prevention
2. Early Detection
3. Treatment

13
1. Planning and Prevention Cancer Registry (2016.01~)

14
1. Planning and Prevention
Transition of Smoking
Proportion (%)
Male 20-29 Female 20-29
100 30-39 30 30-39
40-49 40-49
90
50-59 25 50-59
80
60+ 60+
70
20
60
50 15
40
10
30
20
5
10 increase in 50’s
0 0
1969

2005
1965

1973
1977
1981
1985
1989
1993
1997
2001

2009
2013

1969

2005
1965

1973
1977
1981
1985
1989
1993
1997
2001

2009
2013
16
2. Early Detection
Cancer Screening Rates

17
2. Early Detection
5 year cancer survival in Japan
diagnosed at 1993-6 to 2006-8

62.1%

19
3. Treatment

NCC – the core of the


nationwide cancer care network
National Cancer Center ---2
Prefectural Designated Cancer Care Hosps---50
District designated Cancer Care Hosps---348
Other designated Hosps ---37

Nationwide clinical support network with


prefectural + district-designated
437 cancer care hospitals

Prefectural cancer care liaison council

Clinical trials Cancer registries Consultation and Palliative care


info sharing

18
Basic Plan to Promote Cancer Control Programs (3rd term)
Section 1 : Overall goals
“People including cancer patients, To understand cancer, To overcome cancer”
(1) Improvement of cancer prevention and cancer screening based on scientific basis
(2) Realization of patient-oriented cancer treatment
(3) Establishment of a society in which cancer patients can live peacefully while maintaining dignity

Section 2 : Specific areas


1.Cancer prevention 2. Improvement of cancer treatment 3. Coexistence (Living) with cancer
(1) Primary prevention (1) Cancer genomic medicine (1) Palliative care appropriately provided after diagnosis
(2) Early detection, (2) Surgical therapy, Radiotherapy, Pharmacotherapy, Immunotherapy (2) Counseling support and information service
Cancer screening (3) Team-based cancer treatment (3) Cancer control and provision of patient support
(Secondary prevention) (4) Rehabilitation founded on social collaboration
(5) Supportive care (4) Social issues including employment of cancer
(6) Rare cancer, Intractable cancer patients
(According to the characteristics of each cancer) (5) Cancer control according to the life stages
(7) Cancer among children, adolescent and young adult, and elderly
(8) Pathological diagnosis
(9) Cancer registry
(10) Promotion of early development and authorization of medical
products and equipment

4. Development of foundation to support above


(1) Cancer research
(2) Human resource training
(3) Cancer education and awareness-raising activities

Section 3 : Necessary items to promote cancer control measures comprehensively and systematically
1. Further strengthening collaboration among relevant organs 5. Implementation of necessary financial measures
2. Prefectures formulate prefectural cancer control plans Efficiency and prioritizing of budget
3. Endeavor of citizens included cancer patients 6. Assessment of the goal achievement status
4. Cooperation with the patient community 7. Reviewing Basic Plan to Promote Cancer Control Programs 20
NCC-Clinical Sequencing

Biobank

IC on Selection of Clinical Expert Panel Recommendation


sequencing test test sample sequencing meeting by attending doctor

Gene A mutation Protein A inhibitor

Candidate Patients
Gene B mutation Protein B signal inhibitor
for chemotherapy

Gene C amplification Anti-protein C antibody

21
NCC-Clinical Sequencing Lab with Quality Assurance
(Oct 13, Open & Nov 13, 2015, Press release)
Division of Pathology & Clinical Laboratories
Pre-PCR Room
Department of Genetic Medicine and Services (GeMS)

Doctor Pathologist

Expert panel
meeting
Patient Pathology info
info
Report draft
Doctor
Approval
For Clinical
Mutation Sequencing
data

SCI-Lab Validation
Sysmex Cancer
Innovation Laboratory

NGS data Genome researcher


Post-PCR Room 22
RET and ALK Fusion Gene in Lung Cancer
RET gene fusion in 1–2% of lung adenocarcinomas

RET fusion protein


KIF5B

KIF5B Tyrosine
RET -RET kinase RET TKIs
Ch10
inversion fusion

ALK gene fusion in 3–5% of lung adenocarcinomas

ALK EML4 ALK fusion protein


-ALK
EML4 fusion

Tyrosine
Ch2
kinase ALK TKIs
inversion

23
Nation-wide Program for Genomic Cancer Medicine
- Response to vandetanib in RET-rearranged NSCLC -
(n = 19: ITT population)

Participation
Participation and
vandetanib 医師主導治験

Pretreatment 3-month after treatment

This patient with CCDC6-RET NSCLC


had a partial response with a 62%
reduction in tumor burden.
(ASCO 2016 annual meeting:
#9012)

24
3. Treatment Rare Cancer Center at NCC
Launched in June 2014 as a multidisciplinary team to take measures
against the innate problems associated with rare cancers.
Mission Statements
1. Establishing a vital network of diagnosis, treatment and research for rare
cancers in the National Cancer Center.
2. Reviewing the problems associated with rare cancers in Japan and making
proposals and taking up the issues as medical professionals.
Homepage

Clinics

Hospital Hospital East


Basic
Advice
Research Neuro-Oncology
Ophthalmic Oncology
Rare http://www.ncc.go.jp/jp/rcc/index.html
Head and Neck Oncology
Breast and Medical Oncology
Cancer Thoracic Oncology
Gastrointestinal Medical Oncology
Patient Clinical Rare Cancer Hotline Hepatobiliary Pancreatic Oncology
Urology
Advocacy Research Coordinate Gynecology
Musculoskeletal Oncology
Dermatologic Oncology
Hematology
Education Pediatric Oncology
Diagnostic Radiology
Radiation Oncology
Pathology and Clinical Laboratories
3. Treatment
Rare Cancers
MASTER KEY PROJECT

Molecular Diagnostic
testing (NGS, IHC, etc)
Registry part
• Rare cancer I.C. May 2017 ~
• Rare histological Registration
subtype
• Carcinoma of
unknown primary Review biomarker
status

Assignment to biomarker-based clinical trial


Sub-study part

Biomarker
Biomarker A Biomarker B Biomarker C
negative

Drug A Drug B Drug C Drug X Drug Y


Clinical trial Clinical trial Clinical trial Clinical trial Clinical trial Follow-up of all patients
[A large scale reliable database]

32
3. Treatment
Rare Cancers
MASTER KEY PROJECT
Collaboration between INDUSTRIES AND ACADEMIA

Astellas Pharma
Eisai
Ono Pharmaceutical
Kyorin Pharmaceutical
Daiichi Sankyo
Taiho Pharma
Takeda Kyoto Univ.
Chugai Pharmaceutical NCC
Novartis hospital
Pfizer
Ignyta

33
Collaboration among
ANCCA members
1. Planning and Prevention
2. Early Detection
3. Treatment

22
1. Planning and Prevention
Cancer Registration
GICR – IARC Regional Hubs
The Global Initiative for Cancer Registry Development (GICR)
is a multi-partner response to the disparity in robust cancer
statistics across the globe, led by the International Agency for
Research on Cancer (IARC) and Union for International Cancer
Control (UICC).

23
1. Planning and Prevention
Cancer Registration
IARC/GICR (Global Initiative for Cancer Registry Development)
Collaborating Centres in Asia

24
1. Planning and Prevention
Cancer Registration
Activities up to now

Yangon, Myanmar (June 2017) Jakarta, Indonesia (Mar 2018)

Hanoi, Vietnam (Sept 2018)


Phnom Penh, Cambodia (Sept 2018)

31
1. Planning and Prevention
Asia Cohort Consortium
The Asia Cohort Consortium Since 2004
A consortium of 30 cohort studies in 10 countries in Asia (n=1.5 million)
More than 150 researchers across Asia, US, and the World.
Aim and scope
 Serve as a platform for cross-cohort
collaborative projects and combined analysis.
 Act as an incubator for new cohorts.
EPIC
UK Mongolia
NCI Cohort Consortium
BiobanK NCI-supported cohorts
China Korea Japan
Iran Bangladesh Other US cohorts
India Taiwan
Malaysia
ACC Research Collaboration with the US
Singapore
A member of NCI Cohort Consortium
Many collaborating researchers are based in
the US (1/3 of the researchers in ACC are
from NCI, Vanderbilt Univ., Univ. Chicago,
NYU, Mt Sinai Med. Sch., Univ. Hawaii and
others)
The ACC Coordinating Center (2014-) Key Research
Publication Ideas and Skills
1. NIHDiabetologia
Funding for theDiabetes
specific
andresearch
Center for Public Health Sciences, NCC, Tokyo project
(2017) cancer mortality
2. Am J Epidemiol (2015) Prostate cancer mortality
 Activities 3. PLoS Medicine (2014) Total and cause-specific
Meeting: Annual (2017 NCC, Tokyo) mortality
Analysis: onsite or remote access analysis 4. BMJ (2013) Cardiovascular disease.
Working groups by research project 5. Am J Clin Nutr (2013) Meat intake
6. Eur J Cancer Prev (2013) Pancreas cancer
Discuss issues on the cohorts and projects
7. Ann Onco(l (2012) Cancer of the small intestine
8. PLoS One (2011) Diabetes.
9. N Engl J Med (2011) Body mass index and risk of
death

29
2-3. Early Detection
and Treatment Cancer Precision Medicine
NCC Oncopanel
Scope of
DNA template Determine base Analysis application
sequence
NCC Oncopanel DNA sequencer Analytical program
Raw data
DNA extraction

レポート
Analysis

Reporting
Patient ID: xxxxx
Genetic
aberrations:
AKT1 E17K
・・・・
Database ・・・・

Compare the gained base sequence with


the database information and detect cancer
gene abnormality

In vitro diagnostic (IVD) Medical device Medical device (program)

Customized for solid cancer


114 mutation/amplification
12 fusion genes

30
2-3. Early Detection
and Treatment Cancer Precision Medicine
Center for Cancer Genomics and Advanced
Therapeutics (C-CAT)
Established in June 2018, responding to the final report from the Expert Meeting for Cancer Genomic Medicine Promotion
Consortium June 2017, appointed by the Ministry of Health, Labour and Welfare. The Meeting called for a new agency to construct
and operate a “Cancer Genomics Information Repository”, a master database for cancer genomic medicine and research in Japan.

Certified
Mission laboratories
for genomic testing
1. Control quality and advance
genomic diagnosis of cancer: Specimens
 Accumulate clinical and genomic information of Sequence Sharing and
Japanese cancer patients and establish a data research use of
database optimized to serve the populace cancer
 Provide support to Expert Panels at Designated genomics data
Core Hospitals for Cancer Genomic Medicine
 Communicate genomic medicine-related Designated Core
information with the public, and advocate policy Hospitals C-CAT
underpinned by nation-wide statistics of cancer for Cancer Genomic Medicine
genomic medicine

alization
Novel targets, individu-
New therapy, diagnosis
Cancer Genomics
2. Lead data sharing: Information Repository
 Promote data sharing among designated and Clinical (genomic and clinical)
cooperative hospitals of cancer genomic medicine info
following appropriate protocol, and promote cancer
care covered by national healthcare insurance
3. Promote clinical trials, research Incl.
AI analyses
and development:
 Establish data utilization as foundation for clinical
trials including investigator-initiated trials, and for
drug/device development and precision medicine Expert Panel
CKDB
for cancer patients
utilized in developing drugs
4. Conduct research, and nurture collaborating with core and cooperative
"Genomic test hospitals, pharma, and relative
talent in preparation for the CKDB report" ministries to maximizing therapy for
introduction of Whole Genome Cooperative annotating clinical Japanese patients

Sequencing to health care Hospitals significance


for Cancer Genomic Medicine

31
3.Treatment
Collaboration in Drug
Development (Phase 1)

26
3.Treatment
Collaboration in Drug
Development (Phase 3)

Example : PATHWAY trial


Asian Phase 3 Randomized Study
Patient Population
Palbociclib
• N = 180 R
A
+
(138 PFS events) N Tamoxifen/Goserelin
D Gosereline only for
O premenopausal
M N=180
 HR+ HER2- I
pre/peri and post- Z 1:1
A
menopausal T
Placebo
+
advanced or I
Tamoxifen/Goserelin
O
metastatic N Gosereline only for
1st or 2nd line BC premenopausal

Endpoints
Stratified Expected Outcome
PE: PFS • Detect PFS improvement from 8.25 months to 13.3
• 1st line vs 2nd line
SEs: OS, OR, DR, CBR, • Menopausal status
months (HR=0.62) with 80% power, 1-sided α=0.025
PK/PD/PGx, Safety (pre/peri vs post) • Accrual Duration: 24 months
• Observation Time: 36 months

27
3.Treatment
Collaboration in Drug
Development (Phase 3)
CRO
・Monitoring
Pfizer ・Data Management
・IP Manufacture NCCH ・QA(Audit)
・Research Funding Study Chair:
・CSR
Kenji Tamura
IDMC Sponsor
・Taizo Hirata (JP) (ICH-GCP) Other Vendors
・Harukaze Yamamoto
(JP)
・IP labeling, Storage,
・Daniel SW Tan (SG) Delivery
・IRT
・Central Lab
IRRC
・Ukihide Tateishi (JP)
・Mitsuhiro Kishino (JP)
・Takashi Ogura (JP)

KCSG
Korean Cancer
Study Group

Study Study Study Study


sites sites sites sites
(Japan:12) (Korea:6) (Taiwan:3) (Singapore:2)

The goal of the PATHWAY trial is to obtain simultaneous drug approval (label change) and
establish a new standard treatment in the participating countries

28
3.Treatment
Training of overseas doctors

Number of overseas doctors by 2017 – Number of overseas doctors by Department


Continent Gastro-intestinal Endoscopy
Radiation Oncology
250 Pathology
Gastro-intestinal Medical Onc.
200 Gastric Surg.
Respiratory Endoscopy.
Exploratory Onc. Research
150 Pharmacy
Musculoskeletal Onc. & Rehabilitation
HPB Surg.
100 Colorectal Surg.
Outpatient ttm center
Radiation Technology
50 Esophageal Surg.
Clin. Trials Coordination
0 Diagnostic Radiology
Thoracic Surg.
Gynecology
Thoracic Onc.
Breast Surg.
Head&Neck Surg.
Palliative Medicine
Anesthesia and intensive Care
Hematopoietic Stem Cell Transplantation
Hematology
HPB Onc.
2017 2016 2015 Brain and spinal cord tumor
0 10 20 30 40 50 60 70 80 9

34
3.Treatment
Training of overseas doctors
0 10 20 30 40 50 60 70 80 90 100
China 42 53
2017
Taiwan 31 29
Thailand 23 14
India 9 3
Hong Kong 6 4
Viet Nam 2 6
Korea 5 2
Philippines 3 3
Singapore 2 2 Nb of trainees 2017 2016 2015
Indonesia 10 China 95 50 82
Pakistan 10
Taiwan 60 45 63
Malaysia 10
Myanmar Thailand 37 44 9
India 12 9 3
2016 32 18 Hong Kong 10 2 4
38 7
23 21 Viet Nam 8 9 7
8 1 Korea 7 11 16
20
2 7 Philippines 6 6 7
4 7 Singapore 4 3 2
1 5
21 Training > 4 days Indonesia 1 1 1
10 Pakistan 1 0 0
0 Short term training
6 1
Malaysia 1 7 5
1 Myanmar 0 1 1
0 10 20 30 40 50 Total
60 242 188 200

35
3.Treatment

Collaboration in Rare Cancers?

Any current activities or future


plans in other ANCCA countries?

28
Thank you !

Slides of cancer statics were cited and modified from "Cancer Statistics in Japan - 2015",
Foundation for Promotion Cancer Research of which information originally came from
Division of Cancer Control and Health Promotion, Health Services Bureau, MHLW

41
Backup

国立がん研究センタ ー
がん対策情報センタ ー
National Cancer Center
Center for Cancer Control and Information Services

42
History of Cancer Control and Research Programs by Government
2017
3rd- Basic Plan (2017~2022)
2nd - Basic Plan (2012-2016) 2012
Basic Plan to Promote Cancer Control 1. Clarification of cancer itself
(2007-2011) 2. Application of basic research results to prevention,
2007 diagnosis, and treatment
Cancer Control Act (2006) 3. Development of innovative prevention, diagnosis,
3rd-term Comprehensive 10- treatment methods
4. Reduction of lifetime cancer morbidity through
year Strategy for Cancer promotion of cancer prevention
Control (2004-2013) 5. Dissemination of high-quality cancer medical services
2004
1. Research on molecular mechanism of carcinogenesis
2. Research on metastasis, infiltration, and characteristics of
New 10-year Strategy to cancer cells
Overcome Cancer 3. Research on cancer predisposition and immunity
(1994-2003) 4. Research on cancer prevention
1994 5. Research on development of new diagnosis technologies
6. Research on development of new treatments
7. Research on QOL of cancer patients

Comprehensive 10-year 1. Research on human cancer genes


2. Research on viral carcinogenesis in humans
Strategy for Cancer Control 3. Research on promotion and inhibition of carcinogenesis
(1984-1993) 4. Research on development of new early diagnosis
1984 technologies
5. Research on development of treatment based on new
Cancer became No.1
theories
cause of death (1981) 6. Research on mechanism of immunosuppression and
immunosuppressive substances 45
Budget for the Cancer Control
million USD
350
300
250
200
150
100
50
0
1984 1987 1990 1993 1994 1997 2000 2003 2004 2007 2010 2013 2016

Apr. 1984.4 Apr. 1994 New Apr. 2004 The 3rd


Comprehensive Comprehensive term Comprehensive
Ten-Year Strategy Ten-Year Strategy Ten-Year Strategy for
for Cancer Control for Cancer Control Cancer Control

46
5 year cancer survival in Japan 国立がん研究センタ ーがん対策情報センタ ー

1993-6 to 2006-8 62.1%


National Cancer Center
Center for Cancer Control and Information Services

0.0 20.0 40.0 60.0 80.0 100.0


1993-1996

All sites
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Oropharyngeal
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Esophagus
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Stomach
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Colon
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Rectum
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Liver
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Gallbladder
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Pancreas
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Larynx
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Lung
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Female breast
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Uterus
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Cervix uteri
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Corpus uteri
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Ovary
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Prostate
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Bladder
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Thyroid
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Malignant lymphoma
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Multiple myeloma
1997-1999
2000-2002
2003-2005
2006-2008
1993-1996

Leukaemia
1997-1999
2000-2002
2003-2005
2006-2008

47
Cancer Control Act
The first comprehensive national cancer control plan, first approved in
2006 in response to patient advocacy. With further revisions in 2016,
it establishes the policies of promoting:
1. Prevention and early detection
2. High treatment quality standards throughout the Nation
3. Cancer Research, and utilization of its outcomes
4. Patients’ employment
5. Inclusion of cancer in national curriculum

The Basic Plans to Promote Cancer Control Program are


subsequently drawn from the above principles.
Cancer incidence transition
国立がん研究センタ ーがん対策情報センタ ー
National Cancer Center
Center for Cancer Control and Information Services

All sites
400

All sites
300
200

Breast (incl. CIS)


Stomach
100

Liver Colon Lung Stomach


50
人口100 000対

Colon
Lung
Prostate
10

Rectum
Corpus uteri
Ovary
Rectum Liver Cervix uteri
1

1975 1980 1985 1990 1995 2000 2005 2010 1975 1980 1985 1990 1995 2000 2005 2010
2012 2012
49