When Koreans think of "cancer," the state-run National Cancer Center (NCC) is the first institution that comes to mind, given its prominent role in leading cancer treatment in Korea. Despite the significant efforts of the largest private hospitals in Korea, including Samsung Medical Center, Asan Medical Center, and Severance Hospital, in establishing cancer centers and prioritizing oncology patients, the NCC continues to maintain a position among the top five in cancer treatment.
The NCC, having pioneered the introduction of the first proton therapy machine in Korea, is currently poised for a significant advancement. This includes the introduction of a second proton therapy machine, the renovation of the main hospital building, and the establishment of a cancer clinical research center.
The NCC is actively fulfilling its role as a national cancer management policy institution, aligning itself with esteemed global cancer research organizations. In April, the institute entered into a memorandum of understanding with the National Cancer Institute (NCI) of the U.S., fostering collaboration in cancer research. Moreover, the NCC is actively participating in the U.S.-led Cancer Moonshot project, contributing to collective efforts aimed at overcoming cancer for the benefit of humanity.
Korea Biomedical Review conducted an interview with Dr. Seo Hong-kwan, the director of the NCC, renowned not only for his leadership in the field but also for his advocacy as an anti-smoking and sobriety evangelist. The conversation aimed to delve into the NCC's achievements over the past 22 years and to gain insights into its strategic vision for evolving into the world's premier cancer center.
Question: Established 22 years ago, the NCC not only treats cancer patients but also functions as a think tank for promoting national cancer management policies. How would you describe the role the NCC has played in shaping and advancing these policies?
Answer: The NCC commenced patient treatment in 2000, marked by an inaugural ceremony in 2001 attended by former President Kim Dae-jung. Over the past 22 years, the National Cancer Center has been actively involved in implementing diverse cancer management policies, encompassing initiatives in cancer prevention and screening. Notably, a major accomplishment has been the generation of comprehensive national cancer registration statistics.
Before the inception of the NCC, reliable statistics on cancer in Korea were nonexistent. The establishment of the NCC marked the initiation of systematic national statistics on cancer. Recognizing the significance of accurate information akin to understanding the trends of an adversary in war, having precise data on cancer is paramount. This serves as the foundational step toward overcoming cancer and plays a crucial role in formulating and assessing national cancer control policies.
The NCC set up the National Cancer Screening Program to cut down on cancer deaths. Treating cancer is important, but catching those curable cancers early is just as crucial.
To keep the National Cancer Screening Program running smoothly, it needs a well-thought-out screening program. The NCC has been taking care of the basics, deciding which cancers to screen for, identifying who should get screened, and setting the screening frequency. When the NCC started in 2001, they laid out screening recommendations and kicked off a national screening program for five major cancers: stomach, liver, colorectal, breast, and cervical. Later on, they added lung and thyroid cancers to the list.
Q: Recently, the NCC and the National Academy of Medicine of Korea collaborated to release a joint recommendation discouraging indiscriminate health screenings.
A: Certainly, cancer screening is crucial because detecting cancer at an advanced stage often leads to lower cure rates. The NCC has notably succeeded in promoting national cancer screening as one of its key accomplishments.
But, these days, Korea seems like a “screening kingdom,” and it's not limited to just cancer screening—it's everything. While understanding the importance of screening is good, it becomes an issue when there are screenings without a solid basis that can be potentially harmful.
Q: Can you clarify what is meant by "unnecessary and harmful screening"?
A: This encompasses screening methods such as PET CT, thyroid ultrasound for thyroid cancer, and cancer marker testing. Employing a PET CT for detecting cancer throughout the body is both inefficient and inaccurate. For instance, discovering a cancerous lump on a PET CT scan without further scans lacks thoroughness. The same caution applies to cancer marker tests. While some might assume they are standard for cancer screening, they are deemed inaccurate and are not endorsed by the scientific community.
An instance of potentially harmful screening is thyroid cancer screening. Individuals without symptoms are often encouraged to undergo a thyroid gland ultrasound under the belief that it will detect cancer. Yet, the challenge lies in the fact that most thyroid cancers are not easily detectable. If surgery is then recommended for their removal, it may result in an unnecessary loss for the individual.
Q: Can you simply ignore cancerous tissue in your body? It's not a straightforward decision. But is it accurate to call it a no-brainer?
A: The five-year survival rate for cancer is a relative measure, comparing the survival rate of individuals with cancer to those without. In the case of thyroid cancer, the five-year survival rate is 100.0, making it equal to the survival rate of individuals without thyroid cancer when rounded to one decimal place.
Certainly, it's important to note that despite the high five-year survival rate of 100 for thyroid cancer, there are cases where individuals do succumb to the disease. While a 100 percent survival rate may suggest a lower immediate life-threatening nature, it's crucial to approach each case individually. The implication that thyroid cancer is not life-threatening might lead to unnecessary surgeries for some individuals who might not require such interventions.
Additionally, the WHO has reported that 90 percent of thyroid cancers in Korea are overdiagnosed. The U.S. Preventive Service Taskforce Team has gone further, issuing a grade D recommendation for thyroid cancer screening in asymptomatic individuals, emphasizing that the potential harms outweigh the benefits.
Q: The NCC was the first to launch the proton therapy in Korea. What are the results of the proton therapy at the NCC?
A: The NCC has been utilizing the first proton therapy machine in Korea since 2007. Proton therapy and heavy particle therapy offer a distinct advantage over X-ray treatment as they minimize side effects by sparing normal tissues from significant irradiation. Unlike X-ray treatment, which damages tissues in its path, proton therapy, and heavy particle therapy target cancer cells while sparing surrounding healthy tissues.
Preserving normal cells is vital for enhancing the survival rate and overall quality of life for cancer patients. This is particularly crucial for children and adolescents, as their immature bodies are more susceptible to severe side effects from radiation compared to adults.
Since the introduction of the proton therapy machine, the NCC has achieved remarkable treatment outcomes by employing proton therapy for solid cancers, excluding blood cancers like leukemia.
From 2007 to 2022, a total of 81,110 proton therapy treatments were administered. In terms of cancer types, the most prevalent were brain tumors (20.0 percent), followed by liver cancer (15.8 percent), pancreaticobiliary cancer (15.1 percent), lung cancer (14 percent), and urinary cancer (12.2 percent).
While heavy particle and proton therapy are often referred to as "dream cancer treatments," it's essential to clarify that they constitute only a portion of radiation therapy. Misinformation exists, such as the misconception that heavy particle therapy machines are two to three times more biologically destructive than proton therapy machines, leading to superior treatment effects.
In reality, there isn't a single study worldwide that directly compares proton therapy to heavy particle therapy. This lack of comparative research means there is no conclusive evidence supporting the superiority of heavy particle therapy over proton therapy.
Moreover, heavy particle therapy is not covered by health insurance and can incur costs in the tens of millions of won. In contrast, proton therapy is covered by health insurance, except for prostate cancer. Leveraging the 95 percent cost reduction system, applicable to certain conditions requiring high-cost, long-term care, a cancer patient undergoing proton therapy may only bear approximately 1 million won in expenses.
Q: It's been 15 years since the proton therapy machine arrived at the NCC. Are there any plans to improve the facility?
A: In order to modernize the aging proton therapy machine facilities, we planned a facility improvement project in 2019. Since 2022, we have been pushing to introduce a stand-alone small proton therapy machine.
Specifically, our plan involves addressing rare and challenging cancers, including pediatric and eye cancers. These conditions are often avoided by private medical institutions due to their low profitability. We aim to offer state-of-the-art treatment and extend benefits to low-income patients. The equipment has already been ordered and is scheduled for introduction within the next two years.
Q: How effective do you believe the NCC has been in enhancing cancer patient care in Korea? If you were to quantify it, what rating would you assign?
A: I'd rate it 90 out of 100. Korea boasts the world's highest five-year cancer survival rate at 71 percent, a significant increase from the pre-NCC era when it was only 43 percent. Korea stands out as the only one globally to achieve such rapid progress over the past 20 years. This success is attributed to effective early detection practices. Furthermore, the NCC secured the 39th spot on Newsweek's 2023 list of the world's best specialty hospitals for cancer.
Q: We understand that the NCC is a pioneer in treating rare and challenging cancers that private hospitals often avoid.
A: Upon assuming the role of director, I outlined several key initiatives, one of which aims to instill hope in cancer patients by broadening treatment options for rare and intractable cancers. As a significant step, we constructed a new hospital building with a project cost exceeding 100 billion won. This expansion includes dedicated facilities for the treatment of rare and challenging cancers, along with the establishment of a hospice ward.
The main building is being remodeled with a total investment of KRW 107.5 billion to equip the new building with state-of-the-art facilities. Rare and intractable cancers are rarely treated in private hospitals due to the low number of patients and low profitability. As the country's only public institution specializing in cancer, the NCC cannot ignore them.