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[Column] The Reason for the Sharp Decrease in Colorectal Cancer and Similar Level in Stomach CancerKim Chul-joong’s differential diagnosis
  • By Kim Chul-joong Columnist
  • Published 2017.01.26 10:35
  • Updated 2017.08.30 09:22
  • comments 0

The Korean cancer patterns are frequently changed, which reflects dynamic changes of Korean society. Cancer occurrence and survival result from life styles such as smoking, diets, and workouts in each country. And also, the healthcare system and healthcare practice have a great effect on cancer occurrence.

Let’s take a look at colorectal cancer. Several years ago, the increasing speed of colorectal cancer occurrence was ranked in the first place in the world. The speed has sharply increased every year and might leave Korean traditional cancer stomach cancer behind. But over 3-4 years ago, the occurrence rate dropped. The new patients with colorectal cancer were 26,978 in 2014, down 3.2% from a year earlier. In the statistics of cancer occurrence, the figure is amazing. Did Koreans reduce abdominal obesity, decrease the intake of meat, and work out harder than before? Even though they did, the anti-cancer effect will be available several years later.
Then why did the occurrence of colorectal cancer decrease? The secret lies in colonoscopy. Since 2010, 2 million colonoscopies have been performed every year. How did the figure come out? The answer is the irony of medical fees. The fee for colonoscopy is very low in Korea. Doctors at the Gastroenterology department say the fee doesn’t reach to the cost price. But there are still many cases because almost all colonoscopies require sedation. Sedation isn’t covered by insurance. Each hospital can set the price and make money. It is strange sedation is the necessary part to make hospitals earn money when doctors conduct colonoscopies. But this is the reason why the cases for colonoscopy have increased.

And also, a lot of surgeons trying to perform colonoscopy are another reason. Korean doctors are good at colonoscopy. Quantity is more important than quality in medical treatment.

As a result, huge amounts of polyps have been removed. Polyps are detected from 4 in 10 middle-aged people. It means 2 million colonoscopies were conducted a year and numerous numbers of polyps from about 800,000 people were removed every year: nip the bud of colorectal cancer. It resulted in a sharp decrease in the occurrence of colorectal cancer.

On the other hand, how about stomach cancer? The occurrence has been steadily reduced. Stomach cancer is ranked in the first place in Korea for several years except for thyroid cancer, the controversial disease for over-diagnosis. Because of gastro fiberscope, the ratio to detect stomach cancer at the early stage is about 70%. Therefore, the survival rate dramatically increased from 57.7% in 2006 to 74.4% in 2016. If people want to dramatically decrease the occurrence of stomach cancer, they have to change some risk factors such as the drop in eating salty and fermented food. Because stomach cancer is related to eating habits, the change is slowly made.

In Japan, the mortality rate from stomach cancer has drastically decreased since 2001. This is because the treatment for infection of Helicobacter pylori was covered by medical insurance. Regardless of the symptoms, if people are infected, they can be treated at low price. In Korea, people can get health insurance only when they are diagnosed with gastric ulcer. Because of the policy, Japan allegedly reduced mortality from stomach cancer by about 16,000 in 2014. Japan could save the budget for medical insurance even though it paid the fee for antibiotic treatment. The reduction of cancer occurrence caused by medical policy includes vaccination for cervical cancer, support for anti-smoking treatment etc.

An ageing population is getting increasing and the cancer occurrence continues to grow. One in 3 or 4 people is dead because of cancer. The government has to compensate enough medical fees for cancer diagnosis and treatment for cancer control and provide health insurance. This is the way to decrease national budget for medical fees and Koreans can enjoy a healthy life for a long time.


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Kim Chul-joong is a radiologist and medical correspondent for Chosun Ilbo. He also served as the former president at the World Federation of Science Journalists (WFSJ).

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