https://www.straitstimes.com/asia/east-asia/how-south-korea-achieved-one-of-the-best-colon-cancer-survival-rates-in-the-world
2023-01-02
SEOUL – Mr Park (not his real name) received a health screening package from his children for his 65th birthday.
He was pleased. A friend of his had gone through a similar screening a couple of years earlier and found himself in the pink of health.
Mr Park expected similar results that he could boast about to his friends.
Basic health screening is free for South Koreans whose income falls below the nation’s median rate. The rest pay up to 10 per cent of the cost, with the remaining 90 per cent borne by the National Health Insurance Service. The screening is for gastric, liver, colorectal, lung, breast and cervical cancers.
South Korea started its national colorectal screening in 2004. By 2021, the participation rate had gone up to 40.3 per cent – or two in five people who are eligible. Under this programme, 5,423 people found out they had colorectal cancer in 2016.
Professor Kim Yeul-hong, from the department of medical oncology and haematology at Korea University in Seoul, said many private companies provide such screening for their employees as part of their perks. Large conglomerates like Samsung and Hyundai extend free screening to employees’ families as well.
Then there are gifts like the one Mr Park received from his children. Such gifts have become part of South Korean culture, says Prof Kim, adding that they have “become a status symbol” and have “also helped to improve the health of people in the country by discovering and treating serious ailments early”.
The number of people who discover their cancers through private screening is not available.
Prof Kim, who also practises at the 1,051-bed Korean University Anam Hospital, said South Koreans are increasingly eager to go for health screening as they know the value of screening and early discovery of serious illnesses.
This has resulted in an increasing trend of children giving screening packages to their parents as presents. Prof Kim added that often, seniors would tell their friends about these packages, further raising awareness of the benefits of screening.
The package Mr Park’s children bought him was a “deluxe” version, and included a colonoscopy, which can detect polyps in the large intestine before they become cancerous, while the national programme uses the faecal occult blood test, which can detect blood in stools, a sign of colon cancer.
However, things did not go as Mr Park expected. The screening found he had colon cancer. Fortunately, it was in the early stage and still confined to the large intestine.
He is one of thousands of patients in South Korea diagnosed with colon cancer through screening, rather than having the disease discovered after symptoms have appeared.
This is one of the factors contributing to the country having possibly the best five-year survival rate for colorectal cancer in the world.
While there are no official figures available, experts estimate that thousands more South Koreans discover polyps at the pre-cancerous stage and have them removed to avoid developing the cancer.
Three in four colorectal cancers are discovered in the early stages in South Korea, compared with less than half in Singapore. Earlier discovery and treatment usually leads to better outcomes.
The five-year survival rate for colorectal cancer in South Korea has improved significantly, from 56.2 per cent in 1993 to 1995, to 74.3 per cent in 2015 to 2019, said Dr Im Jeong-soo, director of the National Cancer Control Institute in South Korea’s National Cancer Centre (NCC).
Only two other countries – Israel and Australia – have five-year survival rates of more than 70 per cent. In Singapore, the rate is 61 per cent. Five-year survival is used as a yardstick as the risk of recurrence is low after five years of being cancer-free.
Colorectal cancer, the third most common cancer globally, kills close to one million people every year. In Singapore, about 2,338 are diagnosed each year, and 856 die from it.
Dr Im said colorectal cancer used to be the second- or third-most common cancer in South Korea from 2003 to 2017. It fell to fourth in 2018, partly due to screening where polyps are removed before they turn cancerous.
However, it remains a major concern as the third leading cause of cancer deaths in the country, after lung and liver cancers.
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Professor Sohn Dae-kyung, a cancer surgeon with the NCC, said: “In South Korea, early detection of colorectal cancer is increasing, and survival rates are improving due to cancer screening programmes.”
But he added that about 20 per cent of patients are still diagnosed after their cancer has spread beyond the colon or rectum. Once that happens, they have a less than one in five chance of surviving five years.
South Korea has increased its use of new targeted therapies for such patients, and results so far are promising, Prof Sohn said.
Other improvements in colon cancer treatment, he said, include using chemotherapy and chemoradiotherapy to shrink the cancerous tumours before surgery, as well as the use of minimally invasive techniques.
He said: “For the treatment of locally advanced colorectal cancer, laparoscopic surgery has become the standard, and robotic surgery has recently been on the rise.
“This minimally invasive surgery supports rapid recovery of patients and supports early start of adjuvant treatment and return to daily life in their society.”
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All three doctors stressed the importance of screening and early detection as the best way to beat cancer, and also emphasised the importance of new anti-cancer drugs.
Dr Im said other areas where South Korea has done well in reducing incidences of cancer are cervical and gastric cancers.
Cervical cancer has fallen from being the fourth-most common cancer in women in 2001 to 10th place by 2019. The drop was attributed to national cervical cancer screening that started in 2002.
In 2021, 3,239,000 women went for screening under the national programme. Today, there is also a vaccine that significantly reduces the risk of cervical cancer.
Gastric cancer used to be the most common cancer in South Korea. With national screening since 2002, it has fallen to third place. In 2021, 4,268,000 people, or about 63 per cent of those eligible, were screened for this cancer under the national programme.
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