Early screenings a must to hit lower cancer mortality goals: Experts

Taipei, Dec. 7 (CNA) Early and widespread screenings are crucial if Taiwan hopes to achieve President Lai Ching-te's (賴清德) "Healthy Taiwan" policy goal of dramatically lowering cancer-related deaths, medical experts said at a forum Saturday.

During his presidential campaign, Lai pledged to reduce the number of deaths from cancer in Taiwan by one-third by 2030 through expanded subsidies for screenings and new treatments under his "Healthy Taiwan" policy.

After Lai took office in May, the Cabinet approved NT$10 billion (US$308.5 million) in funding in November to support the development of new cancer drugs.

At a symposium in Taipei focusing on cancer research held by the National Health Research Institutes, medical experts said Lai's goal to cut cancer deaths was possible if screening was expanded.

Chen Shyh-jye (陳世杰), a professor at National Taiwan University's School of Medicine, looked at the issue from the perspective of his specialty -- oral cancer, the cause of the fourth most cancer deaths in Taiwan.

He said the majority of oral cancer cases are currently diagnosed at stage three or four, a clear indication of the need for earlier detection.

"If we could use a widely accessible tool for mass screenings and detect cases at stage one or even stage zero ... patients could fully recover after surgery," said Chen, who is developing a mobile application using artificial intelligence (AI) to detect oral cancer.

Chen said the five-year survival rate for stage zero oral cancer is 76 percent, compared to 30 to 40 percent for stages three and four, illustrating the possibility that early detection could reduce death rates by more than the target set out in the "Healthy Taiwan" policy.

"The prerequisite is that widespread screening must be implemented," Chen said.

Screening for oral cancer in Taiwan is currently limited, Chen said, especially in remote areas where various challenges result in low screening rates, even among high-risk groups, such as those who chew betel nut.

If oral cancer screening could be expanded, similar to the government-funded, widely accessible pap smear screening program for cervical cancer, achieving the goal would be within reach, Chen said.

According to a Health Promotion Administration report, the age-standardized mortality rate for cervical cancer in women aged 30 and above in Taiwan decreased from 22.0 per 100,000 in 1995 (the year the free pap smear screening program was launched) to 5.4 per 100,000 in 2021.

Different metrics

When first proposed, the goal of cutting cancer deaths by a third seemed unachievable, especially given Taiwan's fast-aging population and cancer's greater prevalence among the elderly, said Shan Yan-shen (沈延盛), a member of the Healthy Taiwan Promotion Committee responsible for "Cancer Prevention & Treatment."

To compensate for Taiwan's aging population, the metric used to judge the target was later changed, Shan said.

"The goal was gradually adjusted to focus on reducing the age-standardized cancer mortality rate by one-third," Shan said.

The World Health Organization (WHO) defines the age-standardized mortality rate as a weighted average of age-specific mortality rates per 100,000 persons, where the weights are the proportions of persons in the corresponding age groups of the WHO standard population.

Standardizing rates offers a more accurate comparison of cancer mortality trends over time or between populations, eliminating the effects of demographic changes like aging.

Shan also said that if the focus on addressing cancer remained solely on treatment, it would become "a reactive effort," making it impossible to achieve the goal.