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JACR MONOGRAPH No.16 がん登録と社会との調和 編集 岡本 直幸 伊藤 秀美 伊藤 ゆり 味木 和喜子 津熊 秀明 特定非営利活動法人 地域がん登録 全国協議会 2010 JACR MONOGRAPH No. 16 ߇ࠎ⊓㍳ߣ␠ળߣߩ⺞ ✬㓸 ጟᧄ દ⮮ દ⮮ ᧁ ᵤᾢ ⋥ᐘ ⑲⟤ ࠁࠅ ༑ሶ ⑲ ․ቯ㕖༡ᵴേᴺੱ ၞ߇ࠎ⊓㍳ ో ࿖ ද ⼏ ળ 2010 ߪߓߦ ╙ 19 ࿁ၞ߇ࠎ⊓㍳ో࿖ද⼏ળ㧔JACR㧕⥃ᤨ✚ળߥࠄ߮ߦቇⴚ㓸ળࠍޔᐔᚑ 22 ᐕ 10 15 ᣣ㧔㊄㧕ߦᮮᵿᏒߩ⿒ࡦࠟୖᐶߢ㐿ߚߒ߹ߒߚᧄޕᐕᐲߪ╙ 32 ࿁࿖㓙߇ࠎ⊓㍳ද⼏ળ 㧔IACR㧕ቇⴚ✚ળߦᒁ߈⛯߈ⴕ߹ߒߚ㑐ଥߢޔᐕߣߪ⇣ߥߞߚ㐿ߦߥࠅ⊝ޔ᭽ߦࠈࠈ ߣߏਇଢࠍ߅߆ߌߔࠆߩߢߪߥ߆ߣ᩺ߓߡ߅ࠅ߹ߒߚ߇ޔᄙߊߩᣇߏߩޘᡰេࠍߚߛ߈ή ߦ㐿ߢ߈߹ߒߚߎߣࠍᗵ⻢ߚߒߡ߅ࠅ߹ߔޕ వߦㅀߴ߹ߒߚࠃ߁ߦޔᐔᚑ 22 ᐕ 10 12㧙14 ᣣߦⴕࠊࠇ߹ߒߚ IACR ߩቇⴚ✚ળߦวࠊߖ ߡ㐿ߒߚ㑐ଥߢޔJACR ߩቇⴚ㓸ળߩ࠹ࡑࠍ IACR ߣหߓ⊓ࠎ߇ޟ㍳ߣ␠ળߣߩ⺞ߒߣޠ ߡ㐿ߐߖߡߚߛ߈߹ߒߚޕ࿖ౝᄖ߆ࠄ 152 ฬߩߏෳട߇ࠅޔᵴ᳇ߩࠆળߣߥࠅ߹ߒߚޕ ඦ೨ਛߪࡐࠬ࠲㧔ቇⴚ⊒ 19 㗴⊓ޔ㍳ቶ⚫ 26 㗴㧕ߢߩߏ⊒ࠍߚߛ߈✚ޔળ㐿ߩᓟޔ ඦᓟ߆ࠄߪ㐿⻠ᐳࠍ㐿ߒޔၞ߇ࠎ⊓㍳ߩ⍮ߣℂ⸃ࠍᷓߡߚߛߊߚߩ⻠Ṷળࠍⴕ ߹ߒߚߩߎޕ㐿⻠ᐳߢߪޔᄹᎹ⋵ஜዪஜක≮ㇱ㐳ߩਛᴛ♿వ↢ޔ࿖㓙߇ࠎ⊓㍳ද ⼏ળℂ㐳ࡉࡦ࠳Kࠛ࠼ࡢ࠭వ↢ߦߏᜦࠍߚߛ߈ޔᒁ߈⛯߈ࠛ࠼ࡢ࠭వ↢ޔᄢ㒋 ᐭ┙ᚑੱ∛ࡦ࠲ߩᄢፉవ↢ࠍᐳ㐳ߦ߆߃ޔ࿖㓙߇ࠎ⎇ⓥᯏ㑐߇ࠎᖱႎㇱㇱ㐳ߩ࠺ࡆ࠶ ࠼ࡈࠜࠕࡑࡦవ↢߆ࠄޟ⇇ߦ߅ߌࠆ߇ࠎߩࡕ࠾࠲ࡦࠣߣ߇ࠎኻ╷⸘↹ޠ ޔ㖧࿖࿖┙߇ࠎࡦ ࠲߇ࠎ⊓㍳↢‛⛔⸘ቇㇱ㐷ㇱ㐷㐳ߩ࠰ࡅࡄࠢవ↢߆ࠄޟ㖧࿖ߦ߅ߌࠆ߇ࠎߩࡕ࠾࠲ࡦ ࠣߣ߇ࠎኻ╷⸘↹ޠ ޔ࿖┙บḧᄢቇⴐⴡ↢ቇ㒮੍㒐කቇ⎇ⓥᚲᢎߩࡔࠗࠪࡘࠗవ↢߆ࠄޟบ ḧߦ߅ߌࠆ߇ࠎߩࡕ࠾࠲ࡦࠣߣ߇ࠎኻ╷⸘↹⻠ߏߩޠṶࠍߚߛ߈߹ߒߚޕભᙑࠍߺࠢࡄޔ వ↢߅ࠃ߮ၞ߇ࠎ⊓㍳ో࿖ද⼏ળℂ㐳ᵤᾢ⑲వ↢ߩᐳ㐳ߦࠃࠅޔ࿖┙߇ࠎ⎇ⓥࡦ࠲߇ ࠎኻ╷ᖱႎࡦ࠲߇ࠎᖱႎ⛔⸘ㇱㇱ㐳ߩῳᳯቁవ↢߆ࠄޟⓍᭂ⊛ߥࡕ࠾࠲ࡦࠣ߆ࠄ ലߥ߇ࠎኻ╷߳㧙ᣣᧄߩታࠃࠅ㧙⻠ߏߩޠṶࠍߚߛ߈ᦨߡߒߘޔᓟߦ⑳ߩᣇ߆ࠄޟᄹᎹ⋵ ߩ߇ࠎ⊓㍳ߡߟߦޠႎ๔ߐߖߡߚߛ߈߹ߒߚޕ 㐿⻠ᐳޔቇⴚࡐࠬ࠲ߩౝኈߦ㑐ߒ߹ߒߡߪᧄࡕࡁࠣࡈࠍ߅⺒ߺߚߛߌࠇ߫ޔචੑಽߦ ߏℂ⸃ߒߡߚߛߌࠆ߽ߩߣᕁߞߡ߹ߔޕᕡߩࡐࠬ࠲ࠕࡢ࠼ߢߪޔቇⴚࡐࠬ࠲߆ࠄ 2 ⚵ޔᄢ㒋ᮦ⬺ᅚሶᄢቇቇ⧓ቇㇱߩ㋈ᧁሶߐࠎߦࠃࠆޟၞ߇ࠎ⊓㍳⾗ᢱߦၮߠߊ⎇ⓥᚑᨐߩ᥉ ߩߚߩᢎ⢒࠷࡞㐿⊒ޠ ޔᄢ㒋ᄢቇᄢቇ㒮කቇ♽⎇ⓥ⑼ߩ↰⌀ߐࠎߦࠃࠆޟ㐳ፒ⋵߇ࠎ⊓ ㍳ߦၮߠߊ 2 ⒳㘃ߩ IM Ყߦ㑐ߔࠆᬌ⸛⊓ޔߚ߹ޔޠ㍳ቶ⚫ࡐࠬ࠲߆ࠄߪ 1 ⚵⟲ޟ㚍⋵ၞ߇ ࠎ⊓㍳ቶ߇ޠㆬ߫ࠇ߹ߒߚޔࠇߙࠇߘޕᣂߒ⹜ߺ߇⹏ଔߩኻ⽎ߣߥࠅ߹ߒߚޕ ᧄᐕᐲߪޔᐕߩቇⴚ㓸ળߣߪ⇣ߥߞߚᒻߢታᣉߒߡෳࠅ߹ߒߚ߇ޔᄙߊߩᣇߏߩޘෳട߿ࡐ ࠬ࠲⊒ࠍߚߛ߈ᔃࠃࠅᗵ⻢ߚߒߡ߅ࠅ߹ߔ⑳ޕੱߣߚߒ߹ߒߡߪޔ10 ᐕ೨ߦ╙ 9 ࿁ JACR ߩ✚ળቇⴚ㓸ળࠍ߅ᒁ߈ฃߌߒޔ࿁ߩ╙ 19 ࿁߇ 2 ࿁⋡ߩ㐿ߢߏߑ߹ߒߚ߇ߏޔᛚ ⍮ߩࠃ߁ߦ╙ 32 ࿁ IACR ߩቇⴚ㓸ળߣวࠊߖߡߩ㐿ߢߏߑ߹ߒߚߩߢޔḰᲑ㓏߆ࠄ⻠Ꮷߩ ଐ㗬ㅪ⛊߿ᷤޔᛞ㍳ߩᚑߥߤߩ⚦߆ോዪᬺߪߔߴߡද⼏ળോዪ⡯ຬߦ߅㗿ߚ ߒߚᰴ╙ߢߔߏߩ߹ߐ⊝ߩࡈ࠶࠲ࠬޕදജ߇ߞߚ߆ࠄߎߘήߦቇⴚ㓸ળࠍ㐿ߢ߈߹ߒߚߎ ߣޔᔃࠃࠅ߅␞ࠍ↳ߒߍ߹ߔޕ ᦨᓟߦ ╙ޔ19 ࿁ߩቇⴚ㓸ળߣᧄࡕࡁࠣࡈ߇ᓟߩࠊ߇࿖ߩၞ߇ࠎ⊓㍳ߩᣂߚߥ␆ߦߥࠆߎ ߣࠍಾߦ㗿ߞߡ߹ߔ⊝ߪߦߚߩߘޕ᭽ߦᧄࡕࡁࠣࡈࠍߏᵴ↪ߒߡߚߛߊߎߣߢࠈ߁ߣ ᕁߞߡ߹ߔ⊝ޕ᭽ᧄޔᒰߦࠅ߇ߣ߁ߏߑ߹ߒߚޕ 㧔ጟᧄ ⋥ᐘ㧕 ၞ߇ࠎ⊓㍳ో࿖ද⼏ળ ╙ 19 ࿁ቇⴚ㓸ળ㐿⻠ᐳࡊࡠࠣࡓ The Extension Course on Cancer Registry organized by JACR ᣣᤨ㧦ᐔᚑ 22 ᐕ 10 15 ᣣ㧔㊄㧕 Date: Friday, October 15, 2010 ႐ᚲ㧦ᮮᵿ⿒ࡦࠟୖᐶ 1 ภ㙚 Place: Yokohama Red Brick Warehouse 㧔2 㓏ࠬࡍࠬ ABޔ3 㓏ࡎ࡞㧕 1. ࡐࠬ࠲⊒ቇ 2. ࡐࠬ࠲ᓆ 3. ᐔ ᚑ 22 ᐕᐲၞ߇ࠎ⊓㍳ታോᜂ ᒰഞഭ⠪ ᓆᑼ 4. ᐔᚑ 22 ᐕᐲ⥃ᤨ✚ળ 5. ᤤ㘩 6. 㐿⻠ᐳ 㐿ળᜦ ਛᴛ ♿ 㧔ᄹᎹ⋵ஜዪஜක≮ㇱ㐳㧕 ࡉࡦ࠳ K. ࠛ࠼ࡢ࠭ 㧔 ࿖ 㓙 ߇ ࠎ ⊓ ㍳ ද ⼏ ળ ℂ㐳☨ޔ࿖࿖┙߇ࠎ⎇ⓥᚲ߇ࠎኻ╷ੱญቇㇱࠨࡌࠗ ࡦࠬࠨ࠴ࡊࡠࠣࡓㇱ㐳㧕 ᐳ㐳㧦ࡉࡦ࠳ K. ࠛ࠼ࡢ࠭ޔᄢፉ 1) ⇇ߦ߅ߌࠆ߇ࠎߩࡕ࠾࠲ࡦࠣߣ߇ࠎኻ╷ ⸘↹ ࠺ࡆ࠶࠼ࡈࠜࠕࡑࡦ㧔IARCޔ࿖㧕 2) 㖧࿖ߦ߅ߌࠆ߇ࠎߩࡕ࠾࠲ࡦࠣߣ߇ࠎኻ╷ ⸘↹ ࠰ࡅࡄࠢ㧔࿖┙߇ࠎࡦ࠲ޔ㖧࿖㧕 3) บḧߦ߅ߌࠆ߇ࠎߩࡕ࠾࠲ࡦࠣߣ߇ࠎኻ╷ ⸘↹ ࡔࠗࠪࡘࠗ㧔࿖┙บḧᄢቇޔบḧ㧕 ᐳ㐳㧦࠰ࡅࡄࠢޔᵤᾢ ⑲ 4) Ⓧᭂ⊛ߥࡕ࠾࠲ࡦࠣ߆ࠄലߥ߇ࠎኻ╷߳ 㧙ᣣᧄߩታࠃࠅ㧙 ῳᳯ ቁ㧔࿖┙߇ࠎ⎇ⓥࡦ࠲㧕 5) ᄹᎹ⋵ߩ߇ࠎ⊓㍳ ጟᧄ ⋥ᐘ㧔ᄹᎹ⋵┙߇ࠎࡦ࠲㧕 7. 㐽ળߩᜦ ጟᧄ ⋥ᐘ㧔ળ㐳ᄹᎹ⋵┙߇ࠎࡦ࠲㧕 Opening Address Mr. Akinori Nakazawa Director, Health Care and Medical Services Dept., Public Health and Welfare Bureau, Kanagawa Pref. Gov., Japan Dr. Benda K. Edwards IACR president, Division of Cancer Control and Population Sciences, NCI, Program Chairpersons: Dr. Brenda K. Edwards and Dr. Akira Oshima 1) Cancer monitoring and control planning in the world by Dr. David Forman, Cancer Information Section, International Agency for Research on Cancer, France 2) Cancer monitoring and control planning in Korea by Dr. Sohee Park, Cancer Registration and Statistics Branch, NCCI Cancer Biostatistics Branch, NCCRI, NCC, Korea 3) Cancer monitoring and control planning in Taiwan by Dr. Mei-shu Lai , Inst. of Prev. Med. College of Public Health, Natl. Taiwan Univ., Taiwan (Break) Chairpersons: Dr. Sohee Park and Dr. Hideaki Tsukuma 4) Active Monitoring of Cancer Incidence Leads to Effective Cancer Control: an Example of Japan by Dr. Tomotaka Sobue, Center for Cancer Control and Information Services, NCC, Japan 5) Cancer Registration in Kanagawa by Dr. Naoyuki Okamoto, Kanagawa Cancer Registry, Cancer Prevention and Control Division, Kanagawa Cancer Center, Japan Closing Remarks Dr. Naoyuki Okamoto Kanagawa Cancer Registry, Cancer Prevention and Control Division, Kanagawa Cancer Center, Japan ߇ࠎ⊓㍳ߣ␠ળߣߩ⺞ ⋡ ᰴ ߪߓߦ ጟᧄ ⋥ᐘ ႎ ๔Σ㧦㐿⻠ᐳࠃࠅ The extension course 1. ⇇ߦ߅ߌࠆ߇ࠎߩࡕ࠾࠲ࡦࠣߣ߇ࠎኻ╷⸘↹ ࠺ࡆ࠶࠼ࡈࠜࠕࡑࡦ------ 1 Cancer Monitoring and Control Planning in the World David Forman 2. 㖧࿖ߦ߅ߌࠆ߇ࠎߩࡕ࠾࠲ࡦࠣߣ߇ࠎኻ╷⸘↹ ࠰ࡅࡄࠢ ------- 13 Cancer Monitoring and Control Planning in Korea Sohee Park 3. บḧߦ߅ߌࠆ߇ࠎߩࡕ࠾࠲ࡦࠣߣ߇ࠎኻ╷⸘↹ ࡔࠗࠪࡘࠗ ------- 35 Cancer Monitoring and Control Planning in Taiwan Mei-Shu Lai 4. Ⓧᭂ⊛ߥࡕ࠾࠲ࡦࠣ߆ࠄലߥ߇ࠎኻ╷߳ ῳᳯ ቁ ------- 49 Active Monitoring of Cancer Incidence Leads to Effective Cancer Control: an Example of Japan 5. ᄹᎹ⋵ߩ߇ࠎ⊓㍳ Cancer Registration in Kanagawa Tomotaka Sobue ጟᧄ ⋥ᐘ ------- 61 Naoyuki Okamoto ႎ ๔Τ㧦ࡐࠬ࠲⊒߆ࠄ 1. ✛⨥៨ขߣ㗡㗖ㇱ㘩߇ࠎߩ㑐ㅪ 2. 1998 ᐕ㧙2000 ᐕߦ⸻ᢿߐࠇߚ⟲㚍⋵ߦ߅ߌࠆ ೨┙⣼߇ࠎ⟕ᖚߩ 5 ᐕ⋧ኻ↢ሽ₸ 3. ࡔ࠶ࠪࡘᴺߢߺߚ߇ࠎ⟕ᖚᱫߣ␠ળ⚻ᷣ⊛ⷐ࿃ߩ㑐ㅪ ጊ ૫ ઍ ሶ 㧘 ઁ ---- 75 4. ᣣᧄߦ߅ߌࠆ⣾⢲߇ࠎߩᕈᏅ ᧻ ↰ ᥓ ᄢ 㧘 ઁ ---- 77 5. ⚵❱⊓㍳߆ࠄߺߚᐢፉ⋵ߦ߅ߌࠆਛᨔ⚻♽⣲≌ߩ ⚵❱ဳᬌ⸛ ┙ ጊ ⟵ ᦶ 㧘 ઁ ---- 78 6. ၞ߇ࠎ⊓㍳࠺࠲ࠍᵴ↪ߒߚ⢗ౝⷞ㏜ᬌ⸻ߩ ↢ሽ₸ߦࠃࠆലᕈ⹏ଔ ጯ ᧄ ᜏ ᴦ 㧘 ઁ ---- 80 7. ၞ߇ࠎ⊓㍳࠺࠲ࠍ↪ߚ↵ᕈ߇ࠎߩ⟕ᖚߩേะ દ ⮮ ⑲ ⟤ 㧘 ઁ ---- 81 㧙ᅚᕈ߇ࠎߣᲧセߒߡ㧙㧦Monitoring of Cancer Incidence in Japan(MCIJ)2004 8. ᣣᧄߩㇺᐭ⋵߇ࠎ⟕ᖚ⠪ᢙផ⸘ ㄖ Ꮘ ૫ ሶ 㧘 ઁ ---- 82 9. PSA ᬌ⸻ዉၞ㧔㐳ፒ⋵Ꮢ㧕ߦࠄࠇߚ ೨┙⣼߇ࠎᱫ₸ᷫዋ ᣧ ↰ ߺ ߤ ࠅ 㧘 ઁ ---- 83 10. 㐳ፒ⋵߇ࠎ⊓㍳ߦၮߠߊ 2 ⒳㘃ߩ IM Ყߦ㑐ߔࠆᬌ⸛ ↰ ⌀ 㧘 ઁ ---- 84 11. ၞ߇ࠎ⊓㍳⾗ᢱߦၮߠߊ⎇ⓥᚑᨐߩ᥉ߩߚߩ ᢎ⢒࠷࡞㐿⊒ ㋈ ᧁ ሶ 㧘 ઁ ---- 86 የ ἑ ഞ 㧘 ઁ ---- 73 ₎ ᧁ ା 㧘 ઁ ---- 74 12. ᣣᧄߩၞ߇ࠎ⊓㍳ߩ⁁㧦╙ 3 ᰴኻ߇ࠎ ᧁ ༑ ሶ 㧘 ઁ ---- 88 ߩࠎ߇ޟታᘒᛠីߦ㑐ߔࠆ⎇ⓥ ╙⃰ޠ3 ᦼ೨⺞ᩏ⚿ᨐࠃࠅ㧔╙㧝ႎ㧕 13. ᣣᧄߩၞ߇ࠎ⊓㍳ߩ⁁㧦╙ 3 ᰴኻ߇ࠎ ਣ ⍮ ⟤ 㧘 ઁ ---- 89 ߩࠎ߇ޟታᘒᛠីߦ㑐ߔࠆ⎇ⓥ ╙⃰ޠ3 ᦼ೨⺞ᩏ⚿ᨐࠃࠅ㧔╙ 2 ႎ㧕 14. 㜞㦂ൻߩㅴⴕߔࠆၞߦ߅ߌࠆ߇ࠎߩ⊒↢ߣኅᣖᕈ࿃ሶ ጟ ᧄ ᐙ ਃ 㧘 ઁ ---- 90 ߅ࠃ߮ࠗࡈࠬ࠲ࠗ࡞ߦ㑐ߔࠆ೨ะ߈ࠦࡎ࠻⎇ⓥ 15. ో࿖߇ࠎ⟕ᖚផ⸘ߩା㗬㑆ߩ▚ 㔀 ⾐ ⟤ ሶ 㧘 ઁ ---- 93 16. ᚒ߇࿖ߦ߅ߌࠆሶች߇ࠎ⟕ᖚߩផ⒖ 㧙11 ߩၞ߇ࠎ⊓㍳࠺࠲߆ࠄ㧙 ᄢ ᧁ ߕ ߺ 㧘 ઁ ---- 94 17. ᣣᧄߩၞ߇ࠎ⊓㍳ቶߦ߅ߌࠆో▤ℂភ⟎ߩ⁁ ㊁ ༀ ৻ 㧘 ઁ ---- 96 18. ࡑ࡞ࠦࡈࡕ࠺࡞ߦࠃࠆ߇ࠎᖚ⠪੍ᓟߩ⸃ᨆ 㧙㐳ፒ߇ࠎ⊓㍳ࠍ↪ߡ㧙 ၳ ⧘ ਭ ⟤ 㧘 ઁ ---- 97 19. ࠺࠲ಽᢔ▤ᛛⴚࠍ↪ߚ߇ࠎ⊓㍳࠺࠲ోߩߚߩ ታ⸽⹜㛎 ਃ ᤐ ᄦ ----199 世界におけるがんのモニタリングとがん対策計画 CANCER MONITORING AND CONTROL PLANNING IN THE WORLD デビッド・フォアマン* David Forman This presentation will examine the 本発表は世界のがんモニタリングにおける contribution of cancer registries to the がん登録の貢献について考察するものである。 global monitoring of cancer. In the last 50 この 50 年間で、先進国においては、何らか years, most developed countries in the の形でがん登録が開始されてきた。カバー率 world have initiated some form of cancer および質は多様であるものの、ある程度の信 registration. Although the coverage and 頼性をもって、先進国間のがんのパターンを quality now 知ることができるようになった。がんの影響 understand the pattern of cancer within は集団が異なれば、その程度も異なることは the developed world with some reliability. 明らかである。異なるコミュニティにおける It is apparent that cancers affect different 異なるがんの相対的な深刻さを知ることや、 populations extents. がんの経年変化を観測することは、証拠に基 Understanding the relative importance of づく対がん戦略の基盤において、いかなる場 different cancers in different communities 合にも不可欠な要素である。しかしながら、 and observation of the trends in cancers 2008 年および 2030 年までの世界のがんの負 over time are vital components of the 担の推計値を提供する GLOBOCAN の最新 evidence cancer 版は、全世界のがんの内、低・中資源国の占 latest める割合が増加していることを示している。 providing 残念なことに、いくつかの例外を除いては、 estimates of the worldwide burden of これらの国では、がん登録は整備中、あるい cancer in 2008 and projections to 2030, は存在しない。それゆえ、そのような地域に shows that an increasing proportion of おいてがんの負担を推計することは、もとも cancer and とかなり不確実なものだ。国連が世界の発展 medium-resource countries. Unfortunately, 途上国における罹患率や死亡率への非感染性 with a few exceptions, these are countries 疾患の寄与の大きさを認識しはじめた今こそ、 where cancer registration is substantially 効果的ながん対策計画を策定するためにがん under developed or non-existent. There are, 登録の可能性を高めることが重要である。 control varies greatly, to base very of is therefore, can different underlying strategy. version we any However, the GLOBOCAN, occurring within considerable low- uncertainties inherent in estimating the burden of cancer in these regions. At a time when the United Nations is recognising the contribution of *国際がん研究機関 がん情報部 Cancer Information Section, International Agency for Research on Cancer, France 1 non-communicable diseases to morbidity and mortality in the developing regions of the world, it is essential to build cancer registration capacity in order to formulate effective control programmes. 2 ⇇䈮䈍䈔䉎 䈏䉖䈱䊝䊆䉺䊥䊮䉫䈫 䈏䉖ኻ╷⸘↹ Cancer monitoring and control planning in the world David Forman 䊂䊎䉾䊄䊶䊐䉤䉝䊙䊮 Section of Cancer Information International Agency for Research on Cancer Lyon, France Section of Cancer Information ࿖㓙䈏䉖⎇ⓥᯏ㑐 䈏䉖ᖱႎㇱ International Agency for Research on Cancer Lyon, France JACR Course (Yokohama) – 15th Oct 2010 IARC Medium-Term Strategy 2010-14 ࿖㓙䈏䉖⎇ⓥᯏ㑐䋨IARC䋩ਛᦼᚢ⇛ 2010-14 Priority - Describing the Global Cancer Burden ఝవ㗄 – ో⇇䈱䈏䉖䈮䉋䉎⽶⩄䈱⁁ᴫ䉕⸥ㅀ The definitive international point of reference for collection, quality control, processing and statistical analysis of accurate data on cancer occurrence 䈏䉖䈱⊒↢䈮䈍䈔䉎ᱜ⏕䈭䊂䊷䉺䈱㓸䇮⾰▤ℂ䇮ಣ ℂ䉇⛔⸘⊛⸃ᨆ䈮䈍䈇䈩ᦨ䉅ା㗬䈱䈍䈔䉎࿖㓙ၮḰὐ 䈫䈒䈮䊂䊷䉺䈏ਇ⿷䈚䈩䈇䉎ၞ䈮䈍䈔䉎䈏䉖⊓㍳ᵴേ 䈱䉦䊋䊷₸䇮ㅪ⛯ᕈ䇮⾰䈱ะ ᖱႎ䉝䉪䉶䉴䈱ᡷༀ ⎇ⓥ䈱䈢䉄䈱ၮ⋚䋺䊥䉴䉪䊐䉜䉪䉺䊷䋻੍㒐น⢻䈭䉇 ⋡ᮡ䉕ቯ䉄䈢ᬌ⸻䊒䊨䉫䊤䊛 Expanded coverage, continuity, and quality of cancer registration activities, particularly in regions where data are lacking Improved access to information A platform for research: risk factors; preventive interventions and targeted screening programmes Cancer monitoring and control planning in the world ⇇䈮䈍䈔䉎䈏䉖䈱䊝䊆䉺䊥䊮䉫䈫䈏䉖ኻ╷⸘↹ UICC World Cancer Declaration - second target for 2020 UICC ⇇䈏䉖ት⸒ – 2020ᐕ䈮ะ䈔䈢2⇟ ⋡䈱⋡ᮡ⸳ቯ The measurement of the global cancer burden and the impact of cancer control interventions will have improved ⇇⊛䈭䈏䉖䈮䉋䉎⽶⩄䈱⸘᷹䈫䈏䉖ኻ╷䈮䉋䉎䈱䉟䊮䊌 䉪䊃䈏⪺䈚䈒ะ䈜䉎 WHO 2008-2013 䉝䉪䉲䊢䊮䊒䊤䊮 significantly WHO 2008-2013 Action Plan 㕖ᗵᨴᕈ∔ᖚ䈱⇇⊛੍㒐䈍䉋䈶ኻ╷ᚢ⇛ ⋡ᮡ6: 㕖ᗵᨴᕈ∔ᖚ䈫䈠䈱ቯⷐ࿃䉕䊝䊆䉺䊷䈜䉎䈖䈫䈫࿖ኅ䇮 ၞ䇮⇇䊧䊔䊦䈪䈱ㅴ⁁ᴫ䉕⹏ଔ䈜䉎䈖䈫 Global Strategy for the Prevention and Control of Noncommunicable Diseases Objective 6: To monitor non-communicable diseases and their determinants and evaluate progress at the national, regional and global levels Cancer monitoring and control planning in the world ⇇䈮䈍䈔䉎䈏䉖䈱䊝䊆䉺䊥䊮䉫䈫䈏䉖ኻ╷⸘↹ 1) Planning for cancer control - estimates of cancer burden, targeting public health interventions (e.g. socio-economic status, ethnicity) 1) 䈏䉖ኻ╷⸘↹ – 䈏䉖䈮䉋䉎⽶⩄䉕ផቯ䈚䇮ⴐ ⴡ↢⊛䉕⋡ᮡ䈫䈜䉎䋨䋺␠ળ⚻ᷣ࿃ሶ䇮᳃ ᣖᕈ䋩 2) ේ࿃⺰䈱⺑ᒻᚑ – 䈏䉖⟕ᖚ䈱ℂ⊛䇮ᤨ㑆 ⊛䈭Ꮕ⇣ 3) ේ࿃䈱ℂ⸃䈫䈱⹏ଔ –∝䈱หቯ䇮䈋䈳 䉮䊖䊷䊃⎇ⓥ䈮䈍䈔䉎⎇ⓥ䈱䉣䊮䊄䊘䉟䊮䊃 4) ⴐⴡ↢⊛䈱⹏ଔ – 䈏䉖⟕ᖚ䊶ᱫ䊶↢ሽ ₸䈱⚻ᐕᄌൻ 2) Generating hypotheses of aetiology – geographic and temporal variations in cancer incidence 3) Understanding aetiology and evaluating interventions - case identification, research endpoints e.g. in cohort studies 4) Evaluating public health interventions – temporal variations in incidence, survival and mortality 3 GLOBOCAN 2008 online http://globocan.iarc.fr GLOBOCAN 2008 online http://globocan.iarc.fr Cancer monitoring and control planning in the world ⇇䈮䈍䈔䉎䈏䉖䈱䊝䊆䉺䊥䊮䉫䈫䈏䉖ኻ╷⸘↹ GLOBOCAN 2008 GLOBOCAN 2008 Definitive global reference source for national and international agencies in setting priorities for cancer control Information on incidence and mortality for all major cancer types (27) for almost all countries of the world (185) Use of best available data from cancer registries worldwide and/or estimates based on most accurate alternative sources together with WHO Mortality databank Provides recent estimates - (not a substitute for Cancer Incidence in Five Continents) User friendly web interface Provided as user-friendly online utility at: ¾ http://globocan.iarc.fr Cancer monitoring and control planning in the world ࿖ኅ䉇࿖㓙ᯏ㑐䈮䈍䈇䈩䇮䈏䉖ኻ╷䈱ఝవ㗅䉕⸳ቯ䈜䉎㓙䈮䇮 ᦨ䉅ା㗬䈱䈍䈔䉎⇇⊛䈭ෳᾖ⾗ᢱ 䈾䈫䉖䈬ో䈩䈱࿖䋨185䉦࿖䋩䈮䈍䈔䉎ో䈩䈱ਥ䈭䈏䉖䈱ㇱ䋨27 ㇱ䋩䈱䈏䉖⟕ᖚ䈍䉋䈶ᱫ䈱ᖱႎ ⇇ਛ䈱䈏䉖⊓㍳⾗ᢱ䈎䉌䈱↪น⢻䈭ᦨ㜞䈱⾗ᢱ䉕↪䈅 䉎䈇䈲䇮ᦨ䉅ᱜ⏕䈭ઍᦧ⾗ᢱ䈫WHOᱫ䊂䊷䉺䊋䊮䉪䈮ၮ䈨䈒ផ ⸘ ᦨᣂ䈱ផ⸘䉕ឭଏȸ䋨ᄢ㒽䈱䈏䉖⟕ᖚ䈱ઍ↪䈪䈲䈭䈇䋩 䊡䊷䉱䊷䊐䊧䊮䊄䊥䊷䈭䉡䉢䊑䉟䊮䉺䊷䊐䉢䉟䉴䈲એਅ䈱䉰䉟䊃䉋䉍 ↪น⢻䋺 ¾ http://globocan.iarc.fr ⇇䈮䈍䈔䉎䈏䉖䈱䊝䊆䉺䊥䊮䉫䈫䈏䉖ኻ╷⸘↹ In 2008, best estimates: 12.7 million new cancer cases 7.6 million cancer deaths 56% of new cancer cases and 63% of deaths in developing regions of the world 2008ᐕ䈱ᦨ䉅ା㗬䈱䈍䈔䉎ផ⸘䈪䈲 1270 ਁੱ䈱䈏䉖⟕ᖚ 760 ਁੱ䈱䈏䉖ᱫ 䈏䉖⟕ᖚ䈱䈉䈤56䋦䇮䈏䉖ᱫ䈱䈉䈤 63% 䈏⊒ዷㅜ࿖ Estimated numbers of new cancer cases and deaths in men In developed and developing regions of the world in 2008. 2008ᐕ ⊒ዷㅜ࿖䈫వㅴ࿖䈮䈍䈔䉎↵ᕈ䈱ផ⸘䈏䉖⟕ᖚᢙ వㅴ࿖ ⊒ዷㅜ࿖ ⢖ ೨┙⣼ ᄢ⣺ ⢗ ⢄ 㘩 ⣾⢲ 㕖䊖䉳䉨䊮䊥䊮䊌⣲ ⊕ⴊ∛ ญໃ䊶ญ⣧ ⣢ ⤟⤳ ༄㗡 ⣖ 㥦ຜ㗡એᄖ䈱ຜ㗡 䋨1000ੱ䋩 4 ⟕ᖚ ᱫ Estimated numbers of new cancer cases and deaths in women In developed and developing regions of the world in 2008. 2008ᐕ ⊒ዷㅜ࿖䈫వㅴ࿖䈮䈍䈔䉎ᅚᕈ䈱ផ⸘䈏䉖⟕ᖚᢙ వㅴ࿖ ⊒ዷㅜ࿖ ᚱ ᄢ⣺ ሶች㗪ㇱ ⢖ ⢗ ሶችㇱ ⢄ ෆᎽ ↲⁁⣼ 㕖䊖䉳䉨䊮䊥䊮䊌⣲ ⊕ⴊ∛ 㘩 ⤟⤳ ⣖ ⣢ 䋨1000ੱ䋩 Estimated age-standardised incidence rate per 100,000 All cancers excl. non-melanoma skin cancer, both sexes, all ages ᐕ㦂⺞ᢛ⟕ᖚ₸䋨ੱญ10ਁኻ䋩䈱ផ⸘୯ ో䈏䉖䋨㕖䊜䊤䊉䊷䊙ᕈ⊹⤏䈏䉖䉕㒰䈒䋩䋺↵ᅚ⸘䋬ోᐕ㦂 ᐕ㦂⺞ᢛ⟕ᖚ₸䋨ੱญ10ਁኻ䋩䈱ផ⸘୯ ⢄䈏䉖䋺↵ᅚ⸘, ోᐕ㦂 ᐕ㦂⺞ᢛ⟕ᖚ₸䋨ੱญ10ਁኻ䋩䈱ផ⸘୯ ሶች㗪䈏䉖䋺ᅚᕈ, ోᐕ㦂 5 ⟕ᖚ ᱫ ᐕ㦂⺞ᢛ⟕ᖚ₸䋨ੱญ10ਁኻ䋩䈱ផ⸘୯ ⢗䈏䉖䋺↵ᅚ⸘, ోᐕ㦂 ⚿⣺䈏䉖 ᐕ㦂⺞ᢛ⟕ᖚ₸䋨⇇ੱญ䋩, ↵ᕈ, ᐕ㦂 [0-85+] Temporal trends in colon cancer by country USA, SEER Australia,South ⚿⣺䈏䉖䈱࿖⚻ᐕᄌൻ ☨࿖, SEER䋨9⊓㍳䋩:⊕ੱ 䉥䊷䉴䊃䊤䊥䉝䋺ධ Denmark 䊂䊮䊙䊷䉪 Singapore:Chinese Japan,Osaka Prefecture 䉲䊮䉧䊘䊷䊦䋺ਛ࿖ੱ Costa Rica 䉮䉴䉺䊥䉦 ᣣᧄ䇮ᄢ㒋 India, Mumbai 䉟䊮䊄䇮䊛䊮䊋䉟 ᣣᧄ, ᄢ㒋ᐭ ᐕ㦂⺞ᢛ⟕ᖚ₸䋨⇇ੱญ䋩, ↵ᕈ, ᐕ㦂 [0-85+] Stomach ⢗ ⢗ Cervix uteri Stomach ᣣᧄ, ᄢ㒋ᐭ ᐕ㦂⺞ᢛ⟕ᖚ₸䋨⇇ੱญ䋩, ᅚᕈ, ᐕ㦂 [0-85+] ሶች㗪ㇱ Breast Lung Liver ᚱ Liver ⢖ Lung ⢄ ⢄ ⢖ ᄢ⣺ Colon Colon ᄢ⣺ NHL Non-Hodgkin lymphoma Prostate ೨┙⣼ Non-Hodgkin lymphoma NHL ⢖䈏䉖 ᐕ㦂⺞ᢛ⟕ᖚ₸䋨⇇ੱญ䋩, ↵ᕈ, ᐕ㦂 [0-85+] ⢖䈏䉖 ᐕ㦂⺞ᢛ⟕ᖚ₸䋨⇇ੱญ䋩, ᅚᕈ, ᐕ㦂 [0-85+] ⧷࿖䇮䉴䉮䉾䊃䊤䊮䊄 UK,Scotland UK,Scotland USA, SEER Singapore:ChineseUSA, SEER Singapore:Chinese ☨࿖䇮SEER䋨9⊓㍳䋩䇮⊕ੱ China,Shanghai Australia,NSW Finland Finland Slovenia Australia,NSW Israel:Jews Japan,Osaka Prefecture Denmark Japan,Osaka Prefecture Costa Rica India, Mumbai Costa Rica India, Mumbai 䊐䉞䊮䊤䊮䊄 USA, SEER Singapore:Chinese ⧷࿖䇮䉴䉮䉾䊃䊤䊮䊄 ਛ࿖䇮ᶏ 䉥䊷䉴䊃䊤䊥䉝䇮䊆䊠䊷䉰䉡䉴 䉡䉢䊷䊦䉵 China,Shanghai USA, SEER ਛ࿖䇮ᶏ 䉲䊮䉧䊘䊷䊦䋺ਛ࿖ੱ 䉴䊨䊔䊆䉝 Australia,NSW Slovenia Israel:Jews Denmark 䉲䊮䉧䊘䊷䊦䋺ਛ࿖ੱ UK,Scotland China,Shanghai 䉥䊷䉴䊃䊤䊥䉝䇮䊆䊠䊷 䉰䉡䉴䉡䉢䊷䊦䉵 䊂䊮䊙䊷䉪 Israel:Jews 䉟䉴䊤䉣䊦䋺䊡䉻䊟ੱ 䉟䉴䊤䉣䊦䋺䊡䉻䊟ੱ ᣣᧄ䇮ᄢ㒋 Japan,Osaka Prefecture Denmark Costa Rica Slovenia India, Mumbai Finland 䉟䊮䊄䇮䊛䊮䊋䉟 䉮䉴䉺䊥䉦 ᣣᧄ䇮ᄢ㒋 䊂䊮䊙䊷䉪 䉴䊨䊔䊆䉝 䊐䉞䊮䊤䊮䊄 6 䉮䉴䉺䊥䉦 䉟䊮䊄䇮䊛䊮䊋䉟 ሶች㗪䈏䉖 ᐕ㦂⺞ᢛ⟕ᖚ₸䋨⇇ੱญ䋩, ᅚᕈ, ᐕ㦂 [0-85+] Impact of introduction of screening on incidence of cervical cancer in selected countries Denmark 䊂䊮䊙䊷䉪 Sweden 䉴䉡䉢䊷䊂䊮 Norway Finland ሶች㗪䈏䉖⟕ᖚ₸䈮䈍 䈔䉎ᬌ⸻ዉ䈱ᓇ㗀 䊉䊦䉡䉢䊷 UK,Scotland 䊐䉞䊮䊤䊮䊄 USA,SEER(9registries) ⧷࿖䇮䉴䉮䉾䊃䊤䊮䊄 ☨࿖䇮SEER䋨䋹⊓㍳䋩 ᦨ䉅ᄙ䈇䈏䉖䈱ㇱ ⣾⢲ 㘩 ᚱ 䉦䊘䉳⡺⣲ ሶች㗪ㇱ ⢄⤳ ⢗ ᄢ⣺ ⢖ ↲⁁⣼ 㕖䊖䉳䉨䊮䊥䊮䊌⣲ 䊂䊷䉺䈭䈚 ᅚᕈ IARC䋨࿖㓙䈏䉖⎇ⓥᯏ㑐䋩䈫 American Cancer Society䋨☨࿖䈏䉖දળ䋩 IARC and American Cancer Society ↵ᕈ ᦨ䉅ᄙ䈇䈏䉖䈱ㇱ ⣾⢲ 㘩 ญ⣧ ᚱ 䉦䊘䉳⡺⣲ ೨┙⣼ ሶች㗪ㇱ ⢄⤳ ⢗ ᄢ⣺ ⢖ ↲⁁⣼ 㕖䊖䉳䉨䊮䊥䊮䊌⣲ 䊂䊷䉺䈭䈚 IARC䋨࿖㓙䈏䉖⎇ⓥᯏ㑐䋩䈫 American Cancer Society䋨☨࿖䈏䉖දળ䋩 IARC and American Cancer Society Global impact of cancer burden 2030* 2030ᐕ*⇇䈮䈍䈔䉎䈏䉖䈮䉋䉎⽶⩄䈱 䉟䊮䊌䉪䊃 Approx. 21.4 million new cases will be diagnosed in 2030 2030ᐕ䈮䈍䉋䈠2140ਁੱ䈏ᣂⷙ䈮䈏䉖䈫⸻ ᢿ䈘䉏䉎 Up 69% from 12.7 million in 2008 2008ᐕ䈱1270ਁੱ䈎䉌69䋦Ⴧട Approx. 13.2 million deaths from cancer will occur in 2030 2030ᐕ䈮䈍䉋䈠1320ਁੱ 䈏䈏䉖䈮䉋䉍ᱫ 䈜䉎 Up 72% from 7.6 million in 2008 2008ᐕ䈱760ਁੱ䈎䉌72䋦Ⴧട * Assuming rates in 2008 do not change. * 2008ᐕ䈱₸䈏ᄌൻ䈚䈭䈇䈫ቯ䈚䈢႐ว 7 Global impact of cancer burden 2030* 2030ᐕ* ⇇䈮䈍䈔䉎䈏䉖䈮䉋䉎⽶⩄ వㅴ࿖ ో䈏䉖䋨㕖䊜䊤䊉䊷䊙⊹⤏䈏䉖䉕㒰䈒䋩 2030ᐕ䈱ᣂⷙ䈏䉖⸻ᢿᖚ⠪ᢙ䋨ోᐕ㦂䋩-↵ᅚ⸘ * 2008ᐕ䈱₸䈏ᄌൻ䈚䈭䈇䈫ቯ䈚䈢႐ว ⊒ዷㅜ࿖ ో䈏䉖䋨㕖䊜䊤䊉䊷䊙⊹⤏䈏䉖䉕㒰䈒䋩 2030ᐕ䈱ᣂⷙ䈏䉖⸻ᢿᖚ⠪ᢙ䋨ోᐕ㦂䋩-↵ᅚ⸘ *assuming rates in 2008 do not change 2008ᐕ䈱⟕ᖚᢙ(1) Patterns of cancer in four contrasting populations ੱญേᘒലᨐ(3-1) 䊥䉴䉪ലᨐ(2-3) 4䈧䈱ኻᾖ⊛䈭㓸࿅䈮䈍䈔䉎 䈏䉖䈱䊌䉺䊷䊮 China Uganda Sweden Japan China ਛ࿖ 䉡䉧䊮䉻 䉴䉡䉢䊷䊂䊮 ᣣᧄ ਛ࿖ ᚱ ⢖ ⢖ ⢗ ⢄⤳ ⢗ 㘩 ⢄⤳ ᄢ⣺ ᄢ⣺ ⣾⢲ ሶችㇱ ⊕ⴊ∛ 㘩 ⣖䇮⚻♽ ሶች㗪ㇱ ೨┙⣼ ⊕ⴊ∛ ⤟⤳ ⣖䇮⚻♽ ຜ㗡 ෆᎽ ⤟⤳ ⣢ 㕖䊖䉳䉨䊮䊥䊮䊌⣲ ༄㗡 ⢙䈱䈉 Uganda ⟕ᖚ ᱫ ੱญ10ਁኻᐕ㦂⺞ᢛ₸䋨⇇ੱญ䋩 ↲⁁⣼ ⢙䈱䈉 㕖䊖䉳䉨䊮䊥䊮䊌⣲ ⟕ᖚ ᱫ ੱญ10ਁኻᐕ㦂⺞ᢛ₸䋨⇇ੱญ䋩 䉡䉧䊮䉻 ೨┙⣼ ሶች㗪ㇱ 䉦䊘䉳⡺⣲ ᚱ 㘩 䉦䊘䉳⡺⣲ ⢄⤳ ⢗ ⢗ 㘩 㕖䊖䉳䉨䊮䊥䊮䊌⣲ ⢄⤳ ญໃ䊶ญ⣧ ᄢ⣺ ᄢ⣺ ෆᎽ ⢖ 㕖䊖䉳䉨䊮䊥䊮䊌⣲ ⣾⢲ ሶችㇱ ຜ㗡ઁ ญໃ䇮ญ⣧ ⤟⤳ 䊜䊤䊉䊷䊙 ⊕ⴊ∛ ⣢ 8 ⢖ ⟕ᖚ ᱫ ੱญ10ਁኻᐕ㦂⺞ᢛ₸䋨⇇ੱญ䋩 䊜䊤䊉䊷䊙 ↲⁁⣼ ⤟⤳ ⟕ᖚ ᱫ ੱญ10ਁኻᐕ㦂⺞ᢛ₸䋨⇇ੱญ䋩 Sweden 䉴䉡䉢䊷䊂䊮 ೨┙⣼ ᚱ ᄢ⣺ ᄢ⣺ ⢖ ⢖ ⣾⢲ 䊜䊤䊉䊷䊙 䊜䊤䊉䊷䊙 ሶችㇱ 㕖䊖䉳䉨䊮䊥䊮䊌⣲ ෆᎽ ⊕ⴊ∛ ሶች㗪ㇱ ⣢ 㕖䊖䉳䉨䊮䊥䊮䊌⣲ ᷡ ⊕ⴊ∛ ⣖䇮⚻♽ ⣢ ⢗ ⣾⢲ ⤟⤳ ⤟⤳ ญໃ䇮ญ⣧ ⟕ᖚ ᱫ ᄙ⊒ᕈ㛽㜑⣲ 㘩 Japan ⣖䇮⚻♽ ⟕ᖚ ᱫ ↲⁁⣼ ⢗ ੱญ10ਁኻᐕ㦂⺞ᢛ₸䋨⇇ੱญ䋩 ੱญ10ਁኻᐕ㦂⺞ᢛ₸䋨⇇ੱญ䋩 ᣣᧄ ᚱ ⢗ ᄢ⣺ ᄢ⣺ ⢗ ⢖ ⢖ ೨┙⣼ ሶች㗪ㇱ ⢄⤳ ሶችㇱ 㘩 ෆᎽ ⤟⤳ ⤟⤳ ⣾⢲ ⢄⤳ ⣢ ↲⁁⣼ 㕖䊖䉳䉨䊮䊥䊮䊌⣲ ⢙䈱䈉 ⢙䈱䈉 㕖䊖䉳䉨䊮䊥䊮䊌⣲ ⊕ⴊ∛ ⊕ⴊ∛ ญໃ䇮ญ⣧ ⟕ᖚ ᱫ ຜ㗡ઁ ⣖䇮⚻♽ National impact of cancer burden 2030* ⟕ᖚ ᱫ ⣢ ⣖䇮⚻♽ ੱญ10ਁኻᐕ㦂⺞ᢛ₸䋨⇇ੱญ䋩 ੱญ10ਁኻᐕ㦂⺞ᢛ₸䋨⇇ੱญ䋩 2030ᐕ* ࿖䈏䉖䈮䉋䉎⽶⩄䈱䉟䊮䊌䉪䊃 ਛ࿖ ో䈏䉖䋨㕖䊜䊤䊉䊷䊙⊹⤏䈏䉖㒰䈒䋩 2030ᐕᣂⷙ䈏䉖ᖚ⠪ᢙ䋨ోᐕ㦂䋩ʊ↵ᅚ⸘ 2008ᐕ䈱⟕ᖚᢙ(1) ੱญേᘒലᨐ(3-1) 䉴䉡䉢䊷䊂䊮 ో䈏䉖䋨㕖䊜䊤䊉䊷䊙⊹⤏䈏䉖㒰䈒䋩 2030ᐕᣂⷙ䈏䉖ᖚ⠪ᢙ䋨ోᐕ㦂䋩ʊ↵ᅚ⸘ 䊥䉴䉪ലᨐ(2-3) 2008ᐕ䈱⟕ᖚᢙ(1) ੱญേᘒലᨐ(3-1) 2008ᐕ䈱⟕ᖚᢙ(1) ੱญേᘒലᨐ(3-1) 䊥䉴䉪ലᨐ(2-3) ᣣᧄ ో䈏䉖䋨㕖䊜䊤䊉䊷䊙⊹⤏䈏䉖㒰䈒䋩 2030ᐕᣂⷙ䈏䉖ᖚ⠪ᢙ䋨ోᐕ㦂䋩ʊ↵ᅚ⸘ 䉡䉧䊮䉻 ో䈏䉖䋨㕖䊜䊤䊉䊷䊙⊹⤏䈏䉖㒰䈒䋩 2030ᐕᣂⷙ䈏䉖ᖚ⠪ᢙ䋨ోᐕ㦂䋩ʊ↵ᅚ⸘ 䊥䉴䉪ലᨐ(2-3) 2008ᐕ䈱⟕ᖚᢙ(1) ੱญേᘒലᨐ(3-1) 䊥䉴䉪ലᨐ(2-3) * 2008ᐕ䈱₸䈏ᄌൻ䈚䈭䈇䈫ቯ䈚䈢႐ว *assuming rates in 2008 do not change Cancer monitoring and control planning in the world ⇇䈮䈍䈔䉎䈏䉖䈱䊝䊆䉺䊥䊮䉫䈫䈏䉖ኻ╷⸘↹ GLOBOCAN 2008 provides consistent set of definitive national and regional incidence and mortality rates; indicates large and growing burden of cancer in developing world; points the way for setting priorities in national cancer control programmes. GLOBOCAN 2008 ᦨ䉅ା㗬䈪䈐䉎࿖ၞ⟕ᖚ₸䊶ᱫ ₸䈱৻⽾ᕈ䈱䈅䉎䉶䉾䊃䉕ឭଏ䋻 ⊒ዷㅜ࿖䈪䈱䈏䉖䈮䉋䉎⽶⩄䈱Ⴧᄢ䊶 ᚑ㐳䉕␜ໂ䈚䈩䈇䉎䋻 ࿖ኅ䈱䈏䉖ኻ╷⸘↹䈱ఝవ㗅䉕⸳ቯ 䈜䉎䈢䉄䈱ᣇᴺ䉕ᜰ៰䈜䉎 9 Challenges and opportunities for future cancer registration ᧪䈱䈏䉖⊓㍳䈱䈢䉄䈱ᚢ䈫ᯏળ Increase coverage and quality in areas of the world currently underrepresented, especially in low and middle-income countries ⇇䈱ਛ䈪ታᣉ䈘䉏䈩䈇䈭䈇ၞ䈮 䈍䈔䉎䉦䊋䊷₸䈫⾰䈱ะ䇮․䈮ૐ䊶ਛ ࿖䈮䈍䈇䈩 Preparing National Incidence Estimates ࿖ြ膶輙ြ貢緍ြ謹菤 National incidence data ࿖䈱⟕ᖚ䊂䊷䉺 (Modelling) ᱫ䊂䊷䉺 (Weighting) ၞ䈱⟕ᖚ䊂䊷䉺 Mortality data Regional incidence data Relative frequency No data (Frequency) ⋧ኻ㗫ᐲ 䊂䊷䉺䈭䈚 Average (䊝 䊝䊂䊥䊮䉫) (㊀䉂ઃ䈔) (㗫ᐲ) ᐔဋ GLOBOCAN 2008: Incidence, methods of estimation (1) GLOBOCAN 2008: ⟕ᖚ䋬ផ⸘ᣇᴺ䋨1䋩 National Incidence ࿖䈱⟕ᖚ 62 countries (15% total population) 62 䉦࿖ (ోੱญ䈱15%) 䊐䊤䊮䉴䇮䉝䊜䊥䉦䇮䉥䊷䉴䊃䊤䊥䉝䋺࿖䈱⛔⸘ዪ䈮䉋䉎ផ⸘ France, USA and Australia: national estimated by national statistical offices GLOBOCAN 2008: ⟕ᖚ䋬ផ⸘ᣇᴺ䋨4䋩 GLOBOCAN 2008: Incidence, methods of estimation (4) Frequency data (no accurate incidence rates) 㗫ᐲ䊂䊷䉺 (ᱜ⏕䈭⟕ᖚ₸䈭䈚) 13 countries (6% total population) 13䉦࿖ (ోੱญ䈱6%) 10 GLOBOCAN 2008: Incidence, methods of estimation (5) GLOBOCAN 2008: ⟕ᖚ䋬ផ⸘ᣇᴺ䋨5䋩 No data 䊂䊷䉺䈭䈚 32 countries (10% total population) 32䉦࿖ (ోੱญ䈱10%) Cancer Incidence in Five Continents 5ᄢ㒽䈱䈏䉖⟕ᖚ % population covered by cancer registries in Vol. IX (number of registries/number of countries providing data) ╙9Ꮞ䈮䈍䈔䉎䈏䉖⊓㍳䈮䉋䉎ੱญ䉦䊋䊷ഀว䋨䋦䋩 (䈏䉖⊓㍳ቶ䈱ᢙ/䊂䊷䉺䉕ឭଏ䈚䈩䈇䉎࿖䈱ᢙ) 83.0 (54/2) 1.1 (5/5) 5.5 (11/7) 11.6 total (225/60) 32.5 (100/29) 4.0 (44/15) 83.0 (54/2) 5.5 (11/7) 80.5 (11/2) 11.6 total (225/60) Challenges and opportunities for future cancer registration 80.5 (11/2) ᧪䈱䈏䉖⊓㍳䈱䈢䉄䈱ᚢ䈫ᯏળ Inclusion of additional data e.g. 1.1 (5/5) 32.5 (100/29) 4.0 (44/15) staging, to permit evaluation of earlier diagnosis on cancer outcomes; screening status to discriminate screen detection vs interval cancers ㅊട䊂䊷䉺䈱൮ 䋩 䉴䊁䊷䉳ᖱႎ䋬䈏䉖䈱੍ᓟ䈮䈍䈔䉎ᣧᦼ⸻ᢿ䈱⹏ଔ䉕น⢻䈮䈜䉎; ᬌ⸻⊒䈏䉖䈫ਛ㑆ᦼ䈏䉖䈫䉕䈜䉎䈢䉄䈮ᬌ⸻⁁ᴫ Address issues of more detailed classification and coding of cancers e.g. oesophagus & liver by histological sub-types 䉋䉍⚦䈭ಽ㘃䉇㘩䈏䉖䇮⢄䈏䉖䈭䈬䈱䉋䈉䈭⚵❱ቇ⊛䉰䊑䉺䉟䊒䈮䉋䉎䉮䊷 䊂䉞䊮䉫䈱㗴䈮ข䉍⚵䉃 Linkage of cancer registration to datasets on screening, treatment modalities, hospital admissions, access to services, co-morbidities, etc (e.g. for the study ᬌ⸻䇮ᴦ≮ᴺ䇮㒮䇮ᴦ≮䈻䈱䉝䉪䉶䉴䇮ว૬∝䈭䈬䈱䊂䊷䉺䉶䉾䊃䈫䈏䉖⊓㍳ᖱ ႎ䈫䈱䊥䊮䉬䊷䉳䋨䈋䈳䇮䈏䉖䈱੍ᓟ䈮䈧䈇䈩䈱⎇ⓥ䈱䈢䉄䈮䋩 䉋䉍䉋䈒∔∛䈱ේ࿃⺰䈫ಽሶ∛ේ⺰䋨molecular pathogenesis䋩䉕ℂ⸃䈪䈐䉎䉋䈉䈮䇮 㑐ଥ䈜䉎䊋䉟䉥䊋䊮䉪䋨∛ℂ⚵❱ᬌ䉃䋩䉕⊒ዷ䈘䈞䉎 of cancer outcomes) Development of associated biobanks (including pathology specimens) to permit a better understanding of the aetiology and molecular pathogenesis of disease Challenges and opportunities for future cancer registration ᧪䈱䈏䉖⊓㍳䈱䈢䉄䈱ᚢ䈫ᯏળ Training - cancer registration and associated research Funding – integral part of a national cancer control program Use the data – opportunities for publication; provide the evidence-base for cancer control Co-ordination – joint efforts among international partners ⸠✵ – 䈏䉖⊓㍳䈫㑐ㅪ⎇ⓥ ⾗㊄⺞㆐ – ࿖ኅ䈱䈏䉖ኻ╷⸘↹䈮䈍䈇䈩ਇ นᰳ䈭ㇱಽ 䊂䊷䉺䈱↪ – 䈱ᯏળ䋻䈏䉖ኻ╷䈱䈢䉄 䈱⸽䈫䈭䉎䉅䈱䉕ឭଏ ⺞ᢛ䊶ද⺞ – ࿖㓙䊌䊷䊃䊅䊷㑆䈪䈱หദജ 11 Cancer monitoring and control planning in the world ⇇䈮䈍䈔䉎䈏䉖䈱䊝䊆䉺䊥䊮䉫䈫䈏䉖ኻ╷⸘↹ We can now map the global burden of cancer and provide projections for 185 countries – GLOBOCAN Time trend analysis can provide important leads and monitor progress – CI5 Considerable challenges for improvement to cancer registries to but biggest single problem is: variability in data sources and lack of information from Africa, parts of Asia and central & south America. ⇇⊛䈭䈏䉖䈮䉋䉎⽶⩄䉕࿑䈮ឬ䈒䈖䈫䈏䈪 䈐䇮185䉦࿖䈱ផ⸘୯䉕ឭଏ䈪䈐䉎ȸ GLOBOCAN ⚻ᐕᄌൻ䈱⸃ᨆ䈲㊀ⷐ䈭ᚻដ䈎䉍䉕ឭଏ䈚䇮 ㅴ䉕䊝䊆䉺䊷䈜䉎䈖䈫䈏䈪䈐䉎ȸCI5䋨ᄢ㒽 䈱䈏䉖⟕ᖚ䋩 䈏䉖⊓㍳䈱ᡷༀ䈻䈱㊀ⷐ䈭ᚢ䇮ᦨ䉅ᄢ䈐䈭 ৻䈧䈱㗴ὐ䋺䊂䊷䉺䉸䊷䉴䈱ᄌൻᕈ䇮䉝䊐䊥 䉦䉇䉝䉳䉝䊶ਛධ☨䈱৻ㇱ䈎䉌䈱䊂䊷䉺䈱ᰳ⪭ 12 韓国におけるがんのモニタリングとがん対策計画 CANCER MONITORING AND CONTROL PLANNING IN KOREA ソヒー・パク* Sohee Park Cancer has been the leading cause of 韓国では、1983 年からがんが死因の第一位 death in Korea since 1983. In 1996, the となっている。1996 年に、韓国政府は、総合 Korean a 的な「がん対策に対する 10 カ年計画」を開 comprehensive “10-year Plan for Cancer 始し、その後、2006－2015 年のタイムスケ Control.”, and established “The 2nd term ジュールで、全てのがんに対する一次予防か 10-year Plan for Cancer Control” for year ら緩和ケア体制の確立やがん研究開発の整備 2006-2015 within the framework of all を中心とした「第二次がん対策 10 カ年計画」 cancer spectrum ranging from primary を開始した。韓国がん登録が提供しているが prevention to palliative care and the ん罹患データと韓国統計局が提供しているが infrastructure for R&D on cancer. The ん死亡データは、韓国におけるがん対策プロ cancer incidence data from The Korea グラムの計画と評価において必要不可欠な役 Central Cancer Registry and the cancer 割を果たしている。 「第二次がん対策 10 カ年 mortality data Statistical 計画」の 2 つの主目的は、がん死亡率の 19.4％ Office have played an essential part in 減少（2005 年人口 10 万対 116.7 から 2015 planning and evaluating the cancer control 年で 94.1 へ）とがん生存率の改善（2005 年 programs で 45.9％から 2015 年で 54.0％へ）である。 government in from Korea. initiated Korea The two major objectives in “The 2nd term 10-year Plan 2010 年に、がん対策プログラム中間解析が実 for Cancer Control” were to achieve the 施され、目的がひとつひとつ再評価され、必 decreased cancer mortality rate by 19.4% 要に応じて修正された。韓国では、急激な高 from 116.7 per 100,000 persons in 2005 to 齢化社会に伴い、がんによる社会的不安はさ 94.1 per 100,000 persons in 2015, and to らに大きくなり、科学的根拠に基づきがん対 improve the cancer survival rate from 策計画をさらに発展させる必要が生じるであ 45.9% in 2005 to 54.0% in 2015. In 2010, ろう。 the mid-term analysis of the cancer control programs was item-by-item performed objectives and have the been re-evaluated and modified when necessary. With rapidly aging population in Korea, we expect that cancer burden will become even *韓国国立がんセンター がん登録・生物統計部門 Cancer Registration and Statistics Branch, NCCI Cancer Biostatistics Branch, NCCRI, NCC, Korea 13 larger and we will need the further development of evidence-based cancer control programs. 14 Cancer Monitoring and Control Planing in Korea 橢⦌ርሴቮ ሯቶቑከኜዐኍቋሯቶ⺍䷥岗䟊 Sohee Park 䉸䊍䊷䊶䊌䉪 Division of Cancer Registration and Surveillance National Cancer Center, Korea 䈏䉖⊓㍳䋧䉰䊷䊔䉟䊤䊮䉴ㇱ ࿖┙䈏䉖䉶䊮䉺䊷 Annual Meeting of Japanese Association of Cancer Registries October 15, 2010 Annual Meeting of Japanese Association of Cancer Registries October 15, 2010 Contents ⋡ᰴ &DQFHU6WDWLVWLFVLQ.RUHD 1DWLRQDO&DQFHU&RQWURO3URJUDP ದ &DQFHU5HJLVWU\6\VWHP ದ 3ULPDU\&DQFHU3UHYHQWLRQ3URJUDP ದ &DQFHU6FUHHQLQJ3URJUDP ದ 0HGLFDO&DUH3DOOLDWLYH&DUH ದ &DQFHU,QIRUPDWLRQ&HQWHU ದ 5HVHDUFKDQG'HYHORSPHQW,QIUDVWUXFWXUH ,QWHULP$QDO\VLVRQQG 7HUP\HDU3ODQIRU&DQFHU &RQWURO )XWXUH'LUHFWLRQ 㖧࿖䈮䈍䈔䉎䈏䉖⛔⸘ ࿖䈱䈏䉖ኻ╷䊒䊨䉫䊤䊛 ದ 䈏䉖⊓㍳䉲䉴䊁䊛 ದ 䈏䉖䈱৻ᰴ੍㒐䊒䊨䉫䊤䊛 ದ 䈏䉖ᬌ⸻䊒䊨䉫䊤䊛 ದ ᴦ≮ 㪆㩷✭ක≮ ದ 䈏䉖ᖱႎ䉶䊮䉺䊷 ದ ⎇ⓥ䈫㐿⊒䋨䉟䊮䊐䊤䋩 ╙ੑᰴ䈏䉖ኻ╷㪈㪇䉦ᐕ⸘↹䈮䈍䈔䉎ਛ㑆⸃ᨆ ᧪䈱ᣇะᕈ Cancer burden of Korea worldwide Incidence: Mortality: 12.7 million 7.6 million 㖧࿖䇮⇇䈮䈍䈔䉎䈏䉖䈮䉋䉎⽶⩄ IIncidence: 161,920 Mortality: 67,561 Prevalence: 6,270 ⟕ᖚᢙ㪑㩷㩷㩷㪈㪍㪈㪃㪐㪉㪇 ᱫᢙ㪑㩷㩷㩷㩷㪍㪎㪃㪌㪍㪈 ∛ᢙ㪑 㪍㪃㪉㪎㪇 ⟕ᖚᢙ㪑㩷㩷㩷㩷㩷㪈㪉㪎㪇 ਁੱ ᱫᢙ㪑㩷㩷㩷㩷㩷㩷㪎㪍㪇 ਁੱ Source: GOLOBOCAN 2008, IARC, 2010 㪪㫆㫌㫉㪺㪼㪑㩷㪞㪦㪣㪦㪙㪦㪚㪘㪥㩷㪉㪇㪇㪏㪃㩷㪠㪘㪩㪚㪃㩷㪉㪇㪈㪇 Causes of death in Korea 㖧࿖䈮䈍䈔䉎ᱫ࿃ (%) 㩿㩼㪀 㪊㪇㪅㪇 䈏䉖 ⣖ⴊ▤㓚ኂ ᔃ∔ᖚ ⢄∔ᖚ ♧ዩ∛ 㪉㪌㪅㪇 28.0% 㪉㪏㪅㪇㩼 㪉㪇㪅㪇 㪈㪈㪅㪊㩼 11.3% 㪈㪌㪅㪇 㪈㪇㪅㪇 㪌㪅㪇 㪇㪅㪇 㩾㪏㪊 㩾㪏㪋 㩾㪏㪌 㩾㪏㪍 㩾㪏㪎 㩾㪏㪏 㩾㪏㪐 㩾㪐㪇 㩾㪐㪈 㩾㪐㪉 㩾㪐㪊 㩾㪐㪋 㩾㪐㪌 㩾㪐㪍 㩾㪐㪎 㩾㪐㪏 㩾㪐㪐 㩾㪇㪇 㩾㪇㪈 㩾㪇㪉 㪇㪊 㩾㪇㪋 㩾㪇㪌 㩾㪇㪍 㩾㪇㪎 㩾㪇㪏 Source: Korea National Statistical Office, 2008 ౖ㪑㩷㖧࿖⛔⸘ዪ㪃㩷㪉㪇㪇㪏 15 Economic Burden of Cancer 16.0 䈏䉖䈱⚻ᷣ⊛⽶ᜂ 75$KNNKQP 14.0 12.0 㪈㪍㪅㪇 75$KNNKQP 7.9 10.0 8.0 7.4 6.0 3.0 4.0 1.6 0.7 1.6 2.0 0.0 0.9 2.3 Productivity Loss Cost of Early Death 㪈㪋㪅㪇 Productivity Loss Cost of Disability 㪈㪇㪅㪇 㪈㪋㪈㩷ం☨䊄䊦 㪈㪈㪊㩷ం☨䊄䊦 㪈㪉㪅㪇 ᣧᦼᱫ䈮䉋䉎↢ ↥ജ៊ᄬ⾌ 㪎㪅㪐 㪏㪅㪇 㓚ኂ䈮䉋䉎↢↥ജ ៊ᄬ⾌ 㪎㪅㪋 㪍㪅㪇 Non- Medical Cost 㪈㪅㪍 㪇㪅㪎 㪈㪅㪍 㪇㪅㪐 㪉㪇㪇㪉 㪉㪇㪇㪌 㪉㪅㪇 Medical Cost 㪇㪅㪇 Kim SG et al, 2008 㕖ක≮⾌ 㪊㪅㪇 㪋㪅㪇 ක≮⾌ 㪉㪅㪊 㪢㫀㫄㩷㪪㪞㩷㪼㫋㩷㪸㫃㪃㩷㪉㪇㪇㪏 National Cancer Incidence 㪉㪇㪇㪍䌾㪉㪇㪇㪎 ࿖䈱䈏䉖⟕ᖚ㪃㩷㪉㪇㪇㪍䌾㪉㪇㪇㪎 ☻₸ 䈏䉖䈱⟕ᖚᢙ 䋨න䋺ੱญ㪈㪇ਁੱኻ䋩 ↵ᕈ ᅚᕈ 䋨න䋺ᢙ䋩 ↵ᅚ⸘ ᅚᕈ ↵ᕈ ᐕ㦂⺞ᢛ₸ 䋨න䋺ੱญ㪈㪇ਁੱኻ䋩 ↵ᅚ⸘ Trend of Cancer Incidence by Sex, Year ᅚᕈ ↵ᕈ ᕈ䇮ᐕ䈏䉖⟕ᖚᢙ䈱䊃䊧䊮䊄 ᅚᕈ ↵ᕈ 䋨න䋺ᢙ䋩 㶎㪈㪐㪐㪐ᐕ䈫Ყセ䈚䈩㪉㪇㪇㪎ᐕ䈪䈲䇮↵ᕈ㪋㪏䋦Ⴧ䇮ᅚᕈ㪎㪍㪅㪌䋦Ⴧ Cumulative Risk of Cancer in Korea, 2007 㖧࿖䈮䈍䈔䉎䈏䉖䈱⚥Ⓧ䊥䉴䉪㪃㩷㪉㪇㪇㪎 ᐔဋ㪁 㩿㪉㪇㪇㪎㪀 㪁ౖ䋺㪥㪪㪦 ⚥Ⓧ䊥䉴䉪 㖧࿖⛔⸘ዪ 16 ↵ᅚ⸘ ↵ᕈ ᅚᕈ ᱦ ᱦ ᱦ 䋨㪊ੱ䈮㪈ੱ䋩 䋨㪊ੱ䈮㪈ੱ䋩 䋨㪋ੱ䈮㪈ੱ䋩 Relative Frequency of Cancer Sites in Korea, 2007 㖧࿖ߦ߅ߌࠆ߇ࠎߩㇱߩ⋧ኻ㗫ᐲ න ሶች㗪ㇱ ⢗ 䈠䈱ઁ ⤟⤳ ⢙䈱䈉 ⢙▤ 䈏䉖 ⟕ᖚᢙ ೨┙⣼ ↲⁁⣼ ᄢ⣺ ᚱ ⢄ ⢖ 㖧࿖䈮䈍䈔䉎䈏䉖䈱ㇱ䈱⋧ኻ㗫ᐲ㪃㩷㪉㪇㪇㪎 Relative Frequency of Cancer Sites in Korea, 2007 න ⣢⤳ ⤟⤳ 䈠䈱ઁ ⢗ ⢙䈱䈉 ⢙▤ 䈏䉖 ⟕ᖚᢙ ⤟⤳ ⣾⢲ ⢖ ↲⁁⣼ ⢙䈱䈉 ⢙▤ 䈏䉖 ⟕ᖚᢙ ሶች 㗪ㇱ ↲⁁⣼ ೨┙⣼ 䈠䈱ઁ ෆᎽ ⢄ ⢖ ᄢ⣺ ⢗ ᄢ⣺ ⢄⤳ ↵ᕈ ᚱ ᅚᕈ ㇱᐕ㦂㓏⚖⟕ᖚ₸䋬↵ᕈ䋬㪉㪇㪇㪎ᐕ Age-specific incidence rates by cancer sites, Male, 2007 ⢖ ₸ ੱญ Lung Stomach ⢗ ਁੱኻ 㪈㪇 Colon and rectum ᄢ⣺ ೨┙⣼ Prostate Liver ⢄ Thyroid ↲⁁⣼ ᐕ㦂㓏⚖ ⢗ Age-specific incidence rates by cancer sites, Female, 2007 ⢖ ᄢ⣺ ೨┙⣼ ⢄ ↲⁁⣼ ㇱᐕ㦂㓏⚖⟕ᖚ₸䋬ᅚᕈ䋬㪉㪇㪇㪎ᐕ ₸ ੱญ Lung Colon and rectum ⢖ ᄢ⣺ ⢗ ਁੱኻ 㪈㪇 Stomach Liver ⢄ Breast Cervix uteri Thyroid ᚱ ሶች㗪ㇱ ↲⁁⣼ ↲⁁⣼ 17 ᚱ ⢗ ᄢ⣺ ⢖ ⢄ ሶች㗪ㇱ Trend of Major Cancers in Korea, Male 㖧࿖䈮䈍䈔䉎ਥ䈭䈏䉖䈱䊃䊧䊮䊄䋬↵ᕈ Stomach ੱญ Lung ⢗ ㇱ ⢖ ⢗ ਁኻᐕ㦂⺞ᢛ₸ 㪈㪇 Liver Colon and rectum ᐕᐔဋ ᄌൻ₸ 䋨䋦䋩 ⢖ ⢄ ᄢ⣺ ᄢ⣺ ⢄ Prostate ೨┙⣼ ೨┙⣼ Thyroid ↲⁁⣼ ↲⁁⣼ ⢗ Trend of Major Cancers in Korea, Female ⢖ ᄢ⣺ ⢄ ೨┙⣼ ↲⁁⣼ 㖧࿖䈮䈍䈔䉎ਥ䈭䈏䉖䈱䊃䊧䊮䊄䋬ᅚᕈ ᐕᐔဋ ᄌൻ₸ 䋨䋦䋩 ㇱ ↲⁁⣼ ੱญ Thyroid ↲⁁⣼ ਁኻᐕ㦂⺞ᢛ₸ 㪈㪇 Breast Stomach Cervix uteri Colon and rectum Lung ᚱ ᚱ ⢗ ⢗ ᄢ⣺ ᄢ⣺ ሶች㗪ㇱ ⢖ Liver ⢄ ⢖ ሶች㗪 ⢄ ↲⁁⣼ International Comparison of Age-standardized Rates 1) by Sex: All Cancers ᚱ ⢗ ᄢ⣺ ሶች㗪ㇱ -QTGC 㖧࿖ 㩿㪉㪇㪇㪎㪀 -QTGC 㖧࿖ 㩿㪉㪇㪇㪏㪀㪉㪀 %JKPC ᣣᧄ㩿㪉㪇㪇㪏㪀㪉㪀 (GOCNG ਛ࿖ 㩿㪉㪇㪇㪏㪀㪉㪀 ↵ᕈ 6JCKNCPF ᅚᕈ 䉺䉟㩿㪉㪇㪇㪏㪀㪉㪀 (TCPEG 䊐䊤䊮䉴㩿㪉㪇㪇㪏㪀㪉㪀 'PINCPF 䍐䍻䍖䍼䍵䍻䍢䍼㩿㪉㪇㪇㪏㪀㪉㪀 75# +PEKFGPEGTCVGQHCNNV[RGUQHECPEGTGZEGRVHQTQVJGTUMKP %VQEQORCTGINQDCNN[ UMKP % VQ EQORCTG INQDCNN[ &CVCUQWTEG ).1$1%#0+#4% ⢄ ᕈᐕ㦂⺞ᢛ⟕ᖚ₸㪈㪀䈱࿖㓙Ყセ䋺ోㇱ ,CRCP /CNG ⢖ ☨࿖㩿㪉㪇㪇㪏㪀㪉㪀 (┾ ┾㥚: ⳛ/10Ⱒⳛ) 㩿න㪑ੱญ㪈㪇ਁኻ㪀 㪈㪀 ࿖㓙⊛䈮Ყセ䈜䉎䈢䉄䈮䇮䈠䈱ઁ⊹⤏䋨㪚㪋㪋䋩䉕㒰䈇䈢ో䈩䈱ㇱ䈱䈏䉖䈱⟕ᖚ₸ 䈱䈏䉖䈱⟕ᖚ₸ 㪉㪀 ౖ䋺㪞㪣㪦㪙㪦㪚㪘㪥㩷㪉㪇㪇㪏㪃㩷㪠㪘㪩㪚㪃㩷㪉㪇㪈㪇 Trend of Five-Year Relative Survival by Sex : All Cancers ᕈ㪌ᐕ⋧ኻ↢ሽ₸䈱䊃䊧䊮䊄䋺ోㇱ䈱䈏䉖 ↵ᅚ⸘ 18 ↵ᕈ ᅚᕈ International Comparison of Five-Year Relative survival 㪌ᐕ⋧ኻ↢ሽ₸䈱࿖㓙Ყセ න 㖧࿖ (‘96-’00) ㇱ 㖧࿖ (’01-’05) ☨࿖1) (‘99-’05) 㖧࿖ (‘03-’07) ࠞ࠽࠳2) (‘98-’00) ᣣᧄ3) (‘97-’99) ోㇱ ⢗ ⢄ ሶች㗪ㇱ ᄢ⣺ ↲⁁⣼ ᚱ ⢖ ⤟⤳ ೨┙⣼ Trend of major cancer death rates ਥ䈭ㇱ䈱䈏䉖䈱ᱫ₸䈱䊃䊧䊮䊄 Age-standardized rate per 100,000 male 60.0 50.0 Stomach Lung ੱญ㪈㪇ਁኻᐕ㦂⺞ᢛ₸ female ↵ᕈ 50.0 Stomach 40.0 Lung ⢄ ⢖ ᄢ⣺ 50 ⢗ ⢄ Stomach 20.0 Lung Uterus Breast 10.0 Colorectum ⢖ ⢄ 10 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 year year ⢖ ሶች ᚱ ᄢ⣺ ሶች㗪 0 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 ᐕ ᐕ Data source: Annual Report of Causes of Death, NSO ሶች㗪 ⢗ 20 ᄢ⣺ 0.0 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 8 ⢖ ᚱ 30 Cervix 0.0 ⢄ ᄢ⣺ ሶች 20.0 Liver Colorectum ⢗ 40 30.0 30.0 10.0 60 ⢗ Liver 40.0 ᅚᕈ 60.0 Liver Colorectum 㪛㪸㫋㪸㩷㫊㫆㫌㫉㪺㪼㪑㩷㪘㫅㫅㫌㪸㫃㩷㪩㪼㫇㫆㫉㫋㩷㫆㪽㩷㪚㪸㫌㫊㪼㫊㩷㫆㪽㩷㪛㪼㪸㫋㪿㪃㩷㪥㪪㪦 Prevalence of Major Cancer sites by duration, 2007 ਥ䈭ㇱ䈱䈏䉖䈱ᦼ㑆䈗䈫䈱∛⠪ᢙ䋮㪉㪇㪇㪎 ⢗ ᄢ⣺ ↲⁁⣼ 㪈ᐕᧂḩ ᚱ 㪈㪄㪉ᐕ ⢄ 㪉㪄㪌ᐕ ⢖ 㪌㪄㪐ᐕ ሶች㗪 ೨┙⣼ ⣾⢲ 㕖䊖䉳䉨䊮䊥䊮䊌⣲ 䈏䉖∛⠪ᢙ ⢗ ᄢ⣺ ↲⁁⣼ ᚱ ⢄ ⢖ ሶች 㗪ㇱ ೨┙⣼ ⣾⢲ 㕖䍬䍚䍼䍕䍻䍶 䍻䍨䍽⣲ ోㇱ 㪈ᐕᧂḩ 㪈㪄㪉ᐕ 㪉㪄㪌ᐕ 㪌㪄㪐ᐕ ว⸘ 䈏䉖⟕ᖚᢙ䈱੍᷹ Expected Cancer Incidence Cases Ĺ 5.9% χ 19 Contents ⋡ᰴ %CPEGT5VCVKUVKEUKP-QTGC 0CVKQPCN%CPEGT%QPVTQN2TQITCO ̄ %CPEGT4GIKUVT[5[UVGO ̄ 2TKOCT[%CPEGT2TGXGPVKQP2TQITCO ̄ %CPEGT5ETGGPKPI2TQITCO ̄ /GFKECN%CTG2CNNKCVKXG%CTG ̄ %CPEGT+PHQTOCVKQP%GPVGT ̄ 4GUGCTEJCPF&GXGNQROGPV +PHTCUVTWEVWTG +PVGTKO#PCN[UKUQPPF 6GTO[GCT2NCPHQT %CPEGT%QPVTQN (WVWTG&KTGEVKQP 㖧࿖䈮䈍䈔䉎䈏䉖⛔⸘ ࿖䈱䈏䉖ኻ╷䊒䊨䉫䊤䊛 ̄ 䈏䉖⊓㍳䉲䉴䊁䊛 ̄ 䈏䉖䈱৻ᰴ੍㒐䊒䊨䉫䊤䊛 ̄ 䈏䉖ᬌ⸻䊒䊨䉫䊤䊛 ̄ ᴦ≮ 㪆㩷✭ක≮ ̄ 䈏䉖ᖱႎ䉶䊮䉺䊷 ̄ ⎇ⓥ䈫㐿⊒䋨䉟䊮䊐䊤䋩 ╙ੑᰴ䈏䉖ኻ╷㪈㪇䉦ᐕ⸘↹䈮䈍䈔䉎ਛ㑆⸃ᨆ ᧪䈱ᣇะᕈ Basic Principle of Cancer Control 䈏䉖ኻ╷䈱ၮᧄ⊛ᣇ㊎ WHO, 2002 㪮㪟㪦㪃㩷㪉㪇㪇㪉 1/3: Prevention Anti-smoking campaign HBV vaccination 㪈㪆㪊㪑㩷੍㒐 ኻ䉺䊋䉮䉨䊞䊮䊕䊷䊮 㪟㪙㪭䊪䉪䉼䊮 1/3: Early detection Screening 㪈㪆㪊㪑ᣧᦼ⊒ ᬌ⸻ 1/3: Palliative care 㪈㪆㪊㪑㩷✭䉬䉝 Add dd effective distribution of therapeutic resources and research ᴦ≮⾗Ḯ䈫⎇ⓥ䈱ലᨐ⊛䈭ಽ㈩䉕ㅊട ᴦ≮ 10-Year Plan of Cancer Control 䈏䉖ኻ╷㪈㪇䉦ᐕ⸘↹ 1st 10-Year Plan for Cancer Control (1996-2005) – Constructing Infra-structure of CC Building Capacity of Cancer Control Setting Program of Cancer Control ╙৻ᰴ䈏䉖ኻ╷㪈㪇䉦ᐕ⸘↹ 㩿㪈㪐㪐㪍㪄㪉㪇㪇㪌㪀 – 䈏䉖ኻ╷䈱䉟䊮䊐䊤ᢛ 䈏䉖ኻ╷䈱䉨䊞䊌䉲䊁䉞䉕⏕┙ 䈏䉖ኻ╷䈱䊒䊨䉫䊤䊛䉕⸳ቯ 2nd 10-Year Plan of Cancer Control (2006-2015) – Operating Program effectively and efficiently ╙ੑᰴ䈏䉖ኻ╷㪈㪇䉦ᐕ⸘↹ 㩿㪉㪇㪇㪍㪄㪉㪇㪈㪌㪀 – 䊒䊨䉫䊤䊛䉕ലᨐ⊛䈎䈧ല₸⊛䈮ታⴕ 2nd 10-Year Plan for Cancer Control ╙ੑᰴ䈏䉖ኻ╷㪈㪇䉦ᐕ⸘↹㩿㪉㪇㪇㪍㪄㪉㪇㪈㪌㪀 (2006-2015) 䈏䉖䈮䉋䉎⽶ᜂ䈱シᷫ Reduction of Cancer Burden Incidence љ Main Program Mortality љ Early Detection Healthy Survive Death Palliative care Supportive Program 䊜䉟䊮 䊒䊨䉫䊤䊛 Onset Quality of life Symptomatic ↢ሽ₸㸡 ᣧᦼ⊒ ஜᐽ ᱫ ⊒∝ ↢ᵴ䈱⾰ 䋨㪨㪦㪣䋩 ∝⁁⊒ ✭䉬䉝 ⸻ᢿ䋧ක≮ 䉰䊘䊷䊃⊛䊒 䊨䉫䊤䊛 Education & Advocating Expanding Capacities Develop new diagnosis & treatment ᱫ₸ 㸣 ৻ᰴ੍㒐 ↢ሽ⠪ Diagnosis & Treatment Registry & Evaluation Understand cancer biology/pathology Research ⟕ᖚ₸ 㸣 Survival ј Primary prevention ᢎ⢒䋧䉝䊄䊗䉦䉲䊷 ⊓㍳䋧⹏ଔ 䈏䉖䈱↢‛ቇ⊛㪆∛ℂቇ⊛ ℂ⸃ Provide evidence for policymakers ⎇ⓥ Basic / Translational / Clinical / Policy 20 䉨䊞䊌䉲䊁䉞䈱ᒛ ᣂ䈚䈇⸻ᢿ䋧ᴦ≮䈱㐿⊒ ╷ቯ⠪䈻䈱 䉣䊎䊂䊮䉴䈱ឭଏ ၮ␆ 㪆㩷䍢䍵䍻䍛䍸䍎䍚䍌䍣䍷 㪆㩷⥃ᐥ 㪆㩷╷ Contents ⋡ᰴ %CPEGT5VCVKUVKEUKP-QTGC 0CVKQPCN%CPEGT%QPVTQN2TQITCO ̄ %CPEGT4GIKUVT[5[UVGO ̄ 2TKOCT[%CPEGT2TGXGPVKQP2TQITCO ̄ %CPEGT5ETGGPKPI2TQITCO ̄ /GFKECN%CTG2CNNKCVKXG%CTG ̄ %CPEGT+PHQTOCVKQP%GPVGT ̄ 4GUGCTEJCPF&GXGNQROGPV +PHTCUVTWEVWTG +PVGTKO#PCN[UKUQPPF 6GTO[GCT2NCPHQT %CPEGT%QPVTQN (WVWTG&KTGEVKQP 㖧࿖䈮䈍䈔䉎䈏䉖⛔⸘ ࿖䈱䈏䉖ኻ╷䊒䊨䉫䊤䊛 ̄ 䈏䉖⊓㍳䉲䉴䊁䊛 ̄ 䈏䉖䈱৻ᰴ੍㒐䊒䊨䉫䊤䊛 ̄ 䈏䉖ᬌ⸻䊒䊨䉫䊤䊛 ̄ ᴦ≮ 㪆㩷✭ක≮ ̄ 䈏䉖ᖱႎ䉶䊮䉺䊷 ̄ ⎇ⓥ䈫㐿⊒䋨䉟䊮䊐䊤䋩 ╙ੑᰴ䈏䉖ኻ╷㪈㪇䉦ᐕ⸘↹䈮䈍䈔䉎ਛ㑆⸃ᨆ ᧪䈱ᣇะᕈ Cancer Registry System in Korea 㖧࿖䈮䈍䈔䉎䈏䉖⊓㍳䉲䉴䊁䊛 Regional Cancer Registries Hospital Cancer Registries hospital-based population-based since 1980 11 Regional Cancer Registries Busan Daegu / Gwangju Incheon / Daejeon Ulsan / Jeju Chungbuk, etc KCCR at NCC headquarter : NCC coverage: 90% of all cancers 㒮ౝ䈏䉖⊓㍳ ∛㒮䊔䊷䉴 ၞ᳃䊔䊷䉴 㪈㪐㪏㪇ᐕ䉋䉍 㪈㪈㩷䈱ၞ䈏䉖⊓㍳ ᧄㇱ㪑࿖┙䈏䉖䉶䊮䉺䊷 䊒䉰䊮 䊁䉫 㪆㩷䉪䉜䊮䉳䊠 䉟䊮䉼䊢䊮㪆䊁䉳䊢䊮䉡 䊦䉰䊮㪆䉼䉢䉳䊠 䉼䊠䊮䊑䉪㪃㩷䈭䈬 ࿖┙䈏䉖䉶䊮䉺䊷 䈮䈍䈔䉎 㖧࿖ਛᄩ䈏䉖⊓㍳ 䉦䊋䊷₸㪑 ో䈏䉖䈱㪐㪇㩼 Site-specific Cancer Registries ⤳ེ䈏䉖⊓㍳ Academic Societies: breast, uterine, cervix etc. ቇⴚቇળ㪑㩷ᚱ䇮ሶች䇮ሶች㗪ㇱ ╬ Cancer Registration System in Korea KCCR 㖧࿖䈮䈍䈔䉎䈏䉖⊓㍳䉲䉴䊁䊛 Cancer Billing Claims NHIC KCCR Data collection 㖧࿖ਛᄩ䈏䉖⊓㍳ 䊂䊷䉺䊶䊙䊈䉳䊜䊮䊃 Quality assurance ຠ⾰⸽ NSO Death data Data dissemination Develop manual / training Data process and dissemination Passive Cancer statistics Medical Record review Regional eg 䊙䊆䊠䉝䊦䉇䊃䊧䊷䊆䊮䉫㐿⊒ Active Regional Others 䈏䉖⛔⸘ ၞ ၞ DB management Academic Societies (Relevant cancer registration) (Cancer Mortality DB) Collection & feedback of Cancer Mortality DB Cancer registration data 2CTVKEKRCVKPI*QURKVCNU Registration Of Cancer patient Cancer registration DB per hospital Data quality & feedback 0*+% 㖧࿖䈮䈍䈔䉎䈏䉖⊓㍳䉲䉴䊁䊛 㖧࿖⛔⸘ዪ 㩿䈏䉖ᱫ䍡䍼䍎䍞䍫䍼䍎䍛㪀 Collection of resident registration address DB ෳട∛㒮 ∛㒮න䈱䈏䉖⊓㍳䊂䊷䉺䊔䊷䉴䈮 䉋䉎䈏䉖ᖚ⠪䈱⊓㍳ 䊂䊷䉺䈱⾰䍪䍆䍎䍢䍼䍨䍼䍍䍖 Generate list of potential cancer Incidence cases (using medical billing claims data and death certificate data) Relevant cancer incidence DB 㖧࿖ਛᄩ䈏䉖⊓㍳ 㖧࿖ਛᄩ䈏䉖⊓㍳䊂䊷䉺䊔䊷䉴 Result DB ᡰᛄ䈇⺧᳞ᦠ Ministry of Health & Welfare (Management & Publication of Cancer incidence rates) 䈏䉖 ᖚ⠪ National and Regional Cancer Statistics Billing claims 㪁࿖᳃ஜᐽ㒾࿅䋨㪥㪟㪠㪚䋩 ෘ↢⋭ 㩿䈏䉖⟕ᖚ₸䈱▤ℂ䈫⊒ⴕ㪀㩷 㑐ㅪ䈜䉎䈏䉖⟕ᖚ䊂䊷䉺䊔䊷䉴 䈏䉖ᖚ⠪䈱⸻ᢿ䋧ฃ⸻䊂䊷䉺䋧㜞 㗵ක≮∔ᖚ䊂䊷䉺䊔䊷䉴 Medical Record Review Send Review Results ⚿ᨐ䊧䊘䊷䊃 น⢻ᕈ䈱䈅䉎䈏䉖⟕ᖚ䉬䊷䉴䈱䊥䉴䊃 䈱ᚑ䋨ක≮⾌ᡰᛄ䈇⺧᳞ᦠ䉇ᱫ 䉕↪䈇䈩䋩 ࿖䇮ၞ䈱䈏䉖⛔⸘ ⚿ᨐ䊂䊷䉺 䊔䊷䉴 ᡰᛄ䈇⺧᳞ᦠ ක≮⸥㍳䈱䊧䊎䊠䊷 4GIKQPCN%CPEGT4GIKUVT[ 4GIKQPCN%CPEGT4GIKUVT[ DB %QQRGTCVKQP1HECPEGTKPEKFGPEG5WTXG[ %CPEGTRCVKGPVU&$KPJQURKVCN ᳃⊓㍳䈱ᚲ䊂䊷䉺䊔䊷 䉴䈱㓸 䈏䉖⟕ᖚ⺞ᩏ䋧⚿ᨐ Patients of cancer diagnosis & visit data & Catastrophic Diseases DB 0QP 2CTVKEKRCVKPI*QURKVCNU 䈏䉖⊓㍳䈱 㓸䋧䊐䉞䊷䊄䊋䉾䉪 䈏䉖⊓㍳䊂䊷䉺 Result report 㪁ⴕోㇱ㪤㪦㪧㪘㪪 㩿᳃ᚲ䊂䊷䉺䊔䊷䉴㪀 ቇⴚ♽ቇળ 㩿㑐ㅪᕈ䈏䉖⊓㍳㪀 䈏䉖ᱫ䊂䊷䉺䊔䊷䉴䈱 㓸䋧䊐䉞䊷䊄䊋䉾䉪 -QTGC%GPVTCN%CPEGT4GIKUVT[ -QTGC%GPVTCN%CPEGT4GIKUVT[ DB Cancer incidence survey & result ၞ䈏䉖⊓㍳ ၞ䈮䈍䈔䉎䈏䉖⟕ᖚ *MOPAS (residential address DB) Collection & feedback of Cancer registration DB ක≮⸥㍳ 䊂䊷䉺䊔䊷䉴䈱䊙䊈䉳䊜䊮䊃 Cancer Registration System in Korea Korea National Statistical Office 䉝䉪䊁䉞䊑 ዊ䈘䈇∛㒮䈎䉌䈱 㖧࿖ਛᄩ䈏䉖⊓㍳䈫䈱ද Regional Cancer Registry Regional cancer Incidence ၞ 䈠䈱ઁ 䊂䊷䉺䊔䊷䉴᭴▽ small hospital Collaboration with KCCR 䉝䉪䊁䉞䊑 ၞ䈏䉖⊓㍳ 䊒䉰䊮㪃㩷䊁䉫㪃㩷 䊁䉳䊢䊮㪃㩷㵺㪅㪅 ၞ䈮䈍䈔䉎䊂䊷䉺㓸 MR review from DB construction 䊂䊷䉺䊒䊨䉶䉴䈫 ᥉ 䊌䉾䉲䊑 ක≮⸥㍳䈱 䊧䊎䊠䊷 Active 䈏䉖䈮ኻ䈜䉎 㒾⺧᳞ ࿖᳃ஜᐽ㒾࿅ 䋨㪥㪟㪠㪚䋩 ⛔⸘ዪ ᱫ䊂䊷䉺 䊂䊷䉺᥉ Busan, Daegu, Daejeon, ….. Data collection for the region Billing claims ⎇ୃ∛㒮 㖧࿖ਛᄩ䈏䉖⊓㍳ 䈎䉌䈱 ⊓㍳䉬䊷䉴 䊂䊷䉺㓸 Data management Cancer patient ၞ䈏䉖⊓㍳ 㕖ෳട∛㒮 Result report 䊧䊎䊠䊷䈱⚿ᨐㅍା 䈏䉖⟕ᖚ⺞ᩏ䈻䈱දജ ∛㒮䈮䈍䈔䉎䈏䉖ᖚ⠪䊂䊷䉺䊔䊷䉴 Medical Record Review * MOPAS : Ministry of public administration and security * NHIC : National Health Insurance Corporation 㪁㩷㪤㪦㪧㪘㪪㩷㪑㩷ⴕోㇱ 㪁㩷㪥㪟㪠㪚㩷㪑㩷࿖᳃ஜᐽ㒾࿅ ※ P.33 Enlarged slide ※ P.33 拡大スライド 21 ၞ䈏䉖⊓㍳ ၞ䈏䉖⊓㍳䊂䊷䉺䊔䊷䉴 ක≮⸥㍳䈱䊧䊎䊠䊷 ⚿ᨐ䊧䊘䊷䊃 Quality Indices of Cancer Incidence Data in Korea 㖧࿖䈮䈍䈔䉎䈏䉖⟕ᖚ䊂䊷䉺䈱⾰⊛ᜰᮡ (1999-2002) 㩿㪈㪐㪐㪐㪄㪉㪇㪇㪉㪀 Death Certificate Only : 5.9% (not acceptable: > 20%) ᱫ䈱䉂䈮䉋䉎⊓㍳䋨㪛㪚㪦㩼䋩 㪑㩷㩷㪌㪅㪐㩼㩷 㩿ਇណ↪㪑㩷㪕㩷㪉㪇㩼㪀 Microscopic Verification : 75.5% (not acceptable: < 75%) 㗼ᓸ㏜⊛⸻ᢿ䋨㪤㪭㩼䋩 㪑㩷㪎㪌㪅㪌㩼㩷 㩿ਇណ↪㪑㩷㪓㩷㪎㪌㩼㪀 (acceptable: 0.3~0.7) ᱫ䊶⟕ᖚᲧ䋨㪤㪠Ყ䋩 㪑㩷㪇㪅㪌㪌㪋㩷㩷㩷㩷㩷㩷㩷 㩿ណ↪㪑㩷㪇㪅㪊䌾㪇㪅㪎㪀 Mortality/Incidence ratio : 0.554 㖧࿖䈏䉖⟕ᖚ⛔⸘㩿㪈㪐㪐㪐㪄㪉㪇㪇㪉㪀 䈲ᄢ㒽䈱䈏䉖⟕ᖚ╙㪐Ꮞ 㩿㪠㪘㪩㪚㪃㩷㪉㪇㪇㪎㪀䈮ឝタ䈘䉏䈢 Korean cancer incidence statistics (1999-2002) was published in Cancer Incidence in Five Continents, Volume IX (IARC, 2007) Contents ⋡ᰴ %CPEGT5VCVKUVKEUKP-QTGC 0CVKQPCN%CPEGT%QPVTQN2TQITCO ̄ %CPEGT4GIKUVT[5[UVGO ̄ 2TKOCT[%CPEGT2TGXGPVKQP2TQITCO ̄ %CPEGT5ETGGPKPI2TQITCO ̄ /GFKECN%CTG2CNNKCVKXG%CTG ̄ %CPEGT+PHQTOCVKQP%GPVGT ̄ 4GUGCTEJCPF&GXGNQROGPV +PHTCUVTWEVWTG +PVGTKO#PCN[UKUQPPF 6GTO[GCT2NCPHQT %CPEGT%QPVTQN (WVWTG&KTGEVKQP 㖧࿖䈮䈍䈔䉎䈏䉖⛔⸘ ࿖䈱䈏䉖ኻ╷䊒䊨䉫䊤䊛 ̄ 䈏䉖⊓㍳䉲䉴䊁䊛 ̄ 䈏䉖䈱৻ᰴ੍㒐䊒䊨䉫䊤䊛 ̄ 䈏䉖ᬌ⸻䊒䊨䉫䊤䊛 ̄ ᴦ≮ 㪆㩷✭ක≮ ̄ 䈏䉖ᖱႎ䉶䊮䉺䊷 ̄ ⎇ⓥ䈫㐿⊒䋨䉟䊮䊐䊤䋩 ╙ੑᰴ䈏䉖ኻ╷㪈㪇䉦ᐕ⸘↹䈮䈍䈔䉎ਛ㑆⸃ᨆ ᧪䈱ᣇะᕈ Primary Prevention: Anti-smoking program ৻ᰴ੍㒐䋺䈢䈳䈖ኻ╷䊒䊨䉫䊤䊛 Increase in Tax on Cigarettes Anti-smoking campaign & education – Ban on smoking in public places – Warning on cigarette packets – Education program for youth – Say ‘No’ campaign for second hand smoking 䈢䈳䈖⒢䈱Ⴧട 䈢䈳䈖䉨䊞䊮䊕䊷䊮䋧ᢎ⢒ – 䈱႐䈮䈍䈔䉎༛ᾍ䈱ᱛ – 䈢䈳䈖䊌䉾䉬䊷䉳䈮䈍䈔䉎⼊๔ – ⧯⠪䈻䈱ᢎ⢒䊒䊨䉫䊤䊛 – ฃേ༛ᾍ䈮ኻ䈜䉎䇸㪥㫆䇹䈫䈇䈉䉨䊞䊮䊕䊷䊮 Prohibit promoting the sales of tobacco – Ban on cigarette advertising – Prohibition of sales to teenagers 䈢䈳䈖䈱⽼ᄁଦㅴ䈱ᱛ – 䈢䈳䈖䈱ᐢ๔䈱ᱛ – 㪈㪇ઍ䈻䈱⽼ᄁᱛ Quitline service for smoking cessation ᾍ䈱䈢䉄䈱㪨㫌㫀㫋㫃㫀㫅㪼䋨ᾍ㔚⋧⺣䋩䉰䊷䊎䉴 Smoking cessation counseling by telephone since April 2006 ARS, On-line portal services Collaboration with 251 Health ᾍ䉦䉡䊮䉶䊥䊮䉫 㪉㪇㪇㪍ᐕ㪋䈎䉌㔚䈮䉋䈦䈩 㪘㪩㪪㪃㩷䉥䊮䊤䉟䊮䊘䊷䉺䊦䉰䊷䊎 䉴 Centers for pharmacotherapy : NRT and Medical drug by all the health centers charge free ⮎‛ᴦ≮䈱䈢䉄䈱㪉㪌㪈䈱ஜᚲ䈫 䈱ㅪ៤䋺ో䈩䈱ஜᚲ䈪䈱䊆䉮䉼䊮 ઍᦧ≮ᴺ䋨㪥㪩㪫䋩䈫ක⮎ຠ䉕ήᢱ䈮 22 Smoking prevalence : Adults ༛ᾍ₸䋺ᚑੱ 90.0 79.3 80.0 71.2 ↵ᕈ 75.3 75.1 72.9 69.8 70.0 64.9 ᅚᕈ 67.6 69.9 60.5 60.0 56.7 57.8 50.3 50.0 44.1 42.0 43.1 40.4 40.0 30.0 20.0 12.6 10.0 8.0 7.7 5.1 3.5 5.3 4.4 3.0 3.1 6.0 3.5 4.0 3.1 2.3 4.6 3.7 3.9 0.0 1980 1985 1990 1992 1994 1996 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Source: Ministry of Health & Welfare, Korean Association of Smoking & Health ౖ䋺ෘ↢⋭㪃㩷㖧࿖༛ᾍ䈫䈢䈳䈖දળ Smoking prevalence : Youths ༛ᾍ₸㧦⧯⠪ [W [W Z\ ZW 譄ቇ蒥O羖P Z\ tGGOtP oGGOtP tGGOmP oGGOmP 緷繩蒥O羖P 譄ቇ蒥O羬P ZW 緷繩蒥O羬P Y\ Y\ YW YW X\ X\ XW XW \ \ W X`__ X`_` X``X X``Z X``\ X``^ X``` YWWW YWWX YWWY YWWZ YWW[ YWW\ YWW] W YWW^ X`__ X`_` X``X X``Z X``\ X``^ X``` YWWW YWWX YWWY YWWZ YWW[ YWW\ YWW] YWW^ Source: Ministry of Health & Welfare, Korean Association of Smoking & Health ౖ䋺ෘ↢⋭㪃㩷㖧࿖༛ᾍ䈫䈢䈳䈖දળ Hepatitis B vaccination 㪙ဳ⢄Ἳ䊪䉪䉼䊮 HBV vaccination History in Korea 㖧࿖䈮䈍䈔䉎㪟㪙㪭䊪䉪䉼䊮䈱ᱧผ 1985: Temporary basis 1995: Regular basis 㪈㪐㪏㪌㪑㩷৻ᤨ⊛䈭ធ⒳ 㪈㪐㪐㪌㪑㩷ቯᦼ⊛䈭ធ⒳ (Nationwide childhood immunization) 㩿࿖ኅⷙᮨ䈪䈱ዊఽᦼ䈱੍㒐ធ⒳䋩 Positive rate(%) of HBsAg 㪟㪙㫊㪘㪾㩷㓁ᕈഀว 㩿㩼㪀 10 Action Codes of Cancer Prevention ߇ࠎ੍㒐ߩߚߩ10ࠞ᧦ 23 Contents ⋡ᰴ %CPEGT5VCVKUVKEUKP-QTGC 0CVKQPCN%CPEGT%QPVTQN2TQITCO ̄ %CPEGT4GIKUVT[5[UVGO ̄ 2TKOCT[%CPEGT2TGXGPVKQP2TQITCO ̄ %CPEGT5ETGGPKPI2TQITCO ̄ %CPEGT+PHQTOCVKQP%GPVGT ̄ 2CNNKCVKXG%CTG ̄ 4GUGCTEJCPF&GXGNQROGPV +PHTCUVTWEVWTG +PVGTKO#PCN[UKUQPPF 6GTO[GCT2NCPHQT %CPEGT%QPVTQN (WVWTG&KTGEVKQP 㖧࿖䈮䈍䈔䉎䈏䉖⛔⸘ ࿖䈱䈏䉖ኻ╷䊒䊨䉫䊤䊛 ̄ 䈏䉖⊓㍳䉲䉴䊁䊛 ̄ 䈏䉖䈱৻ᰴ੍㒐䊒䊨䉫䊤䊛 ̄ 䈏䉖ᬌ⸻䊒䊨䉫䊤䊛 ̄ ᴦ≮ 㪆㩷✭ක≮ ̄ 䈏䉖ᖱႎ䉶䊮䉺䊷 ̄ ⎇ⓥ䈫㐿⊒䋨䉟䊮䊐䊤䋩 ╙ੑᰴ䈏䉖స㪈㪇䉦ᐕ⸘↹䈮䈍䈔䉎ਛ㑆⸃ᨆ ᧪䈱ᣇะᕈ Early Detection: Organized Cancer Screening ᣧᦼ⊒䋺⚵❱ဳ䈏䉖ᬌ⸻ Nationwide organized cancer screening program Managed by two systems ࿖ኅ䊧䊔䊦䈱⚵❱ဳ䈏䉖ᬌ⸻䊒䊨䉫䊤䊛 㪉䈧䈱䉲䉴䊁䊛䈮䉋䉍▤ℂ – Upper 50% contributors: National Health Insurance Screening Program – Lower 50% contributors & Medicaid: National Cancer Screening Program Level of Contribution National 50% Health Insurance – 㪌㪇㩼㩷䈱⽸₂㪑㩷࿖᳃ஜᐽ㒾ᬌ⸻䊒䊨䉫䊤䊛䋨㪥㪟㪠䋩 – ਅ 㪌㪇㩼䈱⽸₂䋧 ක≮ᛔഥ㪑㩷࿖᳃䈏䉖ᬌ⸻䊒䊨䉫䊤䊛䋨㪥㪚㪪㪧䋩 ⽸₂䈱䊧䊔䊦 NHI Cancer Screening ࿖᳃ஜᐽ㒾䈮䉋䉎䈏䉖ᬌ⸻ 㪥㪟㪠㩷㪚㪸㫅㪺㪼㫉㩷㪪㪺㫉㪼㪼㫅㫀㫅㪾 ࿖᳃ஜᐽ㒾 㪌㪇㩼 ࿖᳃䈏䉖ᬌ⸻䊒䊨䉫䊤䊛 㪥㪸㫋㫀㫆㫅㪸㫃㩷㪚㪸㫅㪺㪼㫉㩷㪪㪺㫉㪼㪼㫅㫀㫅㪾㩷㪧㫉㫆㪾㫉㪸㫄 㩿㪥㪚㪪㪧㪀 National Cancer Screening Program (NCSP) Medicaid ක≮ᛔഥ Stomach Liver Colorectum Breast Cervix ⢗ ᄢ⣺ ᚱ ሶች㗪ㇱ ࿖᳃䈏䉖ᬌ⸻䊒䊨䉫䊤䊛 䋨㪥㪚㪪㪧䋩䈱ੱญ䉦䊋䊷ഀว Population Coverage for NCSP Source population for screening: 24.4 million ᬌ⸻ኻ⽎䈱ੱญ䋺㪉㪋㪋㪇ਁੱ – Women \UVDQGPHQ\UV – ᅚᕈ 㻠㪊㪇ᱦ㪃㩷↵ᕈ㻠㩷㪋㪇ᱦ 1RRISHUVRQVFRYHUHGE\16&3PLOOLRQ ࿖᳃䈏䉖ᬌ⸻䊒䊨䉫䊤䊛㩿㪥㪚㪪㪧㪀䈮䉋䉎䉦䊋䊷ᢙ㪑㩷㪈㪊㪎㪇ਁੱ – Coverage rate: 56% 10.7 million (44%) ⢄ – 䉦䊋䊷ഀว㪑㩷㪌㪍㩼 12.7 million (52%) 1.0 million (4%) 㪈㪇㪅㪎㩷㫄㫀㫃㫃㫀㫆㫅㩷㩷㩷 㩿㪋㪋㩼㪀 NHI Beneficiaries (lower 50%) 㪈㪉㪎㪇ਁੱ 㩿㪌㪉㩼㪀 㪥㪟㪠㩷ฃ⛎⠪ 㩿ਅ㪌㪇㩼㪀 㪈㪇㪇ਁੱ 㩿㪋㩼㪀 Medicaid recipients NHI Beneficiaries (upper 50%) ක≮ᛔഥฃ⛎⠪ 㪥㪟㪠㩷ฃ⛎⠪ 㩿㪌㪇㩼㪀 ࿖᳃䈏䉖ᬌ⸻䊒䊨䉫䊤䊛 ᬌ⸻䉧䉟䊄䊤䉟䊮 Screening Guideline of NCSP Cancer Age Interval 䈏䉖 ᐕ㦂 㑆㓒 Stomach ш40 2 yrs Gastro-endoscopy or UGI ⢗ 㻠㪋㪇 㪉ᐕ ш40 high risk group* 6 mo Liver sonography & AFP ⢄ 㻠㪋㪇 䍨䍐䍶䍛䍖䍖䍼䍷䍎䍪䍽㪁 㪍㩷䈎 ш50 1 yr FOBT o colonoscopy or DCBE ᄢ⣺ 㻠㪌㪇 㪈ᐕ ଢẜⴊᬌᩏ䋨㪝㪦㪙㪫䋩 o ᄢ⣺ౝⷞ㏜ 㫆㫉㩷ᵈ⣺ᬌᩏ Breast ш40͕ women 2 yrs Mamongraphy & CBE ᚱ 㻠㪋㪇㪃㩷ᅚᕈ 㪉ᐕ 䊙䊮䊝䉫䊤䊐䉞 㩽㩷ⷞ⸅⸻ Cervix ш30͕ women 2 yrs Pap smear ሶች㗪 㻠㪊㪇㪃㩷ᅚᕈ 㪉ᐕ ⚦⢩⸻䋨㪧㪸㫇㩷㫊㫄㪼㪸㫉䋩 Liver Colorectum Methods ᣇᴺ ⢗ౝⷞ㏜ 㫆㫉㩷⢗㪯✢ᬌᩏ ⢄⤳㖸ᵄ㩽㩷㪘㪝㪧䋨䍭䍎䍔䍎䋩 㪁㩷㩷㪋㪇ᱦએ䈪㪟㪙㫊㪘㪾㓁ᕈ 㫆㫉㩷㪸㫅㫋㫀㪄㪟㪚㪭㓁ᕈ 㫆㫉㩷⢄⎬ᄌ * 40 & over with HBsAg positive or anti-HCV positive or liver cirrhosis 24 ࿖᳃䈏䉖ᬌ⸻䊒䊨䉫䊤䊛䋨㪥㪚㪪㪧䋩 䈱ฃ⸻₸ Participation Rate of NCSP No. % 㪥㫆㪅 㩼 30 ฃ⸻⠪ᢙ(㬍1͕000ੱ) 25 19.6 20 15 12.7 14.4 14.7 2003 2004 27.7 ฃ⸻₸(%) 23.9 21.1 10 5 0 2002 Cancer screening rates with recommendations 38.8 45.6 42.3 40.3 53.3 Stomach 40.0 Liver 30.0 % Colorectum 20.0 Breast 10.0 Cervix 53.3 50.7 50.0 Mean 38.8 42.3 40.3 45.6 ᐔဋ ⢗ ⢄ 30.0 ᄢ⣺ 20.0 ᚱ ሶች㗪 10.0 0.0 0.0 2004 2005 2006 2007 2008 2009 2004 Source: Korea National Cancer Screening Survey 2004-2009 2005 2006 2007 2008 2009 ౖ䋺㖧࿖࿖᳃䈏䉖ᬌ⸻⺞ᩏ㪉㪇㪇㪋㪄㪉㪇㪇㪐 Evaluating Cancer Screening Units 2008 60.0 50.7 50.0 2007 70.0 60.0 40.0 2006 ផᅑ䈮ၮ䈨䈒䈏䉖ᬌ⸻ฃ⸻₸ 70.0 % 2005 5000 4500 4000 3500 3000 2500 2000 1500 1000 500 0 䈏䉖ᬌ⸻ㇱ㐷䈱⹏ଔ 2006-2007 㪉㪇㪇㪍㪄㪉㪇㪇㪎 Enactment for Evaluation of Cancer Screening Unit (ECSU) 䈏䉖ᬌ⸻ㇱ㐷䈱⹏ଔ㩿㪜㪚㪪㪬㪀䈮䈧䈇䈩䈱┙ᴺ䈏䈏䉖ኻ╷ passed by revision of Cancer Control Act (Oct. 28͕ 2006) Model test with 5 hospitals Establishing three year period evaluation system 㪌∛㒮䈪䈱䊝䊂䊦䊁䉴䊃 ᴺ䈱ᡷ⸓䈱㓙䈮ㅢㆊ䈚䈢㩿㪉㪇㪇㪍ᐕ㪈㪇㪉㪏ᣣ㪀 㪊ᐕ㑆න䈪䈱⹏ଔ䉲䉴䊁䊛䉕⸳⟎ 2008-2010 㪉㪇㪇㪏㪄㪉㪇㪈㪇 2008: evaluation of general hospitals 㪉㪇㪇㪏㪑㩷✚ว∛㒮䈱⹏ଔ 2009: evaluating of hospitals 㪉㪇㪇㪐㪑㩷∛㒮䈱⹏ଔ 2010: evaluating of clinics 㪉㪇㪈㪇㪑㩷⸻≮ᚲ䈱⹏ଔ Contents ⋡ᰴ %CPEGT5VCVKUVKEUKP-QTGC 0CVKQPCN%CPEGT%QPVTQN2TQITCO ̄ %CPEGT4GIKUVT[5[UVGO ̄ 2TKOCT[%CPEGT2TGXGPVKQP2TQITCO ̄ %CPEGT5ETGGPKPI2TQITCO ̄ /GFKECN%CTG2CNNKCVKXG%CTG ̄ %CPEGT+PHQTOCVKQP%GPVGT ̄ 4GUGCTEJCPF&GXGNQROGPV +PHTCUVTWEVWTG +PVGTKO#PCN[UKUQPPF 6GTO[GCT2NCPHQT %CPEGT%QPVTQN (WVWTG&KTGEVKQP 㖧࿖䈮䈍䈔䉎䈏䉖⛔⸘ ࿖䈱䈏䉖ኻ╷䊒䊨䉫䊤䊛 ̄ 䈏䉖⊓㍳䉲䉴䊁䊛 ̄ 䈏䉖䈱৻ᰴ੍㒐䊒䊨䉫䊤䊛 ̄ 䈏䉖ᬌ⸻䊒䊨䉫䊤䊛 ̄ ᴦ≮ 㪆㩷✭ක≮ ̄ 䈏䉖ᖱႎ䉶䊮䉺䊷 ̄ ⎇ⓥ䈫㐿⊒䋨䉟䊮䊐䊤䋩 ╙ੑᰴ䈏䉖ኻ╷㪈㪇䉦ᐕ⸘↹䈮䈍䈔䉎ਛ㑆⸃ᨆ ᧪䈱ᣇะᕈ 25 ක≮䋺㪌ᐕ⋧ኻ↢ሽ₸ Medical Care: 5-Year Relative Survival rate ┾㥚 㩿න㪑㩷㩼㪀 site Korea (‘03-’07) USA1) (‘99-’05’) Canada2) (‘98-’00) Japan3) (‘97-’99) ㇱ 㖧࿖(‘03-’07) ☨࿖1) (‘99-’05’) All Cancer 66.1 60 ోㇱ Stomach 61.2 22 62.1 ⢗ 61.2 Liver 14 ⢄ ࠞ࠽࠳2) (‘98-’00) ᣣᧄ3) (‘97-’99) 66.1 60 22 62.1 14 Cervix 80.5 ሶች㗪ㇱ 80.5 Colorectum 65.2 59/61 4) 65.2 ᄢ⣺ 65.2 59/61 4) 65.2 Thyroid 98.8 96.9 92.4 ↲⁁⣼ 98.8 96.9 92.4 Breast 89.5 89.1 85.5 ᚱ 89.5 89.1 85.5 Lung 15.6 15 25.6 ⢖ 15.6 15 25.6 Pancreas 5.5 6 ⤟⤳ 5.5 6 Prostate 82.4 94 ೨┙⣼ 82.4 94 +RUQHU0-5LHV /$*.UDSFKR 01H\PDQ 1$PLQRX 5+RZODGHU 1HW DO HGV6((5&DQFHU6WDWLVWLFV5HYLHZ 1DWLRQDO&DQFHU,QVWLWXWH 6WDWLVWLFV&DQDGD&DQFHU6XUYLYDO6WDWLVWLFV 1DWLRQDO&DQFHU&HQWHULQ-DSDQ&DQFHU6WDWLVWLFVLQ-DSDQ &RORQ5HFWXP 㪈㪀㩷㪟㫆㫉㫅㪼㫉㩷㪤㪡㪃㩷㪩㫀㪼㫊 㪣㪘㪞㪃㩷㪢㫉㪸㫇㪺㪿㫆 㪤㪃㩷㪥㪼㫐㫄㪸㫅 㪥㪃㩷㪘㫄㫀㫅㫆㫌 㪩㪃㩷㪟㫆㫎㫃㪸㪻㪼㫉 㪥㪃㩷㪼㫋 㪸㫃 㩿㪼㪻㫊㪀㪅㩷㪪㪜㪜㪩㩷㪚㪸㫅㪺㪼㫉㩷㪪㫋㪸㫋㫀㫊㫋㫀㪺㫊㩷㪩㪼㫍㫀㪼㫎㪃㩷㪈㪐㪎㪌㪄㪉㪇㪇㪍㪃㩷 㪥㪸㫋㫀㫆㫅㪸㫃㩷㪚㪸㫅㪺㪼㫉㩷㪠㫅㫊㫋㫀㫋㫌㫋㪼㪅㩷㪉㪇㪇㪐 㪉㪀㩷㪪㫋㪸㫋㫀㫊㫋㫀㪺㫊㩷㪚㪸㫅㪸㪻㪸㪅㩷㪚㪸㫅㪺㪼㫉㩷㪪㫌㫉㫍㫀㫍㪸㫃㩷㪪㫋㪸㫋㫀㫊㫋㫀㪺㫊㩷㪈㪐㪐㪉㪄㪉㪇㪇㪇㪃 㪊㪀㩷࿖┙䈏䉖䉶䊮䉺䊷㪅㩷䈏䉖䈱⛔⸘㪃㩷㪉㪇㪇㪏 㪋㪀㩷⚿⣺䊶⋥⣺ Cancer Patient Financial Aid Program 䈏䉖ᖚ⠪䈱⚻ᷣᡰេ䊒䊨䉫䊤䊛 Financial support to the lower income group – Medicaid – Participants of NCSP – Under age 18 3URYLGH-RIRXWRISRFNHWPHGLFDO expenditure ૐᚲᓧ㓸࿅䈻䈱⚻ᷣ䉰䊘䊷䊃 – ක≮ᛔഥ䋨㪤㪼㪻㫀㪺㪸㫀㪻䋩 – ࿖᳃䈏䉖ᬌ⸻䊒䊨䉫䊤䊛䋨㪥㪚㪪㪧䋩䈻䈱ෳട – 㪈㪏ᱦᧂḩ 㪊㪇㪄㪎㪇㩼䈱⥄Ꮖ⽶ᜂක≮⾌䉕ᡰ⛎ Challenges of Medical Care ක≮䈮䈍䈔䉎ᚢ Reducing variation of care quality – Assessment of quality including patient’s satisfaction – Public reporting and Pay for performance (P4P) Increasing benefit coverage of National Health Insurance and the amount of financial aid 䉬䉝䈱⾰䈱䈳䉌䈧䈐䉕ᷫዋ䈘䈞䉎 – ᖚ⠪䈱ḩ⿷ᐲ䉕䉄䈢⾰䈱⹏ଔ – ⊛ႎ๔䈫ක≮䈱⾰䈮ၮ䈨䈒ᡰᛄ䈇㩿㪧㪋㪧㪀 ࿖᳃ஜᐽ㒾䈪䉦䊋䊷䈘䉏䉎⋉䈫⚻ᷣ⊛ᡰេ 㗵䉕ะ䈘䈞䉎 Palliative Care ✭䉬䉝 Support hospice-care hospitals Provide home-based care from regional public health centers Provide education program to the health care providers for palliative care Publish cancer pain control guidelines for providers and patients 䊖䉴䊏䉴䉬䉝∛㒮䈱ᡰេ ၞஜ䉶䊮䉺䊷䈎䉌䈱ቛ䉬䉝䈱ឭଏ 䊓䊦䉴䉬䉝ឭଏ⠪ኻ⽎䈱✭䉬䉝ᢎ⢒䊒䊨䉫䊤䊛 䈱ឭଏ 䊓䊦䉴䉬䉝ឭଏ⠪䈍䉋䈶ᖚ⠪䈮ኻ䈜䉎䈏䉖−∩䉮 䊮䊃䊨䊷䊦䉧䉟䊄䊤䉟䊮䈱 26 Cancer Pain Control Guideline for Health Care Providers 䈏䉖−∩䉮䊮䊃䊨䊷䊦䉧䉟䊄䊤䉟䊮 for Patients 䊓䊦䉴䉬䉝ឭଏ⠪↪ Contents ⋡ᰴ %CPEGT5VCVKUVKEUKP-QTGC 0CVKQPCN%CPEGT%QPVTQN2TQITCO ̄ %CPEGT4GIKUVT[5[UVGO ̄ 2TKOCT[%CPEGT2TGXGPVKQP2TQITCO ̄ %CPEGT5ETGGPKPI2TQITCO ̄ /GFKECN%CTG2CNNKCVKXG%CTG ̄ %CPEGT+PHQTOCVKQP%GPVGT ̄ 4GUGCTEJCPF&GXGNQROGPV +PHTCUVTWEVWTG +PVGTKO#PCN[UKUQPPF 6GTO[GCT2NCPHQT %CPEGT%QPVTQN (WVWTG&KTGEVKQP 㖧࿖䈮䈍䈔䉎䈏䉖⛔⸘ ࿖䈱䈏䉖ኻ╷䊒䊨䉫䊤䊛 ̄ 䈏䉖⊓㍳䉲䉴䊁䊛 ̄ 䈏䉖䈱৻ᰴ੍㒐䊒䊨䉫䊤䊛 ̄ 䈏䉖ᬌ⸻䊒䊨䉫䊤䊛 ̄ ᴦ≮ 㪆㩷✭ක≮ ̄ 䈏䉖ᖱႎ䉶䊮䉺䊷 ̄ ⎇ⓥ䈫㐿⊒䋨䉟䊮䊐䊤䋩 ╙ੑᰴ䈏䉖ኻ╷㪈㪇䉦ᐕ⸘↹䈮䈍䈔䉎ਛ㑆⸃ᨆ ᧪䈱ᣇะᕈ Education & Advocating ᢎ⢒䈫ᠩ⼔ ࿖┙䈏䉖ᖱႎ䉶䊮䉺䊷㩿㪉㪇㪇㪌㪄㪀 National Cancer Information Center(2005-) Web Portal http://www.cancer.go.kr/ ᖚ⠪↪ Call Center 䉡䉢䊑䊘䊷䉺䊦 䉮䊷䊦䉶䊮䉺䊷 㪿㫋㫋㫇㪑㪆㪆㫎㫎㫎㪅㪺㪸㫅㪺㪼㫉㪅㪾㫆㪅㫂㫉㪆 1577-8899 ࿖┙䈏䉖ᖱႎ䉶䊮䉺䊷 National Cancer Information Center 0RUHWKDQHGXFDWLRQPDWHULDOV – Leaflet, booklet, panel and DVD – Distributing to public and professionals 㪊㪇⒳㘃એ䈱ᢎ᧚ – 䊥䊷䊐䊧䉾䊃䇮ዊౠሶ䇮䊌䊈䊦䇮䌄䌖䌄 – Ꮢ᳃䉇ኾ㐷ኅ䈻䈱㈩Ꮣ 27 㪈㪌㪎㪎㪄㪏㪏㪐㪐 Contents ⋡ᰴ %CPEGT5VCVKUVKEUKP-QTGC 0CVKQPCN%CPEGT%QPVTQN2TQITCO ̄ %CPEGT4GIKUVT[5[UVGO ̄ 2TKOCT[%CPEGT2TGXGPVKQP2TQITCO ̄ %CPEGT5ETGGPKPI2TQITCO ̄ /GFKECN%CTG2CNNKCVKXG%CTG ̄ %CPEGT+PHQTOCVKQP%GPVGT ̄ 4GUGCTEJCPF&GXGNQROGPV +PHTCUVTWEVWTG +PVGTKO#PCN[UKUQPPF 6GTO[GCT2NCPHQT %CPEGT%QPVTQN (WVWTG&KTGEVKQP 㖧࿖䈮䈍䈔䉎䈏䉖⛔⸘ ࿖䈱䈏䉖ኻ╷䊒䊨䉫䊤䊛 ̄ 䈏䉖⊓㍳䉲䉴䊁䊛 ̄ 䈏䉖䈱৻ᰴ੍㒐䊒䊨䉫䊤䊛 ̄ 䈏䉖ᬌ⸻䊒䊨䉫䊤䊛 ̄ ᴦ≮ 㪆㩷✭ක≮ ̄ 䈏䉖ᖱႎ䉶䊮䉺䊷 ̄ ⎇ⓥ䈫㐿⊒䋨䉟䊮䊐䊤䋩 ╙ੑᰴ䈏䉖ኻ╷㪈㪇䉦ᐕ⸘↹䈮䈍䈔䉎ਛ㑆⸃ᨆ ᧪䈱ᣇะᕈ Expending Capacities 䉨䊞䊌䉲䊁䉞䈱ᄢ National Cancer Center, Korea Research Institute 㖧࿖䇮࿖┙䈏䉖䉶䊮䉺䊷 National Cancer Control Institute Hospital ⎇ⓥᚲ Constructing Infra-structure 䉟䊮䊐䊤᭴ㅧ䈱᭴▽ Designation of 9 comprehensive regional cancer centers National Cancer Center(NCC) 䋹䈧䈱ၞ䈏䉖䉶䊮䉺䊷䈱ᜰቯ ࿖┙䈏䉖䉶䊮䉺䊷 㩿㪥㪚㪚㪀 Kangwon Year Chung-Buk Dae-Jeon Daegu Jeon-Buk Busan Jeon-Nam 2004 2005 2006 ࿖┙䈏䉖ኻ╷⎇ⓥᯏ㑐 ∛㒮 䉦䊮䉡䉤䊮 梛 Financial & technical supports 䉼䊠䊮䊑䉪 䊁䉳䊢䊮 by Ministry of Health and Welfare, and Regional Governments 䉼䊢䊮䊑䉫 䊁䉫 䊒䉰䊮 䉼䊢䊮䊅䊛 Gyeong-Nam 2004 2005 ෘ↢⋭䈫ၞᐭ䈮䉋䉎 ⽷⊛䈭䉌䈶䈮ᛛⴚ⊛ᡰេ 2006 䉨䊢䊮䉰䊛 Jeju 䉼䉢䉳䊠 Contents ⋡ᰴ %CPEGT5VCVKUVKEUKP-QTGC 0CVKQPCN%CPEGT%QPVTQN2TQITCO ̄ %CPEGT4GIKUVT[5[UVGO ̄ 2TKOCT[%CPEGT2TGXGPVKQP2TQITCO ̄ %CPEGT5ETGGPKPI2TQITCO ̄ /GFKECN%CTG2CNNKCVKXG%CTG ̄ %CPEGT+PHQTOCVKQP%GPVGT ̄ 4GUGCTEJCPF&GXGNQROGPV +PHTCUVTWEVWTG +PVGTKO#PCN[UKUQPPF 6GTO[GCT2NCPHQT %CPEGT%QPVTQN (WVWTG&KTGEVKQP 㖧࿖䈮䈍䈔䉎䈏䉖⛔⸘ ࿖䈱䈏䉖ኻ╷䊒䊨䉫䊤䊛 ̄ 䈏䉖⊓㍳䉲䉴䊁䊛 ̄ 䈏䉖䈱৻ᰴ੍㒐䊒䊨䉫䊤䊛 ̄ 䈏䉖ᬌ⸻䊒䊨䉫䊤䊛 ̄ ᴦ≮ 㪆㩷✭ක≮ ̄ 䈏䉖ᖱႎ䉶䊮䉺䊷 ̄ ⎇ⓥ䈫㐿⊒䋨䉟䊮䊐䊤᭴ㅧ䋩 ╙ੑᰴ䈏䉖ኻ╷㪈㪇䉦ᐕ⸘↹䈮䈍䈔䉎ਛ㑆⸃ᨆ ᧪䈱ᣇะᕈ 28 Cancer Facts Book 䈏䉖䈱䊐䉜䉪䊃䊑䉾䉪 $CUKE(CEVU 5VCVKUVKEU 㪈 ၮᧄ䊐䉜䉪䊃㩿⛔⸘㪀 %CPEGT2TGXGPVKQP 㪉 䈏䉖੍㒐 %CPEGT5ETGGPKPI2TQITCO 㪊 䈏䉖ᬌ⸻䊒䊨䉫䊤䊛 %CPEGT&KCIPQUKUCPF6TGCVOGPV 㪋 䈏䉖䈱⸻ᢿ䈫ᴦ≮ 2CNNKCVKXG%CTG/CPCIGOGPVQH %CPEGT5WTXKXQTU 㪌 ✭䉬䉝㪆㩷䈏䉖↢ሽ⠪䈱▤ℂ 4GIKQPCN%CPEGT%GPVGTU 㪍 ၞ䈏䉖䉶䊮䉺䊷 PF 6GTO[GCT2NCPHQT 0CVKQPCN%CPEGT%QPVTQN 㪎 ╙㪉ᰴ䈏䉖ኻ╷㪈㪇䉦ᐕ⸘↹ Research ⎇ⓥ Develop new diagnosis & treatment Methods, especially Anti-Cancer drug Provide evidence for policy-making ᣂⷙ䈱⸻ᢿ䈍䉋䈶ᴦ≮ᣇᴺ䋨․䈮᛫䈏䉖䋩䈱 㐿⊒ ╷┙᩺䈮ኻ䈜䉎䉣䊎䊂䊮䉴䈱ឭଏ Develop new technology ᣂ䈢䈭ᛛⴚ䈱㐿⊒ Early Diagnosis Palliative Detection Treatment Care Primary Prevention ৻ᰴ੍㒐 Evidence for program ᣧᦼ⊒ ⸻ᢿ ᴦ≮ ✭䉬䉝 䊒䊨䉫䊤䊛䈮ኻ䈜䉎䉣䊎䊂䊮䉴 Key Success Factors ਥ䈭ᚑഞⷐ࿃ ⾗㊄ – ஜᐽჇㅴᴺ䋨㪈㪐㪐㪌䋩䈮䉋䉎䈢䈳䈖ᶖ⾌⒢ 㪈㪌㩷䉶䊮䊃 㪆㩷㪈㪅㪌㪄㪉㪅㪇㩷䊄䊦 㪆㩷▫㩿䌾㪉㪇㪇㪋㪀 㪊㪌㩷䉶䊮䊃 㪆㩷㪈㪅㪐㪄㪉㪅㪌㩷䊄䊦 㪆㩷▫㩿㪉㪇㪇㪌䌾㪀 – 㪈㪐ం ☨䊄䊦 㐳ᦼ⊛⸘↹ – 㪈㪇䉦ᐕ䈏䉖ኻ╷⸘↹ 㩿㪈㪐㪐㪍䌾㪀 䈏䉖⊓㍳ – 㪈㪐㪏㪇ᐕ䈎䉌 Fund – Tabacco sales tax by Health Promotion Act(1995) 15 cents / 1.5-2.0 dollars / pack (~2004) FHQWV-2.5 dollars / pack (2005~) – 1.9 billion US$ Long-term Plan – 10-year Cancer Control Plan (1996~) Cancer Registry – Since 1980 Weakness ᒙὐ Government driven cancer control – Plan & fund from the Government ᐭਥዉ䈱䈏䉖ኻ╷ – ᐭ䈎䉌䈱⸘↹䈫⾗㊄ A few activities of cancer NGOs – Limited donation for cancer control 䈏䉖䈮㑐䈜䉎㪥㪞㪦䈱ᵴേ䈏ዋ䈭䈇 – 䈏䉖ኻ╷䈮ኻ䈜䉎ነઃ䈏㒢䉌䉏䈩䈇䉎 Lack of evidence for cancer control programs 䈏䉖ኻ╷䊒䊨䉫䊤䊛䈱䉣䊎䊂䊮䉴䈱ᰳᅤ 29 Brief History of NCC 㖧࿖࿖┙䈏䉖䉶䊮䉺䊷䋨䌎䌃䌃䋩䈱⇛ᱧ 1989. 12. Plan to Establish NCC Formulated by MOHW 2000. 01. National Cancer Center Act enacted 2001. 06. Inauguration Ceremony Held 1DW¶O6FUHHQLQJ*XLGHOLQHIRU&RPPRQ Cancers Developed 2005. 04. Nat’l Cancer Control Institute Established 2005. 06. Research Building Completed 2005. 10. ‘Vision 2020’ Announced Proton Therapy System Introduced Nat’l Cancer Prevention & Detection Building Completed 㪈㪐㪏㪐㪅㩷㪈㪉㪅㩷㩷㩷ෘ↢⋭䈮䉋䉎㪥㪚㪚⸳┙⸘↹ 㪉㪇㪇㪇㪅㩷㪇㪈㪅㩷㩷㩷࿖┙䈏䉖䉶䊮䉺䊷ᴺቯ 㪉㪇㪇㪈㪅㩷㪇㪍㪅㩷㩷 ቢᎿᑼ㐿 㪉㪇㪇㪉㪅㩷㪇㪊㪅㩷㩷㩷ਥⷐ㪌ㇱ䈱䈏䉖ᬌ⸻䉧䉟䊄䊤䉟䊮㐿⊒ 㪉㪇㪇㪌㪅㩷㪇㪋㪅㩷㩷㩷࿖┙䈏䉖ኻ╷ᯏ㑐⸳┙ 㪉㪇㪇㪌㪅㩷㪇㪍㪅㩷㩷㩷⎇ⓥቢᚑ 㪉㪇㪇㪌㪅㩷㪈㪇㪅㩷㩷㩷㵬㪭㫀㫊㫀㫆㫅㩷㪉㪇㪉㪇㵭㩷䈱⊒ 㪉㪇㪇㪎㪅㩷㪇㪊㪅㩷㩷 㓁ሶ✢ᴦ≮䉲䉴䊁䊛䈱ዉ 㪉㪇㪇㪎㪅㩷㪇㪍㪅㩷㩷 ࿖┙䈏䉖੍㒐䋧ᬌ⸻䊎䊦䊂䉞䊮䉫ቢᚑ Functions of NCC Korea Hospital Quality patient care through innovative clinical practice 㖧࿖࿖┙䈏䉖䉶䊮䉺䊷䈱ᯏ⢻ Research Institute ⎇ⓥᚲ Creating a new frontiers in cancer research 䈏䉖⎇ⓥ䈮䈍䈔䉎 ᣂ㗔ၞ䈱᭴▽ Clinical guidelines development Analysis/ problem finding /policy development NCCI ∛㒮 Support for National cancer control programs ⥃ᐥ䉧䉟䊄䊤䉟䊮䈱㐿⊒ 㕟ᣂ⊛䈭⥃ᐥ⸻≮䉕ㅢ䈚䈢 ⾰䈱㜞䈇ᖚ⠪䉬䉝 ⸃ᨆ㪆㩷㗴⊒ 㪆╷ዷ㐿 National Cancer Control Institute ࿖┙䈏䉖ኻ╷ᯏ㑐 Think-Tank for cancer control policy – Planning and evaluating the National Cancer Control Programs Support National Cancer Control Programs – Prevention, Screening, Palliative care Operating Central Cancer Registry, National Cancer Information Center(NCIC) and Smoking Quitline Research for cancer control 䈏䉖ኻ╷╷䈱䉲䊮䉪䉺䊮䉪 ࿖┙䈏䉖ኻ╷ ⎇ⓥᯏ㑐 ࿖䈱䈏䉖ኻ╷䊒䊨䉫䊤䊛 ᡰេ – ࿖䈱䈏䉖ኻ╷䊒䊨䉫䊤䊛䈱⸘↹䈫⹏ଔ ࿖䈱䈏䉖ኻ╷䊒䊨䉫䊤䊛ᡰេ – ੍㒐䇮ᬌ⸻䇮✭䉬䉝 ਛᄩ䈏䉖⊓㍳䇮࿖┙䈏䉖ᖱႎ䉶䊮䉺䊷䈫ᾍ䊤 䉟䊮䈱ㆇ༡ 䈏䉖ኻ╷⎇ⓥ Contents ⋡ᰴ %CPEGT5VCVKUVKEUKP-QTGC 0CVKQPCN%CPEGT%QPVTQN2TQITCO ̄ %CPEGT4GIKUVT[5[UVGO ̄ 2TKOCT[%CPEGT2TGXGPVKQP2TQITCO ̄ %CPEGT5ETGGPKPI2TQITCO ̄ /GFKECN%CTG2CNNKCVKXG%CTG ̄ %CPEGT+PHQTOCVKQP%GPVGT ̄ 4GUGCTEJCPF&GXGNQROGPV +PHTCUVTWEVWTG +PVGTKO#PCN[UKUQPPF 6GTO[GCT2NCPHQT %CPEGT%QPVTQN (WVWTG&KTGEVKQP 㖧࿖䈮䈍䈔䉎䈏䉖⛔⸘ ࿖䈱䈏䉖ኻ╷䊒䊨䉫䊤䊛 ̄ 䈏䉖⊓㍳䉲䉴䊁䊛 ̄ 䈏䉖䈱৻ᰴ੍㒐䊒䊨䉫䊤䊛 ̄ 䈏䉖ᬌ⸻䊒䊨䉫䊤䊛 ̄ ᴦ≮ 㪆㩷✭ක≮ ̄ 䈏䉖ᖱႎ䉶䊮䉺䊷 ̄ ⎇ⓥ䈫㐿⊒䋨䉟䊮䊐䊤䋩 ╙ੑᰴ䈏䉖ኻ╷㪈㪇䉦ᐕ⸘↹䈮䈍䈔䉎ਛ㑆⸃ᨆ ᧪䈱ᣇะᕈ 30 Direction of NCCP ࿖䈱䈏䉖ኻ╷䊒䊨䉫䊤䊛䈱ᣇะᕈ 5JCTKPIYKVJ#UKC 䉝䉳䉝⻉࿖䈫䈱 Sharing with Asia 䉝䉳䉝⻉࿖䈫䈱 Asian Pacific Rim Region 䉝䉳䉝Ⅳᄥᐔᵗၞ 2000 – Incidence cases – Mortality cases 2050 – Incidence cases – Mortality cases 㪉㪇㪇㪇 – ⟕ᖚᢙ – ᱫᢙ 㪉㪇㪌㪇 – ⟕ᖚᢙ – ᱫᢙ 0 2M 0WLPHV 0WLPHV Source: Yang BH, et al. 2004 㪊㪇㪇ਁ 㪉㪇㪇ਁ 㪎㪏㪇ਁ 㩿㪉㪅㪍㩷㪀 㪌㪎㪇ਁ㩿㪉㪅㪐㩷㪀 Source: Yang BH, et al. 2004 Sharing with Asia ࠕࠫࠕ⻉࿖ߣߩ Sharing experiences of cancer control – Success and failure ߇ࠎኻ╷ߩ⚻㛎ߩ – ᚑഞߣᄬᢌ Korea, Japan, other Asian countries and IACR / IARC 㖧࿖ޔᣣᧄ⻉ࠕࠫࠕߩઁޔ࿖ߣ࿖㓙ၞ߇ࠎ ⊓㍳ද⼏ળ࿖㓙߇ࠎ⎇ⓥᯏ㑐㧔IACR / IARC㧕 Population in Korea Korea(1990) (1995) (2000) (2005) (2010) (2015) (2020) (2025) 3RSXODWLRQLQ.RUHD 㪧㫆㫇㫌㫃㪸㫋㫀㫆㫅㩷㫀㫅㩷㪢㫆㫉㪼㪸㩿㪈㪐㪐㪇㪀 㪧㫆㫇㫌㫃㪸㫋㫀㫆㫅㩷㫀㫅㩷㪢㫆㫉㪼㪸㩷㩿㪈㪐㪐㪌㪀 㪧㫆㫇㫌㫃㪸㫋㫀㫆㫅㩷㫀㫅㩷㪢㫆㫉㪼㪸㩷㩿㪉㪇㪇㪇㪀 㪧㫆㫇㫌㫃㪸㫋㫀㫆㫅㩷㫀㫅㩷㪢㫆㫉㪼㪸㩷㩿㪉㪇㪇㪌㪀 㪧㫆㫇㫌㫃㪸㫋㫀㫆㫅㩷㫀㫅㩷㪢㫆㫉㪼㪸㩷㩿㪉㪇㪈㪇㪀 㪧㫆㫇㫌㫃㪸㫋㫀㫆㫅㩷㫀㫅㩷㪢㫆㫉㪼㪸㩷㩿㪉㪇㪈㪌㪀 㪧㫆㫇㫌㫃㪸㫋㫀㫆㫅㩷㫀㫅㩷㪢㫆㫉㪼㪸㩷㩿㪉㪇㪉㪇㪀 㪧㫆㫇㫌㫃㪸㫋㫀㫆㫅㩷㫀㫅㩷㪢㫆㫉㪼㪸㩷㩿㪉㪇㪉㪌㪀 㖧࿖ੱญ㩿㪉㪇㪊㪇㪀 80-80- 80-80- 75-75- 75-75- 70-70- 70-70- 65-65- 65-65- 60-60- 60-60- 55-55- 55-55- 50-50- 50-50- 5-5- 5-5- 0-0- 0-0- 35-35- 35-35- 30-30- 30-30- 25-25- 25-25- 20-20- 20-20- 15-15- 15-15- 10-10- 10-10- 5- 5- 5- 50- 0- 0- 0- 250 200 150 Male 100 50 0 0 50 100 150 200 10,000 250 250 200 150 100 50 0 0 50 100 150 200 㪈㪇㪃㪇㪇㪇 Female ↵ᕈ 31 ᅚᕈ 250 Thank you 䈅䉍䈏䈫䈉 Sohee Park ࠰ࡅࡄࠢ [email protected] [email protected] 32 Cancer Registration System in Korea Korea National Statistical Office Academic Societies (Relevant cancer registration) (Cancer Mortality DB) Collection & feedback of Cancer Mortality DB Cancer registration data 2CTVKEKRCVKPI*QURKVCNU Registration Of Cancer patient Cancer registration DB per hospital Billing claims Cancer patient Data quality & feedback Collection & feedback of Cancer registration DB Collection of resident registration address DB -QTGC%GPVTCN%CPEGT4GIKUVT[ Result report -QTGC%GPVTCN%CPEGT4GIKUVT[ DB Cancer incidence survey & result 0*+% *MOPAS (residential address DB) Generate list of potential cancer Incidence cases (using medical billing claims data and death certificate data) Ministry of Health & Welfare (Management & Publication of Cancer incidence rates) Relevant cancer incidence DB Patients of cancer diagnosis & visit data & Catastrophic Diseases DB Result DB National and Regional Cancer Statistics Billing claims Medical Record Review 0QP 2CTVKEKRCVKPI*QURKVCNU 4GIKQPCN%CPEGT4GIKUVT[ Send Review Results Result report 4GIKQPCN%CPEGT4GIKUVT[ DB %QQRGTCVKQP1HECPEGTKPEKFGPEG5WTXG[ %CPEGTRCVKGPVU&$KPJQURKVCN Medical Record Review * MOPAS : Ministry of public administration and security * NHIC : National Health Insurance Corporation 㖧࿖䈮䈍䈔䉎䈏䉖⊓㍳䉲䉴䊁䊛 㖧࿖⛔⸘ዪ 㩿䈏䉖ᱫ䍡䍼䍎䍞䍫䍼䍎䍛㪀 䈏䉖ᱫ䊂䊷䉺䊔䊷䉴䈱 㓸䋧䊐䉞䊷䊄䊋䉾䉪 䈏䉖⊓㍳䈱 㓸䋧䊐䉞䊷䊄䊋䉾䉪 䈏䉖⊓㍳䊂䊷䉺 ෳട∛㒮 ∛㒮න䈱䈏䉖⊓㍳䊂䊷䉺䊔䊷䉴䈮 䉋䉎䈏䉖ᖚ⠪䈱⊓㍳ 䊂䊷䉺䈱⾰䍪䍆䍎䍢䍼䍨䍼䍍䍖 㪁ⴕోㇱ㪤㪦㪧㪘㪪 㩿᳃ᚲ䊂䊷䉺䊔䊷䉴㪀 ቇⴚ♽ቇળ 㩿㑐ㅪᕈ䈏䉖⊓㍳㪀 ᳃⊓㍳䈱ᚲ䊂䊷䉺䊔䊷 䉴䈱㓸 㖧࿖ਛᄩ䈏䉖⊓㍳ 㖧࿖ਛᄩ䈏䉖⊓㍳䊂䊷䉺䊔䊷䉴 ⚿ᨐ䊧䊘䊷䊃 䈏䉖⟕ᖚ⺞ᩏ䋧⚿ᨐ ᡰᛄ䈇⺧᳞ᦠ 䈏䉖 ᖚ⠪ 㪁࿖᳃ஜᐽ㒾࿅䋨㪥㪟㪠㪚䋩 น⢻ᕈ䈱䈅䉎䈏䉖⟕ᖚ䉬䊷䉴䈱䊥䉴䊃 䈱ᚑ䋨ක≮⾌ᡰᛄ䈇⺧᳞ᦠ䉇ᱫ 䉕↪䈇䈩䋩 ෘ↢⋭ 㩿䈏䉖⟕ᖚ₸䈱▤ℂ䈫⊒ⴕ㪀㩷 㑐ㅪ䈜䉎䈏䉖⟕ᖚ䊂䊷䉺䊔䊷䉴 䈏䉖ᖚ⠪䈱⸻ᢿ䋧ฃ⸻䊂䊷䉺䋧㜞 㗵ක≮∔ᖚ䊂䊷䉺䊔䊷䉴 ࿖䇮ၞ䈱䈏䉖⛔⸘ ⚿ᨐ䊂䊷䉺 䊔䊷䉴 ᡰᛄ䈇⺧᳞ᦠ ක≮⸥㍳䈱䊧䊎䊠䊷 㕖ෳട∛㒮 ၞ䈏䉖⊓㍳ 䊧䊎䊠䊷䈱⚿ᨐㅍା 䈏䉖⟕ᖚ⺞ᩏ䈻䈱දജ ∛㒮䈮䈍䈔䉎䈏䉖ᖚ⠪䊂䊷䉺䊔䊷䉴 ၞ䈏䉖⊓㍳䊂䊷䉺䊔䊷䉴 ක≮⸥㍳䈱䊧䊎䊠䊷 㪁㩷㪤㪦㪧㪘㪪㩷㪑㩷ⴕోㇱ 㪁㩷㪥㪟㪠㪚㩷㪑㩷࿖᳃ஜᐽ㒾࿅ 33 ⚿ᨐ䊧䊘䊷䊃 34 台湾におけるがんのモニタリングとがん対策計画 CANCER MONITORING AND CONTROL PLANNING IN TAIWAN メイシュ・ライ* Mei-Shu Lai Cancer surveillance systems provide がんのサーベイランスシステムは、がん罹 timely information, not only on cancer 患・死亡・生存の情報だけでなく、がん予防、 incidence, mortality, and survival, but also 早期発見、治療、医療の質に関連する要因の on factors related to cancer prevention, 情報をタイムリーに提供する。台湾では、 early detection, treatment, and quality of 1979 年に中央がん登録が設立されて以来、が care. In Taiwan, the central cancer registry んによる社会的負荷を評価するためにデータ has been established since 1979 and が収集されている。2003 年にがん対策法が公 collected data to evaluate cancer burden. 布されてから、がん登録の完全性とデータ精 After the Cancer Control Act promulgated 度は、北米中央登録室協議会（NAACCR : in 2003, the completeness and data quality North American Association of Central of cancer registry has achieved at the Cancer Registries）の定める“優秀”なレベル excellent level according to the NAACCR に達している。 standard. 台湾がん登録では、がん医療パターンの実 In order to monitor the care patterns and 態把握やがん治療成績評価のため、2001 年か evaluate the outcomes of cancer treatment, ら登録項目が 2 度改編され、長票を使って診 our cancer registry has been reformed 断時進行度や初回治療の詳細な情報が収集さ twice since 2001 to include items of stage れるようになった。現在、長票は、口腔、咽 at diagnosis and their detail information 頭、胃、結腸・直腸、肝、肺、女性乳房、子 (long form database) on the first course of 宮頸部、子宮体部、卵巣、膀胱の主要 10 部 treatment. Till now, total 53 hospitals, 位に適用されていて、53 病院からこの長票に which count for more than 80% of total よる届出がある。なお、この 53 病院からの national cancer cases, join the long form 届出で、台湾のがん患者の 80％以上を占めて reporting and apply it to the 10 major いる。 cancers which are cancers of oral cavity 台湾行政院衛生署は、高危険要因の除去や and pharynx, stomach, colon and rectum, 定期的ながん検診など、主要ながんに対する liver, lung, female breast, uterine cervix, 一次予防や二次予防を実施している。一次予 uterine corpus, ovary and bladder. 防として禁煙や噛みタバコ（ビンロウ、キン Primary and secondary prevention of マ）禁止などの予防政策があり、これらは確 major cancers, such as high-risk factor 実にがんリスク要因への曝露に影響を及ぼし avoidance and periodical cancer screening, ている。また、1984 年から台湾全土において *国立台湾大学公共衛生学院予防医学研究所 Inst. of Prev. Med. College of Public Health, Natl. Taiwan Univ., Taiwan 35 National B 型肝炎ワクチンプログラムが開始され、急 Department of Health of Taiwan. Certain 性・慢性肝炎予防に効果をあげている。さら preventive policies including smoking and に、台湾では、二次予防として、子宮頸がん、 betel quids cessation affect exposure to 結腸・直腸がん、女性乳がん、卵巣がんに対 cancer risks. Since 1984, the nationwide する定期検診プログラムが実施されている。 hepatitis B vaccination program has been 今後、国家レベルの総合的ながんモニタリ successful in preventing acute and chronic ングとがん克服に対する取り組みにおいて十 liver disease. Additionally, the government 分に成果をあげるには、現存するシステムと established periodical screening program の大規模な連携と調整が必要であろう。 were implemented by the for major cancers of uterine cervix, colon and rectum, female breast and oral cavity. Achieving a fully integrated national framework controlling for cancer monitoring and will require extensive collaborations and coordination to the existing systems. 36 บḧ䈮䈍䈔䉎 䈏䉖䈱䊝䊆䉺䊥䊮䉫䈫 䈏䉖ኻ╷⸘↹ Cancer Monitoring and Control Planning in Taiwan 3UHVHQWDWWK-$&50HHWLQJ 3UHVHQWDWWK-$&50HHWLQJ ╙㪈㪐࿁ቇⴚ㓸ળ䈏䉖⊓㍳䈫␠ળ䈫䈱⺞ 2FWREHU<RNRKDPD-DSDQ ╙㪈㪐࿁ቇⴚ㓸ળ䈏䉖⊓㍳䈫␠ળ䈫䈱⺞ 㪉㪇㪈㪇ᐕ㪈㪇㪈㪌ᣣ ᮮᵿ Mei-Shu Lai, M.D, Ph.D. 䊜䉟䉲䊠䊶䊤䉟 කᏧ䊶කቇඳ჻ Institute of Preventive Medicine, College of Public Health, National Taiwan University ࿖┙บḧᄢቇⴡ↢ቇ㒮 ੍㒐කቇ⎇ⓥᚲ Taiwan Cancer Registry Taiwan Cancer Registry The work of cancer registration in Taiwan: บḧ䈮䈍䈔䉎䈏䉖⊓㍳䈱ᓎഀ䋺 surveillance system 䉰䊷䊔䉟䊤䊮䉴䊶䉲䉴䊁䊛 7HFKQLFDODVSHFWVRIFDQFHUUHJLVWUDWLRQ 6HHNLQJLQIRUPDWLRQIURPPXOWLSOHVRXUFHVDYDLODEOH LQHOHFWURQLFGDWDEDVHV z 4XDOLW\RIFDQFHUUHJLVWU\GDWD z z䈏䉖⊓㍳䈱ᛛⴚ⊛㕙 z z㔚ሶ䊂䊷䉺䊔䊷䉴䈮䈍䈇䈩ᚻน⢻䈭ⶄᢙ䈱ᖱႎḮ䈎䉌 䈱ᖱႎ㓸 z䈏䉖⊓㍳䊂䊷䉺䈱⾰ Taiwan Cancer Registry Taiwan Cancer Registry Aim: ⋡⊛ through national cancer registry system to set up the epidemiology surveillance system to see the trend of cancer-specific incidence ࿖┙䈏䉖⊓㍳䉲䉴䊁䊛䉕ㅢ䈚䈩䇮䈏䉖䈮․ൻ䈚䈢⟕ᖚ 䉕ᛠី䈜䉎䈢䉄䈱∉ቇ䉰䊷䊔䉟䊤䊮䉴䉲䉴䊁䊛䉕┙䈤 䈕䉎䈖䈫 Health reform : NHI 1995 ක≮㒾ᡷ㕟࿖᳃ஜᐽ㒾 Taiwan Cancer Registry Taiwan Cancer Registry Phase I (1979-2002) ╙৻ᦼ (1979-2002) Set up in 1979 to provide epidemiologic information and cancer burden ᐕ䈮∉ቇ⊛ᖱႎ䉇䈏䉖䈮䉋䉎␠ળ⊛⽶⩄䋨䈱ᄢ 䈐䈘䈱ᖱႎ䋩䉕ឭଏ䈜䉎䈢䉄䈮⸳┙䈘䉏䈢 230 hospitals (҈50 beds) report in situ and invasive incident cancers annually ᐕ䈮৻࿁䇮㪉㪊㪇ක≮ᯏ㑐䋨∛ᐥએ䋩䈎䉌䇮⊹ౝ 䈏䉖䊶ᶐẢ䈏䉖䈱ዯ 20 items (Short Form) are reported 㓸㗄⋡䋺㪉㪇㗄⋡ ⍴ᑼ 9Case demography, diagnostic age and methods, site and morphology, summary of treatment and death 9ᖚ⠪ၮᧄᖱႎ䇮⸻ᢿᤨᐕ㦂䇮⸻ᢿᣇᴺ䇮ㇱ䇮⚵❱ቇ ⊛⸻ᢿ䇮ᴦ≮ᣇᴺ䇮ᱫ Cancer statistics in Taiwan Taiwan Cancer Registry บḧ䈱䈏䉖⛔⸘ Taiwan Cancer Registry 37 Problems of TCR บḧ䈏䉖⊓㍳䈱㗴ὐ Hospitals ක≮ᯏ㑐 Low priority , insufficient and untrained manpower, long lag of reporting, missing data in chart ఝవ㗅䈱ૐ䈘䊶ੱ᧚ਇ⿷䈫䊃䊧䊷䊆䊮䉫䈘䉏䈩䈇䈭 䈇ੱ᧚䊶ዯㆃ䉏䉦䊦䊁⸥タ䈱ṳ䉏 Registrars ⊓㍳჻ Lack of training, no support from doctors/peers, and hospitals 䊃䊧䊷䊆䊮䉫䈱ᰳᅤ䇮කᏧ䉇ห䈎䉌䈱䉰䊘䊷䊃䈏 ฃ䈔䉌䉏䈭䈇䇮 ⾰䈜䉎వ䈏䈭䈇䇮ኾ㐷⡯䈫䈚䈩 ⼂䈘䉏䈭䈇 Department of Health Low priority, 1 person manage, prelimary data check ⴕ㒮ⴡ↢⟑ ఝవ㗅䈱ૐ䈘䇮▤ℂ⠪䈏㪈ੱ䈱䉂䇮䊂䊷䉺䉼䉢䉾䉪 䈚䈩䈇䈭䈇 Taiwan Cancer Registry Taiwan Cancer Registry ࿖┙บḧᄢቇ䈻䈱บḧ䈏䉖⊓㍳䈱ᬺോᆔ⸤ 䋨㪈㪐㪐㪍ޯ䋩 To commission TCR to NTU since 1996 Closely work with senior registrars and doctors ਥછ⊓㍳჻䈫කᏧ䈫䈱✕ኒ䈭දജ Enough manpower to manage data and remind hospitals to report 䊂䊷䉺▤ℂ䈫ዯ䉕ක≮ᯏ㑐䈮ଦ䈜䈱䈮චಽ䈭ੱ᧚ ቯᦼ⊛䈭㆚䉍⺞ᩏታᣉ䊶ቢోᕈ㪐㪎䋦䈫䈭䉎 ක≮ᯏ㑐䈻䈱㔚ሶᇦ䈮䉋䉎ዯ䈱ផᅑ ቯᦼ⊛䈭䊂䊷䉺䉼䉢䉾䉪䈫ୃᱜ䊶 ක≮ᯏ㑐䈮䈍䈔䉎ዯ ೨䊂䊷䉺䉼䉢䉾䉪 ᣂ䈢䈭⛔⸘䊂䊷䉺䉕ട䈋䈢ᐕᰴႎ๔ᦠᡷ⸓ Trace back unreported potential cases regularly and completeness reach to 97% Encourage hospital report by electronic form Data check and corrigendum run regularly and hospitals proceed data check before sent out Revised annual report by adding more statistics Taiwan Cancer Registry Taiwan Cancer Registry Overview of Cancer Registry system In Taiwan Bureau of Health Promotion Department of Health Data Collection Data Management Analysis Academic use บḧ䈱䈏䉖⊓㍳䉲䉴䊁䊛䈱⇛ ࿖᳃ஜᐽዪ ⴕ㒮ⴡ↢⟑ $WTGCWQH*GCNVJ2TQOQVKQP$*2 &GRCTVOGPVQH*GCNVJ Policy Making Data Monitoring, Audit Quality Accreditation National Taiwan University ̒ ̒ ̒ ̒ Taiwan Society (NTU) of 䊂䊷䉺㓸 䊂䊷䉺▤ℂ ⸃ᨆ ቇⴚ⊛↪ ̒ ̒ ̒ ̒ ╷┙᩺ 䊂䊷䉺䊝䊆䉺䊥䊮䉫 ຠ⾰⋙ᩏ ቯ ࿖┙บḧᄢቇ 0CVKQPCN6CKYCP7PKXGTUKV[067 Cancer Registry Central Cancer Registry (Short Form Database) Central Cancer Registry (Long Form Database) บḧ 䈏䉖⊓㍳ቇળ 䋨บἨ䈏䉖∝⊓⸥ቑᦩ䋩 ਛᄩ䈏䉖⊓㍳ ⍴䊂䊷䉺䊔䊷䉴 Training course Certified cancer registrars Taiwan Cancer Registry ਛᄩ䈏䉖⊓㍳ 㐳䊂䊷䉺䊔䊷䉴 ̒ 䊃䊧䊷䊆䊮䉫䉮䊷䉴 ̒ ⣲≌⊓㍳჻䈱ቯ Taiwan Cancer Registry The work of cancer registration in Taiwan: บḧ䈮䈍䈔䉎䈏䉖⊓㍳䈱ᓎഀ䋺 Cancer monitoring-surveillance system 䈏䉖䊝䊆䉺䊥䊮䉫 - 䉰䊷䊔䉟䊤䊮䉴䊶䉲䉴䊁䊛 7HFKQLFDODVSHFWVRIFDQFHUUHJLVWUDWLRQ 6HHNLQJLQIRUPDWLRQIURPPXOWLSOHVRXUFHVDYDLODEOH LQHOHFWURQLFGDWDEDVHV z 4XDOLW\RIFDQFHUUHJLVWU\GDWD z z䈏䉖⊓㍳䈱ᛛⴚ⊛㕙 z z㔚ሶ䊂䊷䉺䊔䊷䉴䈮䈍䈇䈩ᚻน⢻䈭ⶄᢙ䈱ᖱႎḮ䈎䉌 䈱ᖱႎ㓸 z䈏䉖⊓㍳䊂䊷䉺䈱⾰ Taiwan Cancer Registry Taiwan Cancer Registry 38 Data Collection and Management Procedure of TCR in NTU ࿖┙บḧᄢቇบḧ䈏䉖⊓㍳䈮䈍䈔䉎䊂䊷䉺㓸䊶▤ℂ䈱ᵹ䉏 Registry Hospitals with over 50 beds ⊓㍳ක≮ᯏ㑐 㪌㪇ᐥએ䈱∛㒮 䈏䉖∝䈱㔚ሶ⊛ዯ䇮䊂䊷䉺ୃᱜ䇮 ㆚䉍∝䈱⏕ቯ Reporting cancer cases electronically, data correction, trace-back cases confirmed ਇ⏕䈎䈭䊂䊷䉺䈱 䈇ว䈞 Return questionable data to reconfirm 䊂䊷䉺䉼䉢䉾䉪䋧ୃᱜ Data Check & Corrigendum Correct data Data Linkage from profiles of Death Certificates, Catastrophic Illnesses, Potential and Cancer cancer Screening Program cases ୃᱜ䊂䊷䉺 ᱫ⸻ᢿᦠ ⥌ᱫ⊛∔ᖚ䊂䊷䉺䊔䊷䉴 䈏䉖ᬌ⸻䊂䊷䉺䊔䊷䉴 Data Input & Consolidation Trace potential cancer cases back to Registry Hospitals Data Integration 䈫䈱䊂䊷䉺䊥䊮䉬䊷䉳 䈏䉖ᖚ⠪ Cancer Registry Office 䊂䊷䉺ജ䋧ᾖว ⊓㍳ක≮ᯏ㑐䈻䈏䉖ᖚ⠪䈱 ㆚䉍⺞ᩏ 䊂䊷䉺⛔ว 䈏䉖 ⊓㍳ቶ T aiwan Cancer Cancer Registry Registry Taiwan Aim: ⋡⊛ requests DOH to promote the cancer care quality ⴕ㒮ⴡ↢ᚲ䈮䈏䉖ᴦ≮䈱⾰䈱ะ䈱ଦㅴ䉕ⷐ᳞䈜䉎䈖䈫 Health reform : National cancer control act 2003 ක≮㒾ᡷ㕟䋺บḧ 䈏䉖ኻ╷ᴺ 㪉㪇㪇㪊 Taiwan Cancer Registry Taiwan Cancer Registry Phase II (after 2002) ╙ੑᦼ 䋨㪉㪇㪇㪉ᐕએ㒠䋩 Cancer Control Act promulgated in 2003 which requests DOH to promote the cancer care quality 䈏䉖ኻ╷ᴺ䋨㪉㪇㪇㪊ᐕᏓ䋩㪑㩷ⴕ㒮ⴡ↢⟑䈮ኻ䈚䈩䇮 䈏䉖ᴦ≮䈱⾰䈱Ⴧㅴ䉕ⷐ᳞䈚䈩䈇䉎 To know the treatment patterns, we extended reported items from 20 to 65 in 2002 and further to 95 in 2007 which modified from US FORDS ᴦ≮䊌䉺䊷䊮䉕ᛠី䈜䉎䈢䉄䇮ዯ㗄⋡䉕㪉㪇㪇㪉ᐕ䈮㪉㪇 䈎䉌㪍㪌䇮䈘䉌䈮㪉㪇㪇㪎ᐕ䈮䇮䉝䊜䊥䉦䈱㪝㪦㪩㪛㪪䉕ర䈮ᡷᄌ 䈚䈢㪐㪌㗄⋡䈻ᒛ䈚䈢 9 ∝ၮᧄᖱႎ䇮⸻ᢿᤨᐕ㦂䇮⸻ᢿᣇᴺ䇮ㇱ䇮⚵❱ቇ⊛ ⸻ᢿ䇮㪫㪥㪤䉴䊁䊷䉳䇮⚦䈭ᴦ≮ᖱႎ䇮↢ᱫᖱႎ 9 Case demography, diagnostic age and methods, site and morphology, TNM Staging, more detail treatment information and follow-up 53 hospitals (҈500 annual incident cases) report long form information on 6 to 14 major cancers Long form cases are counted for 80% of total national cancer cases Taiwan Cancer Registry ක≮ᯏ㑐䋨ᐕ㑆㪌㪇㪇એ䈱ᣂⷙ䈏䉖ᖚ⠪䉕⸻ᢿ䊶 ᴦ≮䋩䈎䉌䇮ਥⷐ㪍㪄㪈㪋ㇱ䈱㐳䈱ᖱႎ䈏ዯ䈘䉏䉎 㐳䈮䉋䉍ዯ䈔䉌䉏䈢∝䈲䇮บḧ䈱ో䈏䉖䈱㪏㪇䋦 䈮䈱䈿䉎 Taiwan Cancer Registry Consolidate registrars ⊓㍳჻䈱ᒝൻ Trained senior registrars and organize a tutor group 9Help to form future plan, provide training courses, maintain FAQ, hospital audit Certify registrar (coding short form) since 2004 Taiwan Society of Cancer Registry was established in 2006 ⎇ୃ䉕ୃੌ䈚䈢⚖⊓㍳჻䈮䉋䉎䉼䊠䊷䉺䊷䉫䊦䊷䊒 䈱⚿ᚑ 9ᓟ䈱⸘↹䈱┙᩺ᡰេ䇮䊃䊧䊷䊆䊮䉫䉮䊷䉴䈱ឭ ଏ䇮䉋䈒䈅䉎⾰䈫䈠䈱࿁╵䉕䉁䈫䉄䈢㪨㩽㪘㓸 䋨㪝㪘㪨㪀䈱⛽ᜬ䇮∛㒮⋙ᩏ 9 Carry out BHP programs including audit, ducation, certification and FAQ ቯ⊓㍳჻䋨⍴䈱䉮䊷䊂䉞䊮䉫䋩䇮㪉㪇㪇㪋ᐕ䈎䉌 㪉㪇㪇㪍ᐕ䇮บḧ䈏䉖⊓㍳ቇળ䋨บἨ≸∝⊓⸥ቑᦩ䋩⸳┙ 9⋙ᩏ䇮ᢎ⢒䇮ቯ䉇㪝㪘㪨䉕䉃㪙㪟㪧䊒䊨䉫䊤䊛䈱 ታᣉ Taiwan Cancer Registry Taiwan Cancer Registry 39 Cancer Control Act milestone for TCR quality บḧ䈏䉖⊓㍳䈱♖ᐲ䈮ኻ䈜䉎 䈏䉖ኻ╷ᴺ䈱䊙䉟䊦䉴䊃䊷䊮 Cancer Control Act requires hospitals to follow DOH rules on cancer registration, $300-1600 penalty for not reporting 䈏䉖ኻ╷ᴺ䈲䇮ක≮ᯏ㑐䈮ⴕ㒮ⴡ↢⟑䋨㪛㪦㪟䋩䈱ቯ䉄 䉎䊦䊷䊦䈮ೣ䈦䈢䈏䉖⊓㍳䈱ታᣉ䉕ⷐ᳞䇯㩿ዯ䉕䈚䈭䈇 ႐ว㪑㪊㪇㪇䊄䊦䈎䉌㪈㪍㪇㪇䊄䊦䈱⟏㊄㪀 DOH’s rules for cancer registration (2005) 䈏䉖⊓㍳䈱㪛㪦㪟䊦䊷䊦 㩿㪉㪇㪇㪌㪀 Dr lead and report before 1 year after diagnosis කᏧ䈏₸వ䈚䇮⸻ᢿ䈎䉌㪈ᐕએౝ䈮ዯ䈚䈭䈔䉏䈳䈭 䉌䈭䈇 Manpower: 1 registrar/1000-1500 cases ੱ᧚䋺㪈㪇㪇㪇㪄㪈㪌㪇㪇∝䈮ኻ䈚䇮⊓㍳჻㪈ੱ Perform self-audit and 10% reviewed by cancer committee ⥄Ꮖ⋙ᩏ䉕ⴕ䈉䈖䈫䈫䇮ዯ䈱㪈㪇㩼䈮ኻ䈚䈩䈏䉖ᆔຬ ળ䈮䉋䉎ክᩏ䈏ⴕ䉒䉏䈩䈇䉎 ҈ 70% case FU, чϯϬйůŽƐƚ&hŝŶϭϱŵŽŶƚŚƐ 㪎㪇䋦એ䈱∝䈱↢ᱫ⏕䈏䈪䈐䈩䈇䉎䈖䈫䈫䇮 㪈㪌䊱䈪↢ᱫ⏕䈏䈪䈐䈩䈇䈭䈇∝䈲㪊㪇䋦એਅ Should be used in care quality improvement 䊂䊷䉺䈲䇮ක≮䈱⾰䈱ᡷༀ䈮↪䈘䉏䉎䈼䈐䈪䈅䉎 Taiwan Cancer Registry Taiwan Cancer Registry Summary of Central Cancer Registry Database Short Form Database Phase Data Available Year I III 1979 2007 until now Registry Hospitals From 100 to 223 hospitals Data & Item Numbers Diagnosis, treatment: 20 ⍴䊂䊷䉺䊔䊷䉴 Long Form Database II All Cancers REQUIRED Reporting Cancers ਛᄩ䈏䉖⊓㍳䊂䊷䉺䊔䊷䉴䈱䉁䈫䉄 III 2JCUG +++ 䉁䈪 ᒰᐕ 2002-2003 2004-2006 Cervix: REQUIRED Breast, liver, lung, oral cavity, colon & rectum: OPTIONAL Cervix, breast, liver, lung, oral cavity, colon & rectum: REQUIRED 15-17 hospitals 27- 33 hospitals 2007 until now ዯኻ⽎ Cervix, breast, liver, lung, oral cavity, colon & rectum: REQUIRED (2007) +++ 䉁䈪 ሶች㗪ㇱ䇮ᚱ䇮 ሶች㗪ㇱ䇮ᚱ䇮⢄䇮⢖䇮 ⢄䇮⢖䇮ญ⣧䇮⚿ ญ⣧䇮⚿⣺䊶⋥⣺ ⣺䊶⋥⣺ ᔅ㗇(2007) ᔅ㗇 ೨┙⣼䇮㘩䇮⢗䇮⣾⢲ ᚱ䇮⢄䇮⢖䇮ญ ᔅ㗇(2008䈮ㅊട) ⣧䇮⚿⣺䊶⋥⣺ છᗧ ༄㗡䇮ሶችㇱ䇮ෆᎽ䇮 ሶች㗪ㇱ ᔅ㗇 Prostate, esophagus, stomach, bladder: ADD REQUIRED (2008) Nasopharynx, Corpus, ovary, Lymphoma & Leukemia: ADD REQUIRED (2009) 䊥䊮䊌⣲䇮⊕ⴊ∛ ᔅ㗇(2009䈮ㅊട) ⊓㍳ක≮ ᯏ㑐 42-53 hospitals 䊂䊷䉺 㗄⋡ᢙ Diagnosis, Diagnosis, stage, treatment, Diagnosis, stage, follow-up: 95 stage, treatment, treatment, Taiwan Cancer Registry65 follow-up: 65 follow-up: Diagnosis, treatment: 33 ක≮ᯏ 㑐 ක≮ᯏ㑐 ⸻ᢿ䇮ᴦ≮ ⸻ᢿ䇮ᴦ≮ ⸻ᢿ䇮ㅴⴕᐲ䇮 ᴦ≮䇮↢ᱫᖱ ႎ䋺 ක≮ᯏ ක≮ᯏ㑐 㑐 ⸻ᢿ䇮ㅴⴕᐲ䇮 ᴦ≮䇮↢ᱫᖱ ႎ䋺 ⸻ᢿ䇮ㅴⴕᐲ䇮ᴦ≮䇮 ↢ᱫᖱႎ Taiwan Cancer Registry 䈏䉖ᴦ≮䈱⾰䈱ቯ Subsidize hospitals to fulfill DOH rules on CR and improve care quality during 2002-2007 㪉㪇㪇㪉ᐕ䈎䉌㪉㪇㪇㪎ᐕ䈮䇮ක≮ᯏ㑐䈮ኻ䈚䇮䈏䉖⊓㍳䈮䈍䈔䉎䌄䌏䌈 䊦䊷䊦䉕ḩ䈢䈚䈏䉖ᴦ≮䈱⾰䉕ᡷༀ䈜䉎䈢䉄䈱ഥ䉕䈚䈢 䈏䉖⊓㍳䈱⾰䈫ㆡ↪䈮䈧䈇䈩⋙〈䈚䈩䈇䉎䈏䉖ᆔຬળ䈱䊧䊔 䊦䈻䈏䉖⊓㍳䉕ะ䈘䈞䉎 Upgrade CR to the level of cancer committee which is in charge of its quality and application ਥዉ⠪䈪䈅䉎කᏧ䈮䉋䉎⊓㍳჻䈫⥃ᐥක䈫䈱ᯅᷰ䈚 Doctor leader bridges registrars and clinicians ++ ో䈏䉖 ᔅ㗇 Accreditation cancer care quality 㐳䊂䊷䉺䊔䊷䉴 + ᐕ䈎䉌䇮ක≮ᯏ㑐䈮ኻ䈚䈩䈏䉖ᴦ≮䈱⾰䈱ቯ䉕䈚䈩䈇䉎 䊘䉟䊮䊃ਛ䇮㪍䊘䉟䊮䊃䈏䈏䉖⊓㍳䈮㑐ㅪ䈜䉎䈖䈫 Accredit hospitals for cancer care quality since 2007 6 of 30 points are related to CR “A level” hospitals can apply medical center accreditation which influence NHI payment Taiwan Cancer Registry 䌁䊧䊔䊦䈱ක≮ᯏ㑐䈲䇮࿖᳃ஜᐽ㒾䈱ᡰᛄ䈇䈮ᓇ㗀䉕ਈ 䈋䉎ක≮䉶䊮䉺䊷䈱ቯ䉕↳⺧䈜䉎䈖䈫䈏䈪䈐䉎 Taiwan Cancer Registry Data Quality Indices for Taiwan Cancer Registry Subsequent to “Cancer Control Act” enacted 䈏䉖ኻ╷ᴺቯᓟ䈱บḧ䈏䉖⊓㍳䈱♖ᐲᜰᮡ ၮḰ 2002 2003 2004 2005 2006 2007 Criterion 2002 2003 2004 2005 2006 2007 ቢోᕈ㪃㩷㩼 92.80 95.46 94.27 96.69 97.59 97.82 Completeness, % 92.80 95.46 94.27 96.69 97.59 97.82 㪛㪚㪦㩷㩼㩷㪈 2.89 2.57 2.32 1.67 1.38 1.40 54.59 55.85 51.18 51.65 49.98 52.04 87.37 87.05 88.51 88.06 88.91 89.78 24 24 23 17 17 17 DCO % 1 M/I % 2 MV % 3 Timeliness, months 2.89 2.57 2.32 1.67 1.38 1.40 㪤㪆㪠㩷㩼㩷㪉 54.59 55.85 51.18 51.65 49.98 52.04 㪤㪭㩷㩼㩷㪊 89.78 හᤨᕈ㪃㩷 87.37 24 Note: 1. Death Certificate Only percentage 2. Mortality : Incidence ratio 3. Microscopically Verified percentage T aiwan Taiwan 87.05 24 88.51 23 88.06 17 88.91 17 Note: 1. Death Certificate Only percentage䋨ᱫ䈱ᖱႎ䈱䉂䈱∝䇮䋦䋩 2. Mortality : Incidence ratio䋨ᱫ䋺⟕ᖚᲧ䋩 3. Microscopically Verified percentage䋨㗼ᓸ㏜ቇ⊛⸻ᢿ䈱ታᣉഀว䇮䋦䋩 17 Cancer R egistry Cancer Registry Taiwan Cancer Registry 40 2002 1979 Year Policy 2007 2002 1979 ╷ “Cancer Control Act” enacted & trace-back procedure started Cancer Registry Database set up to register all cancer cases identified in hospitals with more than 50 beds Taiwan Cancer Database (TCDB) set up to register six major cancer cases identified in hospitals with more than 500 cases/year Short Form (SF) system only Short Form & Long Form (LF) were two separate DB in year 2002-2003 2004 1995 2003 National Health Insurance (NHI) Program started Central Cancer Registry Database 2004 ᐕ 1995 2003 ࿖᳃ஜᐽ㒾 ᐲ㐿ᆎ 䈏䉖⊓㍳䊂䊷䉺䊔䊷䉴 䉲䉴䊁䊛⸳⟎䋺 㪌㪇ᐥએ䈱ක≮ᯏ㑐 䈪⸻ᢿ䊶ᴦ≮䈘䉏䈢䈏 䉖ᖚ⠪䈜䈼䈩䉕⊓㍳ SF & LF data were combined since 2004, but were still separate DB SF& LF system were officially merged since 2007 㵰䈏䉖ኻ╷ᴺ㵱ቯ 㩽 ㆚䉍⺞ᩏ㐿ᆎ บḧ䈏䉖䊂䊷䉺䊔䊷䉴 䉲䉴䊁䊛⸳⟎䋺 Ფᐕ㪌㪇㪇∝એ䈏䉖 ∝䉕䈜䉎∛㒮䈪⸻ ᢿ䊶ᴦ≮䈘䉏䈢ਥⷐ㪍ㇱ 䈱䈏䉖䉕⊓㍳ ⍴ 䋨㪪㪿㫆㫉㫋㩷㪝㫆㫉㫄㪑㩷㪪㪝㪀 ᑼ 䈱䉂 ਛᄩ 䈏䉖⊓㍳ 䊂䊷䉺䊔䊷䉴 2007 㪉㪇㪇㪉㪄㪉㪇㪇㪊䋺 ⍴ 䈫 㐳 㩿㪣㫆㫅㪾㩷㪝㫆㫉㫄㪑㩷㪣㪝㪀㩷 䈱䊂䊷䉺䊔䊷䉴 䈲䇱 㪉㪇㪇㪋㪄 ⍴ 䈫㐳䊂 䊷䉺䈱⚿ว䇯 䊂䊷䉺䊔䊷䉴䈲 䇱 㪉㪇㪇㪎㪄 ⍴ 䈫 㐳䈱 䊂䊷䉺䊔䊷䉴 䉲䉴䊁䊛䈱ᱜᑼ 䈭⛔ว Taiwan Cancer Registry บḧ䈏䉖⊓㍳䈱ᱧผ Taiwan Cancer Registry Evolution of Taiwan Cancer Registry 䈏䉖䈱䊝䊆䉺䊥䊮䉫 Cancer Monitoring 䈏䉖⊓㍳䊂䊷䉺䊔䊷䉴䉕↪䈇䈢 Cancer surveillance using CR database 䈏䉖䉰䊷䊔䉟䊤䊮䉴 7RSQDWLRQDOFDQFHULQFLGHQFHPRUWDOLW\E\\HDU ,QWHUQDWLRQDOFRPSDULVRQ z &DQFHULQFLGHQFHWUHQGFKDQJH z 6WDJLQJWUHDWPHQWVXUYLYDO z z㪈ᐕ䈗䈫䈱࿖䈱䈏䉖⟕ᖚ䊶ᱫ䊃䉾䊒㪈㪇 z z࿖㓙Ყセ z䈏䉖⟕ᖚ䊃䊧䊮䊄䈱ᄌൻ zㅴⴕᐲ䋯ᴦ≮䋯↢ሽ₸ Taiwan Cancer Registry 70.0 Taiwan Cancer Registry Taiwan Top 10 Cancer in 2007 66.1 70 60.0 60 40.0 53.1 45.8 37.1 44.0 %TWFGTCVG 39.5 36.4 #IGCFLWUVGFTCVG 31.6 30.0 29.0 23.5 20.0 ੱญਁੱኻ 2GTRQRWNCVKQP 53.1 50.0 㪉㪇㪇㪎ᐕ บḧ䊃䉾䊒㪈㪇䈱䈏䉖 66.1 50 45.8 40 37.1 44 %TWFGTCVG ☻₸ 39.5 ᐕ㦂⺞ᢛ₸ #IG CFLWUVGFTCVG 36.4 31.6 30 23.8 29 23.5 19.5 15.7 12.5 15.4 12.2 10.0 23.8 19.5 20 10.6 8.4 10.3 8.3 15.7 12.5 15.4 12.2 10 0.0 0 ᅚᕈᚱ 䋨C50䋩 Taiwan Cancer Registry ᄢ⣺ 䋨C18-21䋩 ⢄⤳ 䋨C22䋩 ⢖ 䋨C34䋩 ೨┙⣼ 䋨C61䋩 ญ⣧ 䋨C00-06, C09-10, C12-14䋩 ⢗ 䋨C16䋩 ሶች㗪ㇱ 䋨C53䋩 10.6 8.4 ⊹⤏ 䋨C44䋩 ሶችㇱ 䋨C54䋩 Taiwan Cancer Registry ࣹΚڣ嚰ᓳᖞ圹2000ڣԳՑ圵ഗ圯圗ጩנ土坖地圎坕 Note: age-adjusted rate which is calculated based on the 2000 world standard population บḧ 㖧࿖䇮䉸䉡䊦 ᣣᧄ䇮ᄢ㒋 ਛ࿖䇮㚅᷼ ਛ࿖䇮ᶏ 䊐䉞䊥䊏䊮䇮䊙䊆䊤 䉲䊮䉧䊘䊷䊦 䉟䉺䊥䉝䇮䊯䉢䊈䊃 䉴䉟䉴䇮䊁䉞䉼䊷䊉 䊐䊤䊮䉴䇮䉟䉷䊷䊦 䉴䊕䉟䊮䇮䉝䉴䊃䉠䊥䉝䉴 䉺䉟䇮䉸䊮䉪䊤䊷 䉪䉡䉢䊷䊃䋺䉪䉡䉢䊷䊃ੱ 䉼䉢䉮࿖ 䊄䉟䉿䇮䉱䊷䊦䊤䊮䊃 䉝䊜䊥䉦䇮䌓䌅䌅䌒䋨䋱䋴䋩 䉴䊨䊯䉢䊆䉝 䉮䉴䉺䊥䉦 䊨䉲䉝䇮䉶䊮䊃䊕䊁䊦䉴䊑䊦䉫 䊐䉞䊮䊤䊮䊄 䉟䊮䊄䇮䊛䊮䊋䉟 䉦䊅䉻 䊆䊠䊷䉳䊷䊤䊮䊄 䊂䊮䊙䊷䉪 䉥䊷䉴䊃䊤䊥䉝䇮䉪䉟䊷䊮䉵䊤䊮䊄 䉟䉴䊤䉣䊦 䉮䊨䊮䊎䉝䇮䉦䊥 䉴䉡䉢䊷䊂䊮 䊘䊷䊤䊮䊄䇮䊪䊦䉲䊞䊪Ꮢ 䉝䉟䊦䊤䊮䊄 䊉䊦䉡䉢䊷 䉥䊤䊮䉻 䉟䉩䊥䉴䇮䉟䉩䊥䉴᧲ㇱ 䉝䊦䉳䉢䊥䉝䇮䉶䊁䉞䊐 LIVER ⢄⤳ ↵ ᅚ ᐕ㦂⺞ᢛ⟕ᖚ₸䋨ੱญ㪈㪇ਁ䈅䈢䉍䋩 Taiwan Cancer Registry Taiwan Cancer Registry ⢄䈏䉖䈱ᐕ㦂⺞ᢛ⟕ᖚ₸䈱࿖㓙Ყセ 41 10.3 8.3 Studies of staging and pattern of care z z ㅴⴕᐲ䈫ᴦ≮䊌䉺䊷䊮䈱⎇ⓥ 6WDJLQJ and survival Pattern of care 拁嫛ㄵቋ䞮ⷧ䘖 ᴦ≮䊌䉺䊷䊮 z z Taiwan Cancer Registry Taiwan Cancer Registry ઁ ዊ⚦⢩䈏䉖 ᚳᐔ⊹䈏䉖 ⣼䈏䉖 ⣼䈏䉖 ᐕ บḧ䈮䈍䈔䉎↵ᕈ⢖䈏䉖䈱⚵❱ဳ䉺䉟䊒䈱ಽᏓ 㪈㪐㪐㪏㪄㪉㪇㪇㪎ᐕ ઁ ዊ⚦⢩䈏䉖 ᚳᐔ⊹䈏䉖 ⣼䈏䉖 ⣼䈏䉖 Ta aiwan Cancer Ca ance er R egistry g y Taiwan Registry ᐕg Ta aiwan Cancer Ca ance er Registry Registry y Taiwan บḧ䈮䈍䈔䉎ᅚᕈ⢖䈏䉖䈱⚵❱ဳ䉺䉟䊒䈱ಽᏓ 㪈㪐㪐㪏㪄㪉㪇㪇㪎ᐕ บḧ䈮䈍䈔䉎ᅚᕈ䈏䉖䈱∛ᦼಽᏓ Staging and Survival for Female Breast Cancer 㪇ᦼ 㸇ᦼ 㪠㪠ᦼ 㪠㪠㪠ᦼ 㪠㪭ᦼ ᅚᕈ䈏䉖 ∛ᦼ 䈫 ↢ሽ₸ ਇ ᐕ AJCC ∛ᦼ T aiiwan Cancer Canc cer R eg gisttry Taiwan Registry ታ᷹↢ሽ₸䋨䋦䋩, 2004-2008 1ᐕ 2ᐕ 3ᐕ 4ᐕ 5ᐕ 0ᦼ 99.6 99.1 98.6 97.8 96.8 Iᦼ 99.5 98.7 97.6 96.4 95.1 IIᦼ 99.0 96.9 94.3 91.9 89.5 IIIᦼ 96.4 88.9 82.0 75.1 69.7 39.9 31.5 21.0 Taiwan Cancer Registry g y 72.4 52.8 IVᦼ 㪁㪉㪇㪇㪐ᐕ㪈㪉㪊㪈ᣣ䉁䈪ㅊ〔䈘䉏䈢ᖚ⠪ Distribution of First Course Treatment by Stage for Female Breast Cancer Diagnosed in 2007 2007ᐕ ᐕ⸻ᢿ䈱䈏䉖䋨ᅚᕈ䋩䈮䈍䈔䉎 ∛ᦼ䈗䈫䈱ೋ࿁ᴦ≮䈱ಽᏓ ᚻⴚ䋧䊖䊦䊝䊮≮ᴺ ᚻⴚ䋧ൻቇ≮ᴺ䋧䊖䊦䊝䊮≮ᴺ ᚻⴚ䋧✢≮ᴺ䋧䊖䊦䊝䊮≮ᴺ ᚻⴚ䋧ൻቇ䊶✢≮ᴺ䋧䊖䊦䊝䊮≮ᴺ ✭䉬䉝 ઁ䈱ᴦ≮䈱⚵䉂ว䉒䈞 T aiiwan Cancer Cancer R egi gisttry y Taiwan Registry T aiiwan Cancer Cancer Registry Regi gisttry y Taiwan 㪇ᦼ 42 㸇ᦼ 㪠㪠ᦼ 㪠㪠㪠ᦼ 㪠㪭ᦼ Cancer registry in cancer control 䈏䉖ኻ╷䈮䈍䈔䉎䈏䉖⊓㍳ ,PSDFWRIWKHWREDFFRFRQWURODFWWROXQJFDQFHU 7REDFFRFRQWURODFW z ,PSDFWRIKHSDWLWLV%YDFFLQDWLRQPDVVSURJUDPWRKHSDWRPD z ,PSDFWRISDSVPHDUVFUHHQLQJSURJUDPWRWKHFDUFLQRPDV LQVLWXUDWLRRILQVLWXWRDGYDQFHFDQFHURUWRWDOFDQFHU z Geographic variation study on oral cancer ⢖䈏䉖䈮ኻ䈜䉎䈢䈳䈖ⷙᴺ䈱ᓇ㗀䋺䈢䈳䈖ⷙᴺ䋨㪈㪐㪐㪎䋩 ⢄䈏䉖䈮ኻ䈜䉎䌂ဳ⢄Ἳ䉡䉟䊦䉴䊪䉪䉼䊮੍㒐ធ⒳䊒䊨䉫䊤䊛䈱ᓇ㗀 z ሶች㗪䈏䉖䈮䈍䈔䉎⊹ౝ䈏䉖䊶ㅴⴕ䈏䉖䋨䈅䉎䈇䈲ో䈏䉖䋩Ყ䈮ኻ 䈜䉎ᡂㆊ⚦⢩⸻ᬌ⸻䊒䊨䉫䊤䊛䈱ᓇ㗀 z ญ⣧䈏䉖⟕ᖚ䈱ℂቇ⊛⋧㆑ z z z Taiwan Cancer Registry Taiwan Cancer Registry Cancer Prevention 䈏䉖੍㒐 ∔ᖚ䈱⥄ὼ⚻ㆊ Natural History of Disease X Y 5WUEGRVKDNG5VCIG 2TGENKPKECN5VCIG Z %NKPKECN5VCIG [ &KUCDNG5VCIG \ &GCVJ X ᓇ㗀䉕ฃ䈔䉇䈜䈇 Ბ㓏 Y ೨⥃ᐥᲑ㓏 Z ⥃ᐥᲑ㓏 [ 㓚ኂ䈱Ბ㓏 \ ᱫ P ォ⒖䈱੍㒐 Q 䊥䊊䊎䊥䊁䊷䉲䊢䊮 PPrevention of metastasis QRehabilitation O 䈏䉖ᬌ⸻㪆ᣧᦼ⊒ O Cancer Screening/ Early Detection Mᢎ⢒ N䊪䉪䉼䊮ធ⒳ MEducation NVaccination Cancer Control in Taiwan บḧ䈮䈍䈔䉎䈏䉖ኻ╷ Primary Prevention ৻ᰴ੍㒐 9 National Policy and Health Education: 9 ஜᐽᢎ⢒ ༛ᾍ䇮䉝䊦䉮䊷䊦䇮䊎䊮䊨䉡䉳䈭䈬䇮⊒䈏䉖䈱 䊥䉴䉪䉇ⷐ࿃䈻䈱ᦑ㔺䉕㒐䈓䇮䈅䉎䈇䈲ᦨዊ䈮䈜䉎 9 䊪䉪䉼䊮ធ⒳ 㪙ဳ⢄Ἳ䉡䉟䊦䉴䇮䊍䊃䊌䊏䊨䊷䊙䉡䉟䊦 䉴 9 Tobacco control act 9 Health literacy 9 Vaccination: 9 Hepatitis B vaccine, 9 HPV vaccine Taiwan Cancer Registry g y ੑᰴ੍㒐 9 䈏䉖ᬌ⸻䈫ᣧᦼ⊒ ሶች㗪䈏䉖䇮䈏䉖䇮⚿⣺䊶⋥⣺ 䈏䉖䇮ญ⣧䈏䉖䈮ኻ䈜䉎䉴䉪䊥䊷䊆䊮䉫䊒䊨䉫䊤䊛 Secondary Prevention 9 Cancer Screening/ Early Detection : 9 Cancer Control Act: screening program for cancers of cervix uteri, breast, colon-rectum and oral cavity Taiwan Cancer Registry Taiwan Cancer Registry 䈏䉖⊓㍳䊂䊷䉺䊔䊷䉴䉕↪䈚䈢 䈏䉖䉰䊷䊔䉟䊤䊮䉴 Cancer Surveillance Using CR Database ৻ᰴ੍㒐 ஜᐽ䈭 ੱ䇱 ੑᰴ੍㒐 ᣂⷙ䈮䈏䉖䈫⸻ ᢿ䈘䉏䈢ੱ䇱 ਃᰴ੍㒐 䈏䉖ᴦ≮䉕ฃ 䈔䈢ੱ䇱 䈏䉖䈫 䈮↢䈐䉎 ੱ䇱 䈏䉖䈪 ᱫ䈜䉎ੱ 䇱 ᔅⷐ䈭ᖱႎ ᮮᢿ⊛ 㪁ో࿖⊛䈭䇮ၞ䈱䇮⋭䉇ၞ␠ળ䈱䈏䉖䈮䉋䉎⽶⩄䈱⸥ㅀ 㪁ੱ⒳䇮᳃ᣖ䇮␠ળ⊛䉇ᢥൻ䋻䇮␠ળ⊛䇮↢‛ቇ⊛࿃ሶ䋻䊒䊨䊋䉟䉻䈱⍮⼂䇮ᘒᐲ䇮ታ〣 ⴕേෂ㒾࿃ሶ 䉴䉪䊥䊷䊆䊮䉫ᬌᩏ ⅣႺᦑ㔺 ␠ળ⊛䊶ⅣႺ⊛╷ Taiwan Cancer Registry 䈏䉖⟕ᖚ ක≮䈱↪ᕈ ක≮䉕ฃ䈔䉎ᯏળ ↢ᵴ䈱⾰ ว૬∝ ᦨవ┵䈱ක≮ 䉮䊮䊒䊤䉟䉝䊮䉴 ↢ᵴ䈱⾰ ว૬∝ ౣ⊒ ↢ሽ 䈏䉖䈱∛₸ Taiwan Cancer Registry 43 ක≮䈱↪ᕈ ක≮䉕ฃ䈔䉎ᯏળ ↢ᵴ䈱⾰ ว૬∝ 䊖䉴䊏䉴䊶⚳ᧃᦼක≮ 䈏䉖ᱫ₸ Cancer registry in cancer control 䈏䉖ኻ╷䈮䈍䈔䉎䈏䉖⊓㍳ ,PSDFWRIWKHWREDFFRFRQWURODFWWROXQJFDQFHU 7REDFFRFRQWURODFW z ,PSDFWRIKHSDWLWLV%YDFFLQDWLRQPDVVSURJUDPWRKHSDWRPD z ,PSDFWRISDSVPHDUVFUHHQLQJSURJUDPWRWKHFDUFLQRPDV LQVLWXUDWLRRILQVLWXWRDGYDQFHFDQFHURUWRWDOFDQFHU z Geographic variation study on oral cancer ⢖䈏䉖䈮ኻ䈜䉎䈢䈳䈖ⷙᴺ䈱ᓇ㗀䋺䈢䈳䈖ⷙᴺ䋨㪈㪐㪐㪎䋩 ⢄䈏䉖䈮ኻ䈜䉎䌂ဳ⢄Ἳ䉡䉟䊦䉴䊪䉪䉼䊮੍㒐ធ⒳䊒䊨䉫䊤䊛䈱ᓇ㗀 z ሶች㗪䈏䉖䈱⊹ౝ䈏䉖䊶ㅴⴕ䈏䉖䋨䈅䉎䈇䈲ో䈏䉖䋩Ყ䈮ኻ䈜䉎ᡂ ㆊ⚦⢩⸻ᬌ⸻䊒䊨䉫䊤䊛䈱ᓇ㗀 z ญ⣧䈏䉖⟕ᖚ䈱ℂቇ⊛⋧㆑ z z z Taiwan Cancer Registry Taiwan Cancer Registry 䌂ဳ⢄Ἳ䉡䉟䊦䉴䈱⇇⊛䈭ᵹⴕ 䊣䊷䊨䉾䊌 ർ䉝䊜䊥䉦 䉝䉳䉝䊶Ⅳᄥᐔᵗ 䉝䊐䊥䉦䊶ਛ᧲ 㪉㪇㪇㪉 䊤䊁䊮䉝䊜䊥䉦 ᘟᕈ䌂ဳ⢄Ἳ䋺 㪕㪊㪌㪇㪤 ᐕ㑆ᣂⷙᗵᨴ⠪䋺 㪉㪄㪊䌍 㜞 ਛ╬ ᐕ㑆ᱫ⠪䋺 㪈㪄㪉䌍 Taiwan Cancer Registry Taiwan Cancer Registry Nationwide HBV Vaccine Prevent Liver Cancer in Children ૐ บḧో䈮䈍䈔䉎㪙ဳ⢄Ἳ䊪䉪䉼䊮䈲 ዊఽᦼ䈱⢄䈏䉖䉕੍㒐䈜䉎 䋲㪅㩷บḧో䈮䈍䈔䉎㪙ဳ⢄Ἳ䉡䉟䊦䉴䊪䉪䉼䊮䊒䊨䉫䊤䊛䈱䉁䈫䉄 ᦼ㑆 䉟䊔䊮䊃䈫ኻ⽎⠪ 䉮䊜䊮䊃 1980 ࿖┙⢄Ἳኻ╷ㆇ༡ᆔຬળ䈫⢄Ἳኻ╷ᆔຬળ䈏ታᣉ 1984.7 - 1986.6 HB䌳᛫ේ㓁ᕈ䈱Უ䉕ᜬ䈧ᣂ↢ఽ 1986.7 - 䈜䈼䈩䈱ᣂ↢ఽ 1987.7 บḧડᬺ䈮䉋䉎ᦨೋ䈱ⴊẏ↱᧪Bဳ⢄Ἳ䊪䉪䉼䊮䈱ㅧ䈫⽼ᄁ䈱น 1987-1989 ᣂ↢ఽᦼ䈮䊪䉪䉼䊮䉕ធ⒳䈚䈩䈇䈭䈇ᐜ⒩ ఽ䈫කቇ⊛ᤃᗵᨴ⠪ 1988-1990 䈜䈼䈩䈱ዊቇ↢ 1991.7 ዊቇᩞᣂ↢䈮ኻ䈜䉎䊪䉪䉼䊮ធ⒳ᱧ⺞ᩏ 1992 10ઍޯᄢੱ䈻䈱䊪䉪䉼䊮ធ⒳䋨᧪㜞ᛄ䈇䋩 ⟕ᖚ₸义 ੱญ 6-14ᚽ ਁੱ丵 ᐕ乊 10 T aiwan Cancer Cance cer R egistry Taiwan Registry 2010-10-15 䈜䈼䈩䈱ᣂ↢ఽ䈮ኻ䈚䇮0,1,2,12䊱䈮ⴊẏ↱᧪Bဳ⢄Ἳ䊪䉪䉼䊮䉕ᛩਈ 䋰í䋵ᚽ ↢ᐕ 1992.11.1એ㒠䇮⚵឵䈋㉂Უ䊪䉪䉼䊮䈱0,1,6䊱䈱3࿁ធ⒳䈫䈭䉎 ࿑㪈㪅㩷↢䉮䊖䊷䊃㪍㪄㪈㪋ᚽఽ䈫㪇㪄㪌ᚽఽ䈱⢄䈏䉖⟕ᖚ₸䈱Ყセ䇯㪇㪄㪌ᱦ ఽ䈱⢄䈏䉖⟕ᖚ₸䈏ၮᧄ⊛䈮ᄌൻ䈚䈩䈇䈭䈇䈱䈮ኻ䈚䇮㪍㪄㪈㪋ᚽఽ䈱 ⢄ 䈏䉖⟕ᖚ₸䈲ᷫዋ䈚䈩䈇䈢䇯䈖䉏䈲䇮㓸࿅੍㒐ធ⒳䊒䊨䉫䊤䊛ታᣉ䈱⚿ ᨐ䇮㪙ဳ⢄Ἳ䉡䉟䊦䉴䈱᳓ᐔ䈍䉋䈶↥ᦼ䈱ᗵᨴ₸ᷫዋ䈮䉋䉍⺑䈘䉏 䉎น⢻ᕈ䈏䈅䉎䇯㓸࿅੍㒐ធ⒳䊒䊨䉫䊤䊛䈲⧯ᐕ⠪䈮⋥ធല䈪䈅䉍䇮 ᐕ㐳⠪䈮䈲䉨䊞䊥䉝䉕ᷫ䉌䈚᳓ᐔᗵᨴ䈱䊥䉴䉪䉕ᷫዋ䈘䈞䉎䈖䈫䈮䉋䉍㑆 ធ⊛䈮ല䈪䈅䈦䈢䇯㪍㪄㪈㪋ᚽఽ䈱⢄䈏䉖⟕ᖚ₸䈲㪈㪐㪏㪍ᐕ䈎䉌㪏㪎ᐕ↢䉁 䉏䈱ዊఽ䈮䈍䈇䈩䈲㪇䉁䈪ᷫዋ䈚䈢䇯㪈㪐㪏㪍ᐕ↢䉏䈱ⷰኤᢙ䋨ੱᐕ䋩䈲 㪍㪈㪊㪃㪏㪊㪎ੱ䈪㪈㪐㪏㪎ᐕ↢䉁䉏䈲㪊㪈㪊㪃㪊㪈㪈ੱ䈪䈅䈦䈢䇯 T aiwan Cancer Cance cer Registry Registry Taiwan MH Chang et al., N Engl J Med 1997;336:1855-9 Cancer registry in cancer control 䈏䉖ኻ╷䈮䈍䈔䉎䈏䉖⊓㍳ ,PSDFWRIWKHWREDFFRFRQWURODFWWROXQJFDQFHU 7REDFFRFRQWURODFW z ,PSDFWRIKHSDWLWLV%YDFFLQDWLRQPDVVSURJUDPWRKHSDWRPD z ,PSDFWRISDSVPHDUVFUHHQLQJSURJUDPWRWKHFDUFLQRPDV LQVLWXUDWLRRILQVLWXWRDGYDQFHFDQFHURUWRWDOFDQFHU z Geographic variation study on oral cancer ⢖䈏䉖䈮ኻ䈜䉎䈢䈳䈖ⷙᴺ䈱ᓇ㗀䋺䈢䈳䈖ⷙᴺ䋨㪈㪐㪐㪎䋩 ⢄䈏䉖䈮ኻ䈜䉎䌂ဳ⢄Ἳ䉡䉟䊦䉴䊪䉪䉼䊮੍㒐ធ⒳䊒䊨䉫䊤䊛䈱ᓇ㗀 z ሶች㗪䈏䉖䈮䈍䈔䉎⊹ౝ䈏䉖䊶ㅴⴕ䈏䉖䋨䈅䉎䈇䈲ో䈏䉖䋩Ყ䈮ኻ 䈜䉎ᡂㆊ⚦⢩⸻ᬌ⸻䊒䊨䉫䊤䊛䈱ᓇ㗀 z ญ⣧䈏䉖⟕ᖚ䈱ℂቇ⊛⋧㆑ z z z Taiwan Cancer Registry Taiwan Cancer Registry 44 䉮䊨䊮䊎䉝䇮䉦䊥 บḧ 㪁䊐䉞䊥䊏䊮䇮䊙䊆䊤 䉮䉴䉺䊥䉦 䉺䉟䇮䉸䊮䉪䊤䊷 㖧࿖䇮䉸䉡䊦 䉴䊨䊋䉨䉝࿖ 䉼䉢䉮࿖ 䉴䊨䊯䉢䊆䉝 䉟䊮䊄䇮䊛䊮䊋䉟 䊘䊷䊤䊮䊄䇮䊪䊦䉲䊞䊪Ꮢ 㪁䉝䊦䉳䉢䊥䉝䇮䉶䊁䉞䊐 䊂䊮䊙䊷䉪 䉲䊮䉧䊘䊷䊦 䊉䊦䉡䉢䊷 䊄䉟䉿䇮䉱䊷䊦䊤䊮䊃 㪁ਛ࿖䇮㚅᷼ 䊨䉲䉝䇮䉶䊮䊃䊕䊁䊦䉴䊑䊦䉫 䉝䉟䊦䊤䊮䊄 䊆䊠䊷䉳䊷䊤䊮䊄 䉝䊜䊥䉦䇮䌓䌅䌅䌒䋨䋱䋴䋩 䉴䊕䉟䊮䇮䉝䉴䊃䉠䊥䉝䉴 䉥䊷䉴䊃䊤䊥䉝䇮䉪䉞䊷䊮䉵䊤䊮䊄 䉴䉡䉢䊷䊂䊮 䉦䊅䉻 䉴䉟䉴䇮䊁䉞䉼䊷䊉 䊐䊤䊮䉴䇮䉟䉷䊷䊦 䉥䊤䊮䉻 ᣣᧄ䇮ᄢ㒋 䉟䉺䊥䉝䇮䊔䊈䊃 䉟䉩䊥䉴䇮䉟䊮䉫䊤䊮䊄᧲ㇱ 䉟䉴䊤䉣䊦 䉪䉡䉢䊷䊃䋺䉪䉡䉢䊷䊃ੱ 䊐䉞䊮䊤䊮䊄 ਛ࿖䇮ᶏ ᐕ㦂⺞ᢛ⟕ᖚ₸䋨ੱญ㪈㪇ਁ䈅䈢䉍䋩 Taiwan Cancer Registry Taiwan Cancer Registry ሶች㗪䈏䉖䈱ᐕ㦂⺞ᢛ⟕ᖚ₸䈱࿖㓙Ყセ Note: data from Cancer Incidence in five Continents Vol. IX, IARC 2007 Note: data from Cancer Incidence in five Continents Vol. IX, IARC 2007 ෳᾖ䋺㪌ᄢ㒽䈱䈏䉖⟕ᖚ╙䋹Ꮞ䇮㪠㪘㪚㪩㪃㪉㪇㪇㪎䈱䊂䊷䉺 Coverage of Pap Smear in Taiwan บḧ䈱ሶች㗪ㇱᡂㆊ⚦⢩⸻ᬌᩏ䈱䉦䊋䊷₸ 60 60 annual screening rate annual screening rate ᐕ㑆䉴䉪䊥䊷䊆䊮䉫ฃ⸻₸ 㪊ᐕ䉴䉪䊥䊷䊆䊮䉫ฃ⸻₸ 3-year screening rate 3-year screening rate 53.9 50 53.8 51.6 53.5 53.9 53.8 52.4 51.5 53.9 50 52.6 53.5 53.9 53.8 52.4 51.5 27.4 28.3 52.6 48.1 䴿䴿 䴿䴿 40 53.8 51.6 48.1 41.3 40 41.3 䵀 䵀 㧑 㧑 33.4 30 28.7 29.6 30.5 28.6 30.6 27.8 28.6 25.4 27.4 28.3 28.8 33.4 30 21.1 20 10 28.7 29.6 30.5 28.6 30.6 27.8 28.6 25.4 21.1 20 16.5 9.7 10 0 16.5 9.7 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Taiwan Cancer Registry บḧⴕ㒮ⴡ↢⟑䈱䉡䉢䊑䉰䉟䊃䉋䉍 From the website of Department of Health, Taiwan Improvement of Cervical Cancer Screening Program in Taiwan 28.8 บḧ䈱ሶች㗪䈏䉖䉴䉪䊥䊷䊆䊮䉫䊒䊨䉫䊤䊛䈱ะ 6QKPETGCUGVJGUETGGPKPIRCTVKEKRCVKQPTCVGU COQPIGNFGTYQOGP 6QCFQRVCNVGTPCVKXGUETGGPKPIOGVJQFUGNH EQNNGEVKQPFGXKEG*28VGUVKPI ᐕ㑆䷸䷮丩丶上丱䷯ෳട₸ 义 䋦乊 30-39 40-49 50-59 30-39 40-49 50-59 60-69 60-69 70+ ᐕ㈩⠪ߩᬌ⸻ෳട₸ߩჇട ઍᦧߩࠬࠢ࠾ࡦࠣᣇᴺߩណ↪㧦⥄Ꮖណขེߦ ࠃࠆ*28࠹ࠬ࠻ 70+ T aiwan Cancer Cancer R egistry Taiwan Registry T aiwan Cancer Cancer Registry Registry Taiwan ᥲᐕ From the website of Department of Health, Taiwan 2CR5OGCTHQT%GTXKECN%CPEGT5ETGGPKPI YCURGTHQTOGFHTQO บḧⴕ㒮ⴡ↢⟑䈱䉡䉢䊑䉰䉟䊃䉋䉍 ሶች㗪䈏䉖䉴䉪䊥䊷䊆䊮䉫䈱䈢䉄䈱ᡂㆊ⚦⢩⸻䈲 㪈㪐㪐㪌ᐕ䈎䉌ታᣉ䈘䉏䈩䈇䉎 Invasive incidence rate Mortality rate ਁኻ乊 㪈㪇 In-situ incidence rate ᬌ⸻ฃ⸻₸ ⊹ౝ䈏䉖⟕ᖚ₸ ᶐẢ䈏䉖⟕ᖚ₸ ᱫ₸ ᬌ⸻ฃ⸻₸ ᶐẢ䈏䉖⟕ᖚ₸ ᱫ₸ ⊹⡺䈏䉖⟕ᖚ₸ บḧ䈮䈍䈔䉎ሶች㗪䈏䉖䋨㪊㪇ᚽએ䋩䈱⟕ᖚ䇮ᱫ䇮ᬌ⸻ฃ⸻₸䈱 㐳ᦼ⊛ะ䇮㪈㪐㪎㪐㪄㪉㪇㪇㪎 Taiwan Cancer Registry Taiwan Cancer Registry ᵈ䋺㪉㪇㪇㪇ᐕ⇇ੱญ䉕ర䈮▚䈘䉏䈢ᐕ㦂⺞ᢛ₸ 45 ᬌ⸻ฃ⸻₸义 䋦乊 ᐕ㦂⺞ᢛ₸义ੱญ Screening rate Prediction of HPV Vaccination Impact on Disease 㵶 Vaccination was predicted to provide a reduction of 31.2% in the prevalence of high-grade lesions (i.e., CIN 2 + CIN 3) across all ages. KG%+0%+0 3738 4000 Number of cases ోᐕ㦂䈮䉒䈢䉍䇮䊪䉪䉼䊮䈮䉋䉍䇮㜞ᐲ⇣ᒻᚑ䈱∛₸ 䈮䈍䈇䈩㪊㪈㪅㪉䋦䈱ᷫዋ䈏ㄟ䉁䉏䉎䇯 3738 4000 3500 No vaccination coverage 3500 No䊪䉪䉼䊮ធ⒳᥉䈭䈚 vaccination coverage 3000 100% vaccination coverage 3000 㪈㪇㪇䋦䊪䉪䉼䊮ធ⒳᥉ 100% vaccination coverage Number of cases ͻ 㪟㪧㪭䊪䉪䉼䊮䈱ᓇ㗀䈱੍᷹ 2500 1755 2000 1201 1500 1000 570 2500 1201 1500 1000 500 500 0 0 Cervical cancer 1755 2000 570 ሶች㗪䈏 Cervical cancer 䉖 Cancer death 䊪䉪䉼䊮ធ⒳᥉䈭䈚 Taiwan Cancer Registry 䈏䉖䈮䉋䉎ᱫ Cancer death 䊪䉪䉼䊮ធ⒳᥉ Taiwan Cancer Registry Cancer registry in cancer control 䈏䉖ኻ╷䈮䈍䈔䉎䈏䉖⊓㍳ ,PSDFWRIWKHWREDFFRFRQWURODFWWROXQJFDQFHU 7REDFFRFRQWURODFW z ,PSDFWRIKHSDWLWLV%YDFFLQDWLRQPDVVSURJUDPWRKHSDWRPD z ,PSDFWRISDSVPHDUVFUHHQLQJSURJUDPWRWKHFDUFLQRPDV LQVLWXUDWLRRILQVLWXWRDGYDQFHFDQFHURUWRWDOFDQFHU z Geographic variation study on oral cancer ⢖䈏䉖䈮ኻ䈜䉎䈢䈳䈖ⷙᴺ䈱ᓇ㗀䋺䈢䈳䈖ⷙᴺ䋨㪈㪐㪐㪎䋩 ⢄䈏䉖䈮ኻ䈜䉎䌂ဳ⢄Ἳ䉡䉟䊦䉴䊪䉪䉼䊮੍㒐ធ⒳䊒䊨䉫䊤䊛䈱ᓇ㗀 z ሶች㗪䈏䉖䈮䈍䈔䉎⊹ౝ䈏䉖䊶ㅴⴕ䈏䉖䋨䈅䉎䈇䈲ో䈏䉖䋩Ყ䈮ኻ 䈜䉎ᡂㆊ⚦⢩⸻ᬌ⸻䊒䊨䉫䊤䊛䈱ᓇ㗀 z ญ⣧䈏䉖⟕ᖚ䈱ℂቇ⊛⋧㆑ z z z Taiwan Cancer Registry Taiwan Cancer Registry บḧ 䉴䊨䊋䉨䉝࿖ 䊐䊤䊮䉴䇮䉟䉷䊷䊦 䉴䊨䊯䉢䊆䉝 䉟䊮䊄䇮䊛䊮䊋䉟 䊄䉟䉿䇮䉱䊷䊦䊤䊮䊃 䉴䊕䉟䊮䇮䉝䉴䊃䉠䊥䉝䉴 䉟䉺䊥䉝䇮䊔䊈䊃 䉺䉟䇮䉸䊮䉪䊤䊷 䊨䉲䉝䇮䉶䊮䊃䊕䊁䊦䉴䊑䊦䉫 䉼䉢䉮࿖ 䉴䉟䉴䇮䊁䉞䉼䊷䊉 䊂䊮䊙䊷䉪 䉝䊜䊥䉦䇮㪪㪜㪜㪩㩿㪈㪋㪀 䉦䊅䉻 䊘䊷䊤䊮䊄䇮䊪䊦䉲䊞䊪Ꮢ 䉥䊤䊮䉻 䉝䉟䊦䊤䊮䊄 䊉䊦䉡䉢䊷 䊐䉞䊮䊤䊮䊄 㪁䉝䊦䉳䉢䊥䉝䇮䉶䊁䉞䊐 䊆䊠䊷䉳䊷䊤䊮䊄 㪁ਛ࿖䇮㚅᷼ 㪁䊐䉞䊥䊏䊮䇮䊙䊆䊤 ᣣᧄ䇮ᄢ㒋 䉴䉡䉢䊷䊂䊮 䉟䉩䊥䉴䇮䉟䊮䉫䊤䊮䊄᧲ㇱ 䉲䊮䉧䊘䊷䊦 㖧࿖䇮䉸䉡䊦 䉟䉴䊤䉣䊦 䉮䊨䊮䊎䉝䇮䉦䊥 䉮䉴䉺䊥䉦 䉪䉡䉢䊷䊃䋺䉪䉡䉢䊷䊃ੱ ਛ࿖䇮ᶏ ↵ ᅚ ᐕ㦂⺞ᢛ⟕ᖚ₸䋨ੱญ㪈㪇ਁ䈅䈢䉍䋩 ญໃ䇮ญ⣧䇮ਛຜ㗡䇮ਅຜ㗡䈏䉖䈱ᐕ㦂⺞ᢛ⟕ᖚ₸䈱࿖㓙Ყセ Taiwan Cancer Registry Taiwan Cancer Registry Note: data from Cancer Incidence in five Continents Vol. IX, IARC 2007 Note: data from Cancer Incidence in five Continents Vol. IX, IARC 2007 ෳᾖ䋺㪌ᄢ㒽䈱䈏䉖⟕ᖚ╙䋹Ꮞ䇮㪠㪘㪚㪩㪃㪉㪇㪇㪎䈱䊂䊷䉺 㪁⿒䋺㜞⟕ᖚ *Red means high incidence *Green means low incidence 㪁✛䋺ૐ⟕ᖚ *Red means high incidence *Green means low incidence Geographical Variation of Age-Adjusted Incidence Rates for Male Oral Cancer in Taiwan, 1980-2000 Taiwan Cancer Registry Geographical Variation of Age-Adjusted Incidence Rates for บḧ䈱↵ᕈญ⣧䈏䉖ᐕ㦂⺞ᢛ⟕ᖚ₸䈱ℂ⊛䈭㆑䈇䇮㪈㪐㪏㪇㪄㪉㪇㪇㪇 Male Oral Cancer in Taiwan, 1980-2000 Taiwan Cancer Registry 46 บḧ䈮䈍䈔䉎ᐔဋ䊎䊮䊨䉡䉳ᶖ⾌䈫↵ᕈญ⣧䈏䉖 Batel nut consumption Age-adjusted incidence rate Age-adusted incidence rate ᐕ㦂⺞ᢛ⟕ᖚ₸ 䊎䊷䊁䊦䊅䉾䉿䋨䊎䊮䊨䉡䈱ታ䋩 Betel nut consumption 䊎䊷䊁䊦䊅䉾䉿䋨䊎䊮䊨䉡䈱ታ䋩 ᐕ㦂⺞ᢛ⟕ᖚ₸ Betel nut consumption (Kg per capita aged 15+) 䊎䊮䊨䉡䉳ᶖ⾌㊂䋨䌫䌧䇮㪈㪌ᚽએ䈱࿖᳃৻ੱ䈅䈢䉍䋩 Age-adjusted incidence rate (per 100,000 populations) ᐕ㦂⺞ᢛ⟕ᖚ₸䋨ੱญ㪈㪇ਁኻ䋩 Age-adusted incidence rate Betel nut consumption Betel nut consumption (Kg per capita aged 15+) Age-adjusted incidence rate (per 100,000 populations) Average betel nut consumption and incidence of male oral cancer in Taiwan ↵ᕈญ⣧䈏䉖䈫䊎䊮䊨䉡䉳䈱ᶖ⾌㊂䈱㐳ᦼ⊛䈭⚻ᐕᄌൻ䇮㪈㪐㪎㪐㪄㪉㪇㪇㪌 Secular Trend of male oral cancer incidence and betel nut consumption, 1979-2005 Taiwan Cancer Registry Taiwan Cancer Registry ᵈ䋺㪉㪇㪇㪇ᐕ⇇ੱญ䈮䉋䉎ᐕ㦂⺞ᢛ⟕ᖚ₸ Note: age-standardized rates based on the 2000 world standard population บḧ䈱ᅚᕈ䈏䉖ᖚ⠪䈲䇮᰷☨䈮Ყ䈼䈩䇮⊒∝ᐕ㦂䈏⧯䈇 䉝䊜䊥䉦䇮㪪㪜㪜㪩 䊂䊮䊙䊷䉪 ᣣᧄ䇮ᐢፉ ⟕ᖚ₸䋨ੱญ㪈㪇ਁኻ䋩 Denmark US, SEER 䊂䊮䊙䊷䉪 ਛ࿖䇮ᶏ บḧ 䉝䊜䊥䉦䇮SEER 㖧࿖ China, Shanghai ਛ࿖䇮ᶏ Japan, Hiroshima Taiwan Korea ᣣᧄ䇮ᐢፉ บḧ 㖧࿖ ᐕ㦂㩿ᚽ䋩 䈏䉖䈱ᐕ㦂⺞ᢛ⟕ᖚ₸䈱࿖㓙Ყセ䇮㪈㪐㪐㪏㪄㪉㪇㪇㪉 T aiwan Cancer Cancer Registry Registry Taiwan ᵈ㪑 㪌ᄢ㒽䈱䈏䉖╙㪐 䋨㪉㪇㪇㪎䋩䉋䉍ᛮ☴ Note: data from Cancer Incidence in five Continents Vol. IX, IARC 2007 Screening Programs in Taiwan บḧ䈱ᬌ⸻䊒䊨䉫䊤䊛 ㇱ ᬌ⸻ᣇᴺ 㐿ᆎ ᐕ ᐕ㦂䊶㑆㓒 ᬌ⸻ฃ⸻₸ 䋨䋲䋰䋰䋸䋩 ሶች㗪ㇱ ሶች㗪ㇱ⚦⢩⸻ 1995 30ᚽએ䊶 3ᐕ 56䋦 䋨3ᐕ䋩 ⚿⣺䊶⋥⣺ ଢẜⴊᔕ 1999 50í69ᚽ䊶 2ᐕ 10䋦 䋨2ᐕ䋩 ᅚᕈᚱ 䊙䊮䊝䉫䊤䊐䉞䊷 2002 50í69ᚽ䊶 2ᐕ 12䋦䋨2ᐕ䋩 ญ⣧䊶ຜ㗡 ญ⣧ౝᬌᩏ 2004 18ᚽએ䊶 2ᐕ 25䋦䋨䋲ᐕ䋩 䋨༛ᾍ⠪䇮䊎䊮䊨䉡䉳 ི䉂䉺䊋䉮↪⠪䋩 *Data from Japanese Journal of Clinical Oncology Advance Access published on May 21, 2010. ౖ䋺 ,CRCPGUG,QWTPCNQH%NKPKECN1PEQNQI[#FXCPEG#EEGUU䋨㪉㪇㪈㪇㪆㪌㪆㪉㪈 䋩 Taiwan Cancer Registry Taiwan Cancer Registry More Challenge than before z ᓥ᧪એ䈱䈘䉌䈭䉎ᚢ More stakeholders in Cancer Monitoring and control planning – – – – z 䈏䉖䊝䊆䉺䊥䊮䉫䈫䈏䉖ኻ╷⸘↹䈮䈍䈔䉎䇮䉋䉍 ᄙ䈒䈱㑐ଥ⠪ 㵨 㵨 㵨 㵨 Collaboration Cooperation Information system Sharing and benchmarking Taiwan Cancer Registry දജ ㅪ៤ ᖱႎ䉲䉴䊁䊛 䈫ၮḰ Taiwan Cancer Registry 47 Thank you! 䈅䉍䈏䈫䈉 Bureau of Health Promotion, DOH College of Public Health, NTU National Taiwan University Cancer Registry Task Force Dr. Mei-Hwei Chang Dr. San-Lin You Dr. Raoh-Fang Pwu Dr. Chun-Ju Chiang ̒ ̒ ̒ ̒ ̒ ̒ ̒ ̒ Taiwan Cancer Registry ⴕ㒮ⴡ↢⟑ ࿖᳃ஜᐽዪ ࿖┙บḧᄢቇⴡ↢ቇ㒮 ࿖┙บḧᄢቇ 䈏䉖⊓㍳㫮․䉼䊷䊛 &T/GK*YGK%JCPI &T5CP.KP;QW &T4CQJ(CPI2YW &T%JWP,W%JKCPI Taiwan Cancer Registry 48 積極的なモニタリングから有効ながん対策へ －日本の実例より－ ACTIVE MONITORING OF CANCER INCIDENCE LEADS TO EFFECTIVE CANCER CONTROL: AN EXAMPLE OF JAPAN 祖父江 友孝* Tomotaka Sobue In Japan, most population-based cancer わが国では、地域がん登録の多くが県単位 registries were operated at prefecture level. で実施されてきた。1975 年罹患データ以降厚 Since 1975 incidence data, a research 生労働省研究班が各県のデータを収集し、罹 group supported by MHLW had been 患率全国値を推計してきたが、2004 年に第 3 collected the data from these registries and 次対がん総合戦略研究事業として国立がん研 estimated incidence data at national level. 究センター関係者を中心とする新たな研究班 In 2004, another research group was が 設 置 さ れ て 、 2003 年 罹 患 デ ー タ 以 降 は organized MCIJ として公表してきた。各年の全国推計 within Comprehensive year 3rd-term for 値をつなげて罹患率の年次推移を観察してき Cancer Control Program and succeeded たが、年により推計に用いた地域が異なるな this activity. After 2003 incidence data, it is どの問題点があるため、地域を固定して推定 reported することを検討している。各県の地域がん登 as 10 the "Monitoring Strategy of Cancer Incidence in Japan (MCIJ)." Secular trends 録は、実測値として年次推移を観察できるが、 of incidence were observed simply linking がん死亡の年次推移と比較して、がん対策の the estimated annual data, but problems 評価を行うことについては、研究的な取り組 exist, such as different registries were used みに止まっていることが多い。 for different year. Currently, recalculation がん対策における評価指標としては、がん by using fixed registries for entire period is 死亡が多く用いられている。2007 年に策定さ considered. At prefecture level, secular れた国レベルのがん対策推進基本計画でも、 trends can be observed without estimation, 全体目標として設定できたのは、がん死亡減 but further usage is limited as research 少 20%のみであり、がん罹患減少については activities, cancer 設定されていない。今後は、罹患減少の目標 control program by comparison of incidence 設定を加えるとともに、死亡と罹患の年次推 trends with mortality. 移を比較することにより、がん対策の評価を such as evaluating In the Basic Plan to Promote Cancer 行い、企画立案にフィードバックすること必 Control Programs (2007), only mortality 要である。 reduction was set as a goal but no goal for incidence reduction. It is needed to add *国立がん研究センターがん対策情報センターがん情報・統計部 Center for Cancer Control and Information Services, NCC, Japan 49 comparing trends of both incidence and goals for incidence in the Plan, and by mortality, evaluation and feedback to the Plan will be essential. 50 JACR Scientific Meeting(2010.10.15)open seminar ؏עƕǜႇμңᜭ˟ܖᘐᨼ˟ πᜒࡈ Active monitoring of cancer incidence leads to effective cancer control - an example of Japan - ᆢಊႎƳȢȋǿȪȳǰƔǒஊјƳƕǜݣሊǁ ȸଐஜƷܱ̊ǑǓȸ zȢȋǿȪȳǰਦ zȬșȫƷƕǜരʧȷ፝ध zଐஜƷƕǜݣሊ zMonitoring indicator zCancer mortality and incidence at national level zCancer control program in Japan Tomotaka Sobue ᇌƕǜǻȳǿȸƕǜݣሊऴإǻȳǿȸ ƕǜऴإȷወᚘᢿ ᅑ༵൶ Ӑܑ Cancer Information Services and Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan Steps for implementing evidence-based cancer control program ᅹܖႎఌਗƴؕƮƘƕǜݣሊ Ⴘႎ Ū፝धȷരʧƷถ ݲŪधᎍȷܼଈƷQOLӼɥ Aim: Reduce mortality and incidence, Improve QOL of patients and their families What is happening? What is effective? incidence Observation & Intervention study Evaluation study Prevention guideline Screening efficacy guideline What is available? planning mortality New drug development clinical trial QOL Assessment Primary Prevention Early detection What is conducted? Life-style monitoring Participation rate Quality assurance incidence mortality Clinical guideline Treatment Mortality rate Incidence rate (5-year) Survival rate Definition Number of cancer deaths per year divided by number of population Number of newly diagnosed cancer cased per year divided by number of population Number of survivors (at 5-year) divided by number of patients at start of observation Number of cancer survivors at Prevalence one point in time divided by rate number of population ᚇݑᄂᆮȷ ʼλᄂᆮ ஊјࣱ ᚸ̖ᄂᆮ ʖ᧸ǬǤȉ ȩǤȳ ౨ᚮஊјࣱ ǬǤȉȩǤȳ ဃ፼ॹ ȢȋǿȪȳǰ ႸႎƸᢋ ƞǕƨƔ QOL survival ଔ ႆᙸ ʖ᧸ ܱ ദƠƘܱ ƞǕƯƍǔƔ ᚮૺችࡇ ᚸ̖ᄂᆮ ဃྙ܍ QOL ၲјௐ ᐮᚾ᬴ QOL ᚸ̖ᄂᆮ ᚮၲȷዼԧDZǢǬǤȉȩǤȳ แǯȪȋǫȫȑǹ Ҕၲเܱ७ᛦ௹ ˖ဒȷᇌక End of life care Clinical practice surveillance Quality Indicator type രʧྙ МဇӧᏡƳ เƸ˴Ɣ Monitoring Indicator and Measuring system Indicator ፝धྙ ˴ƕஊјƳ ૾ඥƔ Medical and social resource surveillance implementation What is achieved? ƕǜƷܱ७ ƸƲƏƔ QOL survival ᚮૺ ኳDZǢ ᚮၲܱ७৭੮ Quality Indicator Ӗᚮྙ ችࡇሥྸ ፝धྙ ၲ QOL ဃྙ܍ രʧྙ ȢȋǿȪȳǰਦƱᚘยǷǹȆȠ Measuring system ਦ ܭ፯ ᆔ ᚘยǷǹȆȠ Vital Statistics രʧྙ ɟ࠰ƋƨǓƷƕǜരʧૠǛ˰ൟૠ ưлƬƨ͌ ྙ TCVG ʴӝѣ७ወᚘ rate Population-base CR ፝धྙ ɟ࠰ƋƨǓƷૼᙹᚮૺƕǜधᎍૠ Ǜ˰ൟૠưлƬƨ͌ ྙ TCVG ؏עƕǜႇ proportion Pop-based CR Hosp-based CR Site-specific CR ᲢᲯ࠰Უ ဃྙ܍ ᲢᲯ࠰ᲣໜƴƓƚǔƕǜဃ܍ᎍ лӳ ૠǛᚇڼݑƷƕǜधᎍૠư RTQRQTVKQP лƬƨ͌ ؏עƕǜႇ ᨈϋƕǜႇ ᐥ֥ƕǜႇ ஊ၏ྙ ƋǔɟໜƴƓƚǔƕǜဃ܍ᎍૠ лӳ Ǜ˰ൟૠưлƬƨ͌ RTQRQTVKQP ፝धྙƱဃྙ܍ ǑǓᚘም രƵLJưƴࡇưNjƕǜƱᚮૺƞ Ǖǔлӳ രʧྙƱ፝धྙ ǑǓᚘም rate proportion Life-time risk Probability to be diagnosed as having cancer at least once in life proportion Inpatients and outpatients rate Number of cancer patients who visited medical facilities at one point in time divided by number of population proportion Calculate using incidence and survival Calculate using mortality and incidence ဃ෨Ȫǹǯ Ӗၲྙ Patients Survey 5 лӳ RTQRQTVKQP ƋǔɟໜƴƓƍƯҔၲೞ᧙ǛӖ лӳ ၲƠƨƕǜဃ܍ᎍૠǛ˰ൟૠư RTQRQTVKQP лƬƨ͌ ੑᰴ੍㒐 ৻ᰴ੍㒐 ஜᐽ䈭 ੱ䇱 ᣂⷙ䈮䈏䉖䈫⸻ ᢿ䈘䉏䈢ੱ䇱 धᎍᛦ௹ 6 ਃᰴ੍㒐 䈏䉖ᴦ≮䉕ฃ 䈔䈢ੱ䇱 䈏䉖䈫 䈮↢䈐䉎 ੱ䇱 䈏䉖䈪 ᱫ䈜䉎 ੱ䇱 ᔅⷐ䈭ᖱႎ ᮮᢿ⊛ 㪁ో࿖⊛䈭䇮ၞ䈱䇮⋭䉇ၞ␠ળ䈱䈏䉖䈮䉋䉎⽶ᜂ䈱⸥ㅀ 㪁ੱ⒳䇮᳃ᣖ䇮␠ળ⊛䉇ᢥൻ䋻䇮␠ળ⊛䇮↢‛ቇ⊛࿃ሶ䋻䊒䊨䊋䉟䉻䈱⍮⼂䇮ᘒᐲ䇮ታ〣 ⴕേෂ㒾࿃ሶ 䉴䉪䊥䊷䊆䊮䉫ᬌᩏ ⅣႺᦑ㔺 ␠ળ⊛䊶ⅣႺ⊛╷ Wingo PA et al. A national framework for cancer surveillance in the United States. 7 Cancer Causes and Control 16: 151–170, 2005. 䈏䉖⟕ᖚ ක≮䈱↪ᕈ ක≮䉕ฃ䈔䉎ᯏળ ↢ᵴ䈱⾰ ว૬∝ ᦨవ┵䈱ක≮ 䉮䊮䊒䊤䉟䉝䊮䉴 ↢ᵴ䈱⾰ ว૬∝ ౣ⊒ ↢ሽ 䈏䉖䈱∛₸ ක≮䈱↪ᕈ ක≮䉕ฃ䈔䉎ᯏળ ↢ᵴ䈱⾰ ว૬∝ 䊖䉴䊏䉴䊶⚳ᧃᦼක≮ 䈏䉖ᱫ₸ Wingo PA et al. A national framework for cancer surveillance in the United States. Cancer Causes and Control 16: 151–170, 2005. 51 zMonitoring indicator zCancer mortality and incidence at national level zCancer control program in Japan zȢȋǿȪȳǰਦ zȬșȫƷƕǜരʧȷ፝ध zଐஜƷƕǜݣሊ ƕǜƷܱ७৭੮ƴ᧙ƢǔǘƕƷྵཞ Current status of nation-wide cancer statistics in Japan z Cancer mortality z ƕǜരʧऴإ – Through well-established nation-wide vital statistics, all cancer deaths are measured. – Rough statistics are reported 1 month later and fixed statistics are reported 0.5 year later. ̄ ʴӝѣ७ወᚘƴƯμૠƕܱยƞǕƯƓǓŴஉǕư ਖ਼͌ܭƕŴኖҞ࠰ǕưᄩܭૠƕإԓƞǕǔŵ ࠰உإԓᲢ࠰ਖ਼ᚘ͌Უ ʴ ࠰உإԓᲢ࠰ᄩܭૠᲣ ʴ Jan 2010 (rough stat. for 2009) 344,000 for all sites Sep 2010 (fixed stat. for 2009) 344,105 for all sites z Cancer Incidence z ƕǜ፝धऴإ – No nation-wide population-based cancer registry. – Based on 5-11 prefecture-wide population-based cancer registries (covered 20-30% of total pop.), nation-wide incidence has been estimated since 1975. ̄ ࠰ˌᨀŴ᳸ࡅჄࠊƷ؏עƕǜႇƴؕƮ ƍƯŴҽіႾᄂᆮྰƴǑǓμ͌ƕਖ਼ᚘƞǕƯƍǔ ƕŴμ͌ƴƭƍƯܱย͌Ƹנ܍ƠƳƍŵᲮ᳸Ჰ࠰ ǕưإԓƞǕǔŵኖᲬƷᢅݱᚸ̖Ʊਖ਼ܭƞǕǔŵ Geographical variation is adjusted using mortality data – Estimated statistics are reported 4-6 years later and probably 20% lower than true incidence. ࠰ˌᨀƷμਖ਼ᚘƸƕǜᲢഏƕǜᅑ༵൶ྰᲣƕਃ࢘ Mar 2010Ტestimated stat. for 2005Უ646,802 for all sites ࠰உإԓ Ტ࠰ਖ਼͌ܭᲣʴ Trends for number of cancer death, all sites ᢿˮКƕǜരʧૠƷ࠰ഏਖ਼ᆆ Source: cancer information services, NCC 14 ࠰ᱫ᨞ኢКƕǜരʧྙᲢμᢿˮᲣƷ࠰ഏਖ਼ᆆ Trends for age-specific death rates, all sites Source: cancer information services, NCC 15 52 Trend of age-standardized rate of mortality All cancers (1958-2009) ో䈏䉖ᐕ㦂⺞ᢛᱫ₸䈱ᐕᰴផ⒖ (1958-2009) 㪉㪌㪇 㪉㪌㪇 㪉㪇㪇 㪉㪇㪇 㪈㪌㪇 㪈㪌㪇 㪈㪇㪇 㪈㪇㪇 㪌㪇 㪌㪇 㪇 㪈㪐㪌㪌 㪈㪐㪍㪌 㪈㪐㪎㪌 㪈㪐㪏㪌 㪈㪐㪐㪌 㪇 㪈㪐㪌㪌 㪉㪇㪇㪌 Trend of age-standardized rate of mortality Selected sites 㪈㪇㪇 㪈㪇㪇 LungĻ LiverĻ ᏍĻ Colon/rectumĻ ColonĻ 㪈 㪈㪐㪌㪌 㪈㪐㪍㪌 㪈㪐㪎㪌 BreastĹ Uterus 㪈㪐㪏㪌 㪈㪐㪐㪌 㪉㪇㪇㪌 㪈 㪈㪐㪌㪌 㪈㪐㪍㪌 㪈㪐㪎㪌 㪈㪐㪏㪌 㪈㪐㪐㪌 㪈 㪈㪐㪌㪌 㪉㪇㪇㪌 㪌㪇㪇 㪋㪇㪇 㪋㪇㪇 㪊㪇㪇 㪊㪇㪇 㪉㪇㪇 㪉㪇㪇 㪈㪇㪇 㪈㪇㪇 㪈㪐㪏㪌 㪈㪐㪐㪇 㪈㪐㪐㪌 㪉㪇㪇㪇 㪇 㪈㪐㪎㪌 㪉㪇㪇㪌 Stomach Colon/rectum Lung Liver Rectum 㪈㪇㪇 㪈㪇㪇 Breast Colon 㪈㪐㪏㪌 Males 㪉㪇㪇㪌 㪈㪐㪏㪇 㪈 㪈㪐㪎㪌 㪈㪐㪏㪌 㪈㪐㪏㪌 Ꮞ ኽᐂ/Ⴚᐂ 㪈㪐㪐㪇 㪈㪇㪇 Lung Ⴚᐂ ኽᐂ 㪈㪐㪎㪌 㪈㪐㪏㪌 㪈㪐㪐㪌 㪉㪇㪇㪌 㪈㪐㪐㪌 㪉㪇㪇㪇 㪉㪇㪇㪌 Эᇌᐄ 㪈 㪈㪐㪎㪌 㪉㪇㪇㪌 Females 㪈㪐㪏㪌 Ꮑ 㪈㪐㪐㪌 ဏ 53 Ꮞ ʐ ኽᐂ/Ⴚᐂ ܷ܇ ኽᐂ Ꮝ 㪈㪇 㪈㪇 㪈㪐㪐㪌 㪈㪐㪍㪌 㪈㪇㪇㪇 Ꮑ Liver Rectum 㪈㪐㪐㪌 㪈 㪈㪐㪌㪌 ڡ Ꮝ 㪈㪇 Prostate 㪈 㪈㪐㪎㪌 Stomach Colon Colon/rectum Uterus 㪈㪇 㪉㪇㪇㪌 㪈㪇㪇㪇 㪈㪇㪇㪇 㪈㪇㪇 㪈㪐㪐㪌 ਥⷐㇱ䈏䉖ᐕ㦂⺞ᢛ⟕ᖚ₸䈱ᐕᰴផ⒖ Trend of age-standardized rate of incidence Selected sites 㪈㪇㪇㪇 㪈㪐㪏㪌 ో䈏䉖ᐕ㦂⺞ᢛ⟕ᖚ₸䈱ᐕᰴផ⒖ (1975-2005) 㪌㪇㪇 㪈㪐㪏㪇 㪈㪐㪎㪌 ܷ܇ ႺᐂĻ ဏ Trend of age-standardized rate of incidence All cancers (1975-2005) 㪇 㪈㪐㪎㪌 㪈㪐㪍㪌 ʐĹ ኽᐂĻ ኽᐂĻ Females Males Ꮝ ႺᐂĻ RectumĻ ኽᐂ/ႺᐂĻ ᏁĻ 㪈㪇 㪈㪇 ColonĻ 㪉㪇㪇㪌 ᏎĻ ኽᐂ/ႺᐂĻ 㪈㪇 Lung 㪈㪐㪐㪌 ᏁĻ Colon/rectumĻ LiverĻ RectumĻ 㪈㪐㪏㪌 㪈㪇㪇 ᏎĻ StomachĻ 㪈㪇 㪈㪐㪎㪌 ਥⷐㇱ䈏䉖ᐕ㦂⺞ᢛᱫ₸䈱ᐕᰴផ⒖ 㪈㪇㪇 StomachĻ 㪈㪐㪍㪌 㪉㪇㪇㪌 㪈 㪈㪐㪎㪌 Ⴚᐂ 㪈㪐㪏㪌 㪈㪐㪐㪌 ڡ 㪉㪇㪇㪌 Indices of data quality for the 30 cancer registries in Japan (2005) Hokkaido (50.1%) Okinawa (39.5%) Toyama(35.0%) Yamagata (8.3%) Ishikawa (48.7%) Niigata Fukui (12.4%) (15.4%) Tottori (19.1%) In practice (not used in estimation of nationwide inc.)Okayama (7.1%) Kyoto (39.5%) Hiroshima (9.4%) In practice Yamaguchi (used in estimation of nationwide inc.) (45.2%) In Practice Shiga (12.7%) ̪ DCO in the CI5 Aichi (model area)16-17% Hiroshima city 3-4% ̪ Not participated in the MCIJ2005 Osaka, Hyogo, Saga Kumamoto (24.7%) Kochi (30.4%) Ehime (43.9%) Period # of data Prefecture Miyagi (10.5%) ܱ Tochigi (28.2%) Gunma (49.1%) Chiba (23.8%) ޥჄᲢ38.0ᲟᲣ ૼჄ Ტ15.4ᲟᲣ ᅦʟჄᲢ12.4ᲟᲣ ᯓӕჄᲢ19.1ᲟᲣ ޛޢჄᲢ7.1ᲟᲣ Ტμ͌ਖ਼ᚘMCIJ2005ƴƸ̅ဇƤƣᲣ ࠼Ⴤ Ტ9.4ᲟᲣ ޛӝჄ ܱ Ტ45.2ᲟᲣ Ტμ͌ਖ਼ᚘMCIJ2005ƴ̅ဇᲣ Ibaraki (20.5%) ܷ؉ჄᲢ10.5ᲟᲣ ʮᣃࡅ Ტ39.5ᲟᲣ ᒠ؉ჄᲢ20.5ᲟᲣ ஙჄᲢ28.2ᲟᲣ ፭ᬔჄᲢ49.1ᲟᲣ ҘᓶჄᲢ23.8ᲟᲣ ܱ ๔Ⴤ Ტ12.7ᲟᲣ ᧈ߃Ⴤ Ტž5ٻᨕƷƕǜ፝धᇹ9ࠇᲢ8.9ᲟᲣ Ტ2007Უſƴਫ਼᠍Უ ༇ஜჄ Ტ24.7ᲟᲣ Tokushima (53.0%) Kagawa (N.A.) ̪ CI5ਫ਼᠍DCO ग़ჷᲢȢȇȫעғᲣ16-17% ࠼ࠊ 3-4Ჟ ̪ MCIJ2005ƴȇȸǿச੩Ј ࡅ᧵ٻτࡉჄ ˱Ⴤ DCO/I (%) Period ჽ߷ჄᲢ48.7ᲟᲣ ܱƠƯƍƳƍ ᅕ߷ډჄᲢ26.6ᲟᲣ ᧲ޟჄᲢ47.0ᲟᲣ ग़ჷჄᲢ33.9ᲟᲣ ᭗ჷჄ ࣈჄᲢ53.0ᲟᲣ Ტ30.4ᲟᲣ ᬐ߷ჄᲢN.A.Უ ग़ۧჄᲢ43.9ᲟᲣ ᰦδჄᲢ73.0ᲟᲣ രʧᅚƷLjưႇƞǕƨ̊ ᲢDCOᲟŴ2005ҥ࠰Უ /%+,ưӓᨼƠƨȇȸǿᲢჄᲣƷ ݣᝋ࠰Ʊȇȸǿˑૠ Period and number of data collected from 30 cancer registries at MCIJ2005 (2009) Prefecture ౕ᩷ჄᲢ 51.1 ᲟᲣ ݈ޛჄᲢ35.0ᲟᲣ ࢟ޛჄᲢ8.3ᲟᲣ Iwate (38.0%) Kanagawa (26.6%) Gifu (47.0%) Aichi (33.9%) Kagoshima (73.0%) ҅ෙᢊ Ტ50.1%Უ ඌጃჄᲢ39.5ᲟᲣ Aomori (51.1 %) Not in practice (as of January 2010) (cited in the Cancer Incidence Nagasaki in the 5 continents vol. 9, 2007) (8.9%) ؏עƕǜႇƷ ܱཞඞ Ʊႇችࡇ # of data ؏עӸ ੩Јݣᝋ࠰ ؏עӸ ੩Јݣᝋ࠰ 302,444 ҅ෙᢊ ग़ჷჄ 1993-2005 62,607 ౕ᩷Ⴤ ๔Ⴤ Kyoto 1993-2005 117,459 ޥჄ ʮᣃࡅ 39,856 ܷ؉Ⴤ ᯓӕჄ ޛޢჄ Hokkaido 2003-2005 70,819 Aichi 1993-2005 Aomori 1993-2005 85,712 Shiga Iwate 2003-2005 18,656 Miyagi 1993-2005 147,401 Tottori 1993-2005 Yamagata 1993-2005 88,435 Okayama 1993-2005 115,697 ࢟ޛჄ ȇȸǿˑૠ ȇȸǿˑૠ Ibaraki 2003-2005 9,794 Hiroshima 2003-2005 58,468 ᒠ؉Ⴤ ࠼Ⴤ Tochigi 2003-2005 23,712 Yamaguchi 1993-2005 82,171 ஙჄ ޛӝჄ Gunma 2003-2005 21,590 Tokushima 2003-2005 9,645 ፭ᬔჄ ࣈჄ Chiba 1993-2005 235,556 2005 2,097 ҘᓶჄ ᬐ߷Ⴤ Kanagawa Niigata 1993-2005 370,874 Ehime 1993-2005 69,527 ᅕ߷ډჄ ग़ۧჄ 1993-2005 160,256 Kochi 1993-2005 37,602 ૼჄ ᭗ჷჄ Toyama 2003-2005 17,199 Nagasaki 1993-2005 112,628 ݈ޛჄ ᧈ߃Ⴤ Ishikawa 2003-2005 9,791 Kumamoto 1993-2005 104,081 ჽ߷Ⴤ ༇ஜჄ Fukui 1993-2005 50,593 Kagoshima 2003-2005 20,689 ᅦʟჄ ᰦδჄ Gifu 1993-2005 79,357 Okinawa 1993-2005 44,246 ᧲ޟჄ ඌጃჄ Cum # of data: 2,568,962 Kagawa Total data: 568,962 # of data for 2005: 312,663 Indices of data quality for the 12 cancer registries used in estimation of nationwide incidence in Japan (2005) Miyagi Yamagata Chiba Kanagawa Niigata Fukui Shiga Tottori Okayama Hiroshima Nagasaki Kumamoto TOTAL ፝धྙμਖ਼ᚘƴဇƍƨ12ƕǜႇƷႇችࡇਦ (2005) IM Population Incidence Mortality DCN/I DCO/I Ratio MV/I MV/R 2360218 13096 5890 10.5 10.5 2.22 78.8 88.0 1216181 7183 3774 23.2 8.3 1.90 71.4 92.9 6056462 22888 13520 33.0 23.8 1.69 55.7 83.2 8791597 34062 18981 27.4 26.6 1.79 54.8 75.5 2431459 13838 7431 15.4 15.4 1.86 74.1 87.6 821592 4375 2240 12.4 12.4 1.95 76.2 86.9 1380361 6070 3144 22.6 12.7 1.93 70.6 91.3 607012 3863 1802 19.1 19.1 2.14 65.5 81.0 1957264 10637 4957 16.2 7.1 2.15 71.6 85.4 2876642 19868 7551 18.2 9.4 2.63 79.6 97.2 1478632 10295 4627 8.9 8.9 2.22 83.2 91.3 1842233 8589 5025 34.6 24.7 1.71 58.1 88.8 14.9* 2.02* 70.0* 87.4* 31819653 154764 78942 20.1* ችၔ ጊᒻ ජ⪲ ᄹᎹ ᣂẟ ṑ⾐ 㠽ข ጟጊ ᐢፉ 㐳ፒ ᾢᧄ ว⸘ ੱญ 2360218 1216181 6056462 8791597 2431459 821592 1380361 607012 1957264 2876642 1478632 1842233 31819653 IM MV/I MV/R ⟕ᖚᢙ ᱫᢙ DCN/I DCO/I Ratio 13096 5890 10.5 10.5 2.22 78.8 88.0 7183 3774 23.2 8.3 1.90 71.4 92.9 22888 13520 33.0 23.8 1.69 55.7 83.2 34062 18981 27.4 26.6 1.79 54.8 75.5 13838 7431 15.4 15.4 1.86 74.1 87.6 4375 2240 12.4 12.4 1.95 76.2 86.9 6070 3144 22.6 12.7 1.93 70.6 91.3 3863 1802 19.1 19.1 2.14 65.5 81.0 10637 4957 16.2 7.1 2.15 71.6 85.4 19868 7551 18.2 9.4 2.63 79.6 97.2 10295 4627 8.9 8.9 2.22 83.2 91.3 8589 5025 34.6 24.7 1.71 58.1 88.8 154764 78942 20.1* 14.9* 2.02* 70.0* 87.4* * Mean Trends of Indices of data quality for the registries used in estimation of nationwide incidence N 5 7 9 10 11 11 10 11 13 14 12 Registries used in estimation Prefecture/City M/Y/O/H/NC M/Y/C/O/H/NC/S M/Y/K/F/O/T/H/NP/S M/Y/C*/K*/F/O/T/H/NP/Okn M/Y/C/K/Ni/F/Si/O/Oky/S/NP M/Y/C/K/Ni/F/Si/O/Oky/Sa/NP M/Y/K/Ni/F/Si/O/Oky/Sa/NP M/Y/K/Ni/F/Si/O/T/Oky/Sa/NP M/Y/C/K/Ni/F/Si/O/T/Oky/HP/Sa/NP M/Y/C/K/Ni/F/Si/O/T/Ok/HP/Sa/NP/Km M/Y/C/K/Ni/F/Si/O/T/HP/NP/Km Data for 2005Ჴ312,663 * Mean Year 1975-1979 1980-1984 1985-1989 1990-1994 1995-1999 2000 2001 2002 2003 2004 2005 ፝धྙμਖ਼ܭƴဇƍƨƕǜႇƷႇችࡇਦƷਖ਼ᆆ Quality Indices* (Range or mean) DCO/I IM Ratio MV/I 13.0-17.2 1.56-1.63 59.9-68.7 13.8-15.9 1.58-1.70 63.2-69.9 13.9-15.4 1.78-1.79 65.9-67.6 16.6 1.87 71.2 16.7 1.70 67.1 15.1 1.80 72.1 14.3 1.90 73.8 13.7 1.92 68.4 16.8 2.01 68.1 17.1 1.96 67.2 14.9 2.02 70.0 ᐕ 1975-1979 1980-1984 1985-1989 1990-1994 1995-1999 2000 2001 2002 2003 2004 2005 M: Miyagi, Y: Yamagata, C: Chiba, K: Kanagawa, Ni: Niigata, F: Fukui, A: Aichi, Si: Shiga, O: Osaka, T: Tottori, Oky: Okayama, H: Hiroshima City, HP: Hiroshima Prefecture, Sa: Saga, NC: Nagasaki City, NP: Nagasaki Prefecture, Okn: Okinawa, Km:Kumamoto * Selected area only N 5 7 9 10 11 11 10 11 13 14 12 μਖ਼ܭƴဇƍƨƕǜႇ ⋵/Ꮢ M/Y/O/H/NC M/Y/C/O/H/NC/S M/Y/K/F/O/T/H/NP/S M/Y/C*/K*/F/O/T/H/NP/Okn M/Y/C/K/Ni/F/Si/O/Oky/S/NP M/Y/C/K/Ni/F/Si/O/Oky/Sa/NP M/Y/K/Ni/F/Si/O/Oky/Sa/NP M/Y/K/Ni/F/Si/O/T/Oky/Sa/NP M/Y/C/K/Ni/F/Si/O/T/Oky/HP/Sa/NP M/Y/C/K/Ni/F/Si/O/T/Ok/HP/Sa/NP/Km M/Y/C/K/Ni/F/Si/O/T/HP/NP/Km ችࡇਦ* (ርLJƨƸ)ר DCO/I IM Ratio MV/I 13.0-17.2 1.56-1.63 59.9-68.7 13.8-15.9 1.58-1.70 63.2-69.9 13.9-15.4 1.78-1.79 65.9-67.6 16.6 1.87 71.2 16.7 1.70 67.1 15.1 1.80 72.1 14.3 1.90 73.8 13.7 1.92 68.4 16.8 2.01 68.1 17.1 1.96 67.2 14.9 2.02 70.0 M: ܷ؉, Y: ࢟ޛ, C: Ҙᓶ, K: ᅕ߷ډ, Ni: ૼ, F: ᅦʟ, A: ग़ჷ, Si: ๔, O: ᧵ٻ, T: ᯓӕ, Oky: ޛޢ, H: ࠼ࠊ, HP: ࠼Ⴤ, Sa: ˱, NC: ᧈ߃ࠊ, NP: ᧈ߃Ⴤ, Okn: ඌጃ, Km:༇ஜ * ȢȇȫעғƷLj 54 Estimation of cancer incidence and rate at national level Estimated incidence 2005Ჴ 646,802 maleᲴ379,436 femaleᲴ267,366 Age-adjusted incidence rateᲴ 310.6 maleᲴ396.1 femaleᲴ247.7 Ტall sitesᲴC00-C96 age-adjusted using 1985Japanese model population per 100,000Უ μƕǜ፝धૠȷྙƷਖ਼ᚘ ဏڡᚘ ဏ ڡ ࠰ 2005࠰μਖ਼ᚘ፝धૠᲴ 646,802 Ƃage-adjusted incidence rate for top 5 sitesƃ maleᲴĬstomach83.9 ĭcolorectum62.9 Į lung58.5įprostate42.0 İliver30.1 femaleᲴĬbreast57.4 ĭcolorectum37.2 Į stomach30.7 įuterus21.1 İlung20.2 Ƃtrends of incidence and incidence rateƃ Number increased 23,000 compared to last year Rates increased compared to last year ဏࣱᲴ379,436 ࣱڡᲴ267,366 ࠰ᱫᛦૢ፝धྙᲴ 310.6 ဏࣱᲴ396.1 ࣱڡᲴ247.7 ᲢμᢿˮᲴC00-C96 1985࠰ଐஜȢȇȫʴӝư࠰ᱫᛦૢ ʴӝ10ɢݣᲣ sourceᲴnational cancer center center for cancer control and information services ဏڡᚘ ဏ ڡ ࠰ᱫᛦૢ፝धྙᲢʴӝɢݣᲣ ႇችࡇؕแǛƨƠƨ12ჄᲢܷ ؉Ŵ࢟ޛŴҘᓶŴᅕ߷ډŴૼŴ ᅦʟŴ๔ŴᯓӕŴޛޢŴ࠼Ŵ ᧈ߃Ŵ༇ஜᲣƷ2005࠰፝धȇȸǿ ǛМဇ ႇྙǛരʧወᚘưᙀദƢǔ ਖ਼ᚘ૾ඥ ࠰ᱫᛦૢ፝धྙᲢʴӝɢݣᲣ Used 2005 incidence data from 12 registries (Miyagi, Yamagata, Chiba, Kanagawa, Kanagawa, Niigata, Fukui, Shiga, Tottori, Okayama, Hiroshima, Nagasaki, KumamotoᲣwhich satisfied quality criteria Estimation method to adjust area variation using mortality statistics ࠰ Ƃɥˮ5ᢿˮƷ࠰ᱫᛦૢ፝धྙƃ ဏࣱᲴĬᏎ83.9 ĭٻᐂ62.9 ĮᏍ58.5 įЭᇌዴ42.0 İᏁᐥ30.1 ࣱڡᲴĬʐ57.4 ĭٻᐂ37.2 ĮᏎ30.7 įܷ܇21.1 İᏍ20.2 Ƃ፝धૠȷྙƷਖ਼ᆆƃ ૠƸЭ࠰ൔ+2ɢ3Ҙʴ ྙƸဏڡƱNjЭ࠰ࡇƔǒفь ЈχᲴᇌƕǜǻȳǿȸƕǜݣሊऴإǻȳǿȸ Future policy for monitoring cancer incidence at national level μȬșȫƷƕǜ፝धȢȋǿȪȳǰƷʻࢸƷ૾ᤆ Estimation of the most recent incidence at national level zUse as many as data from prefectures which satisfied certain level of quality criteria zThe number of prefecture satisfies the criteria seems to increase due to the increase of registration from DHCᲢ14 prefĺ30 prefᲹᲣ இૼ࠰Ʒƕǜ፝धμ͌Ʒਖ਼ᚘ zችࡇؕแǛƨƠƨჄȇȸǿǛӧᏡƳᨂǓٶƘ̅ဇ Ƣǔ zਗໜ၏ᨈƔǒƷႇૠƷفьሁƴǑǓŴችࡇؕแǛ ƨƢჄƷفьƕᙸᡂLJǕǔᲢ14Ⴤĺ30ჄᲹᲣ Observation of incidence trends zDifficult to differentiate real increase of incidence because improvement of completeness (resulted in spurious increase of incidence) is expected even among the prefectures which already satisfied the criteria zLimit to prefectures which can provide high quality data for long periodᲢafter 1985, around 5 prefᲣ zUsing the observed trends, conduct short-term projection. Then provide estimated incidence for the year which most recent data of mortality is already available ፝धྙƷ࠰ഏਖ਼ᆆƷᚇݑ zࢼஹƷμਖ਼̅͌ܭဇჄƷɶưNjŴችࡇӼɥƕᙸᡂ LJǕǔƷưŴჇƷ፝धفьƱƷғКƕᩊƠƍ zᧈ᧓ŴችࡇƷ᭗ƍȇȸǿǛᚇݑưƖǔჄƴᨂǔ Ტ1985࠰ˌᨀŴ5ࡅჄᆉࡇᲣ zᚇݑƞǕƨ࠰ഏਖ਼ᆆǛNjƱƴჺʖยǛᘍƍŴരʧ ȇȸǿஇૼ࠰Ʊӷ࠰Ʒ፝धȇȸǿਖ਼ᚘ͌Ǜ੩ᅆƢǔ zMonitoring indicator zCancer mortality and incidence at national level zCancer control program in Japan zȢȋǿȪȳǰਦ zȬșȫƷƕǜരʧȷ፝ध zଐஜƷƕǜݣሊ Recent events regarding cancer control in Japan ƕǜݣሊȷƕǜႇǛNJƙǔஇᡈƷЈஹʙ 2004 Apr : The 3rd-term Comprehensive 10 year Strategy for Cancer Control 2005 Apr : Committee Report “Promotion of Equalizing Cancer Care Quality” (Chaired by Dr. Kakizoe) May : Headquarters of Cancer Control in MHLW Aug : Action Plan 2005 for Promotion of Cancer Control 2006 Feb : Updated requirements for Designated Cancer Care Hospitals Jun : Cancer Control Act approved Oct : Center for Cancer Control and Information Services at National Cancer Center (NCC-CIS) 2007 Jan: Designated Cancer Care Hospitals expanded 135 -> 286 Apr: Cancer Control Act implemented Jun: Basic Plan to Promote Cancer Control Programs,2007-2016 2008 Mar: Cancer Control Promotion Plans by Local Governments 2009 Apr: Designated Cancer Care Hospitals expanded -> 375 2010 Jun: Interim report of Basic Plan ࠰உᲴ ᇹഏݣƕǜዮӳဦᄂᆮʙಅ ࠰உᲴ ƕǜҔၲ൦แרƯǜ҄Ʒਖ਼ᡶƴ᧙Ƣǔ౨᚛˟إԓ உᲴ ҽဃіႾƕǜݣሊਖ਼ᡶஜᢿᚨፗ உᲴ ƕǜݣሊਖ਼ᡶǢǯǷȧȳȗȩȳ ࠰உᲴ ҽဃіႾͤࡍޅƕǜݣሊਖ਼ᡶܴᚨፗ உᲴ ƕǜݣሊؕஜඥᇌ உᲴ ࠰உᲴ உᲴ 55 ҽဃіႾͤࡍᧈޅᡫჷᲢƕǜᚮၲᡲઃਗໜ၏ᨈƷૢͳƴƭƍƯᲣ உᲴ ᇌƕǜǻȳǿȸƕǜݣሊऴإǻȳǿȸᚨ ƕǜᚮၲᡲઃਗໜ၏ᨈਦ ܭᚨᲢ؏עŴᣃᢊࡅჄᲣ ƕǜݣሊؕஜඥᘍŴƕǜݣሊਖ਼ᡶңᜭ˟ᚨፗ உᲴ ƕǜݣሊਖ਼ᡶؕஜᚘဒ᧚ᜭൿܭŴإ˟ԓ உᲴ ᣃᢊࡅჄƕǜݣሊਖ਼ᡶᡶᚘဒ ࠰உᲴ ƕǜᚮၲᡲઃਗໜ၏ᨈਦ ܭᚨᲢ؏עŴᣃᢊࡅჄᲣ ࠰உᲴ ƕǜݣሊਖ਼ᡶؕஜᚘဒɶ᧓إԓ Basic Plan to Promote Cancer Control Programs 42 General goals in the Basic Plan to promote cancer control program (2007) ƕǜݣሊؕஜᚘဒ(2007)ƴƓƚǔμ˳Ⴘ 1. Reduce cancer mortality Reduce age-standardized cancer mortality (less than 75 years old) by 20% within the next 10 years (2005᳸2015) 1. ƕǜƴǑǔരʧᎍƷถݲ + Reduce cancer incidence ƕǜƷ࠰ᱫᛦૢരʧྙ(75ബச)Ǜʻࢸ10࠰᧓ (2005᳸2015)ƴ20%ถݲ 2. Reduce pain and improve quality of life for all cancer patients and their families Ქ ƕǜ፝धᎍƷถݲ 2. ƢǂƯƷƕǜधᎍӏƼƦƷܼଈƷᒊၘƷ᠉ถɳƼ ƴၲဃƷឋƷӼɥ Goals Decrease age-adjusted rate (0-74 y.o.) for all sites of cancer 20% from 2005 to 2015 z 1% annual decrease (1990-2005) x 10 years = 10% z 10% additional decrease by implementation of cancer control program Methods Tobacco Control Screening Equalize Quality in Cancer Care Total μ˳Ⴘ ʻࢸ࠰᧓ ưŴƕǜƷ࠰ᱫᛦૢരʧྙ ബசƷถݲ z ࠰᧓Ʒᐯถ Z࠰ z ƕǜݣሊƷܱƴǑǔƷᡙьถݲ Mortality reduction in 2015 (%) (1) 50% reduction 1.6 Smoking rate (2) 75% reduction 2.9 (3) increase to 50% 3.9 Participating rate (4) increase to 70% 6.0 5-year survivial (5) 5 major sites 3.2 rate: improve to (6) all sites (10 years) 4.9 6.8 current ideal level (7) all sites (7 years) (1)+(3)+(5) 8.7 (1)+(3)+(6) 10.4 (2)+(4)+(7) 15.7 Strategic Objectives ݣሊϋܾ Scenario ƨƹƜݣሊ ƕǜ౨ᚮ ƕǜᚮၲ רƯǜ҄ ӳᚘ Projection of age-adjusted cancer deaths rates for all sites based on log-linear regression (use data from 1990 to 2005) Males and females, age 0-74 ̾КႸ Ⴘ͌ ྵཞƔǒถݲ ྵཞƔǒถݲ ƴفь Ӗᚮྙ ƴفь ྵཞƴƓƚǔྸ ɼᙲᢿˮ ेႎƳᲯ࠰ဃ ܍μᢿˮ ࠰᧓ưᢋᲣ ྙǛμ̊ƴ୍ӏ μᢿˮᲢ࠰᧓ưᢋᲣ ʴտྙ ࠰ƴƓ ƚǔരʧྙถ ݲᲢᲟᲣ Ꮝƕǜ Ʒئӳ ኻᢙ✢ᒻ࿁Ꮻ䈮䉋䉎ᐕ㦂⺞ᢛᱫ₸䈱੍᷹ 䋨1990-2005ᐕ䊂䊷䉺䈪࿁Ꮻ䋩 ↵ᅚ⸘ 75ᱦᧂḩ 㩿ੱญ㪈㪇ਁኻ㪀 㩿ੱญ㪈㪇ਁኻ㪀 56 Reduce age-standardized cancer mortality (less than 75 years old) by 20% within the next 10 years (2005᳸2015) žƕǜƷ࠰ᱫᛦૢരʧྙ(75ബச)Ǜʻࢸ10࠰ ᧓(2005᳸2015)ƴ20%ถݲſƴƭƍƯ Assumption of 1% annual background decrease; is it valid? zTrend analysis for stomach and liver cancer death zProjection using simulation model considering trends of risk factors, screening and treatment effects -> CISNET ࠰ྙᲫᲟᐯถƷˎܭƸദƠƍƔᲹ zᏎƕǜŴᏁƕǜരʧྙƷѣӼЎௌ zȪǹǯᙲ׆Ŵ౨ᚮŴၲјௐƷѣӼǛᎋॾ ƠƨૠྸȢȇȫƴǑǔਖ਼ ܭĺ CISNET CISNET ȢȇȫƷɟᑍࡸ General Formulation of CISNET Models σᡫƷλщ ǷȟȥȬȸǷȧȳ σᡫƷЈщᲴ Ȣȇȫ ʼλƴǑǔdzǹȈƱșȍȕǣȃȈ Ȫǹǯᙲ׆ ౨ᚮӖᚮ ƕǜȢȇȫ ၲƷ୍ӏ ЈщƷ̊ zരʧ zឋᛦૢʴ࠰ zᢅйᚮૺ zႺҔၲdzǹȈ ᙲ׆КƴЎƚƨٻᐂƕǜരʧྙƷᢅӊƷ࠰ഏਖ਼ᆆ (1975–2000). Figure 4. Partition of past trends in colorectal cancer mortality (1975–2000). Ȫǹǯᙲ׆ ౨ᚮƴǑǔᡙьႎ݃ɨ ၲƴǑǔᡙьႎ݃ɨ Edwards BK, et al. Cancer 2010;116:544–73. Edwards BK, et al. Cancer 2010;116:544–73. Figure 5. Projections of colorectal cancer mortality with differing intensities of cancer control interventions (2000–2020). ီƳǔᆉࡇƷʼλƴǑǔٻᐂƕǜരʧྙǁƷࢨ᪪ʖย (2000–2020). ȢȇȫƴǑǔ ᢅӊƷരʧྙǁƷ࢘ƯƸNJ ܱยരʧྙ 2000࠰ˌЭƷ ᙲ׆Ʒࢨ᪪ Impact of Pre-2000 Trends in Upstream Factors Additional Impact of Post-2000 Continued Trends in Upstream Factors 2000࠰ˌᨀƷ ዒዓᙲ׆Ʒࢨ᪪ Additional Impact of Post-2000 Optimistic Treands in Upstream Factors 2000࠰ˌᨀƷ ᡙьᙲ׆Ʒࢨ᪪ Edwards BK, et al. Cancer 2010;116:544–73. Edwards BK, et al. Cancer 2010;116:544–73. Process indicator for monitoring the implementation status of cancer control program ƕǜݣሊƷᡶཞඞǛ৭੮ƢǔƨNJƷɶ᧓ਦ General goal of the basic plan to promote cancer control progam 20 % reduction of age-adjusted cancer death rate (less than 75 year old) Tobacco control Smoking rate Cancer screening Participation rate ƕǜݣሊਖ਼ᡶؕஜᚘဒƷμ˳Ⴘ žƕǜƷ࠰ᱫᛦૢരʧྙᲢᲱᲯബசᲣƷᲬᲪᲟถݲſ Equalizing the level of cancer care ƨƹƜݣሊ Survival rate Quality Indicator Ჹ տྙ ƕǜ౨ᚮ ƕǜҔၲ൦แ ƷרƯǜ҄ Ӗᚮྙ ဃྙ܍ 3WCNKV[ +PFKECVQT Ჹ 3࠰ƴɟࡇƷൟဃؕᄽᛦ௹ National survey for daily life event???, every 3 years 57 Trends of smoking rate for male adults Trends of smoking rate for female adults Age 30-39 30-39ബ Age 20-29 Age 40-49 20-29ബ 40-49ബ 50-59ബ Age 50-59 All μ࠰ᱫ Age 20-29 20-29ബ Age 60-69 60-69ബ Age 30-39 30-39ബ Age 40-49 Age 70+ 40-49ബ 70ബˌɥ All μ࠰ᱫ Age 50-59 50-59ബ Age 60-69 60-69ബ Age 70+ 70ബˌɥ All (20 or over) All (20 or over) Age group Age group 57 58 National Health and Nutrition Survey Trends of cancer screening participation rate (2004, 2007) Stomach Cancer Screening Colorectal Cancer Screening Lung Cancer Screening Breast Cancer Screening Cervical Cancer Screening Process indicator for monitoring the implementation status of cancer control program ƕǜݣሊƷᡶཞඞǛ৭੮ƢǔƨNJƷɶ᧓ਦ General goal of the basic plan to promote cancer control progam 20 % reduction of age-adjusted cancer death rate (less than 75 year old) Tobacco control ƕǜݣሊਖ਼ᡶؕஜᚘဒƷμ˳Ⴘ žƕǜƷ࠰ᱫᛦૢരʧྙᲢᲱᲯബசᲣƷᲬᲪᲟถݲſ Equalizing the level of cancer care Cancer screening Smoking rate Participation rate zannual zAge-specific (5year age groupᲣdata zUnified system for screening providers zEstablish survey method for target population Survival rate Quality Indicator Ჹ Designated cancer hospital national case survey Data flow of cancer registration system in Japan Institutions for incidence data registration ȷsmall hospitals, clinics, test lab etc. ȷ25 data items for incidence data ƕǜ౨ᚮ ƕǜҔၲ൦แ ƷרƯǜ҄ տྙ Ӗᚮྙ z࠰ z࠰ᱫК(5ബƖ ƟLjᲣƷȢȋǿ Ȫȳǰ z౨ᚮ੩̓˳С ƷɟΨ҄ zݣᝋᎍͨǁƷ ᛦ௹૾ඥƷᄩᇌ ဃྙ܍ 3WCNKV[ +PFKECVQT Ჹ ƨƹƜݣሊ ƕǜႇƷȇȸǿƷ්ǕᲢྵᘍᲣ Institutions for clinical data registration ȷ377 DCCH ȷHospital-based CR ȷabstracted by registrar ȷ49 data items for clinical data With personal identifier Without personal identifier ፝धऴإႇೞ᧙ ᚮၲऴإႇೞ᧙ ȷɶݱ၏ᨈŴᚮၲŴ౨௹ǻȳ ǿȸƳƲ ȷ፝धऴإႸ ȷਗໜ၏ᨈ ȷแᨈϋƕǜႇܱ ȷܱѦᎍƴǑǔᨼኖ ȷᚮၲऴإႸ 30Pref. 312,663 cases (2005) Incidence, Survival, Prevalence Cancer Control Plan, Evaluation Clinical data Prefecture Population-based Cancer Registry ̾ʴऴإƋǓ ̾ʴऴإƳƠ ፝ध ऴإ Incidence data Vital Statistics Mortality data ਗໜ၏ᨈᨈϋƕǜႇ μᨼᚘ 357hospitals 426,783 cases (2008) ʴӝѣ७ രʧȇȸǿ ᲢᣃᢊࡅჄϋᲣ Incidence data 30Ⴤ312,663ˑ(2005) 14 data items National Cancer Center Center for Cancer Control and Information Services Estimated Incidence 646,802 cases (2005) ᣃᢊࡅჄ ؏עƕǜႇ Clinical Survey by hospital, Survival by stage and Tx ፝धૠȷྙ ဃྙ܍ ஊ၏ᎍૠȷྙ Patients, families, health professionals ƕǜݣሊ ሊᇌకȷᚸ̖ 58 ᚮ ၲ ऴ إ 357ᚨ426,783ˑ(2008) ፝ ध ऴ إ ᇌƕǜᄂᆮǻȳǿȸ ƕǜݣሊऴإǻȳǿȸ ፝धμਖ਼͌ܭ646,802ʴ ᚨКᚮၲܱ७ᨼᚘ ᢿˮ5VCIGၲඥК ဃྙ܍ धᎍȷܼଈ Ҕၲࢼʙᎍ Data flow of cancer registration system in Japan Existing data for choosing cancer patients ȷinsurance claim data ȷpathology report data ȷ377 DCCH ȷHospital-based CR ȷabstracted by registrar ȷ49 data items for clinical data ȷsmall hospitals, clinics, test lab etc. ȷ25 data items for incidence data KPSWKT[ With personal identifier Without personal identifier Incidence, Survival, Prevalence 357hospitals 426,783 cases (2008) planning mortality Observation & Intervention study Evaluation study Prevention guideline Screening efficacy guideline Clinical Survey by hospital, Survival by stage and Tx Primary Prevention Early detection What is conducted? Life-style monitoring Participation rate Quality assurance What is achieved? incidence mortality ᚮ ၲ ऴ إ ᣃᢊࡅჄ ؏עƕǜႇ ፝धૠȷྙ ဃྙ܍ ஊ၏ᎍૠȷྙ Patients, families, health professionals New drug development clinical trial ƕǜƷܱ७ ƸƲƏƔ QOL Assessment ˴ƕஊјƳ ૾ඥƔ Clinical guideline Treatment ፝धྙ രʧྙ ᚇݑᄂᆮȷ ʼλᄂᆮ ஊјࣱ ᚸ̖ᄂᆮ ʖ᧸ǬǤȉ ȩǤȳ ౨ᚮஊјࣱ ǬǤȉȩǤȳ МဇӧᏡƳ เƸ˴Ɣ ˖ဒȷᇌక End of life care ܱ ദƠƘܱ ƞǕƯƍǔƔ Clinical practice surveillance Quality Indicator survival धᎍȷܼଈ Ҕၲࢼʙᎍ ᅹܖႎఌਗƴؕƮƘƕǜݣሊ Ⴘႎ Ū፝धȷരʧƷถ ݲŪधᎍȷܼଈƷQOLӼɥ QOL survival ᚨКᚮၲܱ७ᨼᚘ ᢿˮ5VCIGၲඥК ဃྙ܍ ᇌƕǜᄂᆮǻȳǿȸ ƕǜݣሊऴإǻȳǿȸ ƕǜݣሊ ሊᇌకȷᚸ̖ Medical and social resource surveillance implementation ̾ʴऴإƳƠ ፝ ध ऴ إ Estimated Incidence 646,802 cases (2005) incidence ̾ʴऴإƋǓ ፝ध ऴإ Incidence data National Cancer Center Center for Cancer Control and Information Services What is available? ȷਗໜ၏ᨈƳƲ ȷแᨈϋƕǜႇܱ ȷܱѦᎍƴǑǔᨼኖ ȷᚮၲऴإႸ ȷǿǤȠȪȸƳإԓ 14 data items Aim: Reduce mortality and incidence, Improve QOL of patients and their families What is effective? ᚮၲऴإႇೞ᧙ ȷɶݱ၏ᨈŴᚮၲŴ౨௹ǻȳ ǿȸƳƲ ȷ፝धऴإႸ ȷቇତႇǽȕȈƷМဇ ȷբӳƤǁƷׅሉ ʴӝѣ७ രʧȇȸǿ ᲢᣃᢊࡅჄϋᲣ Steps for implementing evidence-based cancer control program What is happening? ፝धऴإႇೞ᧙ բӳƤ Clinical data 30Pref. 312,663 cases (2005) Cancer Control Plan, Evaluation ƕǜधᎍͅᙀਁЈဇ ଏ܍ȇȸǿ ȷᚮၲإᣛȇȸǿ ȷ၏ྸإԓȇȸǿ Incidence data Prefecture Population-based Cancer Registry Vital Statistics Mortality data ƕǜႇƷȇȸǿƷ්ǕᲢݩஹకᲣ Institutions for clinical data registration Institutions for incidence data registration ႸႎƸᢋ ƞǕƨƔ QOL 59 ᚮૺችࡇ ᚸ̖ᄂᆮ ဃྙ܍ QOL ၲјௐ ᐮᚾ᬴ QOL ᚸ̖ᄂᆮ ᚮၲȷዼԧDZǢǬǤȉȩǤȳ แǯȪȋǫȫȑǹ Ҕၲเܱ७ᛦ௹ ଔ ႆᙸ ʖ᧸ ဃ፼ॹ ȢȋǿȪȳǰ ፝धྙ Ӗᚮྙ ችࡇሥྸ രʧྙ ᚮૺ ၲ ኳDZǢ ᚮၲܱ७৭੮ Quality Indicator ဃྙ܍ QOL 60 神奈川県のがん登録 CANCER REGISTRATION IN KANAGAWA 岡本 直幸* Naoyuki Okamoto The Kanagawa population-based cancer 神奈川県地域がん登録は神奈川県内在住の registry started in January 1970. The area 方を対象として、1970 年 1 月より開始して of registration is the whole of Kanagawa いる。神奈川県は日本のほぼ中央にあり、太 Prefecture, located approximately in the 平洋に面しており、また東京に隣接している。 center of Japan. It faces the Pacific Ocean 面積は 2,403 平方キロで、2010 年 1 月 1 日 and adjoins Metropolitan Tokyo. The area の人口は、神奈川県の推計で 9,008,132 人で、 is 2,403 square kilometers. The total 0－14 歳が 13.3％、15－64 歳が 66.5％、65 population was 9,00,8132 people according 歳以上が 19.8％である。人口の 56.4％が川崎 to the estimated number at January 1, あるいは横浜に居住しており、95％が都市部 2010 by the population office of Kanagawa で生活している。日本人以外には台湾人、韓 Prefectural the 国人、中国人も居住している。神奈川県地域 percentages of the population by age-class がん登録は、県衛生福祉部が神奈川県医師会 were 13.3% for 0-14 years, 66.5% for 15-64 と神奈川県立がんセンターに委託をして行わ years and 19.8% for 65 years and over. れている。全ての部位の悪性新生物が医師や Approximately 56.4% of the population 診療録管理室から届け出られる。また、登録 lives in the Yokohama or Kawasaki City 患者の死亡の確認とがん死の確認を行うため areas; 95% lives in urban areas. Most of the や届出の補充のために死亡票も収集している。 population is Japanese, though Formosan, 神奈川県民の死亡者の 15％が東京の病院で Korean and Chinese also live in Kanagawa. の死亡であることから、神奈川県地域がん登 Kanagawa been 録のデータの約 20%が DCO である。届出デ entrusted by the Public Health and Welfare ータは ICD-9 と ICD-O でコード化されてお Department り、毎年、罹患データを年報の形で公表して Government Government, Cancer of to Registry Kanagawa and has Prefectural Kanagawa Medical いる。 Association and Kanagawa Cancer Center. All cases of malignant neoplasm are notified to the registry on a voluntary basis from the physicians treating cancer patients or from the hospital record room. Death certificates have been collected so as to make it possible to determine cause of *神奈川県立がんセンターがん予防・情報研究部門 Kanagawa Cancer Registry, Cancer Prevention and Control Division, Kanagawa 61 death and date of death by record linkage between death certificates and cancer registrations. About 15% of cancer patients lived in Kanagawa attend hospitals in metropolitan Tokyo. It is difficult to collect clinical data for these patients, so that 20% of the incidence data for all aged each year are based on death certificate only (DCO) data. Cancer data have been coded according to ICD-9 and to ICD-O for both topography and histology. Data on incidence have been published in annual reports in Japanese every year. 62 19th Annual Meeting of Japanese Association of Cancer Registries Red Brick Warehouse, Yokohama, Japan October 15, 2010 ╙19࿁ၞ䈏䉖⊓㍳ో࿖ද⼏ળቇⴚ㓸ળ 2010/10/15 ᮮᵿ䇮⿒䊧䊮䉧ୖᐶ Population-based Cancer Registry in Kanagawa ᅕ߷ډჄ↝؏עⅻ⇂ႇ Naoyuki Okamoto Ph.D. Kanagawa Cancer Registry Cancer Prevention & Cancer Control Division Kanagawa Cancer Center Research Inst. ጟᧄ⋥ᐘ ᄹᎹ⋵┙䈏䉖䉶䊮䉺䊷⥃ᐥ⎇ⓥᚲ 䈏䉖੍㒐䊶ᖱႎ⎇ⓥㇱ㐷 Kanagawa Cancer Center Kanagawa Cancer Center Position of Kanagawa Prefecture in Japan (1) ᅕ߷ډჄƷˮፗᲢᲫᲣ Kyoto Prefecture AreaᲴ4,613km2 Pop. Ჴ2,627,508 Osaka Prefecture AreaᲴ1,898km2 Pop. Ჴ8,839,168 ࡅ᧵ٻ ᩿ᆢᲴMO ʴӝᲴʴ Tokyo (Capital) AreaᲴ2,188km2 Pop. Ჴ13,044,818 ʮᣃࡅ ᩿ᆢᲴMO ʴӝᲴʴ ிʮᣃ ᩿ᆢᲴMO ʴӝᲴʴ Tokyo International Airport (Narita) ᅕ߷ډჄ ᩿ᆢᲴMO ʴӝᲴʴ Kanagawa Prefecture AreaᲴ2,416km2 Pop. Ჴ9,028,285 Kanagawa Cancer Center Kanagawa Cancer Center Position of Kanagawa Prefecture in Japan (2) Gunma Pref. Pop.=1,999,868 Yokohama City ፭ᬔჄ ʴ Tochigi Pref. Pop.=2,005,730 Saitama Pref. Pop.=7,189,176 Yamanashi Pref. Pop.=865,112 ᅕ߷ډჄƷˮፗᲢᲬᲣ Ibaragi Pref. Pop.=2,963,959 ྚؖჄ ʴ ޛషჄ ʴ Tokyo Chiba Pref. Pop.=6,200,335 Tokyo International Airport (Narita) ᒠ؉Ⴤ ʴ ிʮᣃʴ ҘᓶჄ ʴ ᅕ߷ډჄ ʴ The Pacific Ocean ٽ Kanagawa Cancer Center Kanagawa Cancer Center Standardized Mortality Ratio (SMR) by Prefectures - All site cancers Male ᧲੩࿖㓙ⓨ᷼䋨ᚑ↰䋩 ᩺ޢჄ ʴ Shizuoka Pref. Pop.=3,774,165 Kanagawa Pref. ஙჄ ʴ ᮮᵿᏒ ᣃᢊࡅჄКแ҄രʧൔᲢ5/4 Ყμƕǜȸ ဏࣱ Female Kanagawa Cancer Center Kanagawa Cancer Center 63 ࣱڡ බ Standardized Mortality Ratio (SMR) by Prefectures - Stomach cancer Male ᣃᢊࡅჄКแ҄രʧൔίᵱᵫᵰᵇ ὼᏎầỮὊ ဏࣱ Female Kanagawa Cancer Center Kanagawa Cancer Center Standardized Mortality Ratio (SMR) by Prefectures - Liver cancer Male ᣃᢊࡅჄКแ҄രʧൔίᵱᵫᵰᵇ ὼᏁᐥầỮὊ ဏࣱ Female Kanagawa Cancer Center Breast ᣃᢊࡅჄКแ҄രʧൔᲢ5/4 ʐầỮ Corpus uteri Kanagawa Cancer Center History of Kanagawa Cancer Registry ᅕ߷ډჄ؏עƕǜႇƷഭӪ 䊶⎇ⓥ⃰䋨ᐔጊ⃰䋩⋵ᖡᕈᣂ↢‛ታᘒ⺞ᩏ 㩿㪈㪐㪎㪇㪄㪈㪐㪎㪍㪀 Kanagawa Medical Association switches to the registration system 䊶ᄹᎹ⋵ታᣉ䇮කᏧળ䈻⊓㍳ᆔ⸤ 䊶ᄹᎹ⋵ᖡᕈᣂ↢‛⊓㍳ᬺ䈮ᄌᦝ Renamed the Kanagawa Cancer Registry Executed by the Medical Division of Kanagawa Prefecture Computerized registration system adopted (batch processing) 1980 77 ˳ܷ܇ầỮ Kanagawa Cancer Center The actual survey on cancer incidence begins (1970-1976) 73 ࣱڡ Kanagawa Cancer Center Standardized Mortality Ratio (SMR) by Prefectures - Female - 1970 ࣱڡ 88 81 86 94 1990 96 䊶ᄹᎹ⋵ⴡ↢ㇱਥ䇮ᚑੱ∛䉶䊮䉺䊷ታᣉ 䊶⊓㍳ᬺ䈱㔚▚ൻ䋨䊋䉾䉼ಣℂ䉲䉴䊁䊛䋩 1970 04 2000 1980 73 2010 Regulations enacted on the implementation guidelines and protection of personal information 77 81 88 86 94 1990 96 04 䊶⊓㍳ᬺ䈱䉥䊐䉮䊮ൻ䋨㓐ᤨಣℂ䉲䉴䊁䊛䋩 ICD-10 & ICD-O introduced Registration system by office computer created (TSS) 2010 2000 䊶ታᣉⷐ✁䇮ੱᖱႎ⼔䈱ⷙቯ䉕⸳ቯ ᮡḰ䉲䉴䊁䊛䉕ㆩ䈚䈢 ⊓㍳䉲䉴䊁䊛䈱䈻䈱ୃ ᱜ㐿ᆎ䋨᳃ᾖળ䊶㆚ 䉍⺞ᩏ䈭䈬䋩 䊶ICD䊷䋱䋰䋮 ICD䊷䌏䈱ዉ Japan cancer surveillance research group established (Cancer registry in Japan standardized) Registration system by personal computer created (Japanese Character system introduced) 䊶䊌䉸䉮䊮䉲䉴䊁䊛䈱ዉ䋨ṽሼജ䈏น⢻䈮䋩 䊶ኻ䈏䉖ᚢ⇛䉰䊷䊔䉟䊤䊮䉴⃰䋨ῳᳯ⃰䋩㐿ᆎ Kanagawa Cancer Center Kanagawa Cancer Center 64 Kanagawa Cancer Registry: System Diagram Kanagawa Residents Information Disclosure Report ᅕ߷ډჄ ̬ͤᅦᅍᢿ ͤࡍفᡶᛢ Notification of Death Municipal Governments ފЈۀᚠ إ ᅕ߷ډჄ Ҕࠖ˟ ԓ ފЈ̔᫂ ႇᅚᣐࠋ ފЈᜓ ႇᅚ Ҕၲೞ᧙ Ტᅕ߷ډჄϋᲣ രʧފ രʧᚮૺ ފЈᅚᆆᡛ Transportation of Registration Sheets Report Hospital & Clinic Registration Sheets إԓ Discussion & Advisory Request for Report Kanagawa Medical Association Ӗᚮ രʧᚮૺ ऴإ ᅆ ݙᜭȷբ Advice & Guidance Consignment of report Ⴤ ൟ Consultation Death Diagnosis ਦݰȷяᚕ Kanagawa Health and Social Affairs Division žᅕ߷ډჄफࣱૼဃཋႇſƷǷǹȆȠ᧙ᡲ ࠊғထ Death Certificate (DC) Committee to Promote the Cancer Registry Central Registry Office Advice & Guidance Discussion & Advisory രʧݱᅚ Health Center Info Service Collection of DC फࣱૼဃཋ ႇʙಅ ਖ਼ᡶۀՃ˟ DC of Vital Statistics ɶځႇܴ ਦݰȷяᚕ ऴإǵȸȓǹ Ⴤᇌƕǜǻȳǿȸϋ ݙᜭȷբ Ministry of Health, Labour and Welfare Anonymity Temporary Encryption file of info Reported data Check list print žᅕ߷ډჄफࣱૼဃཋႇſƷᩓምǷǹȆȠ Check list ዯജ లജ Collation Follow-up & DC data Cumulative file Consolidating file Totaling & statistics ㅊ〔ജ ᱫജ CSV output Collation ৻ᤨ 䊐䉜䉟䊦 ᡲኽӧ ᏡҕӸ ҄ ੱᖱႎ ᥧภൻ ȁǧȃǯ ȪǹȈҮТ ȁǧȃǯ ȪǹȈ ᨼᚘȷወᚘ ȇȸǿЈщ %58 Јщ ༀӳ 㓸⚂ 䊐䉜䉟䊦 ⚥Ⓧ 䊐䉜䉟䊦 ༀӳ Vital statistic Master file Collation tape Making back-up under schedule Collation list print 䊙䉴䉺䊷 䊐䉜䉟䊦 ༀӳ ੱญേᘒ 䊁䊷䊒 ˩ ȪǹȈҮТ ȐȃǯǢȃȗ˺ ᲢǹDZǸȥȸȪȳǰᲣ Results list Back-up File ˩ ȪǹȈ 䊋䉾䉪䉝䉾䊒 䊐䉜䉟䊦 Kanagawa Cancer Center Kanagawa Cancer Center Annual changes of the amount of registration work ႇܴƴƓƚǔ˺ಅƷኺ࠰҄٭ 䋨ઙ䋩 Number of cases 80,000 80,000 Cases of input 50,000 Kanagawa Cancer Center Kanagawa Cancer Registry Computer System 60,000 ͤ ʴӝѣ७രʧᅚ ҽဃіႾ Kanagawa Cancer Center 70,000 ̬ രʧᅚӓᨼ 70,000 Death Cases Notified cases 60,000 Record likage cases Corrected cases 50,000 ജ✚ᢙ Record likage cases 䊙䉴䉺䊷ᾖว䊕䉝 ዯ 䊙䉴䉺䊷ᾖว䊕䉝 30,000 30,000 Cases of input ജ✚ᢙ 20,000 20,000 Corrected cases Death cases 10,000 ᱫ 40,000 40,000 ୃᱜઙᢙ ୃᱜઙᢙ ᱫ 10,000 Notified cases 0 ዯ 0 year 䋨ᥲ䋩 Kanagawa Cancer Center Kanagawa Cancer Center Annual changes of the accuracy of registry (%) Death Certificate Only䋨 䋨DCO) % ႇችࡇƷ࠰ഏ҄٭ (%) Incidence/Death ratio ⟕ᖚ䈫ᱫ䈱Ყ䋨I/D䋩䋩 ᱫ䈱䉂䈱ഀว䋨DCO%䋩䋩 45 2 45 2 40 1.8 40 1.8 35 1.6 35 1.6 1.4 30 1.2 25 1.4 30 1.2 25 1 1 20 20 0.8 0.8 15 15 0.6 10 0.6 10 0.4 5 0 0.2 0 0 year 0.4 5 0.2 year 0 䋨ᐕ䋩 Kanagawa Cancer Center Kanagawa Cancer Center 65 䋨ᐕ䋩 The ratio of the hospital in Tokyo in the hospital that notify the certificate of death by Municipality ࠊғထКẐầỮരʧᎍỉފЈẑầ ிʮỂẝỦлӳ Tokyo (Metropolitan City) ᧲੩ㇺ Kanagawa Cancer Center Kanagawa Cancer Center The ratio of the hospital in other Prefecture except Tokyo in the hospital that notify the certificate of death by Municipality ࠊғထКẐầỮരʧᎍỉފЈẑầ ˂ჄίிʮˌٳὸỂẝỦлӳ Shizuoka Prefecture 㕒ጟ⋵ Kanagawa Cancer Center Kanagawa Cancer Center Annual changes of the cancer incidence by age-class (all sites) ( /100,000) 10000 Male ࠰ᱫ᨞ኢКμƕǜ፝धྙƷኺ࠰҄٭ ↵ Female 10000 65ᱦએ 651000 65ᱦએ 65- 1000 40-64 100 1000 1000 40䌾64ᱦ 40䌾64ᱦ 40-64 100 100 100 15䌾39ᱦ 15-39 15-39 10 ᅚ 10000 10000 15䌾39ᱦ 10 10 0-14 10 0䌾14ᱦ 0䌾14ᱦ 0-14 1 1 1 1 year Kanagawa Cancer Center Kanagawa Cancer Center Annual changes of the cancer incidence in Kanagawa by age-class ( male) ( /100,000) Stomach ca. ࠰ᱫ᨞ኢКᏎȷٻᐂƕǜ፝धྙƷኺ࠰҄٭ᲢဏᲣ ⢗䈏䉖 Colorectal ca. ᄢ⣺䈏䉖 1000 1000 1000 1000 65ᱦએ 65- 65ᱦએ 65- 100 40-64 100 100 40䌾64ᱦ 100 40䌾64ᱦ 40-64 10 10 10 10 15䌾39ᱦ 15-39 1 15䌾39ᱦ 15-39 1 1 year Kanagawa Cancer Center Kanagawa Cancer Center 66 1 Annual changes of the cancer incidence in Kanagawa by age-class ( male) Lung ca. ( /100,000) ࠰ᱫ᨞ኢКᏍȷЭᇌᐄƕǜ፝धྙƷኺ࠰҄٭ᲢဏᲣ ⢖䈏䉖 Prostate ca. ೨┙⣼䈏䉖 1000 1000 1000 1000 65ᱦએ 65- 65ᱦએ 65100 100 100 100 40䌾64ᱦ 40-64 40-64 10 40䌾64ᱦ 10 10 1 1 10 15-39 15䌾39ᱦ 1 1 year Kanagawa Cancer Center Kanagawa Cancer Center Annual changes of the cancer incidence in Kanagawa by age-class ( female) Stomach ca. ( /100,000) ࠰ᱫ᨞ኢКᏎȷٻᐂƕǜ፝धྙƷኺ࠰҄٭ᲢڡᲣ Ꮞƕǜ Colorectal ca. 1000 ٻᐂƕǜ 1000 1000 1000 65ᱦએ 65- 65ᱦએ 65- 100 100 100 40-64 10 100 40䌾64ᱦ 40-64 40䌾64ᱦ 10 10 10 15䌾39ᱦ 15-39 15-39 1 15䌾39ᱦ 1 1 1 year Kanagawa Cancer Center Kanagawa Cancer Center Annual changes of the cancer incidence rate in Kanagawa by age-class ( female) Breast ca. ( /100,000) ࠰ᱫ᨞ኢКʐȷܷ܇ƕǜ፝धྙƷኺ࠰҄٭ᲢڡᲣ ʐƕǜ Uterus ca. ܷ܇ƕǜ 1000 1000 1000 1000 65ᱦએ 65- 100 100 100 100 40-64 40䌾64ᱦ 65- 65ᱦએ 40䌾64ᱦ 40-64 10 10 10 10 15-39 1 15䌾39ᱦ 15䌾39ᱦ 15-39 1 1 1 year Kanagawa Cancer Center Kanagawa Cancer Center Annual changes of the cancer incidence of uterus ca. in Kanagawa by age-class 100.00 Cervix uteri Corpus uteri ܷ܇ƕǜ፝धྙƷ࠰ᱫ᨞ኢКƷኺ࠰҄٭ CIS 100.00 ሶች㗖䈏䉖 ሶች䈏䉖 ⊹ౝ䈏䉖 65ᱦએ 65ᱦએ 6565- 10.00 10.00 40-64 40-64 40-64ᱦ 40-64 15-39 15-39 40-64ᱦ 65- 1.00 `89 `91 `93 `95 `97 `99 `01 `03 `05 65ᱦએ 15-39ᱦ 1.00 `89 `91 `93 `95 `97 `99 `01 `03 `05 15-39ᱦ 15-39ᱦ 15-39 `89 `91 `93 `95 `97 `99 `01 `03 year Kanagawa Cancer Center Kanagawa Cancer Center 67 40-64ᱦ ࠰உ Challenge against Cancer: 10-year Strategy March, 2005 Kanagawa Prefecture Kanagawa Cancer Center Kanagawa Cancer Center Public Demand for Cancer Control Programs 㪇 㪈㪇 㪉㪇 㪊㪇 㪋㪇 㪌㪇 ƕǜݣሊƴݣƢǔࡅǁƷᙲஓ 䋨ౝ㑑ᐭᐔᚑ㪈㪐ᐕ㪐⺞ᩏ䋩 䋦 㪍㪇 㪎㪇 㪇 䈏䉖䈱ᣧᦼ⊒䋨䈏䉖ᬌ⸻䋩 Early detection & treatment of cancer 㪈㪇 㪉㪇 㪊㪇 㪋㪇 䋦 㪌㪇 㪍㪇 䈏䉖䈱ᣧᦼ⊒䋨䈏䉖ᬌ⸻䋩 Enhanced cancer hospitals 䈏䉖ක≮ᯏ㑐䈱లታ 䈏䉖ක≮ᯏ㑐䈱లታ Training for cancer specialists 䈏䉖ኾ㐷ක≮ᓥ⠪䈱㙃ᚑ 䈏䉖ኾ㐷ක≮ᓥ⠪䈱㙃ᚑ Cancer䈏䉖䈮㑐䈜䉎⋧⺣䉇䈠䈱㵺 consultation 䈏䉖䈮㑐䈜䉎⋧⺣䉇䈠䈱ᡰេ Disclosure of cancer information 䈏䉖ᖱႎ䈱ឭଏ 䈏䉖ᖱႎ䈱ឭଏ Promotion of cancer 䈏䉖⎇ⓥ䈱ផㅴ research 䈏䉖⎇ⓥ䈱ផㅴ Enhanced cancer control 䈏䉖੍㒐ኻ╷䈱లታ 䈏䉖੍㒐ኻ╷䈱లታ Enhanced palliative care ✭䉬䉝䈱లታ ✭䉬䉝䈱లታ Development of novel operations ᚻⴚ≮ᴺ䈱㐿⊒ ᚻⴚ≮ᴺ䈱㐿⊒ Development of novel chemotherapies ൻቇ≮ᴺ䈱㐿⊒ ൻቇ≮ᴺ䈱㐿⊒ Development of novel radiation✢ᴦ≮䈱㐿⊒ therapies ✢ᴦ≮䈱㐿⊒ Development of novel cancer therapies ᣂ䈢䈭䈏䉖ᴦ≮䈱㐿⊒ ᣂ䈢䈭䈏䉖ᴦ≮䈱㐿⊒ Promotion the cancer registries 䈏䉖⊓㍳䈱ផㅴ 䈏䉖⊓㍳䈱ផㅴ Other 䈠䈱ઁ䇮ή࿁╵ 䈠䈱ઁ䇮ή࿁╵ 䋨The Cabinet, Sept. 2007䋩 Kanagawa Cancer Center Kanagawa Cancer Center Age-adjusted incidence rate of colorectal ca. in Kanagawa by municipality ( male, 2003-06) ࠊғထКٻᐂƕǜ࠰ᱫᛦૢ፝धྙᲢဏᲣ ᲢᲣ Kanagawa Cancer Center Kanagawa Cancer Center Age-adjusted incidence rate of colorectal ca. in Kanagawa by municipality ( female, 2003-06) ࠊғထКٻᐂƕǜ࠰ᱫᛦૢ፝धྙᲢڡᲣ ᲢᲣ Kanagawa Cancer Center Kanagawa Cancer Center 68 㪎㪇 Age-adjusted incidence rate of breast ca. in Kanagawa by municipality ( female, 2003-06) ࠊғထКʐƕǜ࠰ᱫᛦૢ፝धྙ ᲢᲣ Kanagawa Cancer Center Kanagawa Cancer Center An Image of Kanagawa in the Future ႸਦẴᅕ߷ډỉẴầẺ To execute the overall cancer control program and promote cancer prevention, early detection, novel cancer therapies, palliative care, etc. by 2014 ੍㒐䇮ᣧᦼ⊒䇮ᴦ≮䇮䉺䊷䊚䊅䊦䉬䉝䉁䈪䉕ㅢ䈚 䈢✚ว⊛䈭䈏䉖ኻ╷䈱ዷ㐿䇮ᐔᚑ26ᐕ䉁䈪䈮⋡ᜰ䈜 Promote lifestyles with a reduced cancer risk 䃂ⅻ⇂↚↙↸↙ⅳᅕ↔߷ډⅾ↹ Stop smoking, prevent passive smoking Improve lifestyle overall Enhance cancer screening Offer accurate cancer information ὉᅠẆЎỉ࣋ࡁ ὉầỮ౨ᚮỉΪܱ ὉဃẆᢃѣễỄỉဃોծ ὉầỮỉऴإ੩̓ 䃂ⅻ⇂↚ↀ↙ⅳᅕ↔߷ډⅾ↹ Promote control programs to overcome cancer Specify base hospitals for cancer treatment Promote advanced cancer therapy and research Enhance palliative care ὉầỮᚮၲᡲઃਗໜ၏ᨈ Ὁ᭗ࡇễầỮҔၲởᄂᆮ ὉዼԧἃỴỉΪܱ Kanagawa Cancer Center Kanagawa Cancer Center Emphatic Measures to Achieve an Effective Cancer Control Program ᅕ߷ډỉẴầẺỉܱྵồӼẬẺໜሊ ᲫᲨჄൟƴ៲ᡈƳᐯǒӕኵLjǍƢƍʖ᧸ݣሊƷਖ਼ᡶ 1. Promote cancer prevention measures citizens can do themselves ȷտྙƷ˯ɦ ă Ӗѣտ᧸ഥவ̊ƷСܭǁ Stop smoking and improve lifestyle ȷဃોծŴဃ፼ॹોծ 1. Detect cancer early ᲬᲨƕǜǛଔƴႆᙸƢǔ˳СƷૢͳ Strengthen the breast cancer screening program ȷʐƕǜ౨ᚮƷΪܱࢍ҄ 3. Offer advanced cancer therapy and construct a regional cancer treatment network ᲭᲨ᭗ࡇƳƕǜҔၲƷ੩̓Ʊ؏עƕǜҔၲƷȍȃȈȯȸǯƮƘǓ Introduce state-of-the-art medical equipment ȷஇέᇢҔၲೞ֥Ʒݰλ Promote clinical cancer research cooperatively within the public-industrial-academic complex ȷငܖπσӷƴǑǔᐮᄂᆮŴऴإ੩̓ ȷ؏עƕǜᚮၲᡲઃਗໜ၏ᨈƷȍȃȈȯȸǯƮƘǓ Construct a hospital network ᲮᲨ؏עưƷǿȸȟȊȫDZǢ˳СƷΪܱ 4. Enhance the regional system for terminal care Offer terminal care to esteem of individuals ȷɟʴƻƱǓǛݭƠƨǿȸȟȊȫDZǢƷ੩̓ Kanagawa Cancer Center Kanagawa Cancer Center Participation rate of breast cancer screening program by Prefectures ᣃᢊࡅჄКʐƕǜ౨ᚮӖᚮྙƷൔ᠋ Yamagata ࢟ޛ Ooita ٻЎ Okayama ޛޢ Shizuoka ᩺ޢ Saga ˱ Iwate ޥ Toyama ݈ޛ Miyagi ܷ؉ Tochigi ங Chiba Ҙᓶ Gunma ፭ᬔ ૼ Niigata ࢟ޛ ٻЎ ޛޢ ᩺ޢ ᭗ƍ Higher ᭗ƍ ˱ ޥ ݈ޛ ܷ؉ ங Ҙᓶ ፭ᬔ ૼ ᒠ؉ Ibaragi ྚؖ Saitama ᒠ؉ ˯ƍKanagawa ᅕ߷ډ Lower ˯ƍ ఌ Shimane ிʮ Tokyo ྚؖ ᅕ߷ډ ఌ ிʮ 㪇 㪈㪇 㪉㪇 㪊㪇 㪋㪇 㪌㪇 ᲢᲟᲣ 㪇 Kanagawa Cancer Center Kanagawa Cancer Center 69 㪈㪇 㪉㪇 㪊㪇 㪋㪇 㪌㪇 ᲢᲟᲣ Age-adjusted incidence rate of breast ca. in Kanagawa by municipality ( female, 2003-06) ࠊғထКʐƕǜ࠰ᱫᛦૢ፝धྙ ᲢᲣ Kanagawa Cancer Center Kanagawa Cancer Center Participation rate of breast ca. screening in Kanagawa by municipality ( female, 2003-06) ࠊғထКʐƕǜ౨ᚮӖᚮྙ ᲢᲣ Kanagawa Cancer Center Kanagawa Cancer Center Participation rate in medical examination after screening and cancer detection rate in Kanagawa (breast cancer, 2003-06Უ 㐿ᚑ↸ ᷡᎹ ⪲ጊ↸ ⋧ᮨḓ↸ ⨆䊱ፒᏒ ᮮ㗇⾐Ꮢ ෘᧁᏒ ㎨ୖᏒ ጊർ↸ ⒌㊁Ꮢ ਛ↸ ㅟሶᏒ ᎹፒᏒ ᧻↰↸ ධ⿷ᨩᏒ ᮮᵿᏒ દේᏒ ᗲᎹ↸ ਃᶆᏒ ▫ᩮ↸ ⌀㢬↸ ⋧ᮨේᏒ ၔጊ↸ ᶏ⠧ฬᏒ ḡᴡේ↸ ᵤਭ↸ ኙᎹ↸ ᐔႦᏒ ᄢᏒ ᄢ↸ ⮮㊁↸ ✍ἑᏒ ዊ↰ේᏒ ੑች↸ ᐳ㑆Ꮢ ᄢ⏷↸ ⮮ᴛᏒ #XGTCIG Ჟ 㪇 㪉㪇 㪋㪇 㪍㪇 㪏㪇 㪈㪇㪇 Participation rate in medical examination (%) 㐿ᚑ↸ ᷡᎹ ⪲ጊ↸ ⋧ᮨḓ↸ ⨆䊱ፒᏒ ᮮ㗇⾐Ꮢ ෘᧁᏒ ㎨ୖᏒ ጊർ↸ ⒌㊁Ꮢ ਛ↸ ㅟሶᏒ ᎹፒᏒ ᧻↰↸ ධ⿷ᨩᏒ ᮮᵿᏒ દේᏒ ᗲᎹ↸ ਃᶆᏒ ▫ᩮ↸ ⌀㢬↸ ⋧ᮨේᏒ ၔጊ↸ ᶏ⠧ฬᏒ ḡᴡේ↸ ᵤਭ↸ ኙᎹ↸ ᐔႦᏒ ᄢᏒ ᄢ↸ ⮮㊁↸ ✍ἑᏒ ዊ↰ේᏒ ੑች↸ ᐳ㑆Ꮢ ᄢ⏷↸ ⮮ᴛᏒ ች౨ӖᚮྙƱƕǜႆᙸྙ *࠰Ŵʐƕǜ౨ᚮᲣ 㐿ᚑ↸ ᷡᎹ ⪲ጊ↸ ⋧ᮨḓ↸ ⨆䊱ፒᏒ ᮮ㗇⾐Ꮢ ෘᧁᏒ ㎨ୖᏒ ጊർ↸ ⒌㊁Ꮢ ਛ↸ ㅟሶᏒ ᎹፒᏒ ᧻↰↸ ධ⿷ᨩᏒ ᮮᵿᏒ દේᏒ ᗲᎹ↸ ਃᶆᏒ ▫ᩮ↸ ⌀㢬↸ ⋧ᮨේᏒ ၔጊ↸ ᶏ⠧ฬᏒ ḡᴡේ↸ ᵤਭ↸ ኙᎹ↸ ᐔႦᏒ ᄢᏒ ᄢ↸ ⮮㊁↸ ✍ἑᏒ ዊ↰ේᏒ ੑች↸ ᐳ㑆Ꮢ ᄢ⏷↸ ⮮ᴛᏒ #XGTCIG Ჟ 㪇 㪇㪅㪈 㪇㪅㪉 㪇㪅㪊 㪇㪅㪋 㪇㪅㪌 cancer detection rate (%) Ⴤר Ჟ 㪇 㪉㪇 㪋㪇 㪍㪇 㪏㪇 㪈㪇㪇 㐿ᚑ↸ ᷡᎹ ⪲ጊ↸ ⋧ᮨḓ↸ ⨆䊱ፒᏒ ᮮ㗇⾐Ꮢ ෘᧁᏒ ㎨ୖᏒ ጊർ↸ ⒌㊁Ꮢ ਛ↸ ㅟሶᏒ ᎹፒᏒ ᧻↰↸ ධ⿷ᨩᏒ ᮮᵿᏒ દේᏒ ᗲᎹ↸ ਃᶆᏒ ▫ᩮ↸ ⌀㢬↸ ⋧ᮨේᏒ ၔጊ↸ ᶏ⠧ฬᏒ ḡᴡේ↸ ᵤਭ↸ ኙᎹ↸ ᐔႦᏒ ᄢᏒ ᄢ↸ ⮮㊁↸ ✍ἑᏒ ዊ↰ේᏒ ੑች↸ ᐳ㑆Ꮢ ᄢ⏷↸ ⮮ᴛᏒ Ⴤר Ჟ 㪇 㪇㪅㪈 㪇㪅㪉 㪇㪅㪊 㪇㪅㪋 ƕǜႆᙸྙᲢᲟᲣ ች౨ӖᚮྙᲢᲟᲣ Kanagawa Cancer Center Kanagawa Cancer Center Reasons for not Participating in Cancer Screening Programs ⅻ⇂౨ᚮ⇁Ӗᚮↆ↙ⅳྸဌ 㪇 㪉㪇 ⅻ⇂౨ᚮ⇁Ӗᚮↆ↙ⅳྸဌ 㪇 㪋㪇 Cancer screening not needed 䈏䉖ᬌ⸻䈲ਇⷐ 䈏䉖ᬌ⸻䈲ਇⷐ Inconvenient to participate 㕙ୟ䈒䈘䈇 㕙ୟ䈒䈘䈇 No time to participate ฃ⸻䈜䉎ᤨ㑆䈏䈭䈇 ฃ⸻䈜䉎ᤨ㑆䈏䈭䈇 ฃ䈔ᣇ䉕⍮䉌䈭䈇 ฃ䈔ᣇ䉕⍮䉌䈭䈇 Don't know how to participate ᕯ䈝䈎䈚䈇䈎䉌 Shameful ᕯ䈝䈎䈚䈇䈎䉌 䈍㊄䈏䈎䈎䉎䈎䉌 Costly 䈍㊄䈏䈎䈎䉎䈎䉌 㪉㪇 㪋㪇 䈠䈱ઁ Other 䈠䈱ઁ 䋨The Cabinet, Sept. 2007䋩 䋨ᐔᚑ19ᐕ9ౝ㑑ᐭ⺞ᩏ䋩 Kanagawa Cancer Center Kanagawa Cancer Center 70 㪇㪅㪌 Numerical Targets for the Control of Breast Cancer Mortality ૠ͌Ⴘί䈏䉖䈮㑐䈚䈩䋩 ʐⅻ⇂രʧ⅚∕∞⇟⇮․ˮⅺ↸⇿⇟⇮‣•ˌϋ↧ 㪝㫉㫆㫄㩷㫋㪿㪼㩷㫊㪼㪺㫆㫅㪻㩷㫋㫆㩷㫃㪸㫊㫋㩷㩿㫎㫆㫉㫊㫋㪀㩷㫇㫆㫊㫀㫋㫀㫆㫅㩷㫋㫆㩷㫎㫀㫋㪿㫀㫅㩷㫋㪿㪼㩷㫋㫆㫇㩷㫋㪼㫅㩷㩿㪹㪼㫊㫋㪀㩷 Promote participation in breast cancer screening ≔≑ⅻ⇂౨ᚮ↝Ӗᚮ̟ᡶ Spread enlightenment activities Cooperate in regions and occupational organizations 䊶᥉⊒ Maintain the cancer screening system 䊶ၞ䇮⡯ၞ䈱ㅪ៤ ᲬᲨƕǜ౨ᚮ˳СƷૢͳ Introduce mammographies Deploy a mass screening car 䊶䊙䊮䊝䉫䊤䊐䉞䊷䈱ዉ Improve the accuracy of cancer screening 䊶㓸࿅ᬌ⸻ゞ䈱ᢛ ≖≑ⅻ⇂౨ᚮ↝ችࡇӼɥ Promote specialization Enhance training at cancer base hospitals Control accuracy thoroughly 䊶ੱ᧚⢒ᚑ 䊶ὐ∛㒮䈪䈱⎇ୃ 䍃♖ᐲ▤ℂ䈱ᔀᐩ ≗≑ɟʴ↡↗↹↝ဃ෨ᐯࠁሥྸ↝ↆⅾ↮ Promote of self management Manage the historical data for each participant in the cancer screening program 䊶䈏䉖ᬌ⸻ฃ⸻ᱧ䈱▤ℂ 䊶♖ኒᬌᩏฃ⸻䈱ଦㅴ Promote thorough examination consultation Kanagawa Cancer Center Kanagawa Cancer Center Ratio of cancer patient of cancer screening origin ᵐᵌᵗή ᵐᵌᵐή Stomach cancer ầỮ౨ᚮဌஹỉधᎍлӳ ίᵦᵏᵓ࠰Ẇᅕ߷ډჄ؏עầỮႇἙὊἑợụὸ Screening origin ᵑᵌᵓή Lung cancer ᏎầỮ Uterus cancer ᵓᵌᵕή ʐầỮ ᵒᵌᵓ ή Colorectal cancer ᏍầỮ ౨ᚮဌஹ ᵑᵌᵓή ᵓᵌᵕή Breast cancer ᵐᵌᵗή ᵐᵌᵐή ܷ܇ầỮ ᵒᵌᵓ ή ٻᐂầỮ (2003, Kanagawa Cancer Registry) Kanagawa Cancer Center Kanagawa Cancer Center Summary LJƱNJ - In 1970, Kanagawa Prefecture established its population- based cancer registry for the “Surveillance of actual cancer contraction in Kanagawa Prefecture. ” The number of notified data now exceeds 770,000. - With regard to the accuracy of registration, the DCO% and ID ratio have been sharply improved, but the introduction of the personal computer system for Chinese character input has been insufficient. - Regarding cancer reduction and cancer deaths in Kanagawa Prefecture, the incidences and mortalities of colorectal cancer, breast cancer, and corpus uteri cancer are all high. - Kanagawa is taking measures focused on breast cancer as a tenyear strategy for the cancer control program. - If more cancers are registered directly via medical examinations, we can expect improvements in cancer control. - Population-based cancer registration is an indispensable material for the search for cancer trends. - Kanagawa Prefecture wants its inhabitants and medical personnel to further understand and enhance the cancer registration system as a means of contributing to the cancer control program. ¾ᅕ߷ډჄ؏עầỮႇỊᵏᵗᵕᵓ࠰ẦỤẐჄϋỉầỮ፝धỉἇὊ ἫὊἻὅἋẑửႸႎểẲềڼẰủẆႇἙὊἑờᵕᵕɢˑửឭẴ ểễẾềẟỦẇ ¾ႇỉችࡇίᾓᾒᾞήởᾘᾓൔὸỊἣἏἅὅἉἋἘἲί܌λщݣ ࣖὸỉݰλộỂỊɧҗЎỂẝẾẺầẆᡈ࠰ẆٻẨễોծầễẰ ủềẟỦẇ ¾ᅕ߷ډჄỉầỮ፝धὉരʧỉཎࣉỊẆٻᐂầỮẆʐầỮẆ܇ ܷ˳ầỮỉ፝धྙὉരʧྙầ᭗ẟẇ ¾ᅕ߷ډჄỂỊẆầỮݣሊᵏᵎỽ࠰ဦểẲềẐʐầỮẑỆໜử ࢘ềẺݣሊầӕỤủềẟỦẇ ¾ႇẰủẺἙὊἑỉễẦỂẆầỮ౨ᚮဌஹỉႇầفьẴỦ ẮểỂẆầỮݣሊỉᚸ̖ầỂẨỦẇ ¾ầỮỉѣӼửỦạảỂẆ؏עầỮႇỊ࣏ᙲɧӧഎễ૰ ểễẾềẟỦẇ ¾ჄൟỉႏẰộởҔၲ᧙̞ᎍỉႏẰộỉễỦắྸᚐửẟẺẻ ẨẆầỮݣሊỆᝡྂỂẨỦ؏עầỮႇửΪܱẰẶẺẟẇ Kanagawa Cancer Center Kanagawa Cancer Center 71 72 ✛⨥៨ขߣ㗡㗖ㇱ㘩߇ࠎߩ㑐ㅪ የἑ ഞ* ᧻የ ᕺᄥ㇢ ⚦㊁ ⷡઍ ᷰㆺ ⟤⾆ દ⮮ ⑲⟤ ↰ፉ 㓶 ↰ਛ ⧷ᄦ ࠹ࡦࠕࡔࠞߢߩࡑ࠹⨥߿ᣣᧄߢߩ⨥߇ ✛⨥៨ขߣ㗡㗖ㇱ㘩߇ࠎߣߩ㑆ߦᱜߩ ࠁ╬ߩᾲ㘶㘩‛ߪ㗡㗖ㇱ㘩߇ࠎߩࠬ 㑐ㅪ߇ߺࠄࠇߚ∉ࠆߥᦝޕቇ⊛‛↢ߪߚ߹ޔ ࠢࠍߐߖࠆߣ⠨߃ࠄࠇߡࠆߪ⨥✛ޕᣣ ቇ⊛ߥ⎇ⓥࠍផㅴߔࠆߎߣ߇ᔅⷐߣ⠨߃ࠄࠇ ᧄߢ៨ขߐࠇߡࠆઍ⊛ߥᾲ㘶ᢱߢࠆ ࠆޕ ߇ޔ㗡㗖ㇱ㘩߇ࠎࠬࠢߣߩ㑐ㅪߪᔅߕ ߒ߽ࠄ߆ߢߪߥޕ࿁ᚒ⨥✛ߪޘ៨ขߣ 㗡㗖ㇱ㘩߇ࠎߩ㑐ㅪࠍᬌ⸛ߔࠆߚߦ∝ ኻᾖ⎇ⓥࠍⴕߞߚޕ ኻ⽎ߪ 2001 ᐕ 1 ߆ࠄ 2005 ᐕ 12 ߩ㑆 ߦᗲ⍮⋵߇ࠎࡦ࠲ࠍฃ⸻ߒߚ 961 ฬߩ㗡 㗖ㇱ㘩߇ࠎᖚ⠪㧔㗡㗖ㇱ߇ࠎ 527 ฬޔ㘩 ߇ࠎ 434 ฬ㧕߅ࠃ߮ᐕ㦂ޔᕈࠍ৻⥌ߐߖ ߚ 2883 ฬߩ㕖߇ࠎኻᾖ⠪ߣߒߚ⨥✛ޕ៨ข ߿ߘߩઁ↢ᵴ⠌ᘠߦ㑐ߔࠆᖱႎߪ⥄⸥ᑼ⾰ *p<0.05 ࠍ↪ߡ㓸ߒߚ⨥✛ޕ៨ขߣ㗡㗖ㇱ㘩 ߇ ࠎ ߩ 㑐 ㅪ ߪ conditional logistic regression model ߢ ▚ ߒ ߚ ࠝ ࠶ ࠭ Ყ ߣ 95㧑ା㗬㑆ࠍ↪ߡ⹏ଔߒߚޕ ✛⨥៨ขߣ㗡㗖ㇱ㘩߇ࠎߪోߣߒߡ ᗧߥ㑐ㅪࠍ␜ߒߚ㧔ะᕈ p㧩0.011㧕ޕ1 ᣣ 3 ᧰એ៨ขߔࠆ⟲ߦ߅ߡࠝ࠶࠭Ყߪ 1.26㧔95㧑ା㗬㑆:1.04㧙1.53㧕ߢߞߚޕ ߎࠇࠄ㑐ㅪߪ․ߦ㗡㗖ㇱ߇ࠎߦ߅ߡࠄ߆ ߢߞߚߚ߹ޕ㕖㘶㈬⠪ߢߪᗧߥ㑐ㅪ߇ ࠄࠇߚ৻ᣇߢޔ㘶㈬⠪ߦ߅ߡߪห᭽ߩะ ࠍ␜ߒߚ߽ߩߩޔᗧߢߪߥ߆ߞߚ ޕ * ᗲ⍮⋵߇ࠎࡦ࠲⎇ⓥᚲ ∉ቇ㨯੍㒐ㇱ ޥ464-8681 ฬฎደᏒජ⒳㣮ሶᲚ 1-1 73 1998㧙2000 ᐕߦ⸻ᢿߐࠇߚ⟲㚍⋵ߦ߅ߌࠆ ೨┙⣼߇ࠎᖚ⠪ߩ 5 ᐕ⋧ኻ↢ሽ₸ ₎ᧁ ା* ⨃ᧁ ᢥቁ ㋈ᧁ ᶈ ዊጊ ᵗ 㧝㧚ߪߓߦ 㧠㧚⠨ኤ ⟲㚍⋵ߩၞ߇ࠎ⊓㍳ߪ 1994 ᐕߦᆎ߹ߞ ᣣᧄߩ 11 ߩၞ߇ࠎ⊓㍳ߩ࠺࠲߆ࠄ ߚ߇ޔ2006 ᐕߩ DCO ߪ 39.4㧑ߢࠅ⊓ޔ㍳ 1998㧙2000 ᐕߩ೨┙⣼߇ࠎ☻⟕ᖚ₸ߪੱญ ♖ᐲߩะ߇⺖㗴ߢߞߚޕ2006 ᐕ 6 ޔ ߇ޟ 10 ਁੱᒰߚࠅ 28.8 ߣႎ๔ߐࠇߡࠆ⟲ޕ㚍 ࠎኻ╷ၮᧄᴺߩޠᚑ┙ࠍฃߌޔ ≮⸻ࠎ߇ޟㅪ៤ ⋵ߦ߅ߌࠆ೨┙⣼߇ࠎ㧔C61㧕ߩ 5 ᐕ⋧ኻ↢ ὐ∛㒮߇ޠᜰቯߐࠇࠆߎߣߣߥࠅ⟲ޔ㚍⋵ ሽ₸ߪߢ߹ࠇߎޔႎ๔ߐࠇߡߚᣣᧄߩ 6 ߢߪ 11 ∛㒮߇ὐ∛㒮ߦᜰቯߐࠇߚޕὐ ၞ߇ࠎ⊓㍳ߩ↢ሽ₸㧔1997㧙1999 ᐕ㧕75.5㧑 ∛㒮ߢߪ߇ࠎ⊓㍳߇⟵ോߠߌࠄࠇ⟲ޔ㚍⋵ߢ ߣᲧߴߡ㜞ߊޔUS SEER Program㧔1996㧙 ߽ၞ߇ࠎ⊓㍳߳ߩዯߌᢙ߇ᕆჇߒߕࠊޔ 2003 ᐕ㧕ߢႎ๔ߐࠇߚ↢ሽ₸ 98.1㧑ߣ߶߷ ߆ 3 ᐕߢ DCO ߪ 20㧑บߦߥࠅޔା㗬ᕈߩ หߓߢࠆ⟲ޕ㚍⋵ߦ߅ߌࠆ 75 ᱦᧂḩᐕ㦂 ࠆ࠺࠲⸃ᨆ߇น⢻ߦߥߞߡ߈ߚ ߦ․ޕ1998 ⺞ᢛᱫ₸ߪ 2007 ᐕએ㒠ో࿖ᐔဋࠍਅ࿁ࠆ 㧙 2000 ᐕ ߦ ߅ ߌ ࠆ ೨ ┙ ⣼ ߇ ࠎ ߩ ㅊ 〔 ₸ ߪ ࠃ߁ߦߥߞߡ߅ࠅޔ೨┙⣼߇ࠎߩ☻⟕ᖚ₸ߪ 100㧑ޔDCO ߪ 9.4㧑ߢߞߚޕ ઁၞࠃࠅ㜞ߊޔ࿁ߩ⚿ᨐ߇ PSA ᬌ⸻ߦࠃ ࠆലᨐߣ߃ࠆ߆ߤ߁߆ߐࠄߦᬌ⸛ߔࠆᔅⷐ 㧞㧚ᣇᴺ ߇ࠆޕ ⟲㚍⋵ၞ߇ࠎ⊓㍳ߩ࠺࠲ࠍ↪ߡޔ 1998㧙2000 ᐕ⸻ᢿ∝ߦ߅ߌࠆ೨┙⣼߇ࠎ 㧔C61㧕ߩ 5 ᐕ⋧ኻ↢ሽ₸ࠍ▚ቯߔࠆޕ 㧟㧚⚿ᨐ ⟲㚍⋵ߦ߅ߌࠆ೨┙⣼߇ࠎߩ 5 ᐕ⋧ኻ↢ሽ ₸ߪޔ㒢ዪ 100㧑㧔959 㧕ޔ㗔ၞ 87.6㧑 㧔126 㧕ޔ㆙㓒ォ⒖ 54.1㧑㧔323 㧕ᦼ∛ޔ ਇ 69 ోޔߢ 95.9㧑㧔1,477 㧕ߢ ߞߚޕ *⟲㚍⋵┙߇ࠎࡦ࠲߇ࠎ⊓㍳ቶ ޥ373-8550 ᄥ↰Ꮢ㜞ᨋ↸ 617-1 74 ࡔ࠶ࠪࡘᴺߢߺߚ߇ࠎ⟕ᖚᱫߣ␠ળ⚻ᷣ⊛ⷐ࿃ߩ㑐ㅪ ጊ ૫ઍሶ* ጟᧄ ⋥ᐘ ᄹᎹ⋵ߦ߅ߌࠆ 2005 ᐕߩ⛔⸘࠺࠲ࠍ 㧝㧚ߪߓߦ ࠊ߇࿖ߦ߅ߡଐὼᱫ࿃ߩ╙ 1 ߢࠆ߇ ↪ߒࡘࠪ࠶ࡔޔᴺࠍ↪ߚℂ⊛∉ቇ⊛ߥᣂ ࠎߪޔᐕ㑆 30 ਁੱએ߇ߊߥߞߡ߅ࠅട ߚߥ⸃ᨆᴺߦߟߡᬌ⸛ࠍߒߚߩߢႎ๔ߔࠆޕ 㦂ߦࠃࠅ⊒∝ࠬࠢߪ㜞߹ࠆߎߣࠍ⠨߃ࠆߣޔ ᓟߣ߽Ⴧടߒߡߊߎߣ߇੍ᗐߐࠇࠆߒޕ 㧞㧚⾗ᢱߣᣇᴺ ߆ߒ⟕ࠎ߇ޔᖚ₸߿ᱫ₸ߪᐕ㦂⺞ᢛࠍⴕ߁ ࡔ࠶ࠪࡘ↪ߩ߇ࠎ⟕ᖚ࠺࠲ߪޔᄹᎹ⋵ ߣᮮ߫⁁ᘒߪࠆޔᷫዋߩะ߽ⷰኤߐ ၞ߇ࠎ⊓㍳ߩ⾗ᢱߩਛߢᖚ⠪ᚲ߇⇟߹ ߡࠆߩࠎ߇ޔߚ߹ޕㇱߦⷰኤߔࠆߣޔ ߢജ߇น⢻ߣߥߞߚ 2003 ᐕ⟕ᖚ⠪ߩ࠺ ㇺᐭ⋵߿Ꮢ↸ߦߪࠄ߆ߥၞ ࠲ࠍ⾗ᢱߣߒߡ↪ߚޔߚ߹ޕᏒ↸ Ꮕ߇ሽߒߡࠆޕஜᐽᩰᏅ߿߇ࠎ⟕ᖚᱫ ߩᐕ㦂⺞ᢛᱫ₸࠺࠲ߪޔ2002㧙2005 ᐕ ᩰᏅߩⷐ࿃ߣߒߡߪ↢ޔᵴ᭽ᑼ߿㘩⠌ᘠޔ ߩ㧠ᐕ㑆ߩ࠺࠲ࠍ↪ߚޕ2003 ᐕߩࡔ࠶ࠪ ࠙ࠖ࡞ࠬᕈ∔ᖚߩࠠࡖࡗߩήޔⅣႺߩ ࡘ↪࠺࠲ߦ㑐ߒߡߪ⊓ޔ㍳߇ࠎᖚ⠪ߩዯ ᓇ㗀␠ޔળ⚻ᷣ⊛ⷐ࿃ߥߤߩᓇ㗀߇⠨߃ࠄࠇ ᚲ⇟ߦᓥߞߡޔℂᖱႎࠪࠬ࠹ࡓࡊࡠ ࠆߣߣ߽ߦޔㇺᏒၞߣߘ߁ߢߥၞߢߪ⇣ ࠣࡓ㧔㧩એਅޔMapInfo㧕ࠍ↪ߡฦ⊓㍳ ߥࠆⷐ࿃߇ሽߔࠆߎߣ߇ࠄ߆ߣߥߞߡ ᖚ⠪ߩዬߔࠆࡔ࠶ࠪࡘࠍ⏕ߒߚޕ ࠆ⁁ߥ߁ࠃߩߘޕᴫ߆ࠄℂ∉ቇ⊛⎇ⓥߣߒ ߇ࠎ⟕ᖚߩᜰᮡߣߒߡߪޔ೨࿁ߩ⎇ⓥߢႎ ߡ⟕ࠎ߇ޔᖚᱫߣߩ㑐ㅪⷐ࿃ߩ⸃ᨆ߇ⴕ ๔ߒߚ㑆ធᴺࠍណᛯߒޔ2003 ᐕߩᄹᎹ⋵ో ࠊࠇⴕߪߦ⊛⥸৻ޔၞࠍනߣߒߡᲧセ ߇ࠎ⟕ᖚ₸ࠍၮḰߣߒߡฦࡔ࠶ࠪࡘߩᕈ ߐࠇࠆߎߣ߇ᄙߊ␠ߚ߹ޔળ⚻ᷣ⊛ⷐ࿃ᜰᮡ ᐕ㦂㓏⚖ੱญࠍ↪ߡᦼᓙᖚ⠪ᢙࠍ᳞ ߦ㑐ߒߡ߽ⴕޔනߩ࠺࠲߇߶ߣࠎߤߢ ޔታ᷹୯ߣߩᲧߢߐࠇࠆᮡḰൻ⟕ᖚᲧ ߞߚޔߒ߆ߒޕหߓⴕනౝߢߞߡ߽ 㧔SIR㧕ࠍ↪ߒߚੱࡘࠪ࠶ࡔޕญ߇ 500 ੱ ㇺᏒㇱ߇߹ࠇߡߚࠅޔㄘጊㇱޔṪㇱޔ એਅ⟕ࠎ߇ޔᖚᢙ߇ 0ޔᐕ㦂⺞ᢛ߇ࠎ⟕ᖚ₸ Ꮏ႐ၞߥߤ߇߹ࠇߡߚࠅߔࠆߎߣ߇ ߇ 2,000.0 એߩࡔ࠶ࠪࡘၞߪ࿁ߩ⸃ᨆ ࠅޔᏒ↸ౝߢߩ␠ળ⚻ᷣ⁁ᴫ߇ဋ৻ߢ ߆ࠄߪ㒰ᄖߒߚޕ ࠆߣߪ⠨߃ߦߊ႐ว߽ࠅⴕޔනౝߢ ߪ⋧ߩࠄࠇߎޔ㆑߇ᐔဋൻߐࠇߚ୯ߣߥࠅޔ 㧟㧚⚿ᨐߣ⠨ኤ ၞᏅߩ⸃ᨆࠍⴕ߁㓙ߩ㓖〝ߣߥߞߡߚޕ ၞߦࠃࠆᭂ┵ߥ㓸Ⓧᕈߪࠄࠇߥ߆ߞߚ ㄭᐕ⊒ߩࠬࡦࠛࠗࠨ࠲ࡘࡇࡦࠦޔዷߦࠃ ߇ޔห৻ߩᏒ↸ߢߞߡ߽⟕ᖚ₸ߩ㜞ૐ ࠅޔၞࡔ࠶ࠪࡘ㧔1kmޔ2kmޔ5km ߥߤ㧕 ߇ⷰኤߐࠇߡ߅ࠅޔ㓞ធߔࠆᏒ↸ߦ߅ ࠍනߣߔࠆ␠ળ⚻ᷣᜰᮡߩ⾗ᢱ߇ᢛߟߟ ߡ߽ࡔ࠶ࠪࡘᴺߦࠃࠆၞᏅߩᬌ⸛ߦㆡᒰߢ ࠆߚ⎇ᧄޔⓥߢߪᣂߚߦࡔ࠶ࠪࡘනߢ ࠆߣߎߣ߇␜ߐࠇߚޕ ߩ߇ࠎ⟕ᖚᱫߩ⸃ᨆࠍᬌ⸛ߔࠆߚߦޔ ߹ߚޔᏒ↸නߣ⇣ߥࠅޔၞࡔ࠶ࠪࡘ *ᄹᎹ⋵┙߇ࠎࡦ࠲⥃ᐥ⎇ⓥᚲ ߇ࠎ੍㒐ᖱႎ⎇ⓥㇱ㐷 ޥ241-0815 ᮮᵿᏒᣩਛየ 1-1-2 75 ᴺߪޔ1ޔ2km ࡔ࠶ࠪࡘ߇↪ߐࠇࠆ႐ว߇ ᄙߎߣ߆ࠄ⟕ᖚ₸߿ᱫ₸ߩᜰᮡߦߪ㑆 ធᴺߦࠃࠆᮡḰൻ⟕ᖚᲧ߇ఝࠇߡࠆޕᓟ ߪߩࠎ߇ߦࠄߐޔ࿖㓙Ყセࠍⴕ߁ߎߣࠍ⠨߃ޔ ⋡⊛ߦᔕߓߚᮡḰ⟕ᖚ₸߿⇇ᮡḰߣߥࠆ⟕ ᖚ₸߇ᔅⷐߦߥߞߡߊࠆߢࠈ߁ޕ 76 ᣣᧄߦ߅ߌࠆ⣾⢲߇ࠎߩᕈᏅ ᧻↰ ᥓᄢ* ਣ ⍮⟤ ᧁ ༑ሶ ῳᳯ ቁ Ảഀว㧦↵ᕈ 4.8㧑ޔᅚᕈ 37.3㧑ޔ㆙㓒ォ⒖ 㧝㧚⢛᥊ ⣾⢲߇ࠎߪᴲዩེ♽ߩ৻⥸⊛ߥᖡᕈ⣲≌ߢ ഀว㧦↵ᕈ 6.1㧑ޔᅚᕈ 4.5㧑ߢߞߚߩߎޕ ࠅߦ․ޔᣣᧄߩ↵ᕈߢߪޔㇱߦߚ⣾ ㆑ߪޔᐕ㦂㓏⚖ߦⷰኤߒߡ߽ࠄ߆ߢ ⢲߇ࠎߩ⟕ᖚ₸ߪ 8 ⇟⋡ߣߥߞߡࠆޕ⣾⢲ ߞߚ↵ޔߪߢဳ❱⚵ޕᕈߦ߅ߡዩ〝⊹߇ ߪ↵ޔᅚߦ߅ߡ⟕ࠎ߇ߩߘޔᖚᱫ₸߅ ࠎߪޔᅚᕈࠃࠅ߽ᄙߊⷰኤߐࠇߡ߅ࠅޔ ࠃ߮↢ሽ₸ߩᏅ⇣߇Ყセ⊛ᄢ߈ㇱߣߒߡ 96.0㧑㧦92.8㧑ߢߞߚ⸒ޕ឵߃ࠇ߫ޔᅚ ⍮ࠄࠇߡࠆ⎇ᧄޕⓥߩ⋡⊛ߪోޔ࿖߇ࠎ⟕ ᕈߦ߅ߡߪޔᚳᐔ⊹߇ࠎޔ⣼߇ࠎ߅ࠃ߮ ᖚࡕ࠾࠲ࡦࠣ㓸⸘㧔MCIJ㧕ߩ߇ࠎ⟕ᖚ࠺ ⡺⣲߇↵ᕈࠃࠅᄙߊⷰኤߐࠇߚޕᅚᕈߩ⣾⢲ ࠲ߦၮߠ߈ޔᐕ㦂ߩࠎ߇ޔ߇ࠅޔ⣲≌ߩ ߇ࠎᖚ⠪ߪ↵ޔᕈᖚ⠪ࠃࠅ੍ᓟ߇ᖡߊޔ5 ᐕ ⚦ㇱ߿⚵❱ဳޔℂ⊛ߥಽᏓࠍ⠨ᘦߒߟ ⋧ኻ↢ሽ₸ߪ↵ޔᅚ㑆ߢ߅ࠃߘ 10 ࡐࠗࡦ࠻ ߟޔ⣾⢲߇ࠎߩ⟕ᖚᱫ↢ޔሽ₸ߦ߅ߌࠆ ߩᏅ߇ߞߚ♽ᤨޕߢߪⷰޔኤᦼ㑆ਛ⟕ޔ ᕈᏅࠍⷰኤߔࠆߎߣߦࠆޕ ᖚ₸߅ࠃ߮ᱫ₸↵ߩ₸ࠄࠇߘޔᅚᲧߪ߶ޔ ߷৻ቯߢផ⒖ߒߡ߅ࠅ⟕ޔᖚ₸ߦ߅ߌࠆ↵ᅚ Ყߪ 4㧙5ޔᱫ₸ߢߪ⚂ 3.5 ߢߞߚޕ 㧞㧚ᣇᴺ MCIJ2004 ߣߒߡޔ31 ߩၞ߇ࠎ⊓㍳߆ࠄ ࠃࠅޔICD-10 ࠦ࠼㧔C67㧕ߦᒰߔࠆ⣲≌ 㧠㧚⠨ኤ ⣾⢲߇ࠎߦߪޔᄢ߈ߥ↵ᅚᏅ߇᷹ⷰߐࠇߚޕ ࠍߒߚޕຠ⾰▤ℂߩ⚿ᨐ ߦ⊛⚳ᦨޔ17 ⸻ᢿᤨߩ⥃ᐥㅴⴕᐲߩᕈᏅߦࠃߞߡࠆޔ⒟ ၞߩ࠺࠲࠶࠻㧔↵ᕈ 38,300 ੱޔᅚᕈ ᐲߪޔᱫ₸߿↢ሽ₸ߩᏅ⇣ࠍ⺑ߢ߈ࠆߣ 12,183 ੱ㧕ࠍಽᨆߦ↪ߒߚޕᱫ࠺࠲ߪ ⠨߃ࠄࠇࠆ࠭࠾ࠞࡔߩ∝⊒ޔࠄ߇ߥߒ߆ߒޕ ෘ↢ഭ⋭ߩੱญേᘒ⛔⸘ࠃࠅᓧߚޕ ࡓߩ㆑ޔᴦ≮ᣇᴺߩᏅ␠ޔળ⊛ᕈⷐ࿃ޔ ឭଏ㗂ߚ 1993㧙2004 ᐕߩ߇ࠎ⟕ᖚ࠺࠲ ࠆߪޔᕈ․ߩ࠺࠲ຠ⾰ߩ㆑ߦߟ ߡ߽⠨ᘦߐࠇߥߊߡߪߥࠄߥ߁ࠃߩߎޕ 㧟㧚⚿ᨐ ߥℂ↱߆ࠄޔ⣾⢲߇ࠎߩኻ╷ߪޔᕈߦᔕߓ ⟕ᖚ࠺࠲ߩ♖ᐲၮḰࠍ▚ߒߚߣߎࠈ ߡᬌ⸛ߐࠇࠆߴ߈ߛߣ⠨߃ࠆޕ DCO㧑ߪ↵ޔᕈ 12.5㧑ޔᅚᕈ 20.8㧑ߢޔMV㧑 ߪ↵ᕈ 82.4㧑ޔᅚᕈ 73.3㧑ߢߞߚޕᅚᕈߪޔ ⸻ᢿᤨߦㅴⴕߒߡߚ⣲≌ߩഀว߇㜞ߊ⥃ޔ ᐥㅴⴕᐲߪޔ㒢ዪഀว㧦↵ᕈ 89.5㧑ޔᅚᕈ 57.3㧑ޔᚲዻࡦࡄ▵ォ⒖߹ߚߪ㓞ធ⤳ེᶐ *࿖┙߇ࠎ⎇ⓥࡦ࠲߇ࠎኻ╷ᖱႎࡦ࠲߇ࠎᖱႎ⛔⸘ㇱ ޥ104-0045 ਛᄩ▽ 5-1-1 77 ⚵❱⊓㍳߆ࠄߺߚᐢፉ⋵ߦ߅ߌࠆਛᨔ⚻♽⣲≌ߩ⚵❱ဳᬌ⸛ ┙ጊ ⟵ᦶ* ା㓶 ᧖ጊ ⟤ ዊ╣ ᤩᄥ㇢ ↰ ஜ৻ ㎨↰ ৾↵ ᫃ේ ඳᲞ ᒎ ోߩ⚵❱ဳഀวߪ㜑⤑⣲≌㧔㜑⤑⊹ 㧝㧚⋡⊛ ⚦⢩↱᧪ߢᕈ⁁ਇޔᖡᕈࠍ㧕߇ 1,696 ᐢፉ⋵⣲≌⊓㍳ᬺ㧔ࠊࠁࠆ⚵❱⊓㍳㧕 ߩ࠺࠲ࠍ߽ߣߦਛᨔ⚻♽⣲≌ߩታᘒࠍ 㧔↵ᕈ 442 ޔᅚᕈ 1,254 㧕㧔32.2㧑㧕 ⍮ࠆߚߩ⸃ᨆࠍⴕ⊓❱⚵ޔ㍳߆ࠄߺߚ ߣᦨ߽ᄙߊࡑࠝࠣޔ㧔ᤊ⚦⢩♽ޔ ᐢፉ⋵ߦ߅ߌࠆਛᨔ⚻♽⣲≌ߩታᘒߣߒ ⚦⢩♽ޔᏗ⓭⚦⢩♽ޔ⣂⛊⤑⚦⢩♽ߘޔ 1 㧕ޕ࿁߽ਛᨔ⚻♽⣲≌ ߩઁ⚻⤔⚦⢩↱᧪ߩว⸘㧕߇ 1,303 㧔↵ ߩታᘒࠍ⍮ࠆ⋡⊛ߢ⚵❱ဳߦᬌ⸛ߒߚޕ ᕈ 744 ޔᅚᕈ 559 㧕㧔24.8㧑㧕ߣᰴ ߡᣢߦႎ๔ߒߚ ߢᄙߊ⚦ࡦࡢࡘࠪޔ⢩⣲≌㧔ᖡᕈࠍ㧕 ߇ 814 㧔↵ᕈ 396 ޔᅚᕈ 418 㧕 㧞㧚ኻ⽎ߣᣇᴺ ᣢႎ 1 㧕 ห᭽ޔᐢፉ⋵ౝߩක≮ᯏ㑐 60 ᣉ 㧔 15.5㧑 㧕 ޔਅ ု ⣲ ≌ 㧔 ᖡ ᕈ ࠍ 㧕 ߇ ⸳ߩදജࠍᓧߡ∛ޔℂ⚵❱ߦ㑐ߔࠆ⾗ᢱࠍ 790 㧔↵ᕈ 313 ޔᅚᕈ 477 㧕 㧔 15.0㧑㧕ޔ 㓸ߒޔICD-O-3 ࠍ߽ߣߦߒߚㇱߣ⚵❱ ᖡᕈࡦࡄ⣲㧔㜑ᄖᕈᒻ⾰⚦⢩⣲ࠍ㧕 ⸻ᢿࠍࠦ࠼ൻߐࠇߚ࠺࠲ߩ߁ߜޔਛᨔ 117 㧔↵ᕈ 62 ޔᅚᕈ 55 㧕㧔2.2㧑㧕 ⚻♽ࠍේ⊒ߣߔࠆ⣲≌ߩߺࠍኻ⽎ߣߒޔ ߥߤߣ⛯ߚޕ ⣲≌ߩ⚵❱ဳ⸃ᨆߦਥ⌒ࠍ߅ߡ↵ᅚޔ ᐕ㦂ޔㇱޔᐕᰴߦᬌ⸛ߒߚޕ ↵ᅚߢߪޔ㜑⤑⣲≌ޔਅု⣲≌ߪᅚ ᕈߦޔ⢝ఽᕈ⣲≌ޔ⢦⚦⢩⣲≌▤ⴊޔ⣲ޔ ࠣࠝࡑߪ↵ᕈߦᄙ߆ߞߚޕ 㧟㧚⚿ᨐߩ߹ߣ ᐕ㦂ߢߪޔ㜑⤑⣲≌⧘⤔ޔ⣲㧔ࠣࠝ 1973 ᐕ߆ࠄ 2004 ᐕ߹ߢߩ㑆ߩਛᨔ⚻ ࡑߩ৻ဳ㧕⚦ࡦࡢࡘࠪޔ⢩⣲≌ޔਅု ♽ ⣲ ≌ ߩ ᣂ ⷙ ⊓ ㍳ ✚ ᢙ ߪ 5,262 㧔 ↵ ᕈ ⣲≌ޔᖡᕈࡦࡄ⣲⧘▤ⴊޔ⣲ߪᚑੱߦᄙ 2,264 ޔᅚᕈ 2,998 㧕ߢࠅ߁ߩߘޔ ߊޔ⢦⚦⢩⣲≌ޔ⢝ఽᕈ⣲≌ߪዊఽߦᄙߊޔ ߜ⦟ᕈ⣲≌ߪ 3,377 㧔↵ᕈ 1,210 ޔᅚ ࠣࠝࡑޔ㗡⬄ຜ㗡⣲ߪᚑੱߣዊఽߩਔ ᕈ 2,167 㧕ޔᖡᕈ⣲≌ߪ 1,584 㧔↵ᕈ ⠪ߦᄙ߆ߞߚޔߦࠄߐޕዊఽߩࠣࠝࡑ 903 ޔᅚᕈ 681 㧕ޔᕈ⁁ਇ߇ 301 ߢߪᚑੱߦᲧセߒ⚦⢩♽⣲≌ߩᲧ₸߇ 㧔↵ᕈ 151 ޔᅚᕈ 150 㧕ߢߞߚ 㜞ߊޔዊ⣖߿⣖ቶ⊒↢ߩᲧ₸߽㜞߆ߞߚޕ 1 㧕ޕ ᐕ㦂 㓏 ⚖ ߢ ߪ ⦟ᕈ ⣲ ≌ߢ ߪ ↵ ᅚߣ ߽ 50 ㇱߢߪࡑࠝࠣޔ㧔․ߦ⤔⧘⣲㧕ޔ ᱦઍࠍࡇࠢߣߒߚනፄᕈߦಽᏓߒޔᖡᕈ ᖡᕈࡦࡄ⣲▤ⴊޔ⣲ߪᄢ⣖ߦޔ⢦⚦⢩⣲ ⣲≌ߢߪ 60 ᱦઍߣ 9 ᱦએਅߩ 2 ፄᕈࠍ␜ ≌ߪ᧻ᨐㇱߦ⚦ࡦࡢࡘࠪޔ⢩⣲≌ߪ⣖ ߒߚߎߣ߽ᣢႎߩㅢࠅߢࠆ 1㧕 ޕ ⚻ޔ⣄㜑ߦޔ⢝ఽᕈ⣲≌⧘▤ⴊޔ⣲ߪዊ⣖ ߦᄙ߆ߞߚޕ ᐕᰴഀวߢߪޔ㜑⤑⣲≌ޔਅု⣲≌ޔ 㧖 ⁛┙ⴕᴺੱ࿖┙∛㒮ᯏ᭴ ᐢፉක≮ࡦ࠲ ⎇ⓥᬌᩏ⑼ ޥ739-0696 ᐢፉ⋵ᄢ┻Ꮢ₿ᵄ 4-1-1 78 ᖡᕈࡦࡄ⣲ߪჇടะߦࠅࠝࠣޔ ࡑ⚦ࡦࡢࡘࠪޔ⢩⣲≌ޔ㗡⬄ຜ㗡⣲ߪᷫዋ ะߦߞߚޕ 㧠㧚⚿⺰ ᐢፉ⋵ߩ⚵❱⊓㍳࠺࠲ࠍ߽ߣߦਛᨔ ⚻♽⣲≌ߩ⚵❱ဳᬌ⸛ࠍⴕߞߚޕਛᨔ ⚻♽ߦߪᄙ⒳ᄙᓀߥ⚵❱ဳ߇ሽߒ❱⚵ޔ ဳߦࠃߞߡᕈޔᐕ㦂ޔㇱޔᐕᰴផ⒖ߦ․ ᓽ߇ߺࠄࠇߚޕ 㧡㧚ෳ⠨ᢥ₂ 1. ┙ ጊ ⟵ ᦶ ޔା㓶 ᧖ ޔጊ ⟤ ↰ ޔ ஜ৻ޔ㎨↰৾↵ޔ᫃ේඳᲞޔ ᒎ㧦 ⚵ ❱ ⊓ ㍳ ߆ ࠄ ߺ ߚᐢ ፉ ⋵ ߦ ߅ ߌ ࠆ ਛᨔ ⚻♽⣲≌ߩታᘒޔJACR Monograph No.15ޔ38㧙43ޔ2010 79 ၞ߇ࠎ⊓㍳࠺࠲ࠍᵴ↪ߒߚ⢗ౝⷞ㏜ᬌ⸻ߩ ↢ሽ₸ߦ㑐ߔࠆᬌ⸛ ጯᧄ ᜏᴦ* የፒ ☨ෘ ↰ ᒄ ጟᧄ ᐙਃ ựፉ ߜߐߣ ⷞ㏜ᬌ⸻ߦኻߔࠆ⢗ X ✢ᬌ⸻ߣᧂฃ⸻ߩᱫ 㧝㧚⋡⊛ 2006 ᐕߦߐࠇߚ⢗߇ࠎᬌ⸻ࠟࠗ࠼ ߦ 㑐 ߔ ࠆ ࡂ ࠩ ࠼ Ყ ߪ ࠇ ߙ ࠇ ߘ ޔ1.626 ࠗࡦߢߪޔᱫ₸ᷫዋലᨐ߇⸽ߐࠇߚ⢗ X 㧔p<0.125㧕ޔ5.254 㧔p<0.001㧕ߢߞߚޕ 㧠㧚⚿⺰ ⢗ౝⷞ㏜ᬌᩏߪᧂฃ⸻ߦᲧߴߡߦ⊛⸘⛔ޔ ✢ᬌᩏ߇ផᅑߐࠇޔ⢗ౝⷞ㏜ᬌᩏߪ⸽߇ਇ චಽߣߐࠇߚޕޔ㠽ข⋵ߦ߅ߡ∝ ኻᾖ⎇ⓥߦࠃࠆ⢗ౝⷞ㏜ᬌᩏߩᱫ₸ᷫዋല ᗧߦ㜞↢ሽ₸ࠍ␜ߒߚޔߒ߆ߒޕౝⷞ㏜ ᨐߦ㑐ߒߡᬌ⸛ਛߢࠆ߇ޔ࿁ߪޔ⢗ౝⷞ ᬌᩏฃ⸻⠪ߣᧂฃ⸻⠪ߩ↢ሽ₸ࠍᲧセߔࠆ႐ ㏜ᬌ⸻ߩലᕈߩற⸽ࠍ⹏ଔߔࠆߎߣࠍ⋡⊛ ว ߦ ߪ ޔSelf-selection bias, Length bias, ߦޔ⢗߇ࠎ⟕ᖚ⠪ࠍኻ⽎ߦ⢗㨄✢ᬌᩏฃ⸻⠪ Lead-time bias ߥߤߩᓇ㗀ࠍ㒰ᄖߢ߈ߥޕ ߣ⢗ౝⷞ㏜ᬌᩏฃ⸻⠪ߩ↢ሽ₸ࠍᲧセᬌ⸛ߒ ৻ᣇޔౝⷞ㏜ᬌᩏߣ⢗ X ✢ᬌᩏߩᲧセߢߪޔ ߚߩߢႎ๔ߔࠆޕ ฦ⒳ߩ bias ߩᓇ㗀ߪዋߥߣᕁࠊࠇࠆޕ⢗ ౝⷞ㏜ᬌ⸻ߩᣇ߇㜞↢ሽ₸ߩะࠍ␜ߒߚ 㧞㧚ኻ⽎ߣᣇᴺ ߇ߦ⊛⸘⛔ޔᗧߥᏅߢߪߥ߆ߞߚ↢ޕሽ₸ ኻ⽎ߪޔ2000 ᐕ 4 1 ᣣ߆ࠄ 2007 ᐕ 12 ߇㜞ะࠍ␜ߒߚℂ↱ߪޔ⢗߇ࠎ⟕ᖚ⠪ߩ 31 ᣣ߹ߢߩ⢗߇ࠎ⟕ᖚ⠪ߩ߁ߜ⸻ᢿᤨᐕ ౝⷞ㏜ᬌᩏߦ߅ߌࠆᣧᦼ߇ࠎߩഀว߇㜞߆ߞ 㦂߇ 40 ᱦ߆ࠄ 79 ᱦߩ 1,666 ฬߢࠆޕኻ⽎ ߚ⚿ᨐߣ㑐ㅪߒߡࠆߣᕁࠊࠇࠆߩࠄࠇߎޕ ⠪ߪޔ㠽ข⋵ၞ߇ࠎ⊓㍳࠺࠲߆ࠄߒ ߚޕ⢗߇ࠎߩ⸻ᢿᣣࠍⷰኤᦼ㑆ߩ㐿ᆎᣣߣߒޔ ᱫᣣࠆߪ 2007 ᐕ 12 31 ᣣࠍⷰኤᦼ ⚿ᨐߪޔᱫ₸ᷫዋലᨐ߇ᬌ⸽ߐࠇߡࠆ⢗ X ✢ᬌᩏߣห⒟ᐲ߹ߚߪࠃࠅ㜞↢ሽ₸ࠍ␜ ߒߚ⢗ౝⷞ㏜ᬌᩏߪޔ⢗߇ࠎߩࠃࠅᣧᦼߥ⊒ 㑆ߩ⚳ੌᣣߣߒߚ⸻ޕᢿᣣએ೨ߩ 1 ᐕએౝߩ ߦࠃࠆᬌ⸻ߩലᕈߩน⢻ᕈࠍ␜ໂߒߡ ᬌ⸻ฃ⸻⁁ᴫߦࠃࠅ⢗ౝⷞ㏜ᬌ⸻ޔ⢗ X ✢ᬌ ࠆߣᕁࠊࠇࠆޕ ⸻ᧂޔฃ⸻ߩ 3 ⟲ߦಽߒߚ⸃⸘⛔ޕᨆᣇᴺ ߣߒߡ Kaplan-Meier ᴺޔCox ࿁Ꮻಽᨆᴺࠍ ታᣉߒߚޕ 㧟㧚⚿ᨐ ⚥Ⓧ↢ሽ₸ߪ⢗ౝⷞ㏜ᬌ⸻߇ᦨ߽㜞ߊ⛯ޔ ߡ⢗ X ✢ᬌ⸻߽ᦨޔૐߩߪᧂฃ⸻ߢߞ ߚ ߩ ߎ ޕ㆑ ߪ ޔLog Rank ࠹ ࠬ ࠻ 㧔p<0.001㧕 ߢᗧߥᏅߣࠄࠇߚޕ⢗ౝ *㠽ขᄢቇකቇㇱⅣႺ੍㒐කቇಽ㊁ ޥ683-8503 ☨ሶᏒ↸ 86 80 ၞ߇ࠎ⊓㍳࠺࠲ࠍ↪ߚ↵ᕈ߇ࠎߩ⟕ᖚߩേะ 㧙ᅚᕈ߇ࠎߣᲧセߒߡ㧙 Monitoring of Cancer Incidence in Japan 㧔MCIJ㧕 2004 દ⮮ ⑲⟤* ᧻የ ᕺᄥ㇢ ᧁ ༑ሶ ῳᳯ ቁ ↰ਛ ⧷ᄦ ᕈ ޔ1.48 㧑 㧔 95 㧑 ା 㗬 㑆 , 0.76 㧑 㧙 ↵ᕈ߇ࠎߪ⒘ߢࠆߎߣ߆ࠄޔᅚᕈ߇ 3.77㧑ޔᅚᕈޔ2.95㧑 㧔2.66㧑㧙3.25㧑㧕㧕ޕ ࠎߣᲧセߒߡ⸥ㅀߐࠇࠆߎߣ߇ᄙޕ ᧄ ⎇ ⓥ ߢ ߪ ޔThe Japan Cancer ᧄ⎇ⓥߩ␜ߔ߇ࠎߦ㑐ߔࠆ↵ᅚߩ∉ቇ⊛ Surveillance Group ߇ో࿖㓸⸘ߩߚߦ 31 ․ᕈߩ㆑ߪ↵ޔᅚߩ߇ࠎߩ↢‛ቇ⊛ߥ․ ၞ߇ࠎ⊓㍳߆ࠄ㓸ߐࠇߚ࠺࠲ࡌࠬ ᕈ߇⇣ߥࠆߎߣࠍ␜ໂߔࠆ߽ߩߢࠆޕ 㧔MCIJ ࠺࠲ࡌࠬ㧕ࠃࠅޔ1993 ᐕ߆ࠄ 2004 ᐕߦ⸻ᢿߐࠇߚ↵ᅚߩ߇ࠎ∝ࠍ ߒ⸻ޔᢿᤨᐕ㦂ޔㅴⴕᐲޔᖡᕈᐲߥߤࠍ↵ ᅚߦᲧセ㓸⸘ߒߚޕ⇇ੱญߢ⺞ᢛߒߚ↵ ᅚߩ߇ࠎᐕ㦂⺞ᢛ⟕ᖚ₸ߩ࠻ࡦ࠼ߦߟ ߡߪޔjoinpoint ⸃ᨆࠍ↪ߡ⹏ଔߒߚޕ 1993 ᐕ߆ࠄ 2004 ᐕߦ⸻ᢿߐࠇߚ⊹ౝ߅ ࠃ߮ᶐẢ߇ࠎ∝ߪޔว⸘ 177,401 ߢޔ MCIJ ߦෳടߒߡࠆ 31 ၞ߇ࠎ⊓㍳▤ロ ၞ᳃ߪ 712,504,896 ੱᐕߛߞߚ↵ޕᕈ ߇ࠎ∝ߪోߩ 0.74㧑ߩ 1308 ߛߞߚޕ ↵ᕈߩᐔဋ⸻ᢿᤨᐕ㦂ߪ㧘67.3 ᱦ㧔SE㧘0.34㧕 ߣޔᅚᕈߩ 57.3 ᱦ㧔SE, 0.03㧕ߣ㜞߆ߞߚޕ ↵ᕈ߇ࠎߩੱญ 10 ਁੱߚࠅߩᐕ㦂⺞ᢛ ⟕ᖚ₸ߪ 0.21㧔SE, 0.001㧕ߣޔᅚᕈ㧔31.38㧘 SE, 0.008㧕ߦᲧߴߡ 100 એૐ߆ߞߚޕ ㅴⴕᐲ߿ಽൻᐲߦ㑐ߒߡߪ↵ޔᅚߣ߽ߦ㘃ૃ ߒߡߚޕ1993 ᐕ߆ࠄ 2004 ᐕߩᐕ㦂⺞ᢛ⟕ ᖚ₸ߪ↵ޔᕈߢߪᦼ㑆ࠍㅢߓߡᄌൻ߇ߥ߆ߞ ߚߩߦኻߒޔᅚᕈߢߪᦼ㑆ࠍㅢߓߡჇടะ ߦߞߚޕ 㧔ᐕ㦂⺞ᢛ⟕ᖚ₸ߩᐕ㑆ᄌൻ₸㧦↵ *ᗲ⍮⋵߇ࠎࡦ࠲⎇ⓥᚲ ∉ቇ੍㒐ㇱ ޥ464-8681 ฬฎደᏒජ⒳㣮ሶᲚ 1-1 81 ᣣᧄߩㇺᐭ⋵߇ࠎ⟕ᖚ⠪ᢙផ⸘ ㄖᏈ ૫ሶ* ᄢ㊁ ࠁ߁ሶ ↰ ⌀ଐ ᷡ᳓ ⍮ሶ ട⨃ ᙗ৻ ᣧ↰ ߺߤࠅ ᣣᧄߢᖡᕈᣂ↢‛㧔એਅ߇ࠎ㧕ߪᱫ࿃╙ ߿⒟ᐲߦ㆑߇ߺࠄࠇߚޕၞ߇ࠎ⊓㍳ߩ 1 ߢࠅޔჇടߩ৻ㅜࠍߚߤߞߡࠆޕ ♖ᐲ߇㜞ᄢ㒋ᐭߣ㐳ፒ⋵ߢߪߐࠄߦߒ ᓟᣣᧄߦ߅ߡല₸⊛ߥ߇ࠎኻ╷ࠍⴕ߁ ᬌ⸛߇น⢻ߢࠅޔਔᐭ⋵ߩ߇ࠎ⟕ᖚႎ ߚߦߪޔㇺᐭ⋵ߏߣߩ߇ࠎᱫᢙߛߌ ๔୯ߪ࿁ߩផ⸘ࠃࠅ߽ታࠍᤋߒߡ ߢߥߊ߇ࠎ⟕ᖚᢙ߇㊀ⷐߢࠅߚ߹ޔ᧪ ࠆน⢻ᕈ߇ࠆߣ⠨߃ࠄࠇࠆޔߢߎߘޕផ ߩ߇ࠎ⟕ᖚߩേะࠍ੍᷹ߔࠆߎߣߪ↪ߢ ⸘୯ߣႎ๔୯ࠍᲧセߔࠆߣޔᄢ㒋ᐭߢߪᄙ ࠆޕ ߊߩ߇ࠎߢផ⸘୯ߩ߶߁߇ᄙߊޔ㐳ፒߢߪ ߶ߣࠎߤႎ๔୯ߩ߶߁߇ᄙߥߤߩ⚿ᨐ߇ ߎࠇ߹ߢޔᄢ㊁ࠄߦࠃࠅ 1975 ᐕ߆ࠄ ᓧࠄࠇߚޕ 1994 ᐕߩ࠺࠲ࠍ߽ߣߦޔਛߩࡌࠗ࠭ဳ ࡐࠕ࠰ࡦࠦ࠙ࡎ࠻ࠍㆡ↪ߒߡᐕ㦂ᤨ ᧄ⎇ⓥߢ▚ߒߚㇺᐭ⋵ߏߣߩㇱ ઍઍലᨐࠍផቯߒޔ2020 ᐕ߹ߢߩ߇ࠎ ⟕ᖚᢙߪ⟕ޔᖚ₸ߦߟߡߪో࿖หߓߣߒ ⟕ᖚᢙ᧪ផ⸘߇ⴕࠊࠇߡࠆޕ ߡੱญേᘒߩᓇ㗀ࠍᤋߐߖߚ߽ߩߢࠅޔ ⎇ⓥ⠪ࠄߪㄭᐕᕆỗߦㅴࠎߢࠆ㜞㦂ൻ ߇ࠎ⟕ᖚᢙߩ⋡ࠍឭ␜ߔࠆߎߣ߇ߢ߈ߚ ࠍ⠨ᘦߒߚ߇ࠎ⟕ᖚផ⸘ࠍⴕ߁ߚߦޔᐕ ߣ⠨߃ࠆޕᓟޔㇺᐭ⋵߇ࠎ⊓㍳ߩల 㦂ലᨐߣઍലᨐߪᄢ㊁ࠄߣหߓߊ࿕ቯߒޔ ታߦࠃࠅ⟕ᖚႎ๔୯߇࿁ߩ⋡୯ߣߤߩ ᤨઍലᨐߦߟߡ 12 ㅢࠅߩផ⸘ࠍⴕޔ ࠃ߁ߥ㑐ଥࠍߣࠆ߆ߦߟߡ⛮⛯⊛ߦⷰኤޔ ߇ࠎ⟕ᖚᢙࠍ▚ߒߚߩࠄࠇߘߡߒߘޕផ ᬌ⸛ߔࠆᔅⷐ߇ࠆߣ⠨߃ࠆޕ ⸘ߩ߁ߜᦨ߽ㆡಾߥផ⸘ᴺࠍዉߊߚߦޔ ࿖┙߇ࠎࡦ࠲߇ႎ๔ߒߡࠆ 1995 ᐕ ߆ࠄ 1999 ᐕ߹ߢߩႎ๔୯ࠍ↪ߡࠇߎޔ ࠄߩផ⸘ᴺࠍ⹏ଔߒㇱߦᦨㆡߥᣇᴺࠍ ߒߚ⎇ᧄޕⓥߢߪߘߩᣇᴺߦㇺᐭ⋵ ߏߣߩੱญേᘒࠍߡߪߡㇺᐭ⋵ߩ ߇ࠎ⟕ᖚ⠪ផ⸘ࠍⴕߞߚޕ ߘߩ⚿ᨐోޔ࿖ߩੱญ᭴ᚑߦㄭ੩ㇺᐭ ߣੱญ᭴ᚑഀว߇․ᓽ⊛ߥᴒ✽ߣߢߪޔ 2020 ᐕᤨὐߢ↵ޔᕈߩ⟕ᖚᢙ 5 ߩ ਛߢ㗅߇⇣ߥߞߡߚޕᅚᕈߩ㗅ߪߎ ߩ 2 ᐭ⋵ߢߪᏅߪߥ߆ߞߚ߇ޔჇᷫߩะ ࿑㧝㧚ㇺᐭ⋵ㇱ⟕ᖚᢙផ⸘ *ᄢ㒋ᄢቇᄢቇ㒮කቇ♽⎇ⓥ⑼ ޥ565-0871 ᄢ㒋ᐭ็↰Ꮢጊ↰ਐ 1-7 82 25# ᬌ⸻ዉၞ㧔㐳ፒ⋵Ꮢ㧕ߦࠄࠇߚ ೨┙⣼߇ࠎᱫ₸ᷫዋ ᣧ↰ ߺߤࠅ* 㒻ጊ ᤘᒾ 㑐ᩮ ৻㇢ ฎᎹ ᱜ㓉 Ꮉ ㈬ ⧷᮸ ࠅ 4㧙6 ੱߩ㑆ߦࠅᄌേߪࠄࠇߥ߆ߞߚ߇ޔ 㧝㧚⢛᥊ ᣣᧄߦ߅ߌࠆ೨┙⣼߇ࠎ⟕ᖚ₸ߪࠕࡈࠞ ߢߪ 2006 ᐕߩ 8 ੱ߆ࠄ 2007 ᐕߩ 2 ੱ ♽↵ᕈߩ⚂ 1/10 ߣ㜞ߊߪߥ߇ᦨޔㄭჇട ߳ߣᷫዋߒߡߚ⸻ޕᢿᄾᯏߩ 5 ᐕ⋧ኻ↢ ะ߇⪺ߒޕPSA ᬌ⸻ߩലᕈᬌ⸛ࠍ⋡⊛ߣ ሽ₸ߩផ⒖ߢߪޔ1989 ᐕએ㒠ߕࠇߩ⟲߽↢ ߒߡޔ㐳ፒ⋵Ꮢߢߪ 2003 ᐕࠃࠅ 50㧙 ሽ₸ะ߇ࠄࠇޔ1989㧙1993 ᐕ⸻ᢿᖚ⠪ 79 ᱦࠍኻ⽎ߣߔࠆ PSA ᬌ⸻߇㐿ᆎߐࠇߚޕ5 ߢߪᬌ⸻⟲ 62㧑 ⟲⁁∝ޔ57㧑߆ࠄޔ1999㧙 ᐕ㑆ߩ PSA 㔺₸ߪ 25㧑ߢߞߚޕ 2003 ᐕ⸻ᢿᖚ⠪ߢߪᄦޘ100㧑ޔ77㧑ߣޔ ߕࠇ߽↢ሽ₸ߩะ߇ⷰኤߐࠇߚޕ 㧠㧚⚿⺆ Ꮢߦ߅ߌࠆ PSA ᬌ⸻㔺₸ߪ 5 ᐕ㑆 㧞㧚ኻ⽎߅ࠃ߮ᣇᴺ 㐳ፒ⋵߇ࠎ⊓㍳࠺࠲ࠍ↪ߡޔ1985㧙 2008 ᐕߦ߅ߌࠆ㐳ፒ⋵ߣᏒߩ೨┙⣼߇ ߢ 25㧑ߣૐ߆ߞߚ߽ߩߩޔᬌ⸻ዉᓟߩ⟕ᖚ ࠎ⟕ᖚ₸ޔᱫ₸ߩផ⒖ࠍⷰኤߒߚ⸻ޔߚ߹ޕ ₸ᕆߣߘߩᓟߩૐਅ߇ࠄࠇߚޕᱫ₸ ᢿᄾᯏߦᬌ⸻ߦࠃࠆ⊒⟲ߣ∝⁁ߦၮߠߊ ߦ㑐ߒߡߪޔPSA ᬌ⸻㐿ᆎᓟߦᷫዋ߇ⷰኤߐ ⊒⟲ߦಽߌ↢ޔሽ₸ߩផ⒖߽ⷰኤߒߚޕ ࠇߚ⟕ޕᖚ₸ޔᱫ₸ߩᓟߩേะࠍᵈᗧᷓߊ ࠆᔅⷐ߇ࠆޕ 㧟㧚⚿ᨐ 1985㧙2006 ᐕߦ߅ߌࠆ೨┙⣼߇ࠎ⟕ᖚ⠪ ߪ㐳ፒ⋵ߢߪ 7097 ޔ Ꮢߢߪ 1377 ޔ 1985㧙2008 ᐕߩᱫ⠪ߪ㐳ፒ⋵ߢߪ 2257 ޔ ߢߪ 386 ߢߞߚޕ㐳ፒ⋵ߣ Ꮢߩᐕ㦂⺞ᢛ⟕ᖚ₸ߪࠇ߽ 1990 ᐕઍඨ߫߆ ࠄ✭߿߆ߥჇട߇ᆎ߹ࠅޔ2003 ᐕએ㒠ޔᕆỗ ߥჇട߇ࠄࠇߚޕᏒߢߪ 2004 ᐕߦ ࡇࠢࠍㄫ߃ߩߘޔᓟޔᷫዋߦォߓߡ߅ࠅޔ㐳 ፒ⋵ߢߪ 2005 ᐕߦࡇࠢࠍㄫ߃ޔ2006 ᐕߦ ᷫዋߦォߓߡߚޕ2003 ᐕએ㒠ਔ⠪ߩ⟕ᖚ₸ ߦᏅ߇ࠄࠇࠆࠃ߁ߦߥࠅޔᏒߩᣇ߇ੱ ญ 10 ਁੱᒰߚࠅޔ10㧙20 ੱ࿁ߞߡߚޕ ᱫߦ㑐ߒߡߪޔ㐳ፒ⋵ߢߪੱญ 10 ਁੱᒰߚ *✢ᓇ㗀⎇ⓥᚲ∉ቇㇱ㧔㐳ፒ㧕 ޥ850-0013 㐳ፒᏒਛᎹ 1-8-6 83 㐳ፒ⋵߇ࠎ⊓㍳ߦၮߠߊ 2 ⒳㘃ߩ IM Ყߦ㑐ߔࠆᬌ⸛ ↰ ⌀ଐ* ᄢ㊁ ࠁ߁ሶ ᷡ᳓ ⍮ሶ ᣧ↰ ߺߤࠅ 㒻ጊ ᤘᒾ ᖡᕈᣂ↢‛㧔એਅࠎ߇ޔ㧕ߪ␠ળ⊛ߦ㊀ⷐ ⢗߇ࠎ↵ᕈ߅ࠃ߮߇ࠎᅚᕈߩ⚿ᨐࠍ࿑㧝ޔ ߥ∔ᖚߢࠅޔၞ߇ࠎ⊓㍳ߦࠃࠆ⁁ᛠី 㧞ߦ␜ߔ⚿ޕᨐߩ࿁ߩኻ⽎ߪ 1985 ᐕએ㒠 ߇᳞ࠄࠇࠆޔߒ߆ߒޕᚒ߇࿖ߦߪᴺߦၮߠ ߦ⟕ᖚߒߚᖚ⠪ߢࠆߚޔኻ⽎ᦼ㑆ߩᆎ ߊ⊓㍳ᐲ߇ߥߊ♖ޔᐲ߇ૐၞ߽ᄙޕ ߩᐕ߆ߪኻ⽎ᖚ⠪ߩᱫᢙ߇ዋߥߊޔIM Ყ ߘߎߢੱޔญേᘒ⛔⸘߆ࠄᓧࠄࠇࠆ߇ࠎᱫ ߩᄌേ߇ᄢ߈ޔߢߎߘޕኻ⽎ᦼ㑆ߩ⚳ࠊࠅ ᢙࠍ↪ߡޔၞ߇ࠎߩ⊓㍳ߩ♖ᐲ߇⹏ଔߐ ߩ 5 ᐕ㑆㧔2002 ᐕ߆ࠄ 2006 ᐕ㧕ߩ⟕ᖚᢙߣ ࠇࠆ ߇ࠇߎޕIncidence/Mortality ratio㧔એ ᱫᢙߩว⸘ߦࠃࠅ IM Ყࠍ▚ߒߚోޕㅴ ਅޔIM Ყ㧕ߢࠅޔห৻ᐕߦ߅ߌࠆ߇ࠎ⟕ ⴕᐲߢߪޔ⢖㧔↵ᕈ: IMa 1.14 IMc 1.22ޔ ᖚᢙߣ߇ࠎᱫᢙߩᲧߢࠊߐࠇࠆ ޔߒ߆ߒޕᅚᕈ: IMa 1.36 IMc 1.45㧕ߣ⢄㧔↵ᕈ: IMa ߇ࠎ⟕ᖚ⠪ߩᱫ࿃ߪ߇ࠎߩߺߢߪߥߊࠎ߇ޔ 0.99 IMc 1.11ޔᅚᕈ: IMa 1.03 IMc 1.15㧕 ᱫᢙߩߺߢ߇ࠎ⟕ᖚᢙࠍផ⸘ߔࠆߎߣߪㆡ ߢ IMa ߣ IMc ߇ߦૐߊޔIMa ߣ IMc ߩᏅ ಾߢߥߣ⠨߃ࠆޕ ߇ዊߐ߆ߞߚޕᚱ㧔IMa 3.11 IMc 4.21㧕 ߣ೨┙⣼㧔IMa 2.93 IMc 4.42㧕ߢߪ IMa ߘߎߢᧄ⎇ⓥߢߪޔᓥ᧪↪ࠄࠇߡࠆ߇ ࠎ ᱫ ᢙ ߦ ࠃ ࠆ IM ߣ IMc ߇ߦ㜞ߊޔIMa ߣ IMc ߩᏅ߇ᄢ߈ Ყ ߆ߞߚޕㅴⴕᐲߢߪߩߡߴߔޔㇱߢ߇ࠎ 㧔Incidence/Cancer-Mortality ratio: એਅޔ ߇ㅴⴕߔࠆ߶ߤ IMa ߣ IMc ߇ߦૐߊߥߞ IMc 㧕 ߣ ߩ ߡ ߴ ߔ ޔᱫ ࿃ ߦ ࠃ ࠆ IM Ყ ߡߚޕ㒢ዪߣ㆙㓒ߦ߅ߌࠆ IMc ߩᏅࠍߺࠆ 㧔Incidence/All-Mortality ratio: એਅޔIMa㧕 ߣޔ⢖㧔↵ᕈ: 1.31ޔᅚᕈ: 2.72㧕ߣ⢄㧔↵ᕈ: ߩޔ2 ㅢࠅߩ IM Ყߦߟߡᬌ⸛ߒߩߘޔ㆑ 1.40ޔᅚᕈ: 1.78㧕ߢዊߐߊޔᚱ㧔9.08㧕ߣ ߩ⒟ᐲߣߘߩේ࿃ߦߟߡࠄ߆ߦߔࠆߎ ೨┙⣼㧔13.36㧕ߢᄢ߈߆ߞߚޔߚ߹ޕㅴⴕᐲ ߣࠍ⋡⊛ߣߒߚޕ ਇߩᖚ⠪ഀวߪޔ⢖㧔↵ᕈ: 31.4%ޔᅚᕈ: 31.8%㧕ߣ⢄㧔↵ᕈ: 53.9%ޔᅚᕈ: 62.8%㧕ߢ ኻ⽎ߪޔ㐳ፒ⋵ߦߡ 1985 ᐕ߆ࠄ 2006 ᐕߦ ߇ࠎߣ⸻ᢿߐࠇޔ㐳ፒ⋵߇ࠎ⊓㍳ߦ⊓㍳ߐࠇ 㜞ߊޔㅴⴕᐲਇߩ IMa ߣ IMc ߇㆙㓒ࠃࠅ ߽ૐ߆ߞߚޕ ߚᖚ⠪㧔⢗ 31244 ઙޔ⢖ 21240 ઙޔ⢄ 12695 ઙޔᄢ⣺ 30887 ઙޔᚱ㧔ᅚᕈ㧕9869 ઙޔ ೨┙⣼㧔↵ᕈ㧕7097 ઙ㧕ߢࠆߩߎޕኻ⽎ࠍ ↪ߡోޔㅴⴕᐲߣㅴⴕᐲ㧔㒢ዪޔ㗔ၞޔ ㆙㓒ޔਇ㧕ߦ IMa ߣ IMc ࠍ▚ߒߚޕ *ᄢ㒋ᄢቇᄢቇ㒮කቇ♽⎇ⓥ⑼ ޥ565-0871 ᄢ㒋ᐭ็↰Ꮢጊ↰ਐ 1-7 84 ࿑㧝㧚⢗߇ࠎ↵ᕈߩ +/Cޔ+/E ߩផ⒖࿑ ࿑ 㧚߇ࠎᅚᕈߩ +/Cޔ+/E ߩផ⒖ 85 ၞ߇ࠎ⊓㍳⾗ᢱߦၮߠߊ⎇ⓥᚑᨐߩ᥉ߩߚߩᢎ⢒࠷࡞㐿⊒ ㋈ᧁ ሶ* ጟ Ꮧሶ ᵤᾢ ⑲ ᄢ᧖ ᄹ ޘ ═ᧁ 㤗㉿ᕺ Ꮉ ᱠ ✍㚅 ዊ㦮 ✍ሶ 㑐ญ ⍮ᕺ ↰ਛ ᩕℂሶ ᄖ ⚡㊁ Ḋ ᓀᏗ ศ ᓀ ጤ ఝ⟤ ၞ߇ࠎ⊓㍳⾗ᢱߩಽᨆ߆ࠄ␜ໂߐࠇߚ߇ ࠎኻ╷ߩࠅᣇࠍᐢߊ৻⥸ߩੱߦޘℂ⸃ߒߡ 㒋ᐭߩ߇ࠎ㧙10 ᐕߢ߇ࠎᱫ 20㧑ᷫዋ߳ߩ ࠕ࡚ࠢࠪࡦ㧙ࠍޠෳ⠨ߦߒߚޕ ߽ࠄ߁ߎߣߪ⑼ޔቇ⊛ᩮߦၮߠߊ߇ࠎኻ╷ ࠍផㅴߔࠆߢᄢ߈ߥലᨐ߇ᦼᓙߐࠇࠆߒޕ ᬌ⸛ߩ⚿ᨐޔ࿁㐿⊒ߔࠆᢎ⢒࠷࡞ߩቇ ߆ߒߎࠇࠄߪኾ㐷ᕈ߇㜞ߊ৻⥸ߩੱߦޘℂ⸃ ⠌⋡ᮡߪޔ1)⑼ቇ⊛ᩮߦၮߠߊ߇ࠎኻ╷ⴕ ߐࠇߦߊߣ߁․ᕈ߆ࠄࠎ߇ߪߢ߹ࠇߎޔ േߩ⍮⼂ࠍ⠌ᓧߢ߈ࠆߎߣޔ2)⠌ᓧߒߚ⍮⼂ ∉ቇߩ⎇ⓥ⠪߿৻ㇱߩⴕᜂᒰ⠪߿ஜක≮ ࠍၮ␆ߣߒߡࠎ߇ޔኻ╷ⴕേ߳ߩേᯏࠍ㜞 ᓥ⠪ߩ㑆ߢߒ߆ᵴ↪ߐࠇߡߎߥ߆ߞߚ߹ޕ ࠆߎߣ߇ߢ߈ࠆߎߣޔ3)࿐ߩੱ߳ߩ߇ࠎኻ ߚၞ߇ࠎ⊓㍳ߪޔኻ⽎ߣߥࠆၞߦߔ ╷ⴕേߦ㑐ߔࠆჿ߆ߌࠍⴕ߃ࠆࠃ߁ߦߥࠆߎ ࠆߔߴߡߩ߇ࠎᖚ⠪ࠍ⊓㍳ኻ⽎ߣߔࠆߚޔ ߣޕߚߒߣޔᢎ᧚ߩᒻᘒߪ߇࡞࡞ޔ⏕ߢޔ ߘߩᔅⷐᕈߦߟߡ৻⥸ߩੱߦޘℂ⸃ࠍᷓ ㆆ߮ᣇࠍ⺕߽߇⍮ߞߡࠆࠍޠߚࠆ߆ޟណ↪ ߡ߽ࠄ߁ߎߣ߽⢄ⷐߢࠆ⎇ᧄߢߎߘޕⓥߢ ߒߚޕ ࠎ߇ޔߡߒߣ࠻࠶ࡔߩޠߚࠆ߆ޟኻ╷ ߪޔၞ߇ࠎ⊓㍳⾗ᢱࠍᵴ↪ߒߡዉ߆ࠇߚ߇ ߣ߁ኾ㐷⊛ߢᄙጘߦࠊߚࠆౝኈࠍޔᭉߒߊ ࠎኻ╷ߦߟߡ߇ޘੱߩ⥸৻ޔᭉߒߊቇߴࠆ ⷡ߃߿ߔᢥ⸒ߣࠗࠬ࠻ߢ᭴ᚑߔࠆߎߣ߇ ᢎ⢒࠷࡞ࠍ㐿⊒ߔࠆߎߣࠍ⋡⊛ߣߒߚޕ น⢻ߥߎߣߦࠎ߇ޔ㑐ߔࠆኾ㐷⍮⼂ߩߺߥࠄ ߕޔ ߇ࠊޟ࿖ߢ߇ࠎߪ․ߥ∛᳇ߢߪߥߊ⺕ޔ 㐿⊒ߦߚߞߡߪߦޘੱߩ⥸৻ޔℂ⸃ߐࠇ ߢ߽߆߆ࠆน⢻ᕈ߇ࠆޔ߿ߣߎޠ ࠎ߇ޟኻ╷ ߿ߔߣ߁ὐࠍ㊀ⷞߒޔஜᐽᢎ⢒ߦߟߡ ߣߒߡߣޠࠆ߇ߣߎࠆ߈ߢ߽ߦߚߥޔ ၮ␆ࠍ߽ߟᩕ㙃჻▤ℂᩕ㙃჻㙃ᚑ⺖⒟ߢቇ ߁ࠃ߁ߥޔߩ߳ੱޘേᯏߠߌߩࡔ࠶ࠫ ߱ᄢቇ↢߅ࠃ߮ᄢቇ㒮↢ߣߣ߽ߦⴕߞߚޕ㐿 ࠍ❱ࠅㄟߎߣ߇น⢻ߦߥࠆߣ⠨߃ߚࠇߎޕ ⊒ߩᚻ㗅ߪߕ߹ޔᢎ᧚㐿⊒ߦᔅⷐߥኾ㐷ၮ␆ ࠄߩᣇ㊎ߦၮߠ߈⹜ޔ᩺ࠍᚑߒߦࠄߐޔක ⍮⼂ࠍߔࠆߎߣࠍ⋡⊛ߦޔၞ߇ࠎ⊓㍳ ቇ⊛ޔᢎ⢒⊛ⷞὐ߆ࠄߩౣᬌ⸛ࠍⴕޔᢎ᧚ ⾗ᢱߩ߇ࠎኻ╷߳ߩᵴ↪ߦ㑐ߔࠆቇ⠌ળࠍ㊀ ߩᚑࠍㅴߡࠆޕ ߨߚߩߘޕᓟޔ㐿⊒ߔࠆᢎ⢒࠷࡞ߩቇ⠌⋡ ᮡߩ⏕ൻޔᢎ᧚ᒻᘒߩᬌ⸛⹜ޔ᩺ߩᚑޔ 㐿⊒ߔࠆᢎ⢒࠷࡞ߪ ⚂ޔ50 ᨎߩࠞ࠼ ⹜᩺ߦߟߡකቇ⊛ޔᢎ⢒⊛ⷞὐ߆ࠄߩౣᬌ ߢ᭴ᚑߐࠇࠆࠎ߇ޟኻ╷߆ࠆߚޕࠆߢޠ ⸛ޔᢎ᧚ൻߩᚻ㗅ߢⴕߞߚ߅ߥޕ㐿⊒ߔࠆᢎ ᓟߩ੍ቯߣߒߡࠍࠢࡢࡊ࡞ࠣޔਛᔃߣߒ ⢒࠷࡞ߩ⑼ቇ⊛ᩮߪޔਥߦᄢ㒋ᐭ߇ࠎ⊓ ߚஜᐽᢎ⢒ߩ႐ߦ߅ߌࠆᵴ↪ࠍᬌ⸛ߒߡࠆޕ ㍳⾗ᢱߦၮߠߡᚑߐࠇߚࠆߺߢ⸘⛔ޟᄢ ౕߣߒߡߪޔᢙචੱߩᢎቶᒻᑼߩ႐ߢޔ *ᄢ㒋ᮦ⬺ᅚሶᄢቇቇ⧓ቇㇱ ޥ577-8550 ᄢ㒋ᐭ᧲ᄢ㒋Ꮢ⪉ደ 4-2-26 86 ᢙੱߕߟߩዊࠣ࡞ࡊߦࠊ߆ࠇߡ࡞࠷ᧄޔ 䋮ᢎ⢒䉿䊷䊦䈮䈍䈔䉎ੱ䈱䈏䉖ኻ╷ⴕേ䈱ᣇะᕈ ࠍ↪ߚࠊࠁࠆߚߞⴕࠍޠࠅߣߚࠆ߆ޟᓟޔ ಽ ㊁ ߇ࠎኻ╷ⴕേߦ㑐ߔࠆ⍮⼂ߩቯ⌕߿േᯏࠍ㜞 ࠆߎߣࠍߨࠄߣߒߡࡃࡦࡔࡊ࡞ࠣޔ ߣ߇ࠎኻ╷ߣߒߡ⥄ಽߚߜߢߢ߈ࠆߎߣߦߟ ߡߒวࠍⴕ߁ߥߤߩࠣ࡞ࡊࡢࠢࠍ ૬↪ߒߚᢎ⢒ࡊࡠࠣࡓߢࠆޔߡߖࠊޕ ലᕈߩᬌ⸛߽ⴕߞߡ߈ߚޕ 87 䈏䉖ኻ╷ⴕേ 䈢䈳䈖ኻ╷ ᾍ䇮ฃേ༛ᾍ䈱㒐ᱛ䇮ᧂᚑᐕ⠪༛ᾍ㒐ᱛ ⢄Ἳ䉡䉟䊦䉴ኻ╷ ⢄Ἳ䉡䉟䊦䉴ᬌ⸻䈱ฃ⸻ 䈏䉖ᬌ⸻ ⢗䊶ᄢ⣺䊶ᚱ䊶ሶች㗪ㇱᬌ⸻䈱ㆡᱜᤨᦼ䈱ฃ⸻ 䈏䉖ක≮ 䈏䉖ක≮䈮㑐䈜䉎␠ળ⾗Ḯ䈱ᵴ↪ ᣣᧄߩၞ߇ࠎ⊓㍳ߩ⁁ ╙ 3 ᰴኻ߇ࠎߩࠎ߇ޟታᘒᛠីߦ㑐ߔࠆ⎇ⓥ⃰ޠ ╙ 3 ᦼ೨⺞ᩏ⚿ᨐࠃࠅ㧔╙ 1 ႎ㧕 ᧁ ༑ሶ* ਣ ⍮⟤ ᧻↰ ᥓᄢ ῳᳯ ቁ 㧝㧚⢛᥊ Ḱ⊓㍳㗄⋡ࠍណ↪ߒߡࠆၞߪޔ88㧑ߦ ㄭᐕ⟕ࠎ߇ޔᖚࠍࡕ࠾࠲ࡦࠣߔࠆߚߩ ߩ߷ߞߚޕ63㧑ߩၞ߇ᮡḰ࠺࠲ࡌࠬࠪ ၞ߇ࠎ⊓㍳ᐲߩ㊀ⷐᕈ߇ᒝߊ⼂ߐࠇߡ ࠬ࠹ࡓࠍዉߪߚ߹ޔዉਛߢߞߚ߆ߒޕ ࠆ ╙ޕ3 ᰴኻ߇ࠎ✚วᚢ⇛⎇ⓥᬺࠎ߇ޟ ߒ↢ޔሽ₸㓸⸘ߦᔅⷐߥᦨ⚳↢ሽᐕ߇⸘᷹ ⟕ᖚᱫേะߩታᘒᛠីߦ㑐ߔࠆ⎇ⓥ⃰ޠ ߐࠇߡߥၞ߇ᄙߊࠄࠇߚޕ 㧔3㧕߶ ߪᧄޔᬺਛߩ 10 ࠞᐕ㧔ᐔᚑ 16㧙25 ᐕᐲ㧕 ߣࠎߤߩ⋵ߢ⊓㍳ṳࠇߩᛠីࠍᱫォ౮ߦ ߢᣣᧄߩၞ߇ࠎ⊓㍳ߩᮡḰൻࠍㅴ♖ᐲࠍ ࠃࠅⴕߞߡࠆ߇⊓ޔ㍳ߩߥ∝ߦኻߔ ะߐߖࠆߎߣࠍ⋡ᜰߒߡࠆ⋡ޕᮡ㆐ᚑߩ ࠆ㆚ࠅ⺞ᩏߩታᣉߪ 46㧑ߦߣߤ߹ߞߚ⊓ޕ㍳ ߚߦ ߩߎޔ10 ࠞᐕࠍ 3 ᦼߦಽഀߒߡฦᦼ ߩቢోᕈࠍ╙ 3 ᦼၮḰߢ⹏ଔߔࠆߣޔIM Ყ ߩ㐿ᆎ೨ߣ 10 ࠞᐕ⚳ੌᤨὐߢ㆐ᚑߔߴ߈⋡ޟ 1.5 એࠍ㆐ᚑߒߡࠆၞߪ 77㧑ޔDCN ᮡߣၮḰ 8 㗄⋡ࠍޠቯᵴേߒߡࠆޕᐔᚑ ഀว 30㧑ᧂḩࠍ㆐ᚑߒߡࠆၞߪ 37㧑ޔ 16 ᐕ㧔ᬺ㐿ᆎ೨㧕ޔᐔᚑ 18 ᐕ㧔╙ 2 ᦼ㐿 DCO ഀว 25㧑ᧂḩࠍ㆐ᚑߒߡࠆၞߪ ᆎ೨㧕ޔᐔᚑ 21 ᐕ㧔╙ 3 ᦼ㐿ᆎ೨㧕ߦߪޔㇺ 40㧑ߢߞߚޕ㧔4㧕2009 ᐕ⺞ᩏᤨߩᦨᣂ࠺ ᐭ⋵ߦኻߒታᣉ⁁ᴫ⺞ᩏࠍⴕ⋡ޟᮡߣၮ ࠲ߪޔ74㧑ߩၞ߇ 2005 ᐕ߇ࠎ⟕ᖚߢ Ḱޠ㆐ᚑ⁁ᴫࠍ⹏ଔߒߚޕ ࠅ⚂ 3 ᐕඨㆃࠇߢ㓸⸘ߐࠇߡߚޕ 㧠㧚⠨ኤ ⋡ᮡߣၮḰ㧔1㧕㧙㧔4㧕ߟߡ ╙ޔ3 ᦼၮ 㧞㧚ᣇᴺ ᐔᚑ 21 ᐕ 9 ߦޔ ޟၞ߇ࠎ⊓㍳ߩᮡḰൻ ߣ♖ᐲะߦ㑐ߔࠆ╙ 3 ᦼ೨⺞ᩏޔࠅࠃߦޠ 47 ㇺᐭ⋵ߣᐢፉᏒߩၞ߇ࠎ⊓㍳ታᣉ⁁ Ḱߩ㆐ᚑᐲ߇ૐ㗄⋡ߪ↢ޔሽ⏕ᐕߩ⸘ ᷹ޔ㆚ࠅ⺞ᩏߩታᣉ⊓߮ࠃ߅ޔ㍳ߩቢోᕈߢ ࠆ߇ߩࠄࠇߎޔ㗄⋡߽╙ 1 ᦼ㧙╙ 3 ᦼ೨ ᴫࠍ⹏ଔߒߚ ╙ޕ1 ႎߢߪ⋡ޔᮡߣၮḰ 8 㗄 ⋡ߩ߁ߜޔ 㧔1㧕⊛ᛚో▤ℂភ⟎ޔ 㧔2㧕 ᔅⷐߥ㗄⋡ߩ㓸▤ℂឭଏޔ 㧔3㧕⊓㍳ߩ ቢోᕈޔ 㧔4㧕⊓㍳ߩහᤨᕈߦߟߡႎ๔ߔࠆޕ ⺞ᩏࠍᲧセߔࠆߣ㆐ᚑഀวߪዋߒߕߟߒ ߡࠆ ╙ޕ3 ᦼ㧔ᐔᚑ 22 ᐕ㧙25 ᐕᐲ㧕ߦะ ߌߡޔା㗬ߢ߈ࠆ߇ࠎ⟕ᖚࡕ࠾࠲ࡦࠣߩߚ ߦޔ㒮ౝ߇ࠎ⊓㍳ߣߩㅪ៤ࠍᒝൻߔࠆ╬ޔ ․ߦ⊓㍳ߩቢోᕈࠍ㊀ὐ⊛ߦะߐߖࠆ੍ቯ 㧟㧚⚿ᨐ ߢࠆޕ ⺞ᩏᤨޔ35 ᐭ⋵߇ၞ߇ࠎ⊓㍳ᬺࠍታ 㧔ႎ๔ᦠឝタ URL㧕 ᣉߒߡߚޕ 㧔1㧕ၞ߇ࠎ⊓㍳ᬺߪޔ80㧑 http://ganjoho.jp/professional/registration ၞߢክ⼏ળ╬ߦࠃࠆክᩏࠍ߁ߌᛚߐࠇߚ /situation.html ᬺ⸘↹ߦၮߠߡㆇ↪ߐࠇߡߚޕ 㧔2㧕ᮡ *࿖┙߇ࠎ⎇ⓥࡦ࠲߇ࠎኻ╷ᖱႎࡦ࠲ ޥ104-0045 ਛᄩ▽ 5-1-1 88 ᣣᧄߩၞ߇ࠎ⊓㍳ߩ⁁ ╙ 3 ᰴኻ߇ࠎߩࠎ߇ޟታᘒᛠីߦ㑐ߔࠆ⎇ⓥ⃰ޠ ╙ 3 ᦼ೨⺞ᩏ⚿ᨐࠃࠅ㧔╙ 2 ႎ㧕 ਣ ⍮⟤* ᧁ ༑ሶ ᧻↰ ᥓᄢ ῳᳯ ቁ 㧝㧚⢛᥊ ∛ℂ⸻ᢿߩࠆ∝ߩഀว߽ૐ࡞ࠞࠫࡠޕ ㄭᐕ⟕ࠎ߇ޔᖚࠍࡕ࠾࠲ࡦࠣߔࠆߚߩ ࠴ࠚ࠶ࠢࠍ⊓㍳ᬺߦ⚵ߺㄟࠎߢࠆၞߪ ၞ߇ࠎ⊓㍳ᐲߩ㊀ⷐᕈ߇ᒝߊ⼂ߐࠇߡ 70㧑ߢߞߚޕ 㧔6㧕↢ሽ⏕⺞ᩏࠍታᣉߒߡ ࠆ ╙ޕ3 ᰴኻ߇ࠎ✚วᚢ⇛⎇ⓥᬺࠎ߇ޟ ࠆၞߪ 60㧑ߢࠅ↢ޔሽ⏕⺞ᩏࠍ᳃ ⟕ᖚᱫേะߩታᘒᛠីߦ㑐ߔࠆ⎇ⓥ⃰ޠ ᾖળߦࠃࠅⴕߞߡࠆၞߪ 20㧑ߣߐࠄ ߪᧄޔᬺਛߩ 10 ࠞᐕ㧔ᐔᚑ 16㧙25 ᐕᐲ㧕 ߦዋߥ߆ߞߚޕ 㧔7㧕ႎ๔ᦠߪ 89㧑ߩၞߢ ߢᣣᧄߩၞ߇ࠎ⊓㍳ߩᮡḰൻࠍㅴ♖ᐲࠍ ᚑߒߡࠆ߇ޔᮡḰ㓸⸘ࠗࠕ࠙࠻ࠍណ↪ ะߐߖࠆߎߣࠍ⋡ᜰߒߡࠆ⋡ޕᮡ㆐ᚑߩ ߒߡࠆၞߪᧂߛ 29㧑ߢߞߚޕ2009 ᐕ ߚߦ ߩߎޔ10 ࠞᐕࠍ 3 ᦼߦಽഀߒߡฦᦼ ⺞ᩏᤨޔ51㧑ߩၞ߇ 2005 ᐕ߇ࠎ⟕ᖚ㓸⸘ ߩ㐿ᆎ೨ߣ 10 ࠞᐕ⚳ੌᤨὐߢ㆐ᚑߔߴ߈⋡ޟ ࠍᦨᣂߩႎ๔ᦠߣߒߡߚޕ 㧔8㧕⊓㍳⾗ᢱࠍ ᮡߣၮḰ 8 㗄⋡ࠍޠቯᵴേߒߡࠆޕᐔᚑ ߇ࠎኻ╷ߩડ↹⹏ଔߦࠄ߆ߩᒻߢᵴ↪ߒߡ 16 ᐕ㧔ᬺ㐿ᆎ೨㧕ޔᐔᚑ 18 ᐕ㧔╙ 2 ᦼ㐿 ࠆၞߪ 89㧑ߢࠆ⟕ޔߚ߹ޕᖚ࠺࠲ߩ ᆎ೨㧕ޔᐔᚑ 21 ᐕ㧔╙ 3 ᦼ㐿ᆎ೨㧕ߦߪޔㇺ ⎇ⓥ↪߇ᢛߐࠇߡࠆၞߪ 91㧑 ᐭ⋵ߦኻߒታᣉ⁁ᴫ⺞ᩏࠍⴕ⋡ޟᮡߣၮ ߢߞߚޕ Ḱޠ㆐ᚑ⁁ᴫࠍ⹏ଔߒߚޕ 㧠㧚⠨ኤ ⊓㍳ߩຠ⾰ߩ߁ߜޔᒻᘒࠦ࠼߿⥃ᐥㅴⴕ 㧞㧚ᣇᴺ ᐲߪޔᓟ⚦ߥಽᨆࠍߒߡߊߢ㊀ⷐߢ ᐔᚑ 21 ᐕ 9 ߦޔ ޟၞ߇ࠎ⊓㍳ߩᮡḰൻ ࠆޔߚ߹ޕ᳃ᾖળߢ↢ሽ⏕⺞ᩏࠍታ ߣ♖ᐲะߦ㑐ߔࠆ╙ 3 ᦼ೨⺞ᩏޠ 㧔એਅޔ ᣉߒߡࠆၞߪዋߥ߇ޔታᣉߦߪ ╙ 3 ᦼ೨⺞ᩏ㧕ߦࠃࠅޔ47 ㇺᐭ⋵ߣᐢፉ ⊛⽷⊛ߥᢛ߇ᔅⷐߢࠅ⊓৻ޔ㍳ߩ Ꮢߩၞ߇ࠎ⊓㍳ታᣉ⁁ᴫࠍ⹏ଔߒߚ ╙ޕ2 ദജߩߺߢߪో⊛ߥᐩߍ߇㔍ߒ㕙߽ ႎߢߪ⋡ޔᮡߣၮḰ 8 㗄⋡ߩ߁ߜޔ 㧔5㧕⊓㍳ ߩຠ⾰ޔ 㧔6㧕↢ሽ⏕⺞ᩏޔ 㧔7㧕ႎ๔ᦠᚑޔ 㧔8㧕⊓㍳⾗ᢱߩ↪ߦߟߡႎ๔ߔࠆޕ ࠅޔᓟߩᄢ߈ߥ⺖㗴ߢࠆޔߦࠄߐޕනߦ ႎ๔ᦠᚑߦߣߤ߹ࠄߕࠎ߇ࠅࠃޔኻ╷ߩડ ↹⹏ଔߣ⎇ⓥ↪ߦᓎ┙ߟ߇ࠎ⊓㍳࠺࠲ߩ ᢛࠍㅴߡߊߦߪ⊓ޔ㍳ߩຠ⾰ࠍะߐ 㧟㧚⚿ᨐ ߖ⸃ᨆߦ⠴߃߁ࠆ࠺࠲ߦߔࠆᔅⷐ߇ࠆޕ 㧔5㧕㓸⸘ಽߩၮ␆ߣߥࠆᐕ㦂ޔᕈޔ ㇱ߇ਇߣߥࠆ࠺࠲ߪߤߩၞ߽ዋߥޕ ߒ߆ߒޔᒻᘒࠦ࠼ਇ߿⥃ᐥㅴⴕᐲਇߣ 㧔ႎ๔ᦠឝタ URL㧕 http://ganjoho.jp/professional/registration /situation.html ߥࠆ࠺࠲ߩഀวߪߤߩၞ߽㜞ޔߚ߹ޕ *࿖┙߇ࠎ⎇ⓥࡦ࠲߇ࠎኻ╷ᖱႎࡦ࠲ ޥ104-0045 ਛᄩ▽ 5-1-1 89 㜞㦂ൻߩㅴⴕߔࠆၞߦ߅ߌࠆ߇ࠎߩ⊒↢ߣ ኅᣖᕈ࿃ሶ߅ࠃ߮ࠗࡈࠬ࠲ࠗ࡞ߦ㑐ߔࠆ೨ะ߈ࠦࡎ࠻⎇ⓥ ጟᧄ ᐙਃ 㤥ᴛ ᵗ৻ የፒ ☨ෘ ጯᧄ ᜏᴦ 㧝㧚ߪߓߦ ࠃࠆ⥄⸥ᑼࠕࡦࠤ࠻⺞ᩏߦࠃߞߡᓧࠄࠇߚ N↸ߪ㠽ข⋵ㇱߦ⟎ߔࠆਛጊ㑆ߢ ޔN ↸ ࠦ ࡎ ࠻ ࠺ ࠲ 㧔 ࿁ ₸ ߪ 92.8㧑 ߢ 4,411 ੱ㧕ࠍ↪ߒߚޕ 㜞㦂ൻ₸߇45㧑ߩ㜞㦂ൻߩㅴⴕߔࠆㄘᨋ ォᱫߩㅊ〔ᦼ㑆ߪޔ2008 ᐕ 12 31 ᬺࠍၮᐙ↥ᬺߣߔࠆ↸ߢࠆޕ ߎࠇ߹ ߢN↸ࠍኻ⽎ߦߒߚ↢ ᵴ⠌ᘠߣ ஜ ᣣ߹ߢߩ 19 ᐕ㑆ߢޔᱫᱫ࿃ߩᖱႎߪ✚ ᐽߦ㑐ߔࠆ೨ะ߈ࠦࡎ࠻⎇ⓥ߆ࠄޔห↸ ോ⋭ߩ␜ࠍᓧߡஜᚲߦᾖળޔォߩᖱႎ ߦ߅ߌࠆ㐳ኼߣᔃߩஜᐽ߅ࠃ߮ࠗࡈࠬ࠲ ߪ↸ᓎ႐ࠃࠅ㓸ߒߚޕ Preclinical cancer effect ࠍ⠨ᘦߒߡޔ࿁╵ ࠗ࡞ߩ㑐ଥߦߟߡᬌ⸛ߒߡ߈ߚޕ ߒ߆ߒߣ↢⊒ߩࠎ߇ޔኅᣖᕈ࿃ሶ߿ࠗ ᤨ߆ࠄ 2 ᐕᧂḩߦ߇ࠎ⟕ᖚᱫߒߚੱߪ㒰 ࡈࠬ࠲ࠗ࡞ߩ㑐ଥߦߟߡߪ߹ߛ߹ߛ⸃ ᄖߒߡޔ3㨮780 ੱߦߟߡ⸃ᨆߒߚ㧔࿑ 1ޔ ߔߴ߈ὐ߇ᱷߐࠇߡࠆޕ 1㧕ޕ ߘߎߢ⎇ᧄޔⓥߢߪ1989ᐕ4߆ࠄߎࠇ߹ 40㧙79 ᱦߩኻ⽎⠪ߩ߇ࠎ⟕ᖚߣᱫߩห ߢߦ⺞ᩏ⫾ⓍߐࠇߚN↸ࠦࡎ࠻࠺࠲ߣ ቯࠍⴕޔ㠽ข⋵߇ࠎ⊓㍳⾗ᢱ߆ࠄᓧࠄࠇࠆ 㠽ข⋵߇ࠎ⊓㍳⾗ᢱߩ⸥㍳ᾖวࠍⴕޔኅ ⊓㍳ᖱႎࠍ N ↸ࠦࡎ࠻࠺࠲ߦㅊട⛔ว ᣖᕈ࿃ሶࠍਛᔃߦߒߚⷐ࿃ಽᨆࠍⴕ߁ߎߣ ߒߚޔߡߒߣࠬࡌ࠲࠺ࠍࠇߎޕᣢሽ⾗ᢱ ࠍ⋡⊛ߣߔࠆޕ ߩ N ↸ࠦࡎ࠻⺞ᩏ㗄⋡ 171 㗄⋡ߦߟߡޔ ኻ⽎ዻᕈࠍߪߓߣߒߡⷰኤᦼ㑆ޔኅᣖᕈ࿃ ሶ߅ࠃ߮ࠗࡈࠬ࠲ࠗ࡞ߦ㑐ߔࠆౣቯ⟵ࠍⴕ ࠢ࠶ࠖ࠹ࠬࠫࡠޔ࿁Ꮻಽᨆ߿↢ሽಽᨆ㧔Cox ࿁Ꮻ㧕ߦࠃࠆⷐ࿃ಽᨆࠍⴕߞߚޕ ߇ࠎኅ♽ࠅߪޔ5 ᐕએౝߦⷫఱᒉᆌᆂ ߦ߇ࠎߩᣢᓔߩࠆ႐วߣቯ⟵ߒߡ⸃ᨆߒߚޕ 㪈㩷㩷⸃ᨆኻ⽎䈱䊔䊷䉴䊤䉟䊮ᤨ䈱․ᕈ㩿㪈㪐㪏㪐ᐕ䋩 ↵ᕈ㩿㫅㪔㪈㪃㪍㪈㪏㪀 㪌㪏㪅㪐㫧㪐㪅㪍 ᅚᕈ㩿㫅㪔㪉㪃㪈㪍㪉㪀 㪌㪐㪅㪌㫧㪐㪅㪐 ว⸘㩿㫅㪔㪊㪃㪎㪏㪇㪀 㪌㪐㪅㪉㫧㪐㪅㪏 ⷰኤᦼ㑆㪃㪤㫧㪪㪛㪃ᐕ 㕖༛ᾍ⠪㪃ੱ㩿㩼㪀 㪈㪍㪅㪌㫧㪌㪅㪈 㪊㪎㪐㩿㪉㪋㪅㪎㪀 㪈㪎㪅㪎㫧㪋㪅㪊 㪈㪃㪍㪐㪐㩿㪐㪍㪅㪇㪀 㪈㪎㪅㪈㫧㪋㪅㪎 㪉㪃㪇㪎㪏㩿㪍㪉㪅㪐㪀 ༛ᾍ⠪㪃ੱ㩿㩼㪀 ㆊ༛ᾍ⠪㪃ੱ㩿㩼㪀 㪎㪎㪌㩿㪌㪇㪅㪌㪀 㪊㪏㪇㩿㪉㪋㪅㪏㪀 㪌㪈㩿㪉㪅㪐㪀 㪉㪇㩿㪈㪅㪈㪀 㪏㪉㪍㩿㪉㪌㪅㪇㪀 㪋㪇㪇㩿㪈㪉㪅㪈㪀 㪉㪋㪇㩿㪈㪌㪅㪎㪀 㪈㪃㪈㪐㪈㩿㪎㪎㪅㪐㪀 㪈㪃㪊㪎㪊㩿㪎㪋㪅㪎㪀 㪋㪋㪊㩿㪉㪋㪅㪈㪀 㪈㪃㪍㪈㪊㩿㪋㪎㪅㪐㪀 㪈㪃㪍㪊㪋㩿㪋㪏㪅㪍㪀 㪐㪎㩿㩿㪍㪅㪊㪀 㪉㪉㪅㪍㫧㪉㪅㪍 㪉㪋㪍㩿㪈㪍㪅㪋㪀 㪐㩿㪇㪅㪍㪀 㪏㪇㪅㪌㫧㪈㪈㪅㪈 㪈㪊㪋㪅㪎㫧㪈㪍㪅㪇 㪉㪈㩿㪈㪅㪈㪀 㪉㪉㪅㪎㫧㪊㪅㪈 㪊㪍㪈㩿㪈㪏㪅㪌㪀 㪊㪋㩿㪈㪅㪎㪀 㪎㪍㪅㪏㫧㪈㪇㪅㪐 㪈㪊㪉㪅㪎㫧㪈㪎㪅㪋 㪏㩿㪇㪅㪈㪀 㪉㪉㪅㪍㫧㪉㪅㪐 㪍㪇㪎㩿㪈㪎㪅㪍㪀 㪋㪊㩿㪈㪅㪉㪀 㪎㪏㪅㪋㫧㪈㪈㪅㪈 㪈㪊㪊㪅㪍㫧㪈㪍㪅㪏 ᐕ㦂㪃㪤㫧㪪㪛㪃ᐕ 㧞㧚ኻ⽎ߣᣇᴺ 㠽ข⋵ㇱߩㄘጊၞߢࠆ N ↸ߩ 㘶䉁䈭䈇㪃ੱ㩿㩼㪀 㘶䉃㪃ੱ㩿㩼㪀 ᳃ߩ߁ߜޔ40 ᱦ߆ࠄ 79 ᱦ߹ߢߩੱߦޔᐔᚑ 㘶㈬䉕䉇䉄䈢㪃ੱ㩿㩼㪀 㪉 㪙㪤㪠㪃㪤㫧㪪㪛㩿㫂㪾㪆㫄 㪀 㪊㪇㪕㪙㪤㪠㻢㪉㪌㩿㩼㪀 㪙㪤㪠㻢㪊㪇㩿㩼㪀 ᦨૐⴊ ᦨ㜞ⴊ రᐕ㧔1989 ᐕ㧕4 ߦ↢ᵴ⠌ᘠஜᐽ⁁ᘒ 㘩‛៨ข㗫ᐲߥߤ 171 㗄⋡ߦߟߡ⇐⟎ᴺߦ 㠽ขᄢቇකቇㇱ␠ળකቇ⻠ᐳஜᐽ╷කቇಽ㊁* ޥ683-8503 㠽ข⋵☨ሶᏒ↸ 86 ⇟ 90 㧟㧚⚿ᨐ߅ࠃ߮⠨ኤ ߎࠇߦᕈޔᐕ㦂ޔBMI ߿ㆇേ↢ޔᵴᘒᐲߥ ⷰኤᦼ㑆ౝߩ߇ࠎߩ⊒↢ᢙߪޔ543 ੱ㧔↵ ߤࠍട߃ߡޔੑ㗄ࡠࠫࠬ࠹ࠖ࠶ࠢ࿁Ꮻಽᨆ߅ ᕈ 344 ੱޔᅚᕈ 199 ੱ㧕ߢ↵ᕈߪ 21.3㧑ޔ ࠃ߮ Cox Ყࡂࠩ࠼ಽᨆߦࠃࠆᄙᄌ㊂⸃ᨆ ᅚᕈߪ 9.2㧑ߢߞߚ㧔 2㧕ޕ ࠍߎߎࠈߺߚ߇ࠎ߇ޔኅ♽ߩ߇ࠎ⊒↢ߦኻߔ ࠆᗧߥ⚿ᨐߪ⢗ߦ߅ߡߩߺࠄࠇߚޕ 䋲䇭ᕈ䊶ㇱ⟕ᖚᢙ ㇱ ↵ሶ ᅚሶ ว⸘ 㪎㪊 㪏㪋 㪌㪐 㪈㪐 㪉㪋 㪈㪌 㪈㪋 㪐 㪌㪍 㪋㪉 㪈㪇 㪎 㪈㪉 㪊㪌 㪐 㪐 㪎 㪈㪌 㪈㪋 㪈 㪉㪐 㪈㪉㪐 㪈㪉㪍 㪍㪐 㪉㪍 㪉㪋 㪉㪋 㪉㪊 㪈㪍 㪈㪌 㪈㪋 㪈㪊 㪍㪋 䈏䉖⟕ᖚ✚ᢙ 㪊㪋㪋 㪈㪐㪐 㪌㪋㪊 ⟕ᖚഀว䋦 㪉㪈㪅㪊 㪐㪅㪉 㪈㪋㪅㪋 㕖䈏䉖 㪈㪉㪎㪋 㪈㪐㪍㪊 㪊㪉㪊㪎 ว⸘ 㪈㪍㪈㪏 㪉㪈㪍㪉 㪊㪎㪏㪇 ᄢ⣺ ⢗ ๆེ䋨⢖䋩 ⣢ዩ〝♽ ↵ᕈ↢ᱺེ ⤟⤳ ⢄⤳ ⢙ྙ䊶⢙▤ ᅚᕈ↢ᱺེ ᚱ 㘩 䈠䈱ઁ 㪄 㪄 㪄 ߒ߆ߒޔᗧߢߪߥ߇ࠎ߇ޔኅ♽߇㑐ଥ ߔࠆㇱߣߒߡ㘩ޔᅚᕈ↢ᱺེ↵ޔᕈ↢ᱺ ེ߇ⷰኤߐࠇߚ㧔 3㧕ޕ 䋳䇭ㇱ䈏䉖䈱⊒↢䈫䈏䉖ኅ♽䈱㑐ଥ ⚵䉂ว䉒䈞 䉥䉾䉵Ყ 䋨㪐㪌㩼ା㗬㑆䋩 䊊䉱䊷䊄Ყ 㩿㪐㪌㩼ା㗬㑆䋩 ᕈ ↵ᕈ䋯ᅚᕈ 㪉㪅㪎㪍㩷㩿㪉㪅㪉㪋㪄㪊㪅㪊㪐㪀 㪉㪅㪍㪉㩿㪉㪅㪈㪏㪄㪊㪅㪈㪋㪀 ᐕ㦂 ᐕ㦂䉴䉬䊷䊦 㪈㪅㪇㪊㩷㩿㪈㪅㪇㪉㪄㪈㪅㪇㪋㪀 㪈㪅㪇㪌㩿㪈㪅㪇㪋㪄㪈㪅㪇㪍㪀 㪙㪤㪠 㪙㪤㪠䉴䉬䊷䊦 㪈㪅㪇㪇㩷㩿㪇㪅㪐㪎㪄㪈㪅㪇㪋㪀 㪇㪅㪐㪐㩿㪇㪅㪐㪍㪄㪈㪅㪇㪊㪀 ోㇱ 䈏䉖ኅ♽䋯ή 㪇㪅㪐㪐㩷㩿㪇㪅㪎㪌㪄㪈㪅㪊㪈㪀 㪇㪅㪐㪇㩿㪇㪅㪎㪇㪄㪈㪅㪈㪍㪀 㘩 䈏䉖ኅ♽䋯ή 㪉㪅㪈㪉㩷㩿㪇㪅㪌㪏㪄㪎㪅㪎㪐㪀 㪈㪅㪐㪌㩿㪇㪅㪌㪋㪄㪎㪅㪇㪐㪀 ⢗ 䈏䉖ኅ♽䋯ή 㪈㪅㪎㪌㩷㩿㪈㪅㪈㪈㪄㪉㪅㪎㪍㪀 㪈㪅㪌㪎㩿㪈㪅㪇㪈㪄㪉㪅㪋㪍㪀 ᄢ⣺ 䈏䉖ኅ♽䋯ή 㪇㪅㪏㪊㩷㩿㪇㪅㪋㪏㪄㪈㪅㪋㪏㪀 㪇㪅㪏㪈㩿㪇㪅㪋㪍㪄㪈㪅㪋㪇㪀 ⢄⤳ 䈏䉖ኅ♽䋯ή 㪇㪅㪍㪏㩷㩿㪇㪅㪈㪍㪄㪉㪅㪐㪈㪀 㪇㪅㪍㪏㩿㪇㪅㪈㪍㪄㪉㪅㪐㪈㪀 ⢖ 䈏䉖ኅ♽䋯ή 㪇㪅㪏㪉㩷㩿㪇㪅㪊㪎㪄㪈㪅㪏㪊㪀 㪇㪅㪍㪋㩿㪇㪅㪉㪏㪄㪈㪅㪋㪐㪀 ੍᷹࿃ሶ ߹ߚࠎ߇ޔኅ♽ࠅߩഀวߪ 13㧑㧔↵ᕈ 203 ੱޔᅚᕈ 279 ੱ㧕ߢߞߚ߇⊒ߩࠎ߇ޔ ↢ߣߪᗧߥ㑐ଥ߇ࠄࠇߥ߆ߞߚ㧔࿑ 2㧕ޕ ᚱ 䈏䉖ኅ♽䋯ή 㪇㪅㪌㪈㩷㩿㪇㪅㪌㪈㪄㪊㪅㪐㪇㪀 㪇㪅㪋㪏㩿㪇㪅㪇㪍㪄㪊㪅㪍㪌㪀 ᅚᕈ↢ᱺེ 䈏䉖ኅ♽䋯ή 㪈㪅㪎㪉㩷㩿㪇㪅㪋㪏㪄㪍㪅㪈㪋㪀 㪈㪅㪌㪈㩿㪇㪅㪋㪊㪄㪌㪅㪊㪍㪀 ↵ᕈ↢ᱺེ 䈏䉖ኅ♽䋯ή 㪈㪅㪌㪊㩷㩿㪇㪅㪌㪈㪄㪋㪅㪌㪌㪀 㪈㪅㪌㪍䋨㪇㪅㪌㪊㪄㪋㪅㪍㪊䋩 ⣢ዩ〝♽ 䈏䉖ኅ♽䋯ή 㪇㪅㪍㪈㩷㩿㪇㪅㪈㪋㪄㪉㪅㪌㪏㪀 㪇㪅㪌㪍䋨㪇㪅㪈㪊㪄㪉㪅㪊㪍䋩 䈠䈱ઁ 䈏䉖ኅ♽䋯ή 㪇㪅㪊㪌㩷㩿㪇㪅㪈㪈㪄㪈㪅㪈㪇㪀 㪇㪅㪊㪊䋨㪇㪅㪈㪇㪄㪈㪅㪇㪍䋩 ㇱߦߪ⟕ࠎ߇ޔᖚߥߒߩኻᾖߦ߅ߌࠆ ߇ࠎኅ♽ࠅߩഀว߇ 12.8㧑ߢߞߚߩߦ ߘߩ߶߆↢߈↲߿ࠬ࠻ࠬߥߤ♖ᔃℂ Ყセߒߡ↵ᕈߩ⢗ޔ㘩↵ޔᕈ↢ᱺེޔᅚᕈ ⊛ߥ↢ᵴᘒᐲࠍਛᔃߦߒߚࠗࡈࠬ࠲ࠗ࡞ߩ ߩ⢗ޔᅚᕈ↢ᱺེޔ⣢ዩ〝♽ߦ߅ߡ 17㧙 㑐ㅪᕈߦߟߡ߽⸃ᨆߒߚ߇ޔᗧߥ⚿ᨐߪ 29㧑ߩ㜞ഀว߇ⷰኤߐࠇߚޕ ᓧࠄࠇߥ߆ߞߚޕ ࠗࡈࠬ࠲ࠗ࡞ߦ߅ߡߪޔ༛ᾍޔ㘶㈬⠌ ᘠ߅ࠃ߮ᒝᐲ⢈ḩߦᗧߥ߇ࠎ⟕ᖚࠬࠢࠍ ߚ㧔 4㧕ޕ 91 㧠㧚⠨ኤ 䋴䇭䈏䉖䈱⊒↢䈫䊤䉟䊐䉴䉺䉟䊦䈱㑐ଥ ੑ㗄ࡠࠫࠬ࠹ࠖ࠶ࠢ࿁Ꮻಽᨆ߅ࠃ߮ Cox ࿁ 㶎 ੍᷹࿃ሶ ⚵䉂ว䉒䈞 䊊䉱䊷䊄Ყ 㩿㪐㪌㩼ା㗬㑆䋩 Ꮻಽᨆߩ⚿ᨐࠎ߇ߦ↢⊒ߩࠎ߇ޔኅ♽࿃ሶ߇ ༛ᾍ⠌ᘠ 㕖༛ᾍ 㪈㪅㪇 ༛ᾍ 㪈㪅㪋㪈㩿㪈㪅㪇㪏㪄㪈㪅㪏㪊㪀 ೨༛ᾍ 㪈㪅㪋㪊㩿㪈㪅㪇㪍㪄㪈㪅㪐㪉㪀 㘶㈬⠌ᘠ 㘶䉁䈭䈇 㪈㪅㪇 㘶䉃 㪈㪅㪉㪋㩿㪇㪅㪐㪏㪄㪈㪅㪌㪎㪀 એ೨䈲㘶䉃 㪈㪅㪈㪌㩿㪇㪅㪎㪋㪄㪈㪅㪎㪏㪀 ㅳᐔဋ 䈾䈫䉖䈬䈚䈭䈇 㪈㪅㪇 ㆇേᤨ㑆 䋵ᤨ㑆એ 㪈㪅㪉㪊㩿㪇㪅㪏㪌㪄㪈㪅㪎㪌㪀 䋳䌾䋴ᤨ㑆 㪇㪅㪏㪐㩿㪇㪅㪌㪎㪄㪈㪅㪊㪐㪀 䋱䌾䋲ᤨ㑆 㪇㪅㪐㪌㩿㪇㪅㪍㪐㪄㪈㪅㪊㪈㪀 ⢈ḩᐲ 㪈㪏㪅㪌㻡㪙㪤㪠㪓㪉㪌 㪈㪅㪇 㪙㪤㪠㪓㪈㪏㪅㪌 㪈㪅㪇㪊㩿㪅㪇㪌㪎㪄㪈㪅㪊㪐㪀 㪉㪌㻡㪙㪤㪠㪓㪊㪇 㪇㪅㪏㪋㩿㪇㪅㪍㪌㪄㪈㪅㪇㪐㪀 㪊㪇㻡㪙㪤㪠 㪉㪅㪇㪇㩿㪈㪅㪇㪊㪄㪊㪅㪏㪏㪀 Ⴎㄆ䈇䉅䈱 ህ䈇 㪈㪅㪇 ᄢᅢ䈐 㪈㪅㪇㪌㩿㪇㪅㪌㪎㪄㪈㪅㪐㪌㪀 ᅢ䈐 㪈㪅㪇㪍㩿㪇㪅㪍㪄㪈㪅㪏㪏㪀 ᥉ㅢ 㪇㪅㪐㪇㩿㪇㪅㪌㪈㪄㪈㪅㪌㪎㪀 䉍ᅢ䈐䈪䈭䈇 㪇㪅㪐㪇㩿㪇㪅㪋㪐㪄㪈㪅㪍㪌㪀 㶎㪚㫆㫏࿁Ꮻ䈮䉋䉎ᕈ䊶ᐕ㦂䈪⺞ᢛ䈚䈢䊊䉱䊷䊄Ყ ᒝߊᤋߐࠇࠆㇱߣߒߡޔ⢗߇ߍࠄࠇߚޕ ᗧߢߪߥ߇ޔ㘩ޔᅚᕈ↢ᱺེ↵ޔᕈ↢ ᱺེߦ߽ߚޕ ࠗࡈࠬ࠲ࠗ࡞ⷐ࿃ߣߒߡߪޔ༛ᾍ⠌ᘠޔ 㘶㈬⠌ᘠޔᒝᐲ⢈ḩ߇ߍࠄࠇߚޕ ⸃ᨆߩ㒢⇇ߣߒߡ 5 ᐕએౝߦⷫఱᒉᆌ ᆂߦ߇ࠎߩᣢᓔߩࠆ႐วࠍ߇ࠎኅ♽ࠅߣ ߒߚߎߣߪޔㆊዊ⹏ଔߦߟߥ߇ࠆߣ߃ࠆޕ ᓟߩ⺖㗴ߣߒߡขࠅ⚵ࠎߢ߈ߚޕ 92 ో࿖߇ࠎ⟕ᖚផ⸘୯ߩା㗬㑆ߩ▚ 㔀⾐ ⟤ሶ* ട⨃ ᙗ৻ ㊁↰ ⠹ᄥ ῳᳯ ቁ 㧝㧚⢛᥊ 㧟㧚⚿ᨐ ᣣᧄߩ߇ࠎ⟕ᖚᢙߪ৻ޔቯߩ⊓㍳♖ᐲߩၮ ోㇱ㧔ICD-10: C00㧙C96㧕ߩផ⸘⟕ᖚ Ḱࠍḩߚߒߚၞ߇ࠎ⊓㍳߆ࠄߩᖱႎߦࠃࠆ ₸ߩା㗬㑆ߩߪ↵ޔᕈߢߪផ⸘୯ߩ 6㧙 ో࿖ផ⸘୯ߢࠅࠎ߇ޔኻ╷ᖱႎࡦ࠲ߩ 10㧑ޔᅚᕈߢߪផ⸘୯ߩ 7㧙10㧑ߢߞߚޕ ࡎࡓࡍࠫߦ߅ߡ 1993 ᐕ߆ࠄ 2004 ᐕߩ ߪା㗬㑆߇ឭ␜ߐࠇߡ߅ࠄߕߦࠄߐޔᐕߦ 㧠㧚⠨ኤ ផ⸘ߦ↪ߔࠆၞߩ㆑ߦᵈ⋡ߒޔା㗬 ࠃߞߡផ⸘ߦ↪ߐࠇࠆၞ߇⇣ߥࠆߎߣߥ 㑆ࠍ▚ߒߚߎߣߢޔ↪ߔࠆၞ߇ࠎ⊓ ߤ߇㗴ⷞߐࠇߡࠆߚ⎇ᧄޔⓥߢߪផ⸘ ㍳࠺࠲ߩ㆑ߦࠃߞߡޔផ⸘୯߇↵ᅚߣ߽ ߦ↪ࠆၞߩ㆑ߦᵈ⋡ߒߡ⟕ޔᖚផ⸘୯ 6㧙10㧑ᄌൻߔࠆߎߣ߇ࠄ߆ߣߥߞߚᧄޕ ߩା㗬㑆ࠍ▚ߔࠆߎߣࠍ⋡⊛ߣߒߚޕ ⎇ⓥߦ߅ߌࠆା㗬㑆ߩ▚ߪޔផ⸘ߦ↪ ផ⸘୯߇ߐࠇߡࠆߩࠄࠇߎޕផ⸘୯ߦ ࠆၞߩ㆑ߦߟߡߒ߆ᬌ⸛ߒߡ߅ࠄߕޔ ࠺࠲ߩ⊓㍳♖ᐲ߿ផ⸘ߦ߹ࠇࠆၞߣ 㧞㧚ᣇᴺ ో࿖߇ࠎ⟕ᖚࡕ࠾࠲ࡦࠣ㓸⸘ߦ߅ߡ ߹ࠇߥၞߣߩ㆑ߥߤߦߟߡߪ⠨ᘦߒ 㓸ߐࠇߚၞ߇ࠎ⊓㍳ߩ߁ߜޔએਅߩ 2 ᧦ઙ ߡߥ⟕ޕᖚᢙߩផ⸘ߦ߅ߡࠆߥࠄߐޔ ࠍḩߚߒߚ⊓㍳ࠍో࿖߇ࠎ⟕ᖚផ⸘୯ߦ↪ ផ⸘ᣇᴺߩᬌ⸛߇ᔅⷐߢࠆޕ ࠆޕ2 ߟߩ᧦ઙߪޔ1㧕ోㇱ㧔↵ᅚ⸘ోޔᐕ 㦂㧕ߦ߅ߡޔᱫᖱႎߩߺߢ⊓㍳ߐࠇߚᖚ 䎤䏏䏏䎃䏖䏌䏗䏈䏖䎋䎦䎓䎓䎐䎦䎜䎙䎌䎏䎃䎰䏄䏏䏈 䎤䏏䏏䎃䏖䏌䏗䏈䏖䎋䎦䎓䎓䎐䎦䎜䎙䎌䎏䎃䎩䏈䏐䏄䏏䏈 䎃 䎃 䎯䏒䏚䏈䏕䎃䏏䏌䏐䏌䏗䎃䏒䏉䎃䏗䏋䏈䎃䎜䎘䎈䎃䏆䏒䏑䏉䏌䏇䏈䏑䏆䏈䎃䏌䏑䏗䏈䏕䏙䏄䏏 䎨䏖䏗䏌䏐䏄䏗䏈䏖䎃䏒䏉䎃䏑䏄䏗䏌䏒䏑䏄䏏䎃䏆䏄䏑䏆䏈䏕䎃䏌䏑䏆䏌䏇䏈䏑䏆䏈 䎸䏓䏓䏈䏕䎃䏏䏌䏐䏌䏗䎃䏒䏉䎃䏗䏋䏈䎃䎜䎘䎈䎃䏆䏒䏑䏉䏌䏇䏈䏑䏆䏈䎃䏌䏑䏗䏈䏕䏙䏄䏏 䎛䎓䎓 ᖱႎߢᆎߡ⊓㍳ቶ߇⟕ᖚࠍᛠីߒߚᖚ⠪ 䎚䎓䎓 䎚䎓䎓 ഀว㧔DCN ഀว㧕߇ 30㧑ᧂḩޔ2㧕⟕ᖚᱫ 䎙䎓䎓 䎙䎓䎓 Ყ㧔IM Ყ㧕߇ 1.5 એޕࠆߢޔ1993 ᐕ ߆ࠄ 2004 ᐕߢ᧦ઙࠍḩߚߒߚផ⸘ߦ↪น ⢻ߥฦᐕ 10㧙14 ၞ߇ࠎ⊓㍳࠺࠲ࠍ↪ޔ ోߡߩၞߩ⚵ߺวࠊߖߦ߅ߡផ⸘ߒߚ⟕ ᖚផ⸘୯ߩಽᏓ߆ࠄ 95㧑ା㗬㑆ࠍ▚ߒ ߚޕ 䎘䎓䎓 䎗䎓䎓 䎖䎓䎓 䎖䎓䎓 䎔䎓䎓 䎔䎓䎓 䎔䎜䎜䎙 䎔䎜䎜䎛 䎼䏈䏄䏕 *࿖┙߇ࠎ⎇ⓥࡦ࠲߇ࠎኻ╷ᖱႎࡦ࠲ 93 䎗䎓䎓 䎕䎓䎓 䎔䎜䎜䎗 䎕䎓䎓䎓 䎕䎓䎓䎕 䎕䎓䎓䎗 䎯䏒䏚䏈䏕䎃䏏䏌䏐䏌䏗䎃䏒䏉䎃䏗䏋䏈䎃䎜䎘䎈䎃䏆䏒䏑䏉䏌䏇䏈䏑䏆䏈䎃䏌䏑䏗䏈䏕䏙䏄䏏 䎨䏖䏗䏌䏐䏄䏗䏈䏖䎃䏒䏉䎃䏑䏄䏗䏌䏒䏑䏄䏏䎃䏆䏄䏑䏆䏈䏕䎃䏌䏑䏆䏌䏇䏈䏑䏆䏈 䎸䏓䏓䏈䏕䎃䏏䏌䏐䏌䏗䎃䏒䏉䎃䏗䏋䏈䎃䎜䎘䎈䎃䏆䏒䏑䏉䏌䏇䏈䏑䏆䏈䎃䏌䏑䏗䏈䏕䏙䏄䏏 䎘䎓䎓 䎕䎓䎓 䎓䎃 ޥ104-0045 ਛᄩ▽ 5-1-1 䎛䎓䎓 䏌䏑䏆䏌䏇䏈䏑䏆䏈䎃䏕䏄䏗䏈䎃䎋䏓䏈䏕䎃䎔䎓䎓䎏䎓䎓䎓䎌 䏌䏑䏆䏌䏇䏈䏑䏆䏈䎃䏕䏄䏗䏈䎃䎋䏓䏈䏕䎃䎔䎓䎓䎏䎓䎓䎓䎌 ⠪ഀว㧔DCO ഀว㧕߇ 25㧑ᧂḩߪߚ߹ޔᱫ 䎓䎃 䎔䎜䎜䎗 䎔䎜䎜䎙 䎔䎜䎜䎛 䎼䏈䏄䏕 䎕䎓䎓䎓 䎕䎓䎓䎕 䎕䎓䎓䎗 ᚒ߇࿖ߦ߅ߌࠆሶች߇ࠎ⟕ᖚߩផ⒖ 㧙 ߩၞ߇ࠎ⊓㍳࠺࠲߆ࠄ㧙 ᄢᧁ ߕߺ* ఽ₹ ື㇢ ῳᳯ ቁ 㧝㧚⢛᥊ ߚߩߦኻߒޔሶችㇱߢᦨ߽ᄙ⚵❱ဳߪ⣼ ሶች߇ࠎߩᐕ㦂⺞ᢛᱫ₸ߪ 1990 ᐕઍೋ ≸㧔adenocarcinoma㧕ߢߞߚޕ⣼≸ߪޔሶ ߹ߢߪᷫዋ߇ࠄࠇࠆ߇ߩߘޔᓟᷫዋߩㅦ ች㗪ㇱߢߪ 13㧑ࠍභߚߩߦኻߒޔሶችㇱ ߐ߇㊰ࠅㄭᐕߢߪᮮ߫ߣߥߞߡࠆޕ ߢߪ 73㧑ߢߞߚޕ ᧄ⎇ⓥߢߪޔၞ߇ࠎ⊓㍳ߩ࠺࠲ࠍ↪ ⣼≸ߩᐕ㦂⺞ᢛ⟕ᖚ₸ߪሶች㗪ㇱޔሶች ߡᚒ߇࿖ߩሶች߇ࠎߩ⟕ᖚߩផ⒖ࠍㇱ㧔ሶ ㇱߣ߽ߦჇടะࠍ␜ߒߚ৻ޕᣇߢᚳᐔ⊹ ች㗪ㇱߣㇱ㧕ߦಽߌߡ⚵❱ߦⷰኤߔࠆߎ ≸ߪሶች㗪ㇱߩ 63㧑ࠍභࠆ߇ⷰޔኤᦼ㑆ߢ ߣࠍ⋡⊛ߣߔࠆޕ ࠆ 1993 ᐕ߆ࠄ 2005 ᐕߩ㑆ߦჇടะࠍ ߥ߆ߞߚޕ⣼≸ߦߟߡߪޔሶች㗪ㇱߣሶ ችㇱߩᐕ㦂⺞ᢛ⟕ᖚ₸㧔ੱญ 10 ਁኻ㧕ߪ 㧞㧚ᣇᴺ ߘࠇߙࠇ 1993 ᐕߦߪ 0.9ޔ3.0 ߢߞߚ߇ޔ ╙㧟ᰴኻ߇ࠎ✚วᚢ⇛⎇ⓥᬺ⟕ࠎ߇ޟ ᖚᱫേะߩታᘒᛠីߦ㑐ߔࠆ⎇ⓥ⃰ޠ㧔ో 2005 ᐕߦߪ 1.5ޔ5.8 ߦߘࠇߙࠇߒߚޕ ࿖߇ࠎ⟕ᖚࡕ࠾࠲ࡦࠣ㓸⸘㧕ߦࠃߞߡ㓸 Ფᐕߩᄌൻഀว㧔APC㧕ߪሶች㗖ㇱߢߪ 4.4㧑 ߐࠇߚో࿖ߩၞ߇ࠎ⊓㍳ߩ߁ߜޔሶች߇ࠎ 㧔95㧑ା㗬㑆㧦2.3㧘6.5㧕ޔሶችㇱߢߪ 㧔⊹ౝ߇ࠎࠍ㒰ߊ㧕ߦߟߡ 1993 ᐕ߆ࠄ 5.5㧑㧔95㧑ା㗬㑆㧦4.6㧘6.3㧕ߢߞߚޕ 2005 ᐕߩᐕᰴផ⒖ࠍⷰኤߢ߈ࠆၞࠍ ߒ⸃ޔᨆߩኻ⽎ߣߒߚޕߒߚၮḰߪޔDCN 㧠㧚⠨ኤ 㧔Death Certificate Notification㧕ߣ DCO ሶች㗪ㇱޔሶችㇱߣ߽ߦ⣼≸ߩᐕ㦂⺞ᢛ 㧔Death Certificate Only㧕ࠍ↪ޔᒰߔ ⟕ᖚ₸߇Ⴧടߒߡࠆߎߣ߇ၞ߇ࠎ⊓㍳ߩ ࠆ 11 ߩၞߣߒߚޕᐕ㦂⺞ᢛ⟕ᖚ₸ߪޔᤘ ࠺࠲߆ࠄࠄ߆ߦߥߞߚޕ 60 ᐕ㧔1985 ᐕ㧕ੱญࡕ࠺࡞ࠍ↪ߡ⋥ធ ሶች㗪ㇱߣሶችㇱߢߪ∉ቇ߇⇣ߥࠆߚ ᴺߦߡ᳞ߚޕ ޔಽߌߡⷰኤߔࠆߎߣߪ㊀ⷐߢࠆޕᱫ ߹ߚᐕᰴផ⒖ߩะߪޔᐕ㦂⺞ᢛ⟕ᖚ₸ࠍ ⛔⸘ߢߪ ޔሶ ች߇ࠎ ߢ 㗪ㇱ㧔C53㧕 ߣㇱ Joinpoint regression model㧔Joinpoint 3.4 㧔C54㧕ߩ߶߆ߦሶችㇱਇ㧔C55㧕ߩභ ࡄ࠶ࠤࠫ㧕 ࠍ↪ߚᲤᐕߩᄌൻഀว ࠆഀว߇㜞ߊޔᱜ⏕ߦ㗪ㇱߣㇱߩ․ᓽࠍ 㧔APC㧦Annual Percent Change㧕ߣ 95㧑 ᛠីߔࠆߎߣ߇࿎㔍ߢࠆ߇⟕ޔᖚ࠺࠲ߦ ା㗬㑆ࠍផቯߒߚޕ 㧟㧚⚿ᨐ ሶች㗪ㇱߦߟߡ߽ᦨޔᄙ⚵❱ဳߪᚳᐔ ߟߡߪᱫ࠺࠲ߦᲧߴߡሶችㇱਇߩ ഀว߇ૐߊ∉ࠅࠃޔቇࠍ⚦ߦᛠីߢ߈ࠆޕ ታ㓙ߦᧄ⎇ⓥߩኻ⽎⠪ߩ߁ߜሶችㇱਇߩ ഀวߪ 8㧑ߣૐ߆ߞߚޕ ⊹≸㧔squamous cell carcinoma㧕ߢߞ ߇ࠎ⊓㍳ߩ࠺࠲ࠍᵴ↪ߒߡ∉ቇࠍᛠី *ᩔᧁ⋵┙߇ࠎࡦ࠲ ޥ320-0834 ቝㇺችᏒ㓁ධ 4-9-13 94 ߔࠆߎߣߪሶች߇ࠎߦ߅ߡߪ․ߦ㊀ⷐߢ ࠆޕᓟ߽⾰ߩ㜞ၞ߇ࠎ⊓㍳࠺࠲ࠍⓍ ߺ㊀ߨࠎ߇ޔኻ╷㧔ᬌ⸻߿߇ࠎ੍㒐ኻ╷㧕ߦ ߐࠄߦᵴ↪ߐࠇࠆߴ߈ߣᕁࠊࠇࠆޕ 95 ᣣᧄߩၞ߇ࠎ⊓㍳ቶߦ߅ߌࠆో▤ℂភ⟎ߩ⁁ ㊁ ༀ৻* ᧻↰ ᥓᄢ ᩊ↰ Ꮧሶ ⮮↰ ቇ ጟ Ꮧሶ ਣ ⍮⟤ ᧁ ༑ሶ ῳᳯ ቁ 㧝㧚⢛᥊ ㍤ߣߞߚ‛ℂ⊛ో▤ℂኻ╷ߦߟߡ㆐ᚑ ੱᖱႎࠍᖚ⠪ᖱႎࠍขࠅᛒ߁ၞ߇ ₸߇㜞㗄⋡߇Ყセ⊛ᄙ৻ᣇߢⷙߦ․ޔ⒟ ࠎ⊓㍳ߢߪ࠲࠺ޔ㓸▤ޔℂ⸃ޔᨆޔ↪ 㘃߿ᬺ⸥㍳ߩᚑߦ㑐ߔࠆߊߟ߆ߩ㗄⋡ ߩฦᲑ㓏ߦ߅ߡᔅⷐߥో▤ℂភ⟎ࠍ⻠ߕ ߩ㆐ᚑ₸߇ૐ߆ߞߚޕ ࠆߎߣ߇ਇนᰳߢࠆ߇ࠊޕ࿖ߩၞ߇ࠎ⊓ 㧠㧚⠨ኤ ᧄ⺞ᩏߩ⚿ᨐࠃࠅࠊ߇࿖ߩၞ߇ࠎ⊓㍳ቶ ㍳ߦ߅ߌࠆో▤ℂភ⟎ߩታᘒࠍᛠីߒߐࠄ ߥࠆะࠍߪ߆ࠆߎߣࠍ⋡⊛ߣߒߡએਅߩ⺞ ߦ߅ߌࠆో▤ℂភ⟎ߩข⚵߇⊓㍳ቶ㑆ߢᄢ ᩏࠍታᣉߒߚޕ ߈ߊ⇣ߥࠆน⢻ᕈ߇ࠄ߆ߣߥࠅߦ․ޔ㆐ᚑ ഀว߇ૐ⊓㍳ቶߦኻߒߡߩᛛⴚ⊛⽷ޔ⊛ 㧞㧚ᣇᴺ ᡰេ߇ᔅⷐߣ⠨߃ࠄࠇࠆ৻ޕᣇߢ⺞ᧄޔᩏߩ ᐔᚑ 21 ᐕ 9 ߦ╙ 3 ᰴኻ߇ࠎ✚วᚢ⇛⎇ ߊߟ߆ߩ⸳ߢߪ㆐ᚑߣߺߥߐࠇࠆၮḰ߇ ⓥᬺ⟕ࠎ߇ޟᖚᱫേะߩታᘒᛠីߦ㑐 ߹ߥߚߦ࿁╵⠪ߩ⸃㉼ߦࠃࠆᓇ㗀ࠍ ߔࠆ⎇ⓥ߇⃰ޠታᣉߒߚޟၞ߇ࠎ⊓㍳ߩᮡ ฃߌߚߣផ᷹ߐࠇ⸳ߩࠄࠇߎޔߦ㑐ߒߡߪ Ḱൻߣ♖ᐲะߦ㑐ߔࠆ╙ 3 ᦼ೨⺞ᩏߦޠ ⺑㗄ߩㅊട߿⹏ଔၮḰ߇⏕ߣߥࠆࠃ߁ ߅ߡޔฦၞ߇ࠎ⊓㍳ቶߩᯏኒᜬߩ⁁ᴫ ߥᢥ┨ߩᡷ⸓ࠍⷐߔࠆޕၞ߇ࠎ⊓㍳ቶߦ߅ ߦ㑐ߔࠆࠕࡦࠤ࠻⺞ᩏࠍታᣉߒߚޕห⎇ⓥ ߌࠆో▤ℂភ⟎ߩะࠍߪ߆ࠆߚߦߪౝ ⃰߇ᚑߒߚޟၞ߇ࠎ⊓㍳ߦ߅ߌࠆో▤ ㇱ߅ࠃ߮ᄖㇱߦࠃࠆቯᦼ⊛ߥ⹏ଔ߇㊀ⷐߢ ℂភ⟎ࡂࡦ࠼ࡉ࠶ࠢ╙ 1 ߦޠឝタߐࠇߡ ࠅߦ․ޔౝㇱ⹏ଔߩߚߩ⸻ᢿ⹏ଔ↪࠷ ࠆో▤ℂភ⟎࠴ࠚ࠶ࠢࠬ࠻ߦᴪߞߡ 128 ࡞ߩ㐿⊒ߪ↪ߢࠆߣ⠨߃ࠄࠇࠆޕ 㗄⋡ߩ㆐ᚑ⁁ᴫߦߟߡ⾰ࠍⴕ⺞ޔᩏᤨ ὐߢၞ߇ࠎ⊓㍳ࠍታᣉߒߡࠆ 35 ᐭ⋵ 1 Ꮢߩోߡ߆ࠄ࿁╵ࠍᓧߚޕ 㧟㧚⚿ᨐ ᒛណ㍳ࠍ㒰ߊ 115 㗄⋡ߦ㑐ߒߡฦ⊓㍳ቶ ߩ㆐ᚑ⁁ᴫߪ 4.3㧑߆ࠄ 100㧑ߣᄢ߈ߥ߫ࠄ ߟ߈ࠍߚోޕߩ 80㧑એߩ⊓㍳ቶ߇㆐ ᚑߒߡߚ㗄⋡ߪ 17 㗄⋡ޔ30㧑ᧂḩߩ⊓㍳ ቶߩߺ߇㆐ᚑߒߡߚ㗄⋡ߪ 19 㗄⋡ߢߞ ߚోޕߦ⊓ޔ㍳ߥߤߩ⚕ᇦߩ▤ޔᣉ *ችၔ⋵┙߇ࠎࡦ࠲⎇ⓥᚲ ޥ981-1293 ฬขᏒᗲፉႮᚻሼ㊁↰ጊ 47-1 96 ࡑ࡞ࠦࡈࡕ࠺࡞ߦࠃࠆ߇ࠎᖚ⠪੍ᓟߩ⸃ᨆ 㧙㐳ፒ߇ࠎ⊓㍳ࠍ↪ߡ㧙 ၳ ⧘ਭ⟤* ᄢ㊁ ࠁ߁ሶ ᷡ᳓ ⍮ሶ ᣧ↰ ߺߤࠅ 㒻ጊ ᤘᒾ ၞ߇ࠎ⊓㍳ߩᓎഀߩ৻ߟߦ߇ࠎᖚ⠪ߩ ߇ࠎ⟕ᖚ⠪ߩ੍ᓟߪ↢ޟሽޠ ޟᱫ ߩޠ2 ↢ሽ₸ߩ▚߇ࠆߪࠇߎޕ㐳㑆߇ࠎ߇ ⁁ᘒߒ߆ⷰኤߢ߈ߥ߇⎇ᧄޔⓥߦ߅ߡ ᱫ࿃ߩ╙৻ࠍභߡࠆᣣᧄߦ߅ߡޔ ߪ↢ޟሽޟޠ∛ޟ߇ޠᴦ≹ ߩޠ2 ⁁ᘒߩ ᴦ≮ᛛⴚߥߤ߇ࠎක≮ኻ╷ߩ⹏ଔࠍ␜ໂ ᖚ⠪⟲߆ࠄߥࠆߣߒߡޟߦࠇߎޔᱫࠍޠ ߔࠆ㊀ⷐߥᜰᮡߢࠆ↢ߩࠎ߇ޕሽ₸߇ᤨ ട߃ߚ 3 ⁁ᘒࡑ࡞ࠦࡈࡕ࠺࡞ࠍቯߒߚޕ ઍߦࠃߞߡߤߩࠃ߁ߦᄌൻߒߡࠆ߆ࠄ ▚ߒߚታ᷹↢ሽ₸ࠍ߽ߣߦฦ⁁ᘒ߳ߩផ ߆ߦߔࠆߚߦޔએ೨ࠃࠅ⛔⸘ࡕ࠺࡞ࠍᒰ ⒖⏕₸ࠍផቯߒߚߩ࡞࠺ࡕޕᒰߡߪ߹ࠅߩ ߡߪࠆᣇᴺ߇⹜ߐࠇߡ߅ࠅࡕࡈࠦ࡞ࡑޔ ⦟ߐߪታ᷹↢ሽ₸ߣࡕ࠺࡞ߦࠃࠆផቯ↢ሽ ࠺࡞ߩ↪߽ߎߩ߁ߜߩ৻ߟߢࠆ⎇ᧄޕ ₸ߩ⺋Ꮕᐔᣇߢ⹏ଔߒߚޕ ⓥߢߪ⟕ࠎ߇ޔᖚ⠪ߩ੍ᓟߦߟߡ 3 ⁁ᘒ ࡑ࡞ࠦࡈࡕ࠺࡞ࠍቯߒޔ㐳ፒ߇ࠎ⊓㍳ࠍ ᦼ㑆ޔㇱ⥃ޔᐥㅴⴕᐲߦ㑐ࠊࠄߕ߶ߣ ↪ߡᤨઍߦ↢ሽ₸ࠍಽᨆߒޔᴦ≮ᛛⴚ ࠎߤߩ႐วߢ 2 ⁁ᘒࡕ࠺࡞ࠃࠅ 3 ⁁ᘒࡕ࠺ ߩᄌൻᜰᮡߣߒߡࡑ࡞ࠦࡈࡕ࠺࡞ࠍ↪ࠆ ࡞ߦ߅ߡᒰߡߪ߹ࠅ߇ࠃ߆ߞߚޕ࿑ߦߪ ߎߣߩലᕈࠍᬌ⸛ߒߚޕ ⢖߇ࠎ㒢ዪᖚ⠪ߩ႐วࠍ␜ߔ⚿ߩߎޕᨐ߆ ࠄ೨ᦼޔᓟᦼߩޟࠄ߆ޠ∛ޟᴦ≹ߩ߳ޠ ኻ⽎ߪ 1985 ᐕ߆ࠄ 1997 ᐕߦ㐳ፒ⋵߇ࠎ ផ⒖⏕₸ࠍ 3 ⁁ᘒࡕ࠺࡞ࠍ↪ߡផቯߒߚޕ ⊓㍳ߦ⊓㍳ߐࠇߚ߇ࠎᖚ⠪ߢߜ߁ߩߘޔᱫ ⢖߇ࠎߩ႐วߪ₸⏕ߩߘޔ೨ᦼޔᓟᦼߢߘ ᖱႎߩߺߢ⊓㍳ߐࠇߚ߽ߩޔౣ⊒߇ࠎߢ ࠇߙࠇ 0.0805ޔ0.1007 ߢࠅޔᓟᦼߢ ⊓㍳ߐࠇߚ߽ߩ⸻ޔᢿ㗅߇ 2 ⇟એ㒠ߩ߽ ߒߡߚޕ3 ⁁ᘒࡑ࡞ࠦࡈࡕ࠺࡞ߦ߅ߌ ߩޔ⊹ౝ߇ࠎߩ߽ߩࠍ㒰ߚ 72,223 ฬ ࠆޟࠄ߆ޠ∛ޟᴦ≹ߩ߳ޠផ⒖⏕₸ޔ 㧔1ï ߣߒߚޕ1985ï ᐕࠍ೨ᦼޔ1992ï ޟᱫ₸⏕ޠ㧕ߥߤߪ߇ࠎක≮ᛛⴚߩᄌൻ ᐕࠍᓟᦼߣߒߡᦼ㑆ߏߣߦ↢ሽ₸ࠍ⸘▚ߒ ࠍ␜ໂߔࠆ߽ߩߣ⠨߃ࠄࠇઁޔㇱߢ߽೨ ߚ↢ޕሽ₸ߪታ᷹↢ሽ₸ࠍ↪ࠆߎߣߣߒ ᦼߦᲧߴᓟᦼߩᣇ߇ߎࠇࠄߩᢙ୯ߪᡷༀߒ Kaplan-Meier ᴺߢ▚ߒߚ⸃ޕᨆኻ⽎ㇱ ߡߚޕ ߪਥⷐ 5 ㇱߣߒޔฦㇱߦߟߡਇ ࠍߚోㅴⴕᐲޔ㒢ዪޔ㗔ၞᶐẢޔ㆙㓒 ォ⒖ߏߣߦ↢ሽ₸ࠍ▚ߒߚޕ *ᄢ㒋ᄢቇᄢቇ㒮කቇ♽⎇ⓥ⑼ ޥ565-0871 ᄢ㒋ᐭ็↰Ꮢጊ↰ਐ 1-7 97 ࿑ ⢖߇ࠎ㒢ዪᖚ⠪ߩ੍ᓟ 98 ࠺࠲ಽᢔ▤ᛛⴚࠍ↪ߚ߇ࠎ⊓㍳࠺࠲ ోߩߚߩታ⸽⹜㛎 ਃ ᤐᄦ* 㧝㧚⋡⊛ ࠹ࠬ࠻࠺࠲ߢࠅޔฦᚲߩࠗࡦ࠲ࡀ࠶࠻ 㐳ᦼߦࠊߚࠆ߇ࠎ⊓㍳࠺࠲ࠍో߆ߟᱜ ࿁✢ࠍ↪ߒߚޕ ⏕ߦᰴઍߦ⛮ᛚߔࠆߎߣߪ㐳ᦼ⛔⸘ߩၮ⋚ ⊛ᛛⴚߢࠆߦ․ޕᣣᧄߪ㔡࿖ߢࠅޔᄢ 㧟㧚⚿ᨐ ⷙᮨἴኂ߿Ἣἴ╬ߦࠃࠆ࠺࠲ᶖᄬ߳ߩኻ╷ 1. ࠺࠲▤ޔᓳరޔᢛวᕈ⏕ ߣߒߡᐢၞಽᢔ▤ߩᛛⴚ⊛ⷐઙߦߟߡᬌ ᗐቯߒߚߕࠇߩࠤࠬߢ߽▤ᓳర࠺ ⸛ߔࠆᔅⷐ߇ࠆޕ࿁ታᣉߩታ⸽⹜㛎ߦ߅ ࠲ߩ৻⥌߇⏕ߐࠇߚޕ ߡߪޔችၔ⋵߇ࠎ⊓㍳ޔජ⪲⋵߇ࠎ⊓㍳ޔ 2. ࠺࠲ォㅍㅦᐲ ᄹᎹ⋵߇ࠎ⊓㍳ߩ 3 ࠞᚲߦੱᖱႎࠍߞ ಽഀಽᢔ▤ቢੌ߹ߢߩᚲⷐᤨ㑆ߪޔታ ߐ߹ߥ⹜㛎࠺࠲ࠍ↪ᗧߒ߅ޔઁ ᣉⅣႺߢ 10MB ߚࠅ⚂ 1 ಽߣޔታ↪ߦචಽ ߩ㧞ၞߩ࠺࠲ࠍㇱಽ⊛ߦᜬߒߚޕἴኂ ⠴߃߁ࠆᤨ㑆ߢߞߚ߷߶ޔߚ߹ޕኈ㊂ߦᲧ ࠍᗐቯߒߡ 1 ࠞᚲߩ࠺࠲ࠍ㒰ߒߩઁޔ㧞 ߒߡޔಽഀಽᢔ▤ߩᚲⷐᤨ㑆߇Ⴧടߒ ၞߦ▤ߒߚ࠺࠲ࠃࠅౣߒߚ࠲࠺ޕ ߚޕᓟኈ㊂߇Ⴧ߃ߚ႐วߩᚲⷐᤨ㑆੍߽᷹ ᓳరߩ㓙ߩࠠࡘ࠹ࠖࠦࡦ࠻ࡠ࡞ߪ IC น⢻ߢߞߚߩ࠲࠺▤ޕઍ▤ℂߦ߅ ࠞ࠼ߦࠃࠅ↪⸵⻌▤ℂࠍⴕߞߚߩߢႎ๔ ߡߪޔછᗧߩ㗅ᐨߢછᗧߩઍ߳ᓳᏫน⢻ߢ ߔࠆޕ ߞߚޕ 㧞㧚ᣇᴺ ࿁ߩಽᢔ▤ታ⸽⹜㛎ߦ߅ߡߪ㆙㓒 1 ࿁⋡ 2 ࿁⋡ 3 ࿁⋡ 4 ࿁⋡ 5 ࿁⋡ ߦ⟎ߔࠆၞ߇ࠎ⊓㍳ቶ߇⋧ߦ࠺࠲ߩ ▤ 3’9” 2’39” 2’34” 2’51” 2’46” ৻ㇱಽࠍᜬߜว߁ᒻᘒࠍᗐቯߒߚޕන⚐ߦ ᓳర 1’1” 1’1” 1’1” ᷹ቯߖߕ ᷹ቯߖߕ ߩࡃ࠶ࠢࠕ࠶ࡊࠍᜬߜว߁႐วߦߪ․ޔቯ 100MByte㧔ᄹᎹ⋵߇ࠎࡦ࠲㧕 ߇ࠎ⊓㍳ታᣉ⋵ߩᖚ⠪࠺࠲ࠍઁၞߩ߇ࠎ 1 ࿁⋡ ⊓㍳ቶߦᷰߒߡߒ߹߁ߣ߁ක≮ᖱႎ⼔ ߩ㗴߇ࠆࠍ࠲࠺ࡊ࠶ࠕࠢ࠶ࡃߢߎߘޕ ࠄࠇߚࡠࠫ࠶ࠢߦࠃࠅࡆ࠶࠻නߢಽഀ ▤ 8’55” ᓳర 5’10” 300MByte㧔ችၔ⋵߇ࠎࡦ࠲㧕 ߒߩࡓ࠹ࠬࠪޔᯏ⢻ࠍ↪ߕߦߪ࠺࠲ߩᓳ 1 ࿁⋡ రࠍਇน⢻ߣߒߩߘޔߢ࠺࠲ߦ౬㐳ᕈࠍ ᜬߚߖߡⶄᢙၞߦಽഀ▤ߔࠆ⚵ߺࠍߣ ▤ 25’11”⑽ ߞߚ࠲࠺ޕ࿁✢ߦߟߡߪታㆇ↪ߩ㓙ߪశ ᓳర 19’57”⑽ ࿁✢ࠍ↪ࠆߎߣࠍᗐቯߒߡࠆ߇ޔ࿁ߪ *ජ⪲⋵߇ࠎࡦ࠲⎇ⓥዪ߇ࠎ੍㒐ࡦ࠲ ޥ260-8717 ජ⪲Ꮢਛᄩੳᚭฬ↸ 666-2 99 㧠㧚⠨ኤ ࡃ࠶ࠢࠕ࠶ࡊ㊂ߩჇᄢߣ㆙㓒߳ߩ࠺࠲ 㧡㧚⚿⺆ ៝ㅍᚻᲑ߅ࠃ߮ࠦࠬ࠻ߪ⋧ߔࠆⷐઙߢࠆ ࠬߩ⛮⛯ᕈߣ⠴㓚ኂᕈࠍ㜞ࠆߚߦ࠺࠲ ߇߿࠻࠶ࡀ࠲ࡦࠗޔ㜞ㅦㅢା✂ߩ⊒㆐ߦࠃ ࡃ࠶ࠢࠕ࠶ࡊߦࠃࠆ࠺࠲ోߩⷐ᳞ߪ߹ߔ ࠅߎࠇࠄߩⷐઙߪ✭ߐࠇߟߟࠆޕ ߹ߔ㜞߹ࠆߎߣ߇੍᷹ߐࠇࠆߦࠄߐޕ㔡ἴ߿ 㐳ᦼ⛔⸘ߣߒߡߩၞ߇ࠎ⊓㍳࠺࠲ࡌ ࠺࠲ߩಽᢔ▤ߢߪ 1 ࠞᚲߦో࠺࠲ࠍ Ἣἴߣߞߚᄢⷙᮨἴኂߦኻߔࠆ࠺࠲ో 㓸ਛ▤ߒߥߚޔવㅍ⚻〝ߣ▤వߩ ߩᚻᲑ߇᳞ࠄࠇߡࠆޕ࿁ߩታ⸽⹜㛎ࠍ ᣇߢ࠺࠲߇ᓳภߐࠇࠆߎߣ߇ߥޕᓳภߪ ㅢߓߡ࠺࠲ߩᐢၞಽᢔ▤ᛛⴚ߇ࠠࡘ ᮡḰൻߐࠇߚ IC ࠞ࠼ࠠࡘ࠹ࠖߦࠄ ࠹ࠖߣ⠴㓚ኂᕈࠍਔ┙ߒߚ⸃ᣇᴺߣߥࠆน ࠇ⻌⸵ޔᮭ㒢ࠍߔࠆ߽ߩߩߺ߇⥄ၞએᄖ ⢻ᕈࠍ␜ߒߚޕ ߩࠨࠗ࠻ߢᓳరน⢻ߢࠆޕ᧪ⶄᢙߩၞ ߩၞ߇ࠎ⊓㍳߇ෳടߒ⋧ޔߦಽᢔ▤ߦ ෳടߒߚ႐วޔ㔡ߥߤߩἴኂߦ⠴߃ࠆో ߥ࠺࠲ో߇ో࿖ⷙᮨߢน⢻ߣߥࠆ▤ޕ ࠺࠲ߩࡈࠔࠗ࡞ᒻᑼߦଐሽߒߥሽ߽ᧄ ᴺߩὐߢࠆޕ 100 ߇ࠎ⊓㍳ߣ␠ળߣߩ⺞ 㧛JACR MONOGRAPH No. 16 ᐔᚑ 22 ᐕ 12 1 ᣣ ✬ 㓸 ╙ 1 ⊒ⴕ㧔㕖ᄁຠ㧕 ߅߆߽ߣ ߥ߅ ࠁ߈ ߟ ߊ߹ ߭ߢ߈ ߣ߁ ߭ ߢߺ ߣ߁ ߓ ߈ ࠊ ߈ ߎ ጟᧄ ⋥ᐘ㧘દ⮮ ⑲⟤㧘દ⮮ ࠁࠅ㧘ᧁ ༑ሶ㧘 ᵤᾢ ⑲ ⊒ ⴕ ᵤᾢ ⑲ ․ቯ㕖༡ᵴേᴺੱၞ߇ࠎ⊓㍳ో࿖ද⼏ળ ᧲੩ㇺਛᄩᣣᧄᯅ 3-2-14 ᣣᧄᯅ KN ࡆ࡞ 4F ޥ103-0027 ශᚲ TEL 03-5201-3867 FAX 03-5201-3712 ࡈࠚ࠺࠶ࠢࠬࠠࡦࠦ࠭ࠫࡖࡄࡦᩣᑼળ␠ ࡈࠚ࠺࠶ࠢࠬࠠࡦࠦ࠭᧲㌁ᐳᐫ ᧲੩ㇺਛᄩ㌁ᐳ 7-14-16 ᄥ㓁㌁ᐳࡆ࡞ 1F ޥ104-0061 ISBN 978-4-925059-16-9 Japanese Association of Cancer Registries