Introduction

The global cancer burden has risen to 18.1 million cases and 9.6 million cancer deaths in 2018 [1]. Cancer incidence and mortality are rapidly growing worldwide. The reasons are complex but reflect both aging and growth of the population, as well as changes in the prevalence and distribution of the main risk factors for cancer [2].

In Korea, cancer accounts for one in four deaths and more than 200,000 new cancer cases were diagnosed in 2015 [3]. The number of cancer incidences and deaths are expected to increase with an aging population and westernized lifestyles [4].

In this context, cancer statistics are the most important indicator to assess the national cancer burden, which can be used to establish cancer control strategies. This article aimed to provide nationwide cancer statistics including incidence, survival, prevalence, and mortality in 2016.

Materials and Methods

1. Data sources

The Korea Central Cancer Registry (KCCR) was established by the Ministry of Health and Welfare in 1980 as a nationwide hospital-based cancer registry. Since 1999, the KCCR has collected cancer incidence data nationwide by integrating a nationwide hospital-based KCCR database with data from regional cancer registries. The KCCR currently provides the nationwide cancer incidence, survival, and prevalence statistics annually [5].

The KCCR built the Korea National Cancer Incidence Database (KNCI DB) from hospitals, 11 population-based registries, and additional medical record reviews. The KNCI DB contains information regarding age, sex, region, date of diagnosis, primary cancer site, histological type, most valid diagnostic method, summary stage of surveillance, epidemiology and end results program (SEER) and first course of treatment within four months after diagnosis. The completeness of cancer incidence data for 2016 was estimated to be 98.2% based on the method proposed by Ajiki et al. [6]. The mid-year population and cancer mortality data from 1983 to 2016 were obtained from Statistics Korea [7]. To ascertain vital status and to calculate survival and prevalence, the KNCI DB was linked to mortality data and population registration data from the Ministry of the Interior.

2. Classification

All incidence cases were registered according to the International Classification of Diseases for Oncology, third edition [8] and converted to the International Classification of Diseases, 10th edition (ICD-10) [9]. The mortality cases were registered according to ICD-10. All cancer cases were reported based on the 24 cancer types.

3. Statistical analyses

Rates were expressed as crude and age-standardized rates (CR and ASR, respectively) per 100,000 individuals. The CR was calculated as the total number of incidence/mortality cases divided by the mid-year population of the specified years. The ASR is a weighted average of the age-specific rates, where the weights are the proportions of persons in the corresponding age groups of a standard population [10]. In this report, ASRs were calculated using Segi’s world standard population [11]. The cumulative risk of developing cancer from birth to life expectancy was calculated using cumulative rates; that is, the sum of the age-specific rates from birth to life expectancy, as follows [12]:

Trends in ASRs were summarized as an annual percentage change (APC) by using a Joinpoint regression. APC is the average percentage change of ASRs and is calculated as follows [10]:

, where log(R_y)=b₀+b_1y,

log(R_y) is the natural log transformed age standardized rates.

y=year, b₀=intercept, b₁=slope

The survival duration for each cancer case was determined as the interval between the date of initial diagnosis and the date of death, date of loss of follow-up, or closing date for follow-up, whichever came first. The 5-year relative survival rate was calculated as the ratios of the observed survival of the cancer patients to the expected survival of the general population, which was derived from the standard life table provided by Statistics Korea. Trends in 5-year relative survival rates were evaluated as percentage differences in 5-year relative survival rates from 1993-1995 and 2012-2016. Relative survival rates were calculated using the Ederer II method [13] with some minor corrections, based on an algorithm by Paul Dickman [14].

Prevalent cases were defined as the number of cancer patients alive on January 1, 2017 among all cancer patients diagnosed between 1999 and 2016. Limited-duration prevalences were calculated using SEER*Stat software. Any p-values less than 0.05 were considered statistically significant. SEER*Stat 8.1.2 (National Cancer Institute, Bethesda, MD), Joinpoint 4. 1. 1 (National Cancer Institute), and SAS ver. 9.4 (SAS Institute, Cary, NC) were used for statistical analysis.

Selected Findings

1. Incidence

A total of 229,180 cancer cases were newly diagnosed in 2016, which included 120,068 men (52.4%) and 109,112 women (47.6%) (Table 1). Stomach cancer was the most commonly diagnosed cancer in 2016, followed by colorectal, thyroid, lung, and breast cancer. The overall cumulative risk of developing cancer from birth to life expectancy was 36.2%. The cumulative risk of developing cancer from birth to life expectancy was higher in men (38.3%) than in women (33.3%) (data not shown).

The total CR and ASR for overall cancer incidences in 2016 were 448.4 and 269.0 per 100,000, respectively (Table 2). According to sex, CRs for all sites combined were 470.3 per 100,000 in men and 426.5 per 100,000 in women. The ASRs were 298.0 and 254.6 per 100,000 in men and women, respectively. Stomach cancer (CR, 80.3 per 100,000) was the most common cancer in men, followed by lung (CR, 69.7 per 100,000), colorectal (CR, 65.3 per 100,000), prostate (CR, 46.2 per 100,000), and liver cancer (CR, 46.1 per 100,000). These five cancers accounted for 65.4% of newly diagnosed cases in men during the study period. In contrast, breast cancer (CR, 85.0 per 100,000) was the most common cancer among women, followed by thyroid (CR, 80.2 per 100,000), colorectal (CR, 44.8 per 100,000), stomach (CR, 39.1 per 100,000), and lung cancer (CR, 31.2 per 100,000). These five cancers accounted for 65.7% of cases in women.

2. Mortality

The total number of deaths from cancer in 2016 was 78,194, accounting for 27.8% of all deaths (Table 3). According to sex, 61.7% and 38.3% of cancer deaths occurred in men and women, respectively (Table 1).

The total CR and ASR for cancer deaths were 153.0 and 79.8 per 100,000, respectively, in 2016 (Table 4). The total CR and ASR for cancer deaths per 100,000 were higher among men (CR, 188.8; ASR, 115.5) than in women (CR, 117.2; ASR, 53.6).

According to the cancer sites, lung cancer (CR, 52.2 per 100,000) was the leading cause of death in men, followed by liver (CR, 31.5 per 100,000), stomach (CR, 20.8 per 100,000), colorectal (CR, 18.3 per 100,000), and pancreatic cancer (CR, 11.4 per 100,000). The top five causes of deaths from cancer in women included lung (CR, 18.1 per 100,000), colorectal (CR, 14.5 per 100,000), liver (CR, 11.6 per 100,000), stomach (CR, 11.5 per 100,000), and pancreatic cancer (CR, 10.6 per 100,000).

3. Trends in cancer incidence and mortality

Fig. 1 shows trends in cancer incidence and mortality from 1983 to 2016. The ASR for all-cancer incidence increased by 3.6% annually from 1999 to 2011, and then started to decrease from 2011 to 2016 (APC, –3.1%) (Table 5). Cases of stomach, colorectum, lung, and thyroid cancers started to decrease around 2011. Specifically, ASR for thyroid cancer increased rapidly to 22.6% from 1999 to 2011, but then decreased swiftly by 12.6% annually starting in 2011. The incidence of breast cancer increased constantly throughout the period; however, the APC slowed from 2005 onward. Conversely, the incidence rates of cervix and liver showed a constant decrease for the whole period. Thyroid cancer decreased the most drastically starting in the early 2010s (Fig. 2).

The ASR for all-cancer mortality rate increased until 2002 (Table 6). After that year, it started to decrease (2002-2016; APC, –2.7%). The same patterns were evident in men and women. Cancer incidence at most sites, including the cervix uteri, thyroid, liver, gallbladder, lung, brain and central nervous system, and colorectum started to decrease in the early 2000s. Furthermore, cancers of the lips, oral cavity and pharynx, esophagus, stomach, larynx, and non-Hodgkin lymphoma decreased from 1999. Breast cancer showed constant increasing trends for the whole period (Fig. 3).

4. Age-specific incidence rates

Leukemia was the most commonly diagnosed cancer among children between 0-14 years of age. Thyroid cancer was the most common cancer among adolescents and young adults between 15 and 34 years of age (Table 7). Stomach cancer was the most commonly diagnosed cancer among men aged 35 to 64 years, while lung cancer was the most common among men aged 65 years and above (Fig. 4A). In contrast, breast cancer was the most commonly diagnosed cancer among women aged 35 to 64 years, while colorectal cancer was the most common among women aged 65 years and above. Thyroid and breast cancers showed an inverted U-shaped incidence rate by age (Fig. 4B).

5. Survival rates

The 5-year relative survival rates for all cancer combined improved remarkably in both sexes, from 41.2% in 1993-1995 to 70.6% in 2012-2016 (Table 8). After excluding thyroid cancer, the 5-year relative survival rates for all cancer still increased from 1999 to 2016 (Fig. 5B).

The 5-year relative survival rate during 2012-2016 for all cancer combined was 63.2% in men and 78.0% in women, respectively. The 5-year relative survival rate for thyroid cancer was over 100%, while the 5-year relative survival rates for testis, prostate, and breast cancer were over 90% in 2012-2016 for both sexes, respectively. However, the 5-year relative survival rate for pancreatic cancer was only 11.4% in both sexes in 2012-2016.

When compared to the 5-year relative survival rate for men in 1993-1995, prostate cancer diagnosed from 2012 to 2016 showed the most outstanding improvement, followed by stomach, leukemia, ‘lip, oral cavity, and pharynx,’ esophagus and liver cancer. Among women, stomach cancer diagnosed during 2012-2016 showed the greatest improvement in 5-year relative survival rates compared to those between 1993 and 1995, followed by lung, leukemia, multiple myeloma, liver, and colorectal cancer.

6. Prevalence rates

A total of 1,739,951 cancer prevalent cases were identified on January 1, 2017 (Table 1). Of these cases, 764,103 (43.9%) were men and 975,848 (56.1%) were women. The overall CR and ASR for cancer prevalence were 3,404.1 per 100,000 individuals and 2,046.2 per 100,000 individuals for both sexes, respectively, in 2016 (Table 9).

The five most common cancers for men were stomach (CR, 709.9 per 100,000), colorectal (CR, 551.8 per 100,000), prostate (CR, 304.1 per 100,000), thyroid (CR, 255.9 per 100,000), and liver cancer (CR, 190.6 per 100,000). In contrast, thyroid cancer was most common in women (CR, 1,229.7 per 100,000), followed by breast (CR, 771.0 per 100,000), colorectal (CR, 373.6 per 100,000), stomach (CR, 361.4 per 100,000), and cervix uteri cancer (CR, 206.2 per 100,000).

Analysis of the period after cancer diagnosis revealed that stomach cancer (14.1%) was the most prevalent cancer within 2 years after diagnosis, followed by thyroid (14.0%) and colorectal cancer (13.1%) (Fig. 6). Thyroid cancer (25.5%) was most prevalent for 2-5 years, followed by stomach (14.3%) and colorectal cancer (13.4%). After 5 years, thyroid cancer (23.1%) was the most prevalent cancer, followed by stomach (17.1%) and colorectal cancer (13.9%).

NOTES

Conflict of interest relevant to this article was not reported.

The Community of Population-Based Regional Cancer Registries

Chang-Hoon Kim (Busan Cancer Registry, Pusan National University Hospital), Cheol-In Yoo (Ulsan Caner Registry, Ulsan University Hospital), Yong-Dae Kim (Chungbuk Cancer Registry, Chungbuk National University Hospital), Hae-Sung Nam (Daejeon/ Chungnam Cancer Registry, Chungnam National University and Hospital), Jung-Sik Huh (Jeju Cancer Registry, Jeju National University and Hospital), Jung-Ho Youm (Chonbuk Cancer Registry, Chonbuk National University Hospital), Kyu-Hyoung Lim (Kangwon Cancer Registry, Kangwon National University Hospital), Nam-Soo Hong (Deagu/Gyeongbuk Cancer Registry, Kyungpook National University Medical Center), Sun-Seog Kweon (Gwangju/ Jeonnam Cancer Registry, Chonnam National University Hwasun Hospital), Woo-Chul Kim (Incheon Cancer Registry, Inha University Hospital), Ki Soo Park (Gyeongnam Cancer Registry, Gyeongsang National University and Hospital)

Acknowledgements

The authors would like to specially thank the tumor registrars (Health information manager) of the KCCR-affiliated hospitals and non-KCCR-affiliated hospitals for data collecting, abstracting, and coding. Additionally, we acknowledge the cooperation of the National Health Insurance Service and Statistics Korea for the data support.

This work was supported by the Health Promotion Fund, Ministry of Health & Welfare (No. 1860390) and research grant (No. 1910130) from the National Cancer Center, Republic of Korea.

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Figure & Data

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