Table Speech

Cancer Education for Adults

June 5, 2019

Dr. Keiichi Nakagawa
Director of the Department of Radiation Oncology,
the University of Tokyo Hospital

 In Japan, cancer education has started in schools but adults have no opportunities to learn about this disease. Today, I would like to share my knowledge about cancer.

 Cancer occurs more often in men than in women. Two-thirds of Japanese men get cancer, due to their unfavorable life style.

 Being a heavy drinker and having a fatty liver, I have been examining myself regularly. On December 9th last year, I happened to detect a 14-millimeter bladder cancer, though I had no symptoms such as bloody urine. I was fortunate as it was detected at a very early stage.

 Many Japanese misunderstand that cancer is a painful disease, but there are no symptoms at the early stage. Just like Ms. Kirin Kiki, a renowned film star, who passed away of breast cancer last September, cancer patients often live a normal life towards the end of their life.

 On December 28th I was operated by inserting a hot iron stick into the bladder that cauterized the cancer. I watched the whole operation as I was anesthetized only below the waist. It was extremely painful, but as neither the doctors of surgery or urology failed to give me sufficient painkiller, I prescribed some myself. Interestingly enough, a publisher came to me the following day and asked me to write a book on my experience, which is scheduled to be published in July. On New Year’s Eve I left the hospital, and on January 4th I returned to my normal work.

 Japan has the highest cancer incidence in the world, because it is the most aged society. Cancer is caused by the aging of genes and increases with advancing age. The probability of getting cancer for Japanese men is 5% by 55, but increases to 15% by 65 and 33% by 75. The highest cause of death in Japan before and during WWII was tuberculosis, and during the high economic growth period it was strokes. As our society became affluent and the nutritional status improved, tuberculosis and strokes declined but cancers keeps increasing steadily.

 Countermeasures against various illnesses in Japan is lagging behind. The WHO pointed out countermeasures against passive smoking in Japan is so poor and remains at a “prewar” level. As the cervical cancer is caused 100% by virus infection due to sexual intercourse, vaccination dramatically reduces the risk. However, now in Japan the rate of vaccination dropped to less than 1% from 70% of some years ago. Japanese women checking breast cancer by themselves is only 7%, far less than in western countries. Cancers often don’t show any symptoms till the last stage, so early detection is crucial. However, in Japan, the rate of medical checkups are half of western countries and South Korea.

 Operation and radiotherapy are two major treatments. In western countries 60% of cancer patients undergo radiotherapy, but in Japan only less than 30%. Medical narcotics or opioids are the last resort for patients suffering extreme pains at the terminal stage, but their use is phenomenally less in Japan, maybe because of the Japanese mentality which tells that enduring pain is better for treatment.

 Every year 1.01million people are diagnosed with cancer, and over 370,000 die in Japan, which means two-thirds of cancer patients recover. If detected at the early stage, 95% of them recover. Cancer patients are now informed about their cancer almost 100%, while it was 0% 30 years ago when I started my medical practice.

 Half of the cause of death for salaried workers is now cancer and 90% of cause of death by illness while they are in active service is cancer. It is really a serious issue for the working generations. Working hours in Japan are longest in the world and the ratio of working population over 65 is 12% in comparison with 2% in Germany and 1% in France. Extension of retirement age is also giving impact to working population, as those who were diagnosed cancer as a pensioner at the age of 55 in the past are now diagnosed in active service.

 It is often said that the cancer runs in the family. But hereditary cancer is only 5%, making it almost negligible. Two-thirds of male cancers are caused by life style, of which one-third is smoking followed by drinking, obesity or underweight, lack of exercise, unbalanced diet of eating excessive amount of meat and no vegetables etc.

 The remaining one-third cause of cancer is pure luck or fate. With the damage of a DNA, genetic mutations accidentally occur. A heavy drinker and smoker who does not get cancer is just lucky. The reverse is also true, but the magnitude of the risk varies. If we compare 1,000 heavy smokers with 1,000 saints, the former has an overwhelmingly higher chance of getting cancers. If you don’t want to die of cancer, firstly you should improve your life style, particularly quit smoking, and secondly get early detection by regular health check-ups.

 I have been emphasizing the importance of cancer education in schools, and only 2 years ago it started in junior high schools and last year in senior high schools. In the future, I hope mortality by cancer will decline like in western countries, thanks to cancer education, but it will take 30 years or so. I would like you to bring back this booklet entitled “Recommendation of Cancer Checkup”, and read it through once again at home.