9Cross-boundary Cancer Studies

Date: September 19(Wed.), 2012,
The 71st Annual Meeting of the Japanese Cancer Association
Sapporo, Japan

What Should We do to Raise Awareness on the Issue ofCancer in the Global Health Agenda?
The Asia Cancer Forum has been engaging with the global health community to share information
about the current challenges for cancer in developing countries and to discuss future trends. Discussions
also focus on how we can enhance communication and cooperate in improving the global health status.
It is our intention to position our agenda as an item to be included within the next Millennium
Development Goals (MDGs) of the United Nations.
The starting point of the debates within the Asia Cancer Forum is the concept of human security. Basedon the concept of human security, we are discussing the following questions: What should we do toachieve this goal ? And, further, what items should be added to the revised MDGs ?

http://www.asiacancerforum.org/
1Preface
Asia Cancer Forum Organizer
Norie Kawahara
Scientific advancement empowers people and offers the promise of limitless possibilities and the means
to live long and health lives. The struggle against disease is one that is intrinsically linked with humanexistence, since the dawn of time. That struggle is by no means over. Cancer is now increasingly rapidly
around the world, particularly in developing countries. As gaps in medical treatment widen, in the near
future the international community will be burdened with an unjust situation in which although people
are afflicted with the same disease, some will be cured, whereas others will suffer and die, depending on
their access to medical treatment. We are faced with the question: What must we do to overcome thisgrave impending reality?
The Asia Cancer Forum has continued to engage in analysis as to why cancer has yet to attain its
rightful place in global health dialogue, and has repeatedly discussed ways that would lead to theinclusion of cancer in the Millennium Development Goals (MDGs) of the United Nations, which havesignificant influence on global health agenda priorities. With limited medical resources, the inclusionof cancer on the global health agenda is anticipated to face difficulty, particularly given the medical
treatment costs involved and cancer’s status as a non-communicable disease. However, this does notmean that we should give up the struggle.We should not forget that although it was once said that drugs
to treat AIDS would never be available in Africa, the wisdom and diligent efforts of the international
community resulted in a positive outcome for AIDS treatment in Africa. Let us not forget these shining
achievements.
The Asia Cancer Forum bases its activities on the Universal Declaration of Human Rights, which statesthat everyone has the right to share in scientific advancement and its benefits equally. Discussion on the
inclusion of cancer on the global health agenda does not stop merely at the advocacy of humanitarianprinciples. In fact, what is needed now is a move away from the linear debate such as that which
has dominated discussions of international aid in the past, and a focus on science and technology
grounded in evidence-based data. Careful and considered solutions to the current challenges faced byindustrialized nations can also be utilized in assistance to developing nations. Accordingly, it is now
necessary to establish a framework for resolving issues that face industrialized nations. Over the last 100
years of Asian history conflict has cast a profound shadow over the hearts and minds of people. In orderto overcome these scars of the past it is essential that we work to build links between developing andindustrialized nations. By taking on the daunting common challenges and setting out a roadmap for
peaceful coexistence we will have created the means to build long-lasting, unwavering peace. This is theessence of human security.

2Mission
The Universal Declaration of Human Rights states that everyone has the right to share in scientificadvancement and its benefits equally. Based on that spirit enshrined in the Declaration, with the aimof overcoming the common challenge of cancer that is faced by humanity as a whole, and linking it
to human life in the Asian region, we have attempted to bring together several types of "intelligence",
which we have subsumed as the "3Cs."
Collective IntelligencezContextual IntelligencezContinuous IntelligencezThe relationship between these three forms of modern intelligence and the activities of this forum aredescribed below.
Contextual intelligence is an intuitive skill that helps a leader align tactics with objectives to create smart
strategies in new situations. Contextual intelligence consists partly of analytic capabilities and partly oftacit knowledge built up from experience, which tends to be expressed in rules of thumb.
This is a concept expounded by Joseph Nye in his book The Powers to Lead, and this kind of intelligencerequires a top-down approach. In terms of policy challenges it leads to questions about what kind of
agenda-setting should be employed.
Collective intelligence is a shared or group intelligence that emerges from the collaboration andcompetition of many individuals.
George Pór, defined the collective intelligence phenomenon as "the capacity of human communities
to evolve towards higher order complexity and harmony, through such innovation mechanisms as
differentiation and integration, competition and collaboration."
This is a type of intelligence that supports a bottom-up approach. In the context of the Asia Cancer
Forum our attempt to create a common base for information collection by providing information onsuch topics as cancer prevention educational activities for children and women’s self-respect issues andcancer, is a part of such a bottom-up approach.
Continuous Intelligence is a new approach that derives immediate insights from fast changing, “live”
data, and determines the immediate actions front-line personnel can take to proactively solve problems,or reduce risk. This is an expression taken from IT terminology and it denotes a type of intelligence thatseeks to create driving force to link the two prior noted intelligences (contextual and collective) towards
the future, without losing or disconnecting the main aspects of these two kinds of intelligence. The Asia
Cancer Forum has used these scientific metaphors to create a concept note on this issue, as seen below.

3

The 8th Asia Cancer Forum:
Seeking to Advance the Outcomes of the UN Summit—“Global health as the key to a new paradigm in cancer research”

Norie Kawahara1, Hideyuki Akaza1, Jae Kyung Roh2, Kenji Shibuya3,
Hajime Inoue4, Keizo Takemi5, Shinjiro Nozaki6, Koji Kawakami7, Masaru Iwasaki8
1

Department of Strategic Investigation on Comprehensive Cancer Network, Research Center for Advanced Science andTechnology (RCAST), the University of Tokyo; 2Yonsei University College of Medicine, Republic of Korea; 3Graduate Schoolof Medicine and Faculty of Medicine, The University of Tokyo; 4Department of Health and Welfare, Chiba Prefecture;
5
Japan Center for International Exchange; 6The Global Health Workforce Alliance; 7Graduate School of Medicine and Public
Health, Kyoto University; 8 University of Yamanashi,.
Corresponding author: Norie Kawahara
Institution name: Department of Strategic Investigation on Comprehensive Cancer Network, ResearchCenter for Advanced Science and Technology (RCAST)
Address of the institution: 4-6-1 Komaba, Meguro-ku, Tokyo, 153-8904 JAPAN
Email address: norie.kawahara@med.rcast.u-tokyo.ac.jp
Running title: The 8th Asia Cancer Forum

ABSTRACTTo date the Asia Cancer Forum has focused its efforts on creating a common concept forcollaborative efforts in international cancer research with a focus on Asia, where cancer
incidence is rising dramatically, and also sharing information and knowledge among cancer
specialists about the importance of cancer as a global health agenda issue. The Eighth Asia
Cancer Forum was held following the historic outcome of the High-level Meeting of theUnited Nations General Assembly on the Prevention and Control of Non-communicable
Diseases held in New York in September 2011, at which cancer was duly recognized as a global healthagenda issue. Despite this significant development, however, the issue of cancer, one of the mostintractable of all non-communicable diseases, still faces a variety of challenges if it is to be addressed on
the global level. The Eighth Asia Cancer Forum sought to address these various issues, seeking ways
to capitalize on the outcomes of the UN Meeting and take global collaborative studies and alliancesin the field of cancer further. It was recognized that one of the main challenges for the Asia
Cancer Forum is to formulate a proposal that demonstrates how middle income countries canprovide a good level of care using only their own limited medical resources. Given that the Asia
Cancer Forum is one of the organizations that can provide assistance in working to further
boost awareness about cancer research and the situation relating to cancer in Asian countries,
discussion also focused on how to concretize activities in the future.
Keywords: technology gaps, information sharing, MDGs, maximizing resources

4

OVERVIEW

under the theme of “What Should we do to
Raise Awareness on the Issue of Cancer in the
Global Health Agenda?” The meetings to datehave concentrated on ways to share information
among Asian research colleagues, thus raisingawareness of the importance of including cancer
on the global health agenda.

The Asia Cancer Forum is a grouping thataims to discuss cancer science and policy issues
among Asian countries. The basic conceptof the forum is that discussion will enhancesharing and awareness of the issues and each of
the participants will gain their own take homemessage to apply to their own activities as theoutcomes of the forum. The forum is operated
through the research funds of the participating
members and receives support in the form of
Health and Labour Sciences Research Grants
from the Ministry of Health, Labour andWelfare of Japan, as part of the Third Term
Comprehensive Control Research for Cancer
or its ongoing work to create an Asian network.
The organizer of the forum is Norie Kawahara
and it is chaired by Hideyuki Akaza, both of
the Research Center for Advanced Science andTechnology (RCAST), the University of Tokyo.

In the Sixth Asia Cancer Forum, discussion
focused on the difficulties in achieving acomprehensive cancer information network in
Asia, due to technology and know-how gaps
between frontrunner countries and developing
countries. These discussions led to the themeof the Seventh Asia Cancer Forum being set as“From the perspective of human security, how
can we collaborate as Asians in order to placecancer on the global health agenda? How can we
fill in the gaps that exist among us?”With global momentum gathering in terms ofrecognition of cancer as a global health agenda
issue, as preparations were implemented for
the Eighth Asia Cancer Forum, the Highlevel Meeting of the United Nations General
Assembly on the Prevention and Control of
Non-communicable Diseases was held in New
York in September 2011. The outcomes of the UN
Meeting emboldened the organizers of the Asia
Cancer Forum to further develop discussion on
cross-boundary, collaborative studies on cancer.

The origins of the Asia Cancer Forum dateback to 2004 when a group of Asian researchers
launched a platform called the Asia HighTechnology Network to discuss issues in thefield of medicine. The grouping engaged in
discussions on the formation of an Asia Cancer
Information Network. From 2008 the name of
the research platform was changed to the Asia
Cancer Forum and the first two meetings were
held thereafter. The third meeting was heldin February 2009, on the theme of “Health,
Information and Development.” The third
meeting was held jointly with SciDev.Net andsaw discussion focus closely on issues relating
to the setting of the global health agenda. The
fourth meeting was held in April 2009 under
the theme of “Asian Challenges in Shifting the
Disease Burdens.” In November 2009 the fifth
meeting was held in collaboration with the
20 th Asia Pacific Cancer Conference (APCC)

The Eighth Asia Cancer Forum was held at
Nagoya Congress Center, Japan, on October
29, 2011. The meeting consisted of nine special
presentations, followed by detailed discussions.
Approximately 25 people were present and themeeting provided a forum for active discussions.
Hideyuki Akaza (RCAST) presided, withorganization being facilitated by Norie Kawahara(RCAST). At the end of the meeting the5Declaration of the 8th Asian Cancer Forum wasadopted by members.

intensive and segmentalized, making it easy
to lose sight of the bigger picture. Keeping an
overall picture in mind provides a blueprint
for the future direction of cancer research. In
this context it is important for the Asia Cancer
Forum to consider the actual situation ofcancer in Asia, but this is not an easy task. Thisis because it is difficult to grasp an accurate
picture of a region that is so rich in historicaland cultural diversity, not to mention differencesin medical care standards. However, the global
health agenda can function as a framework
concept to gain a broad understanding. By
framing cancer in Asia in the setting of the
global health agenda, it will be possible to tap
the wisdom and knowledge of the international
community.
The situation surrounding global health isnow far more complex than when the focus
was simply on infectious diseases. It is therefore
essential for an academic basis to be laid out
for global health that provides definitions andcommon language that will promote discussion
among stakeholders. The concept of global
health is founded on the concepts of equality
and human rights. It is important as a meansof sharing information and gaining an accurate
global picture of cancer, that we create an
academic platform, or Global Collaborative
Cancer Studies, as a means of further sharing andexpanding the concept of global health in thecancer research community. Universities are ideal
locations for multi-disciplinary collaboration
with the social sciences. By considering cancer
in terms of global health, it will be possible
to identify new approaches for policymaking
and research, including ways to tackle theexisting challenges of increasing costs and aging
populations in developed societies. Now is time
to look beyond narrow national interests and use
the multi-disciplinary nature of universities to

I. Endeavors of the Asia Cancer Forumwithin the Context of Japan-AsianStudies at the University of Tokyo“Surviving Cancer in Asia”: Efforts of theJapan-Asian Studies Program of UT
Norie Kawahara (Research Center for
Advanced Science and Technology (RCAST)),
The University of Tokyo, noted that the Asia
Cancer Forum had launched dialogue on cancer
at a time when non-communicable diseases did
not attract widespread attention. The activitiesof the forum have been published in various
printed and online journals. The recent outcomeof the High-level Meeting of the United Nations
General Assembly on the Prevention and Control
of Non-communicable Diseases held in New
York in September has brought us to a point where
it is necessary to consider what concrete actions thecancer research community can take. Getting cancer
recognized as a global health agenda item is still achallenge. The discussions that have taken place in
the Asia Cancer Forum among various experts cantherefore be put to good use as dialogue on cancer
moves forward.
Through a series of lectures at the Universityof Tokyo titled “Surviving Cancer in Asia”
experts have been invited to provide insightand opinions into cancer-related issues andthe importance of placing cancer on the global
health agenda. They also aim to examine what
can be done to ensure that developing nations
can avoid making the same mistakes as moreadvanced countries.
One of the challenges that the cancer
community faces is that cancer research is
6

Discussion

further expand and share knowledge, including
with the social sciences.
Given cultural differences the situation
surrounding cancer will vary significantly fromcountry to country. By linking universities in
global collaborative efforts a bottom-up approachto global health that respects and brings together
diverse communities in different regions could
be achieved.
Even following the outcome of the UN
Summit in September, given the downturnin the global economy it cannot be taken for
granted that NCDs will be provided withthe large financial resources that infectious
diseases have enjoyed in the past. Therefore we
can no longer resort to aid, but must instead
create a framework for assistance to developing
countries that is based on our own experiencesof overcoming challenges and creating successful
outcomes. A major challenge is to implement
clinical trials in emerging economies. For thiswe will need the provision of technical assistanceand also to build links between pharmaceuticalcompanies and cancer researchers in emerging
economies.
Until now there has been little interaction
between the field of cancer research and otherareas in the global health agenda. The Asia
Cancer Forum will seek to boost exchange
and interaction among the people engaged indifferent areas of the global health agenda. It isessential for the cancer researchers to interact
and share information and human resources withother global health networks, such as those for
infectious diseases. The Asia Cancer Forum will
aim to gather the knowledge of many experts,
including the people making presentations today,and strive to achieve a firm academic foundationin the field of Global Collaborative Cancer
Studies.

Jun Miyake (Osaka University) congratulated
the Asia Cancer Forum on its efforts, notingthat from the modest beginnings a regularized
forum for dialogue is being developed. He notedthat cancer is not just a fight against disease but
includes diverse layers, incorporating physicians,
researchers, patients and the wider community.
He asked how the Asia Cancer Forum sets thetargets for dealing with these various stakeholders
in the field of cancer.
Norie Kawahara responded that although it
is difficult to respond to the various layers, eachindividual discipline in universities is able to
make a response in differing ways. Therefore
universities are well-placed to connect different
areas in academia and use a disciplinary approach
to further widen the horizons of cancer researchand global efforts to tackle cancer as a whole.

II. Challenges for the Asia Cancer
Forum: “Where is the Necessity forCancer to be one of the Issues on the
Global Health Agenda?”
Strategies for Cancer Collaboration in Asia
Hideyuki Akaza (RCAST) noted that theoriginal target of the Asia Cancer Forum was tohave cancer included as part of the global healthagenda. However, following the UN meeting on
NCDs in September it was agreed to establish
cancer on the global health agenda. One of themain challenges for the Asia Cancer Forumis to formulate a proposal that demonstrates
how middle income countries can provide agood level of care using only their own medical
resources, which amount to approximately
several hundred dollars annually per patient. The
Asia Cancer Forum approach is predominantly
7

an academic one. The UN has decided to placecancer on the global health agenda, reflecting
a situation in which for all levels of income inall countries around the world cancer is now
a major source of mortality. Although thepoliticians have announced that cancer will beplaced on the global health agenda, no specifics
have been forthcoming concerning how muchfunding will be provided and what measures will
be advanced. The Asia Cancer Forum is one ofthe organizations that can provide assistance inworking to further boost awareness about cancer
research and the situation relating to cancer in
Asian countries.
In lower income countries, once people are
diagnosed with cancer, 40 to 60% of people
die from cancer, whereas the mortality rate isconsiderably lower in high income countries. It
is calculated that 2.8m new cancers each year are
linked to diet, exercise and obesity. As countries
become more urbanized, they become more
prone to the Western diseases, including not justcancers, but coronary heart disease, obesity andlung disease.
In terms of strategies for cancer collaborationin Asia, using the example of prostate cancer, we
can see that the incidence rate is very low in Asia
compared to the West. However, the mortality
rate of prostate cancer is rising in Japan as diets
become more westernized. This can be seenclearly in Japanese immigrants to Hawaii, amongwhom incidence of prostate cancer has increased(following Western trends), but incidence of
stomach cancer has decreased (in Japan stomach
cancer has a high prevalence rate). Research
has suggested that soy consumption could havean impact on incidence and mortality rates
for prostate cancer. Soy contains isoflavones
are hypothesized to help prevent cancer, as it
encourages the production of equol in men.
In order to advance measures against prostatecancer, greater cooperation is required, andefforts are being made to refine existing
guidelines.
The 1st APPS (Asia Pacific Prostate Society)
Consultation on New Developments in Prostate
Cancer and Prostate Diseases was recently
held on October 1 in Manila. In addition,
the Fifth Joint Meeting of J-CaP/CaPSURE
Joint initiative was held in July this year. Asian
countries are extremely diverse, but all countries
share the same increasing health burden. In
contrast to other diseases there is no uniform
remedy for cancer treatment, and therefore it isof critical importance that the countries of Asia
work to create a common platform for sharing
information on the current status of cancer inthe various countries, and formulating liaison
and response structures in collaborative efforts.
It is based on this necessity that the Asia Cancer
Forum would like to issue a Declaration throughthe 8th Asia Cancer Forum.
Cancer as a Major Health Agenda in Asia:
How to Overcome Cancer
Jae Kyung Roh (Yonsei Cancer Center, Yonsei
University College of Medicine) noted that Korea
has achieved great advances in cancer treatment
in recent years. Asia has huge populations withdiverse ethnicity, different cultural backgrounds
and diverse economic conditions. Cancer
prevalence is diverse among Asian countries, but
cancer has become the major health agenda evenin economically emerging countries. Guidancefor cancer control is therefore required.
The most prevalent cancers vary from region
to region in Asia, but are gradually changing
as living and eating habits are changing. Asiancancer has ethnic pharmacogenomic differences,
treatment responses and toxicities. There arealso differences in clinical practice for cancer
prevention, detection and treatment. There are8also diverse patterns of treatment tolerability,
mentally and physically. When treatments aredeveloped in western countries, it is therefore
sometimes not appropriate to use them in Asian
countries.
Fifty years ago Korea was very poor, but overthe last fifty years incomes have increased almost
250-fold. There is a mandatory national healthinsurance covering nearly 100% of costs, which
in modern times has tended to drain resources
for health. A National Cancer Screening
Program was established approximately 10 years
ago, including both voluntary and mandatory
checks. There is aggressive competition between
five mega hospitals in the country. Korean
lifestyles are also changing dramatically, withincreasing urbanization, improved hygiene,
and Westernization of diet. Since 1983 cancer
has been the most common cause of death inKorea. Cancer incidence is increasing rapidly
and the prevalence rate is also changing. The
cancer survival rate has improved over the lasttwenty years. In 1999 there were 57,594 men
and 43,438 women with cancer. By 2008 thesefigures had increased to 93,017 and 83,500
respectively. One in three men is expected toexperience cancer and three in ten women,
making Korea a high tumor burden country.
Thyroid cancer is now the most prevalent formof cancer in women in Korea.
During the last 20 years the five-year survival
rate has increased to 59.5 per cent, marking
a radical improvement. Gastric, lung andhepatoma cancers are on a downward trend, but
colorectal cancer has increased in both sexes.
In women breast cancer incidence has risen
dramatically. The number of cancer patients isincreasing by about 6% annually. Patterns ofcancer prevalence have been changing rapidly
during the last two decades. With regard tosmoking, in 1980, 79.3% of men smoked, but

by 2010 this figure stood at 39.6% percent.
Cancer survival has improved thanks toprimary prevention efforts, including improved
hygiene and anti-smoking campaigns. The
National Cancer Screening Program for Early
Detection has also had a positive effect, coupledwith vaccinations for hepatitis B virus.
Overcoming cancer in Asia is difficult but
can be improved by primary prevention efforts,
vaccination for hepatitis B, early detection andstandard guidelines for clinical practice forprevention, early diagnosis and treatment. It willbe essential to engage in multinational ethnic
difference studies, something which is being
implemented.
The Asia Cancer Forum is now required
to promote field and clinical research withm u l t i d i s c i p l i n a r y t e a m a p p ro a c h e s a n dmultinational and multi-institutional trials. The
establishment of a federation comprising Asiancancer organizations will also be an important
step.

Discussion
Hoo-Geun Chun (Korean Association for
Clinical Oncology (KACO)) noted also that
Korea’s experiences could form a source ofreference for other countries’ efforts to tackle
cancer. However, there are various obstacles tocreate a common platform for tackling cancer in
Asia, as discussed by the presenters.
Tadao Kakizoe (Japan Cancer Society) notedthat prostate cancer is sharply increasing in both
Japan and Korea and asked whether it would bepossible to implement a collaborative study on
the effect of isoflavones on prostate cancer. He
noted that one of the issues would be to raise
funds. Dr. Roh acknowledged that the issue offunding is severe, given increasing demands on
health systems. Dr. Akaza noted that it would be
important to secure sources of funding for such9

studies to be implemented.
Hideo Tanaka (Aichi Cancer Center ResearchInstitute) asked what the cause for liver cancer
prevalence decrease was and whether thevaccination for hepatitis B had had such asignificant impact. He noted that the time lag
between the implementation of hepatitis B
vaccinations and the reduction in liver cancers
was very short in Korea and asked whether there
were any other factors that had influenced thedecrease in prevalence. Dr. Roh responded that
hepatitis B vaccination was one contributing
factor, but enhanced treatment for liver cirrhosis
was another factor that had impacted thedecrease in the prevalence rate.
Keunchil Park (KACO) added that improved
hygiene from the 1980s to early 1990s may havecontributed to the low incidence of hepatoma.
In the 1960s-70s, screening before bloodtransfusion was not effectively implemented,
but from the 1980s, improvements in hygiene,
coupled with thorough blood screening measures
had helped to reduce the incidence of hepatoma.

HIV/AIDS in the 1990s. There are deep-seatedperceptions that NCDs are not everybody’s
problem but diseases of affluence and of theelderly. Other received wisdom states that theprovision of NCDs treatment and prevention is
not feasible and too expensive in low-resource
countries. Taking a look at the number of global
deaths shows that NCDs in general should beon the global health agenda, given the fact that
NCDs account for two-thirds of deaths aroundthe world, two-thirds of which are in developing
countries.
NCDs are largely preventable throughintervention, including anti-smoking campaigns,
etc. The five biggest cancers are breast,
cervix, lung, stomach and liver cancers. The
Global Burden of Disease (GBD) Study wascommissioned by the World Bank in 1991.
The World Health Report of 2002 promoted“reducing risks, promoting health life” throughreducing burden due to major risks, costeffectiveness of relevant intervention and policy
implications. Deaths from non-communicabledisease attributed to risk factors in Japan in 2009
show that smoking, alcohol and helicobacter
pylori bacteria are the major risk factors.
There are three policy levels to address the
NCD epidemic that need to be impressed upon
policymakers: (1) Elevating NCDs on the healthagenda of key global health policymakers, (2)Providing them with better evidence about risk
factor control; and (3) Persuading them of theneed for health system change. These policies
will require funding.
The global cancer community needs toconsider at least three things to make a successof cancer control in developing countries.
First, there has to be a demonstration of results
through the development and implementationof a cost-effective delivery strategy, which
requires a paradigm shift away from an emphasis

III. Measures to Tackle Challenges (1)Cancer Control:
Lessons from Global Health Initiatives
Kenji Shibuya (Graduate School of Medicine
and Faculty of Medicine, The University ofTokyo) noted that there are three key questions
that now need to be addressed: (1) Should
NCDs be on the global health agenda? (2)Should cancer be an independent global healthinitiative? and (3) How should cancer be tackled
in the context of global health, particularly in
middle- and low-income countries?
There are myths about NCDs in developing
regions, that echo the myths that grew up around10

on scientific discovery to the implementationand evaluation of preventive and curativeinterventions. Second, a multiple-stakeholder
approach is needed, including policy-makers
and pharmaceutical companies for global
and regional drug pricing and procurement
mechanisms. Finally, a development mechanism
for both external and domestic financing indeveloping countries is also required. All of these
innovations are a central theme in the current
global movement towards universal coverage.
Japan is very advanced in the cancer field andhas the capacity to offer support and assistanceto others. According to Richard Horton in The
Lancet (2010), Japan is “a mirror of our future.”*context of NCDs.
How to Support Middle Income Countries
Hajime Inoue (Department of Health andWelfare, Chiba Prefecture) noted that one of
the biggest risk factors in the world is the aging
of society. Over the next few decades the entire
world will start to age, following the lead ofJapan, which is already experiencing the effects
of an aging society. In September the UN
Meeting on NCDs was held, which came adecade after the establishment of the Millennium
Development Goals (MDGs). In terms of the
global distribution of disease burden, the highest
disease burden for NCDs is in high and middle
income countries. In the Asian context theseinclude Brunei, Japan, Korea, Singapore (highincome) and China, India, Indonesia, Lao PDR,
Malaysia, the Philippines, Thailand and Vietnam(middle income). The disease burden in low
income countries remains greater for infectious
diseases and maternal, newborn and child health(MNCH)-related diseases.
While the global health community continues
to focus its efforts on communicable diseases and
MNCH in least developed countries, ongoing
demographic and epidemiological transitions
around the globe require us to cope withemerging disease burden of non-communicablediseases - especially cancer - among middle
income countries. The relative magnitude of thedisease burden caused by cancer among middle
income countries are expected to grow rapidly inthe next few decades. To support middle income
countries on cancer in comprehensive manner,
including prevention, early detection, treatment
and palliative care, we need to consider different
a approach to that of our ongoing effort to tackle
infectious diseases and MNCH among least
developed countries. Efforts to tackle NCDs
should be less dependent on official development*Horton R. Offline: Japan: a mirror for our
future. Lancet 2010; 376: 858.

Discussion
Doug Pyle (American Society of ClinicalOncology (ASCO)) noted that from theexperience of the ASCO at the UN meetingon NCDs in September, it seems as if a
psychological breakthrough has finally beenachieved at the global level. At the UN meeting
it was possible for the first time to talk about
cancer as a global health emergency. Dr. Pyle
noted that Dr. Shibuya had posed the questionthat in response to this global health emergency
would it be advisable to focus on cancer
individually, or to address cancer issues within
the context of NCDs as a whole. It was notedthat addressing health emergencies using apurely vertical approach may not be possible intoday’s world, as by doing so may cause valuable
opportunities to be lost. The efforts of the Asia
Cancer Forum to endeavor to reach acrossborders and also reach across health disciplines
are to be encouraged as an effective method offurther promoting cooperation on cancer in the11IV. Measures to Tackle Challenges (2)assistance, and more relevant to ongoingdomestic challenges in the various countries. A
systematic approach is required, which covers
not only clinical aspects but also health systems
as well, and requires more involvement fromacademic cancer communities of both developed
and middle income countries.
Cancer requires a new approach as it will bea major risk in the future, with the focus for
NCDs moving to middle income countries in
Asia. Middle income Asia will be the epicenter ofcancer and other NCDs in the next few decades.
The approach to cancer will be different fromthat of our previous global health agenda. The
role of the Asia Cancer Forum will be pivotal, as
it is bodies such as the Asia Cancer Forum thatare capable of decoupling NCDs from the “aidconcept.”

Japan’s Health Diplomacy Responding toChanges in Disease Structure
Keizo Takemi (Japan Center for International
Exchange) noted that although his particularfocus is more political than specifically targetedon cancer, the health system is a very important
topic for international negotiations and is
attracting attention around the world. Infectious
diseases have been the focus of attention fora long time, particularly HIV/AIDS, which
has been the subject of major international
initiatives. The question is how to expand
health-related issues into national policies. There
are many overlaps in terms of the challenges thatare faced.
In terms of the role that Japan can play, formany years Japan was the only developed nationin Asia. However, in the 21st century many Asian
countries are growing as economic powers andJapan is part of the overall dynamism in Asia.
Asian countries are now facing new problems as
the flip-side of their economic dynamism. There
are growing gaps between low and high income
strata in each country, which has the potential tocause turmoil and confusion. Social inequality
and growing gaps between the haves and havenots are serious international challenges. In orderto prevent gaps from emerging it is important toprovide a social safety net. Health security plays
an essential role in reducing social disparity.
Many policymakers are becoming aware of theconcept of the importance of health security.
Japan has had experience in tackling chronic
diseases and has achieved some success. For
example, stroke was one of the biggest causesof death in Japan in the past, but thanks touniversal coverage of the health system, whichmarks its 50th anniversary this year, mortality
from strokes has decreased in recent years.

Discussion
Sumitra Thongprasert (Chiangmai University,
Thailand) agreed that depending on the region
the disease burden may vary. It is important toexamine the specific problems in each country
and the human papilloma virus (HPV) vaccine
would be useful. One of the challenges is towork to ensure that the costs of vaccinations canbe decreased.
R a i n y Um b a s ( In d o n e s i a Un i v e r s i t y,
Indonesia) agreed that many countries in Asia
belong to middle income strata and have an
accordingly increased cancer burden, as lifestyles
change. The incidence of infectious diseaseis decreasing in countries such as Indonesia
and it would be preferable for governments tocontinue to efforts to tackle infectious diseases,
but to boost secondary and tertiary treatment.
It is essential to examine the risk factors in eachindividual population, but it will take time to
implement such measures.

12Cancer researchers need to have excellent
collaboration with specialists from othersectors, including political and economic
specialists. Researchers must send a message
to policymakers, and the Declaration the Asia
Cancer Forum is issuing today will be useful forthis purpose.
In order to achieve a more equal society it isimportant to know the impact of cancer on low
and middle income communities. Good fiscal
analysis needs to be implemented to assess theimpact of cancer on economic growth. Under
this overall framework it will be possible to madea contribution to cancer prevention control.
In terms of requirements for bringing cancer
to a global agenda from the human security
perspective, it is essential to drive momentum forcollaboration among cancer researchers and othersectors. A multisectoral approach is required, in
terms of politics, economics and social sciences.
It is also important that policymakers be madeaware of the importance of cancer.
Japan’s population aging is among the mostadvanced in Asia, but it has also succeeded increating the healthiest society in the world.
Japan’s experience, cultivated as domestic policy,
could be very helpful for Asian countries thatwill soon see their population age, regardlessof whether that is positive or negative. It istime for Japan to provide its knowledge andexpertise globally and to make greater efforts toimprove domestic systems that lead to effective
contributions to strengthening health andmedical systems in Asian countries.

specific cancer plan. The case of regions, as
opposed to global or individual country’s efforts,
is therefore slightly different and he noted that it
would be important for the Asia Cancer Forumto consider whether its focus would be on
prevention or on medical intervention.
Do u g Py l e ( A S C O ) s t a t e d t h a t w h e naddressing the cancer disease burden it isimportant to think creatively and implement
cancer planning. At the clinical level there aremany issues that are specific to cancer, but there
are opportunities to expand into other medical
disciplines and other sectors entirely, as notedby Mr. Takemi. There are vertical and horizontal
and even diagonal elements and the overall
message is that cancer is an increasingly complex
problem and a response will require an openminded outlook.
Mitsuru Sasako (President, JSCO 2012
Annual Meeting) noted that the JSCO isengaged in efforts to (1) cooperate and support
each nation’s public health strategy, (2)educate the general public; (3) educate generalpractitioners, and (4) educate specialists. He
shared his experience from his time working
in the National Cancer Hospital, when he
implemented workshops in Vietnam andMongolia with the aim of detecting early stage
cancers and preventing them. In the case ofgastric cancers these two methods (detection andprevention) are very effective and do not require
expensive machinery or drugs. It is importantto think about the four different efforts noted
above when considering what can be done foreach country.
Tomoyuki Kitagawa (Japanese Foundation forCancer Research) noted that the UN meetingon NCDs created a solid platform for action
and based on the outcomes of the UN meeting
positive progress could be made. NCDs are a big
issue, partly because this is an issue that is related

Discussion
Rolf A. Stahel (President-elect, European
Society for Medical Oncology (ESMO)) statedthat if there is a global strategy for NCDs, thencancer should be part of it. However, in termsof national strategy, it is important to have a13not only to health but also to the economy.
NCDs have an enormous economic impact.
Cancer prevalence is increasing and infectious
diseases are declining in many countries, but it
is important to assess the status of premature
cancer death in each country. After the UN
meeting it is now important to start processes
at the political level and promote action.
Researchers should not just be engaged inresearch, but need to connect with social issues.
JSCO is positively involved in social activities
and UICC Japan also needs to engage in suchactivities. The outcomes of the UN meeting willbe translated into Japanese and used as a tool for
raising awareness.
Keizo Takemi (Japan Center for International
Exchange) noted that the Asia Cancer Forumwas being participated in by cancer specialists,
but the discussions in this forum need to be fed
through into policymaking. A strategy needs
to be developed to call upon politicians to takeaction. It is important to think about cancer in amuch wide context than has previously been thecase.

There has been growing awareness of theconsequences of global workforce shortages,
with various factors hindering the deliveryof health services in low and middle income
countries. GHWA was launched in 2006
to address the health workforce crisis. One
substantial achievement is to make history withthe formulation of the WHO Global Code ofPractice on the International Recruitment of
Health Personnel, which was adopted by the63rd World Health Assembly on 21 May 2010.
This groundbreaking instrument marks the firsttime that WHO Member States have used theconstitutional authority of the Organization todevelop a code in thirty years. The GHWA isalso playing an instrumental role in the HealthWorker Migration Policy Initiative (HWMI),
which is dedicated to monitoring health worker
flows and issuing recommendations to WHO
for an International Code of Practice. GHWA
has worked consistently to bring stakeholders
together to engage in dialogue on HRH. The first
Global Forum on Human Resources for Healthwas held in Kampala, Uganda in 2008. It called
for immediate and sustained action to resolve
the critical shortage of health workers aroundthe world and resulted in the endorsement of the
Kampala Declaration and the Agenda for Global
Action. At the second Global Forum in Thailand
in 2011, countries and stakeholders convened torenew their commitment. GHWA’s mission is to
add greater value to health care.
On the occasion of the NCD Summit
in New York, GHWA held a side-event:“Addressing Noncommunicable Diseases –It Takes a Workforce” organized together
with the Governments of India and Japan,
Touch Foundation and the Health Workforce
Advocacy Initiative. Panelists and keynote
speakers concurred that effectively addressing
the challenges posed by NCDs is dependent

Health Workforce Crisis in the WorldSh i n j i r o No z a k i ( T h e G l o b a l He a l t hWorkforce Alliance (GHWA)) expressedthanks to the JSCO and Asia Cancer Forumfor extending an invitation to attend the 8 thAsia Cancer Forum, and also thanked the Asia
Cancer Forum for its registration on the GHWA
website. The current chair of GHWA is Dr.
Masato Mugitani and Prof. Keizo Takemi is oneof the leading lights in the organization. GHWA
is seeking to achieve new changes in various
areas. The Government of Japan is contributing
almost one-third of the budget for GHWA
activities, making it the largest single donor, and
it is important for Japan to be engaged in efforts
to cultivate human resources for health (HRH).
14

Pharmaceutical Development and Cancer
Treatment in Asia
Ko j i K a w a k a m i ( Gr a d u a t e S c h o o l o f
Medicine and Public Health, Kyoto University)
explained that he would be talking about
health technology assessment (HTA). Under
the HTA are evidence-based medicine (EBM)
and comparative effectiveness research (CER).
When measuring the effectiveness of specificmedicines it is important to have a scale, one ofwhich, developed in the United Kingdom, is the
Quality-adjusted Life Year (QALY).
In the case of cancer, sales of anti-cancer
drugs are increasing rapidly. Molecular targeting
drugs tend to be beneficial for some patients
but not others. It was for this reason that the
U.K. recommended against the use of moleculartargeted drugs from a cost-effect perspective. In
the case of the U.S., EBM has generally tended
to be the focus for activities, but under the
Obama Administration the American Recovery
and Reinvestment Act was passed and there has
been a growing tendency to emphasize CER as a
keyword. Anti-cancer drugs are very expensive at
the moment and there are many hurdles still to
be overcome before they can be used effectively.
Questions about the safety of patent-expired
drugs are also being raised.

on the availability of a prepared, motivated,
supported and well-functioning health workforce
at all levels of care. NCDs have become oneof the major health issues in the international
community. GHWA is targeting 57 countries
to respond to the workforce crisis in low andmiddle income countries. To tackle the problem,
more skilled and experience workforces are
required. Therefore, GHWA is shifting its
interest to NCDs, which it believes is closely
related to HRH.

Discussion
Jin Li (Chinese Society of Clinical Oncology(CSCO)) noted that various speakers had
spoken about collaboration among countries.
In the case of China, he noted that while
economic growth has been rapid in recent
years, the average income in China is still very
low and there are significant gaps between low
and high income levels of society. The Chinese
government has launched a plan to provide
health coverage to the entire population by theend of 2020. Currently 70% of the population
still lives in rural areas and does not have accessto medicines. CSCO is one of the biggest
organizations involved in cancer in China, but
has no financial support from the government.
For the past several decades China has improved
its efforts in health areas. Japan has offeredassistance in the health sector to China in thepast. International cooperation and cooperation
with large pharmaceutical companies willbe essential for the future. It is excellent thatcollaboration among countries to fight against
cancer has begun. It will be essential to consider
what specific collaboration can be implemented
in the future.

Corporations and Cancer Treatment in Asia
Masaru Iwasaki (University of Yamanashi,)noted that it is important for Asian countries
to engage in cancer management and to
implement clinical trials. Research is also
required for the individual differences in drug
response. He presented some intrinsic andextrinsic factors on ethnicity. One example is
PFS in EGFR mutation positive and negative
patients for which the effects of Gefitinib were
investigated. The results were achieved throughsignificant investment in studies. In addition,15

in terms of the Avagast Study by Roche onregional differences in efficacy, there were huge
differences between the active agent and placebo
trials.
In terms of opportunities for Asia
collaboration, the similar ethnic, dietary andsocial habits of people in Asia are good for joint
collaborative efforts. The global pharmaceuticalmarket is continuing to grow, although thepercentage of the market accounted for by the
US has decreased slightly. The pharmaceuticalmarkets in emerging economies are growing
rapidly and the forecast is that the Asian
countries will continue to grow. Several anticancer agents have already developed throughcollaboration in Asia, and Asian contribution
to new drug launches is now very clear. Moving
forward, it will be important to deliver sciencebased evidence from Asia, and make decisions on
effective development of a second line.

budgets for human resources for health, notingthat such aid may not be exclusively for efforts
relating to cancer. He asked whether there wereany areas where JSCO could work together
with GHWA on cancer-related efforts. He alsocommented on heterogeneity in Asia and theimportance of engaging in joint work withmultiple sectors.
Hideyuki Akaza (RCAST) noted that due totime constraints the comments on heterogeneityand commonalities could not be covered, but
asked Dr. Nozaki and Prof. Takemi to respond to
the questions concerning GHWA and a multisector approach.
Shinjiro Nozaki (GHWA) responded that
GHWA is under the WHO and the WHO is
seeking to explore the opinions of academia, theprivate sector and government and is seeking to
expand partnerships on cancer-related issues.
Keizo Takemi (Japan Center for International
Exchange) concurred with Dr. Nishiyama on
the importance of health-related efforts bygovernment. He noted that there is a great dealof cooperation between academia and the private
sector in the U.S. and that this is something thatis lacking in Japan. It is therefore important toeducate and nurture specialists in health andscience-related institutions. It is essential to cometogether to establish a discussion platform inJapan to promote interaction between academia,
the private sector and government, which islagging behind the United States in terms ofcooperation.
Hideyuki Akaza (RCAST) agreed thatas a future step that it would be crucial toengage in greater collaboration among variousorganizations, and advance multi-disciplinary
studies and multi-sector efforts, especially in
Asia.

V. General Discussion
Kazuo Tajima (President of 70 th Annual
Meeting of the Japanese Cancer Association(JCA)) commented on the presentation by Dr.
Akaza on prostate cancer, noting that several
decades ago the incidence rate in Japan was very
low compared to the West, but in recent years
the prevalence is rapidly rising. Progression ofcancer is variable depending on cultural andethnic background. Cancer is positioned in avery broad context and contains many variablefactors and therefore a broad-minded approach
will be required in order to control cancer. The
Asia Cancer Forum is an excellent opportunity
to collaborate on efforts to control cancer.
Masahiko Nishiyama (JSCO) asked the
GHWA about aid for developing countries and16At the end of the meeting the Declarationof the 8th Asian Cancer Forum was adopted bymembers. It reads as follows:
Following the historic outcome of theHigh-level Meeting of the United Nations
General Assembly on the Prevention andControl of Non-communicable Diseases
held in New York on September 19 and 20,
2011, and recognizing the need to maintainmomentum in efforts to address the global
burden and threat of non-communicablediseases, we, the members of the Asia Cancer
Forum,
1.

Affirm the critical importance of placing
cancer on the global health agenda as ameans of further promoting concerted
global action.

2.

Will continue to conduct research amongexperts on their perceptions of the current
situation concerning the positioningof cancer on the global health agenda,
seeking to share a common philosophy on
global health and enhance cooperation in
the field of global health.

3.

Will create a new approach by proposing
lifestyle changes aimed at preventing
cancer that take into consideration
historical and cultural diversity.

4.

5.

Will seek to launch Global
Collaborative Cancer Studies, including
multidisciplinary educational programs
that combine humanities and sciences,
for the purpose of overcoming healthdisparities among different countries
and regions and building mutuallycomplementary long-term partnerships.

6.

Encourage cooperation and collaboration
among Asian federations that are engagedin efforts to promote the treatment ofcancer.

Yoshihiko Maehara (JSCO) noted that as
an academic society the JSCO seeks to engage
in collaboration with similar bodies in othercountries and regions and will be watching theactivities of the Asia Cancer Forum with interestin the future.
Jae Kyung Roh (Yonsei University Collegeof Medicine) thanked the presenters andparticipants for their efforts in the 8 th Asia
Cancer Forum. He noted the continued
importance of discussions on how to distributeknowledge and experience and called on the
Asia Cancer Forum to continue its efforts in thisregard. The meeting was then brought to a close.
In addition to the presenters, participants in thegeneral discussion were as follows:
Hoo-Geun Chun (Korean Association forzClinical Oncology (KACO))
Tadao Kakizoe (Japan Cancer Society)zTomoyuki Kitagawa (Japanese Foundationz
for Cancer Research)
Jin Li (Chinese Society of Clinical Oncologyz(CSCO))
Yoshihiko Maehara (Japan Society of Clinicalz
Oncology (JSCO))
To h r u Ma s u i ( Na t i o n a l In s t i t u t e o fzWill actively provide scientific andtechnological assistance that enableclinical trials to be conducted in bothindustrialized and developing countries
and aim to act as a bridge between theindustrialized and developing world in
the field of cancer research.

17

Biomedical Innovation)
Jun Miyake (Osaka University)z
Masahiko Nishiyama (President, JSCO 2011zAnnual Meeting)
Keunchil Park (KACO)zDoug Pyle (American Society of Clinicalz
Oncology (ASCO))
Mitsuru Sasako (President, JSCO 2012zAnnual Meeting)Rolf A. Stahel (University of Zurich,zPresident-elect, ESMO)
Kazuo Tajima (President, Annual Meeting ofz
the Japanese Cancer Association)
Hideo Tanaka (Aichi Cancer Center ResearchzInstitute)
Sumitra Thongprasert (Chiangmaiz
University)
Rainy Umbas (Indonesia University)zinternational community are widening, and thestatus of cancer prevention, diagnosis, treatment
and palliative care differ from country to country.
The Eighth Asia Cancer Forum issued its firstever declaration with the intention of creating
a blueprint for further action, and one that
could be transmitted around the international
community. The Asia Cancer Forum recognizes
that the formation of a conceptual basis forachieving the targets set out in the declaration isan urgent and pressing challenge.
In particular, the Forum seeks to press
ahead with actions to construct and launch
Global Collaborative Cancer Studies, including
multidisciplinary educational programs thatcombine humanities and sciences. In addition,
the current situation in Asia is that there isno organization that can widely promote
cancer treatment and information like ASCO
or ESMO. It is, therefore, high time that anorganization with comprehensive and wideranging contacts and expertise was created in
Asia, as a counterpart to ASCO and ESMO. It is
the ongoing mission of the Asia Cancer Forumto contribute in some way to the realization ofsuch a concept.

Conclusion
The discussions at the Eighth Asia Cancer
For um demonstrated that while “global
health” is becoming a mainstream concept anda multiplicity of activities aiming to couple
development challenges with disease control arebeing witnessed, cancer is still perceived by manyas being distinct from other non-communicablediseases. There are still those who question
whether it is appropriate or advisable to discusscancer based on the same logic as other globally
prevalent diseases. However, regardless of thequestions that still remain, what is evident for
those of us in Asia is that we need to identify
ways of working together in cancer research andpolicy, given the fact that Asia is a region where
cancer is increasing dramatically and one where
the prevailing western-oriented concepts may
not be entirely applicable. A strategy is necessarythat is capable of working at different levels
and functioning in various diverse systems, inview of the fact that medical disparities in the

Looking to the Ninth Asia Cancer Forum in
2012
The UN Summit on NCDs resulted in wider
recognition of cancer as a global health issue,
but it is nonetheless recognized that cancer isthe most formidable of all NCDs. There is also
a common recognition that cancer needs to beperceived in relation to social challenges such as
poverty. In the UICC International Session at
the 71st Annual Meeting of the Japanese Cancer
Association, scheduled to be held in September
2012, in Sapporo, Japan, co-chairs Hideyuki
Akaza and Jae Kyung Roh will lead discussion on
the theme of cancer and health care economics.
18

The speakers will include a member of facultyfrom the Japan-Asian Studies program of the
University of Tokyo, which has been providing
conceptual resources for the Asia Cancer Forum.
Following the UICC International Session theNinth Asia Cancer Forum will also be held in
Sapporo. It is planned that at the ninth forum
there will be a progress update on the status ofprogress relating to the declaration issued at theeighth forum. Participants are also scheduled
to discuss the significance of gathering multidisciplinary research gathered at universities oncancer and utilizing the results of such research
to make social and policy proposals.

19

THE 8th ASIA CANCER FORUM
Declaration

Following the historic outcome of the High-level Meeting of the United Nations General Assembly on
the Prevention and Control of Non-communicable Diseases held in NewYork on September 19 and20, 2011, and recognizing the need to maintain momentum in efforts to address the global burden andthreat of non-communicable diseases, we

1. Affirm the critical importance of placing cancer on the global health agenda as a means offurther promoting concerted global action.
2. Will continue to conduct research among experts on their perceptions of the current situation
concerning positioning of cancer on the global health agenda, seeking to share a common
philosophy on global health and enhance cooperation in the field of global health.
3. Will create a new approach by proposing lifestyle changes aimed at preventing cancer that take
into consideration historical and cultural diversity.
4. Will actively provide scientific and technological assistance that enable clinical trials to be
conducted in both industralized and developing countries and aim to act as a bridge between
the industrialized and developing world in the field of cancer research.
5. Will seek to create multidisciplinary educational programs that combine humanities andsciences and launch Global Collaborative Cancer Studies, for the purpose of overcoming healthdisparities among different countries and regions and building mutually complementary longterm partnerships.
6. Encourage cooperation and collaboration among Asian federations that are engaged in efforts topromote the treatment of cancer.

AT THE 49th ANNUAL MEETING OF JAPANESE SOCIETY OF CLINlCAL ONCOLOGY
October 29, 2011
Nagoya, Japan20

Seeking to Advance the Outcomes of the UN Summit“Global health as the key to a new paradigm in cancer research”
Among non-communicable diseases, cancer is the condition that requires the greatest financial outlay
and is most difficult to treat. In particular, Asia, which is a region in which incidence rates of cancer
are growing rapidly, faces a multitude of challenges, stemming from differences in medical treatment
standards and vast cultural diversity, making it difficult to apply a uniform policy to the entire region.
Perceiving cancer as part of the global health agenda helps to keep the big picture in focus, thus
providing us with a blueprint for the future direction of cancer research. It is therefore the responsibility
and mission of the cancer research community in Asia to send out a message to the rest of the worldabout the importance of cancer on the global health agenda. Furthermore, such an endeavor would besignificant in that it would help to gather knowledge and experience on advanced models that would
help us in our quest to overcome the most difficult challenges.
We were further encouraged by the truly historic outcome of the High-level Meeting of the United
Nations General Assembly on the Prevention and Control of Non-communicable Diseases held in New
York in September. We believe that we are now in a phase where we must consider what concrete actions
the cancer research community can take. Getting cancer recognized as a global health agenda item is stilla challenge. Therefore We are certain that the discussions we have had in the Asia Cancer Forum among
various experts can be put to good use as we move forward. Under the current situation the resolutionsof the recent UN NCD Summit would be difficult to realize. This is why we have submitted our draft
declaration to the JSCO, with the objective of giving further weight to the historic outcomes in New
York, and promoting further action within the cancer research community.
We are deeply grateful to the Japan Society of Clinical Oncology for providing the benefit of theirgenerous cooperation in issuing the Declaration that we signed, and distributing it to the wider
international community.
The issue of cancer in Asia is of critical importance not merely to Asia but to the global community as
a whole and the issuance of our Declaration will go some way to underline our ongoing efforts. The
power to influence agenda setting lies with human determination and will and is deeply related to thewisdom of humanity.
Based on the Declaration issued in Nagoya the Asia Cancer Forum we will continue to make every
effort to share our determination and knowledge with the international community and advance theundertakings detailed in the Declaration.

21

1. Global Health Agenda

22

2. Networking

Health Systems Strengthening
The Asia Cancer Forum has become a member of the Global Health Workforce Alliance.
Using this channel we will seek to boost exchange and interaction among the people engaged indifferent areas of the global health agenda.
“Working together we can better address the health workforce crisis”
Under the current situation where international health issues have been complicated by entangled
elements of socio-economy and diplomatic policy, the absence of functions to collect and analyze
information with an immediate response is another big factor affecting why cancer has not yet been
positioned as a global health agenda. It is therefore important for us to collect appropriate information
in a timely manner and then create a system that would enable us to share information with a wider
community. Towards this goal we are implementing or planning the following projects.
1. University-wide Graduate School Education Program 2011:
Japan-Asian Studies Program “Surviving Cancer in Asia” given by Prof Hideyuki Akaza, theUniversity of Tokyo
2. Grass Roots Project:“Comprehensive Improvement on Health and Lifestyle for Communities in China through
Education for Preventing Lifestyle-related Diseases”
3. We aim to develop multi-disciplinary educational programs involving a combination of thehumanities and science, for the purpose of establishing long-term mutually complementary
partnerships among universities both in developed and developing countries.
4. We aim to propose new programs through GHWA channels for the purpose of the“Establishment of a cancer information sharing system in the global community”.
The Forum believes it to be important to enhance the role played by universities and also hopes that
health professionals themselves will become central members of an information sharing network given
the fact that they possess cancer information including patient information. We strongly hope todevelop close partnership with GHWA, a key pillar in the field of global health workforce development.

23

3. Cancer and Culture

Comprehensive Improvement on Healthand Lifestyle for People in the Community
The Grass Routs in Halpin city of China
The Asia Cancer Forum is currently involved in community-based activities in villages in northeastern
China that have a high smoking rate. We are truly starting from the grassroots in providing cancer
prevention education and lifestyle suggestions. This is a small-budget program that has achieved large
results, bringing hope for many other communities and regions.

24

4. Clinical Trial AssistanceMoving away from Aid-oriented Concepts◆ Given the downturn in the global economy we must not expect that NCDs will be provided withthe large financial resources that infectious diseases have enjoyed in the past.
◆ Therefore we can no longer resort to aid, but must instead create a framework for assistance todeveloping countries that is based on our own experiences of overcoming challenges and creating
successful outcomes. A major challenge is to implement clinical trials in emerging economies. For
this we will need the provision of technical assistance and also to build links between pharmaceuticalcompanies and cancer researchers in emerging economies. If we can create a collaborative network
between companies and universities, it will surely open up a new era in the fight against cancer.

25

5. Multi-disciplinary Program
Surviving Cancer in Asia

Against the backdrop of a global transformation in the structure and nature of disease, with focus
shifting from infectious diseases to non-communicable diseases, cancer incidence in Asia is rapidly
increasing. Cancer is a pernicious disease that develops over a long period of time, affected by genetic
factors and lifestyle choices. It is a disease that casts a long, dark shadow over human culture andactivities. To date in Asia there has been great divergence in medical standards, and also in the values ofphysicians and patients alike. What is more, data from Asian countries is not immediately comparable,
making cross-border cooperation and information sharing difficult. While on the one hand Asia is
experiencing astonishing economic growth, there are still historical legacies that pervade the region anda stark disjoint between globalism and nationalism can also be perceived. The Department of Strategic
Investigation on Comprehensive Cancer Network aims to develop new drug therapies as well as safe andeffective methods of treatment for cancer in Asia. The Asia Cancer Forum is based in this department
and is engaged in efforts overcome the regional disjoint in Asia by promoting joint action on common
issues. We are accordingly engaged in various policy proposal formulation activities, aimed at achieving
the inclusion of cancer on the global health agenda. Cancer is a disease that is closely related to various
challenges and issues, which are variously political, economic and cultural in nature. In this course we
aim to direct questions relating to cancer in Asia to leading figures and create a forum for dialogue on
how Japan should engage with Asia in fighting cancer.

26

Japan Asia Studies lecturers list
Summer semester 2011
Mirror of our own life - over medical issues on cancer in Asia
Hideyuki Akaza

Professor, Department of Strategic Investigation on Comprehensive Cancer Network, Research Center for Advanced
Science and Technology(RCAST), The University of Tokyo

Connection between East Asian community and our life
Kang Sang-jung

Professor, Interfaculty Initiative in Information Studies / Graduate School of Interdisciplinary Information Studies, The
University of Tokyo

Cancer inb Asia from the perspectives of global health issues and its vision
Kenji Shibuya

Professor and Chair, Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo

Lost two decades - Japan, a part of Asia
Yoshihiro Ohtaki

President, BioFrontier Partners, Inc.

East Asia and the United States
Daikichi MonmaCouncilor, Minister's Secretariat, Ministry of Finance

Cancer in Asia from the point of view of modern Korean government - how it can be a gateway to the future?
Cho Sei YoungCounselor and Head of the Chancellery, Embassy of Korea

Cancer and family - how we face with sudden grief?
Tadao Kakizoe

President, Japan Cancer Society

Cancer in Asia in the super-aging society
Tetsuo Tsuji

Professor, The Institute of Gerontology, The University of Tokyo

Cancer in Asia from the viewpoint of drug development
Kiyoshi Terada

Head, Pharmaceutical Division / Senior Managing Director, Member of the Board of Yakult Honsha Co., Ltd.

Our Asia, with changes in Drug Review Procedure system
Tatsuya Kondo

Chief Executive, Pharmaceuticals and Medical Devices Agency

Cancer in Asia from the viewpoint of pharmaceutical company
Masafumi Nogimori

Representative Director and Chairman, Astellas Pharma Inc.

Winter semester 2011
Oncology in Asian countries; Clinical Development challenges & opportunities
Pascal RIGAUDY

Corporate officer, Sanofi-aventis K.K.

Health Diplomacy
Keizo Takemi

Senior Fellow, Japan Center for International Exchange

Cancer and Insurance in Asia
Yoshiki Otake

Supreme Adviser, Aflac Japan

Cancer and Culture
Rokusuke Ei

Japanese lyricist, composer, author, essayist and TV personality

Considering from the standpoint of drug development
Masaru Iwasaki

Professor, Department of Clinical Research, Yamanashi University Graduate School of Medical Science

Cancer in Asia from the standpoint of field-oriented approach
Shuntaro Torigoe

Journalist

How Japan deal with Cancer in Asia, as an emerging decadent country?
Msaru Kaneko

Professor, Department of Economics, Keio University

How we face with China - role for cancer collaboration in our challenges
Koichi Kato

Chairman, Japan-China Friendship Association

Is it possile to share our vision among Aisa?
Masahiko, Nishiyama

Chief Director, Japan Society of Clinical Oncology

Final Disucussion Session

27

6. Asian Federation
The Asia Cancer Forum was established in 2004. Since 2008 we have been engaging in a series of
discussions about placing cancer on the global health agenda. We launched our dialogue on cancer at atime when non-communicable diseases did not attract widespread attention

28

Trilateral Cross-boundary Cancer Studies

Multidisciplinary Joint Program on Common Social Challenges andIssues in Japan, Korea and China(Proposal)
1. Purpose

we are to tackle these challenges effectively weare now required to take a panoramic look at
the common social challenges being faced inJapan, Korea and China from the perspectivesof various specialized fields and utilize the vast
wealth of knowledge that has been accumulated
in each field in a multidisciplinary manner.
Once engaged in comprehensive,
multidisciplinary efforts, it will then benecessary for Japan, Korea and China to all seek
to responds to the challenges of super-aging
society, changes in the disease structure and theaccompanying strains on the medical economy,
with an eye on 2030, the year in which it is said
that social structures will reach a critical tipping
point.
With our eyes firmly on 2030, the year thatvarious data, including population projections,suggest that the social structures of the Asian
region will reach a tipping point, we will aim to
specify common challenges for Japan, Korea andChina ten years prior to that critical year, setting
2020 as our target year. It is necessary to build
up a mutually complementary and long-term
partnership between Japan, Korea and China
and work to develop human resources for the
next generation, who are capable of responding
to the various challenges we anticipate. Thisis the reason why we propose a university-led
multidisciplinary joint program.

The processes of social and economic
development in Japan, Korea and China
have not followed a uniform time line, withpopulation trends and economic growth eachprogressing along differing time scales. When
we take a look at the various challenges that are
affecting each country in different ways and atdifferent times, such as the onset of a super-aging
society and changes in the disease structure, as
well as the societal changes that are expectedin each country in the future and the strainsthat these changes will place on the medical
economy, we can clearly see that the challenges
each country faces are not unique challenges
but rather societal challenges that we all share incommon. The increase in the elderly populationis bringing about far-reaching changes insociety, including the emergence of new living
environments and new requirements concerning
the utilization of social capital. Social security
that is commensurate to the task of supporting
an elderly population and responding withcountermeasures to the accompanying increasein various diseases is now required, among otherneeds. These common challenges that we face
include elements that are directly related tonational vitality and the stability and growth of
the East Asian region as a whole.
These various challenges are of such a wideranging and diverse nature it is not sufficient toseek to address merely within the confines of asingle specialized field, but rather it is necessary
to position them more comprehensively in both
domestic and international social contexts. If
29

2. Multidisciplinary Joint Program on
Cancer as a Pilot Casetackle these challenges. The Asia Cancer Forum,a general incorporated association, located at
the Department of Strategic Investigation on
Comprehensive Cancer Network (headed by
Prof. Hideyuki Akaza) at the Research Center for
Advanced Science and Technology (RCAST) of
the University of Tokyo, is engaged in organizing
the issues and concepts for multidisciplinary
cooperation and has already launched a seminarand multidisciplinary project at the university.
The Asia Cancer Forum is an organization thathas grown through efforts to link the various
resources that already exist in Japan, Korea andChina, towards the creation of multidisciplinary
cooperation. While based in a university office,the Asia Cancer Forum has worked on theplanning of this multidisciplinary joint program
not only from a specialist academic perspective,
but rather by viewing society as a comprehensive
whole, seeking to create a concept that places
cancer as a common challenge for Japan, Korea
and China. Joint implementation of efforts
by the three countries has yet to be realized,
however, and is still in the preparation phase.
Work is progressing on the formulation ofa concept for cancer in the context of a JapanKorea-China multidisciplinary joint program.
However, the social challenges presented bycancer are not fixed, but rather require a universal
concept that can be adapted to multidisciplinary,cross-border research, which brings together
various specialist fields. A multidisciplinary joint
program that deals with the social challenges
presented by cancer would therefore be best
suited to an initial pilot case that will advance
multidisciplinary research on the whole range ofcancer-related issues in Japan, Korea and China.

(1) Reason for implementation as a pilotcase
We h a v e p l a n n e d p i l o t r e s e a r c h a s apreliminary step prior to full-fledged
consideration of a “Multidisciplinary Joint
Program on Common Social Challenges andIssues in Japan, Korea and China.”
Cancer, as the overall theme of the program,tends to be mainly discussed in medical terms,
concerning disease prevention, early detection(examination) and treatment, as well as thevarious social costs, including medical expenses.
It is important not to forget, however, thatcancer is also affected by other aspects, including
political, economic and cultural influences.
Whether it be in Japan, Korea or China, when
we consider how to confront the disease ofcancer, which continues its inexorable increase inline with the aging of society, we must take into
consideration the impact not only of politicaland economic considerations such as prevention,
early detection and treatment, but also give due
attention to the various impacts of values andsocial recognition of cancer, which are rooted inpeople’s customs and ways of living.
The University of Tokyo is already engaged
in multidisciplinary research and educational
programs relating to cancer. Yonsei University(Korea) and Tianjin Medical University (China),
two respected institutions which concurwith the aims of the programs underway at
the University of Tokyo are also considering
the implementation of similar research andprograms. There is already a commonly heldawareness that cancer is a common social
challenge for the three countries and theimplementation of a multidisciplinary joint
program would form one base from which to30

(2) Launching the program at aninternational conference to be hosted by
the Asia Cancer Forum
An international conference will be heldon the theme of cancer as a common social
challenge in Japan, Korea and China, providing
a venue to discuss the complex and multi-layered
issues relating to cancer in each country andshare information and knowledge.
Theme: Trilateral Cross-boundary Cancer
Studies toward 2020 in East Asia
Contents:① Looking towards 2020 and the social changes
surrounding cancer in Japan, Korea andChina (reports from researchers at institutes
and think tanks of the three countries)② Cancer in Japan, Korea and China (reports
from the three countries and from private
sector corporations)③ Building new knowledge (reports fromuniversity researchers)④ Reports on multidisciplinary lectures atuniversities (report from students at the
University of Tokyo)⑤ General discussion based on ① to ④ above.

to the social challenge of cancer in Japan,
Korea and China. In addition, a platform
for discussion among various specialist fields
would be provided, with the aim of nurturing
outstanding human resources with broadsocial awareness.
② The educational program would provide
opportunities to learn and understandchallenges in a manner that encourages
discussion and debate among people fromdifferent specialist areas.
③ The educational program would be jointly
implemented in the three countries andw o u l d i n vo l ve e xc h a n g e a m o n g b o t hinstructors and students, enabling all persons
involved to learn in a multifaceted manner
about the challenge of cancer in the East
Asian region.
④ After a one-year educational program a forum
would be provided for both instructors andstudents alike to come together to share thethings they have learned and further discuss
what can be done to respond to the social
challenge of cancer in Asia. These efforts
would be disseminated further in society
through publications and academic papers.

(3) Actions following the international
conference
Based on the outcomes of the international
conference a joint educational program would
be launched in Japan, Korea and China. The
educational program would bring together
various specialist fields in each country and link
diverse social resources in cooperative efforts tolearn about approaches to resolving the social
challenge of cancer in a multifaceted manner. In
concrete terms, the following actions would be
implemented:① Students will discuss what they can contributefrom their various specialist fields to respond

The human network that would be createdthrough this process would also be linked
through the creation of a virtual platform thatwould serve to exchange knowledge and share
information.
Based on this platform and also on the
research and study outcomes at universities inJapan, Korea and China, the following actions
would be promoted.
① Joint development of educational programs
and materials for multidisciplinary
cooperation② Establishment of an academic basis for
multidisciplinary cooperation
31

University of Tokyo

Dispatch ofvisiting lecturers

Dispatch ofvisiting lecturers● Remote lectures● Exchange forums● Joint development ofeducational programs and materials

Yonsei University

Creation of avirtual platform forexchanging andsharing knowledge andinformation

Tianjin Medical University

Dispatch of visiting lecturers
Coordination by the Asia Cancer Forum

Asia Cancer Forum,a general incorporated association

cosmetics assistance for cancer patients. Since
April 2010 the Forum has been located at
the Department of Strategic Investigation on
Comprehensive Cancer Network (headed by
Prof. Hideyuki Akaza) at the Research Center
for Advanced Science and Technology (RCAST)of the University of Tokyo. From its RCAST
base and as a platform for multidisciplinary
cooperation, the Forum has launched a numberof endeavors, including a joint project with the
University of Tokyo Center for Contemporary
Korean Studies, and a joint workshop with the
Jing Forum entitled “Considering the joint
creation of public knowledge: To whom does
information about my body belong?”
From April 2011 the Forum became a generalincorporated association, with the following
articles of incorporation:

The Asia Cancer Forum was launched in
2004, with the cooperation of the Asia HighTechnology Network meeting (Prof. Jun
Miyake), under the name of the Asian Cancer
Information Network. Following its inception
the organization engaged in various activities,
including the submission of a policy proposal
to the Japan-China initiative for cooperation in
medicine announced by then Prime Minister
Shinzo Abe of Japan and President Hu Jintao
of China in 2007 and the holding of the Asian
Cancer Information Network meeting inNanjing, China, also in 2007. In 2008 the Asia
Cancer Forum took on its current name andhas since implemented a number of roundtable
meetings comprised of experts from around theworld. In parallel to these activities the Forumhas also implemented a cancer prevention
education program in elementary and juniorhigh schools in rural regions of China, as wellas implementing awareness surveys targeting
researchers and research into make-up and

The purpose of the Asia Cancer Forum shall be tocreate a network for international multidisciplinary
cooperation relating to the collection and utilizationof information on cancer, and engage in activities toraise the profile of cancer and achieve its inclusion32

in the global health agenda, thus contributing to
the improvement of cancer treatment in Asia. In
order to realize the aforementioned purpose, theForum shall engage in the following activities.
( 1 ) H o l d i n g o f t h e A s i a C a n c e r Fo r u m(international conference)(2) Educational activities in universities andresearch institutions(3) Cancer prevention educational activities in thecontext of school health programs(4) Implementation of international awarenesssurveys on cancer and analysis of results(5) Creation of an information sharing system oncancer (awareness-raising activities)(6) Other related activities that may be required for
the Forum to be able to achieve the activities set
out above.

Cancer Forum in October 2011 a declaration
was compiled and approved by international
experts, and publicized to the international
community.
Although globalization is accelerating in
East Asia, it remains a region unique in theworld in that there are still issues outstanding
from the previous century, including historical
recognition relating to the Second World War
and ideological confrontation arising from Cold
War structures. Given these various contrasts andcontradictions, from the practical perspective offacilitating cross-border flows and distribution ofpeople, goods and information, it is essential togain comprehensive knowledge and perspectives
on the diverse social values in the region, andengage in discussion aimed at finding a way to
overcome the contradictions between globalism
and nationalism in the region. In order tocoordinate trilateral efforts among Japan, Korea
and China it will be necessary to conclude
exchange agreements between universities
and this is something that we must work toachieve. A plan is required that sets out clear
goals and clarifies the various phases and major
elements for success. The Asia Cancer Forumis an organization that has already examinedand discussed in depth the unique challenges
faced by the East Asian region and it has set
out ambitious targets by which its degree ofachievement and accomplishment will be able
to be measured.

Furthermore, in April of 2011, based on theconceptual resources accumulated to date, theForum started participating in the formulationof a lecture concept entitled “Sur viving
Cancer in Asia,” which is run by the Network
for Education and Research on Asia of the
University of Tokyo as a cross-departmental
educational program. Based on the experienceand knowledge gained from these various
educational activities the Forum has proposed
the launch of “Cross-boundary Cancer Studies,”
which would seek to establish an international
multidisciplinary cooperative program.
From an early stage in its existence the Forumhas also been engaged in efforts to raise theprofile of cancer on the global health agenda,
with the Forum’s activities to promote discussionof this issue being mentioned in the February
2009 online version of Science. Following theissuance of the Political Declaration of the Highlevel Meeting of the General Assembly on thePrevention and Control of Non-communicable
Diseases in September 2011, at the 8th Asia
33