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Asia (9)Biomedicine (31)FEBRUARY 9, 2009

Japanese Cancer Scientists Plan Asia-Pacific Research Network
TOKYO—International health organizations have long recognized the devastating impact of infectious
diseases such as HIV/AIDS, malaria, and tuberculosis on developing countries. Now researchers are also
sounding an alarm about the burdens of non-communicable diseases, particularly cancer. Japanese

Budget (24)Defense (12)Education (16)Energy (7)researchers hope to highlight the problem and contribute to solutions by bringing together labs andEnvironment/Climate (22)hospitals throughout Asia into a cancer research network.

Europe (27)

"Cancer is expected to become more serious in middle- and low-income countries, yet it has not attracted

Obama Transition (37)sufficient global attention," Hajime Inoue, director of international cooperation for Japan's ministry of health

Physical Science (10)told the Third Cancer Asia Forum on 7 February here.

Space (10)Inoue noted that improving child and maternal health and halting the spread of infectious diseases areamong the United Nations Millennium Development Goals. But he pointed to studies indicating that overTechnology (5)Weblogs

70% of worldwide cancer deaths in 2007 occured in low- and middle-income countries and, that in 2015,
more deaths will likely result from tobacco-related diseases such as cancer, than from HIV/AIDS.

Monthly Archives

While cancer is a global problem, solutions have to be local. "The epidemiology of cancer in Asia and in the

February 2009 (30)West is very different," said Hideyuki Akaza, a urologist at University of Tsukuba in Japan. He explained

January 2009 (63)that because of genetic and dietary factors, certain cancers are more prevalent in Asia than in the West

December 2008 (63)and the response to treatment varies. Yet limited clinical trial data has hindered the development ofevidence-based guidelines for cancer care in Asia, he said.

November 2008 (18)

To fill the gap, researchers are eyeing a network modeled on the United States' National Comprehensive
Cancer Network (NCCN), through which 21 leading American cancer centers collaborate to conduct
research and develop clinical care guidelines. Akaza and others hope a similar Asian network will grow out

Recently on ScienceNOWof the 20th Asia Pacific Cancer Conference to be held in Tsukuba from 12 to 14 November. Akaza, who is

Novel HIV-Fighting Method Finally Gelspresident of the conference, already has groups working on proposals for advancing cancer prevention,

One Giant Leap for Robot-Kinddiagnosis, and treatment and he believes that can set the stage for a more formal ongoing effort.

Flu: It's the Humidity. Absolutely

NCCN makes selected clinical practice guidelines available in Chinese, Korean, and Japanese. It also

Climate Change Is Friend and Foe to Ozone Layerholds meetings to discuss cancer issuse throughout Asia and the Middle East. But rather than tag along on

The Sound of Six-Legged Majesty

an American initiative, "It's important that people in Asia take action," says Akaza.
—Dennis Normile
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Home > News > ScienceInsider > November 2009 > In Asia, A Debate Over Making Cancer a Global Health Priority

In Asia, A Debate Over Making Cancer a Global HealthPriority
by Dennis Normile on 12 November 2009, 11:20 AM | Permanent Link | 1 Comments

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Not surprisingly, cancer researchers in Asia think their specialty deserves to be a higher global health priority. Todayat an Asia Cancer Forum discussion in Tsukuba, Japan, one speaker after another pointed to statistics showing thatcancer, though thought of as an advanced country scourge, is rapidly overtaking AIDS, tuberculosis, and malaria asa cause of premature mortality in the developing world. Yet cancer isn’t mentioned as one of the United Nations
Millennium Development Goals. Shigeru Omi, former World Health Organization Regional Director for the Western
Pacific now at Jichi Medical University in Tochigi Prefecture, drew murmurs of approval from the partisan crowd
when he said the global health pendulum had swung too far towards addressing infectious diseases "at the expenseof non-communicable diseases." He suggested that Japan use its influence with international organizations torebalance priorities.
Not so fast, countered Hiroyoshi Endo, an infectious diseases specialist at Tokyo Women's Medical University.
Saying he was offering "constructive criticism from someone in a field in competition for resources," he noted that
infectious disease scientists not only had very clear goals but proven methodologies and metrics for reducing theinfectious disease burden. "For cancer to be included in the Millennium Development Goals, there must be more
explicit goals and the means of evaluation must be clarified," Endo said.
Hajime Inoue, a public health adviser to the China Prefectural government, suggested cancer researchers do their
homework and have solid proposals ready by 2015, the deadline for the current Millennium Development Goals anda likely starting point for new global health priorities.
The Asia Cancer Forum was held in conjunction with the 20th Asia Pacific Cancer Conference, running from 12 to
14 November.

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キャンセルl 投稿Jpn J Clin Oncol 2010;40(Supplement 1)i82 – i85
doi:10.1093/jjco/hyq132

What Should We Do to Raise Awareness on the Issue of Cancer in
the Global Health Agenda?
Norie Kawahara 1,*, Tohru Masui 2, Jae Kyung Roh 3, Xi Shan Hao 4, David Hill 5 and Hideyuki Akaza 6
1

Project Researcher, Research Center for Advanced Science and Technology (RCAST), The University of Tokyo,
Tokyo, 2Department of Disease Bioresources Research, National Institute of Biomedical Innovation, Osaka, Japan,
3
Institute for Cancer Research, Yonsei University Collage of Medicine, Seoul, South Korea, 4Tianjin Medical
University and afﬁliated Cancer Institute and Hospital, Tianjin, China, 5International Union Against Cancer and
6
RCAST, The University of Tokyo, Tokyo, Japan*For reprints and all correspondence: Norie Kawahara, Research Center for Advanced Science andTechnology(RCAST), The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo, 153-8904, Japan.
E-mail: norie.kawahara@med.rcast.u-tokyo.ac.jp

Key words: global health agenda – millennium development goals (mdgs) – health equity –traditional medicine

INTRODUCTION
The Asia Cancer Forum (3) has been held on a total of fouroccasions since 2008, in collaboration with the Asia-Paciﬁc
Cancer Conference (APCC). With regard to the question ‘whatshould we do to ensure cancer is placed on the global healthagenda?’ a concept note was formulated based on an interview
with Dr. Harold Varmus of the United States, who was responsible for the compilation of The U.S. Commitment to Global
Health (4), and an agenda was duly distributed to Asia Cancer
Forum participants. With regard to the question of how theissue of ‘Health equity’ should be positioned and what indicesshould be utilized to assess health equity, the opinion of
Dr. Ala Alwan, World Health Organization (WHO) Assistant
Director-General for Non-communicable Diseases and Mental
Health was sought, based on discussions that took place atthe WHO’s Kobe Center in June 2009 (5). Dr. Alwan wasscheduled to participate at the APCC, but prior commitments
meant that he recorded a video message, which was relayed tothe participants of the Asia Cancer Forum (6). An established5.5 million people die from cancer each year in developing
countries, and this ﬁgure continues to rise. The WHO projects
that by 2015 an estimated 5.7 million people will die annuallyfrom cancer in developing countries, rising to 8.9 million by
2030. People living in low- and middle-income countries are
in greater danger than people living in high-income countries
of succumbing to risks that can be relatively easily avoided byman-made interventions (Fig. 1). These risks include smoking,unhealthy eating and lifestyle, lack of exercise, excessive
intake of alcohol and chronic infections such as HPV or hepatitis. The importance has been pointed out of quantifying thecurrent status in developing countries and developing projections for the future, and making efforts to track changes in the# The Author (2010). Published by Oxford University Press. All rights reserved.

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Developing and emerging countries, including China and India, account for a large proportionof the global population, and as measures to address infectious diseases in these countries
bear results, we are seeing a transformation in the nature of diseases that affect thesecountries. It is against this backdrop that cancer is presenting an increasingly serious threat indeveloping countries (WHO. The World Health Report 2008—primary health care: now morethan ever.) ‘Global health’ has become an often-heard term in discussions on international
health, and backed by a number of well-funded global initiatives, it is now positioned as oneof the major agenda items for the international community (Reich MR, Takemi K, Roberts MJ,
Hsiao WC. Global Action on Health Systems: A Proposal for the Toyako G8 Summit. Lancet
2008;371:865 – 9). However, cancer has not yet attained its rightful position on this global
health agenda. This paper gives an overview of the discussions that took place at the 5th Asia
Cancer Forum. Based on the challenges and outlook for placing cancer on the global healthagenda, we conduct analysis that focuses on top-down mechanisms and bottom-up
mechanisms.

Jpn J Clin Oncol 2010;40(Supplement 1)

situation. With limited medical resources, diseases such as
HIV/AIDS and malaria remain priority issues for global
health, however, the time has come for policy transformation(7). In strategic terms our objective is to include cancer in theMillennium Development Goals (MDGs) of the United
Nations (8). The question that thus presents itself is what
actions should we engage in to take the next step towards
achieving the inclusion of cancer in the MDGs?

TOP-DOWN MECHANISM(i) Realist approach: emerging pandemics and conﬂicts
between property rights and public health;(ii) Theoretical approach: emerging new theories such associal determinants of health, cross-sectoral approach;(iii) Legalistic approach: health as a human right; and(iv) Moral approach: human dignity and human security.
He also pointed out that a framework is beginning to emerge
in the world that seeks to address health-related issues througha multi-sectoral approach (10). This move to a multi-sectoral
approach has, however, raised other issues, as evidenced by theannouncement of almost 130 global health initiatives invarious areas, and the emergence of numerous players inpolicy formulation, which has served to create confusion.
In order to raise the priority of cancer-related issues in the
global health community, which is facing an era of transition,
Executive Advisor of the Chiba Prefecture Department of
Health and Welfare Hajime Inoue spoke about the importanceof gathering empirical evidence and showing such evidence topolicy-makers and other people who do not necessarily have a
specialist background in cancer. Dr. Inoue pointed out that of
total global expenditure on developing health aid, the proportion of health aid allotted to cancer-related issues is disproportionately small in comparison to the disease burden cancer
presents, and that this is a reality that cancer specialists needto recognize (Fig. 2). However, discussion of high mortality
or morbidity in merely epidemiological terms will not resultin cancer taking its rightful place on the global health agenda(11). Dr. Inoue emphasized that in order to remedy this situation and implement a solution, the most important factor isthe availability of human, physical and ﬁnancial resources,
means of evaluation, and most particularly commitment. In
order words, it is incumbent upon us to demonstrate a meansof tackling and resolving the relevant disease burden. In
developing countries the general understanding is that cancer
treatment is difﬁcult to implement, and it is therefore important for efforts to be made to emphasize that even in thedeveloping world there are means of preventing and treating
cancer.
Hiroyoshi Endo, Professor of the Department ofInternational Affairs and Tropical Medicine of Tokyo
Women’s Medical University spoke, based on his long experience in dealing with infectious diseases, about the differences

Figure 1. The global burden of cancer death.

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In a globalized world, issues relating to global health are notlimited to overcoming disease, but also encompass a numberof other complex factors, including socio-economic elements
and political maneuvering on the diplomatic stage. The erain which international cooperation aimed simply at ‘diseaseeradication’ can bring results is now over and global healthmust now be considered as a series of complex interlinked
elements, even as we face the effects of the worst ﬁnancial
crisis in history (9). Senior Fellow of the Japan Center forInternational Exchange Keizo Takemi identiﬁed the following four approaches concerning what mechanisms and theories have been utilized as determinants for setting the
global health agenda:

i83

i84

Raising awareness on the issue of cancer

in measures required to tackle cancer and infectious diseases,
and accordingly the differences in justiﬁcation for including
cancer in the MDGs. He highlighted the following points forcomparison: (i) time frame for treatment (infectious diseases
can be dealt with in the short term, whereas cancer treatment
is long term, counted usually in units of years), (ii) target fortreatment (collective treatment for infectious diseases andindividual treatment for cancer), (iii) resources for diagnosis
and treatment (overwhelming lack of resources for cancer
treatment in the developing world), and (4) potential for fullrecovery (cancer has a high rate of reoccurrence, etc.). If
cancer is to be included in the MDGs, it will be necessary todeﬁne speciﬁc goals, or possibly to target certain diseases andcreate indicators for measuring and evaluating these. At thesame time, it is important to recognize the importance andeffectiveness of overcoming the differences between cancer
and infectious diseases as noted by Dr. Endo.

BOTTOM-UP MECHANISM
Manami Inoue, Section Head of the Epidemiology andPrevention Division, Research Center for Cancer Prevention
and Screening of the National Cancer Center spoke about thenecessity of monitoring of disease statistics and estimation of
the population attributable fraction of major risk factors bysystematic review and meta-analysis to provide concrete estimates for cancer-prevention strategies. In Asia, disease monitoring systems have been improved and an increased numberof epidemiological evidence has become available in the past
decade. However, current research funding for cancer researchin Asia is generally only available for topic-speciﬁc research(i.e. association between smoking and lung cancer, etc.). The
following needs were identiﬁed:(i) A research platform for cross-country communicationand collaborative research aiming towards an eventual
estimation of the impact of major risk factors andcancers in Asia.
(ii) International organizations and funds are expected toplay a role to act as a funding base, to assure balanced
and equal collaboration, and to ensure the multinational collaborative studies.
It was emphasized that in order to reach out to people otherthan specialists in the cancer-related sector, it is essential togather accurate and convincing data that will provide impact
assessments and estimates for major risk factors and will
stand as concrete statistics to justify funding for cancer-related
research. Dr. Inoue noted that in order for such data collectionin Asia to become reality, an enormous sum of money and agreat pool of human resources would be required (11).

DISCUSSION
In an increasingly internationalized world we still face theharrowing reality that even when afﬂicted with exactly thesame disease, some people will be cured, while others will
suffer and die. What, then, should we do to address thistroubling reality? Proceeding with strategic initiatives alone
blunts sensitivity to the actual situation of the real people
whose health and welfare we are trying to support. A─5─

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Figure 2. International Partoners—ofﬁcial development assistance (ODA) invested in addressing cancer.

Jpn J Clin Oncol 2010;40(Supplement 1)

setting the global health agenda. It is intended that research
will focus on the following two major points:(i) What prevents cancer from being included on the
global health agenda?
(ii) What policy proposals are required to ensure theinclusion of cancer in the revised MDGs?
These questions will be posed to cancer researchers andpolicymakers from various countries in an attempt toanalyze just how current cancer research is positioned in thecontext of global health, and what the perceptions of current
realities are among the various persons concerned, fromwhich challenges and issues will be distilled. The Asia
Cancer forum will continue this work through its online
network. The ﬁrst priority is to share a common awarenessof the current situation with those in the cancer community,
after which it will be essential to issue concrete data thatwill form the basis for policy proposal activities.

Funding
This study was supported by Health and Labour Sciences
Research Grants.

Conﬂict of interest statement
None declared.

References
1. WHO. The World Health Report 2008—primary health care: now morethan ever.
2. Reich MR, Takemi K, Roberts MJ, Hsiao WC. Global Action on Health
Systems: A Proposal for the Toyako G8 Summit. Lancet
2008;371:865 –9.
3. Asia Cancer Forum:. http://www.asiacancerforum.org/
4. Committee on the U.S. Commitment to Global Health; Institute ofMedicine. The U.S. Commitment to Global Health: Recommendations
for the Public and Private Sectors. 2-15 to 2-20, 2009.
5. Health Equity in All Urban Policies:. A Report on the Expert
Consultation on Intersectoral Action (ISA) in the Prevention of
Noncommunicable Conditions. Kobe, Japan, 22–24 June 2009.
6. Opening statement by Dr. Alwan. 20th Asia Paciﬁc Cancer Conference.
Tsukuba, Japan, 12– 14 November 2009.
7. Doha Declaration on NCDs and Injuries, adopted at a preparatory
ECOSOC Regional Ministerial Meeting on NCDs and Injuries. Doha,
Qatar, 10–11 May 2009.
8. UN Millennium Development Goals United Nations Millennium
Declaration UN Stats Division—MDGs MDG Report, 2008
9. UN News Centre. Financial crisis threatens push to boost global health,says top UN ofﬁcial. 12 November 2008.
10. Global Responsibilities for Global Health Rights. Brussels, Belgium
19–21 October 2009.
11. Asia Cohort Consortium. http://www.asiacohort.org
12. World Bank. World Development Indicators Online. Washington, DC:
World Bank 2008; http://www.worldbank.org/
13. FRESH. http://www.freshschools.org/
14. Kawahara N. Perspectives on Strategies for Establishing Cancer on the
Global Health Agenda: Discussion on the possibilities and signiﬁcanceof creating infrastructure for cancer prevention information using school
health classes. Asian Pac J Cancer Prev 2010;8:1106.
15. “Primary Health Care.” Alma-Ata, USSR. Geneva: WHO, 6 – 12
September 1978.

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purely top-down approach brings with it the possibility
that momentum towards encouraging independence andself-help efforts among the public will be lost, and therefore nulliﬁes any results that are achieved. If cancer is not
to take the same path in developing countries that it has
taken in industrialized countries, we must consider mechanisms that allow us to fulﬁll our responsibility to provide
assistance to developing countries in the form of information and knowledge that have already been amassed,
while ensuring that economic development in thesecountries is not hindered.
Preventive activities and measures require a long periodof time before results become apparent and as the costbeneﬁt effect of allocated funds cannot be measured in the
short-term, preventive activities have therefore tended to begiven a low priority in terms of national policy (12).
Taking in a long-term perspective that looks ahead to theissues that will face future generations and responding tochallenges presented by cultural diversity, we must work to
maximize limited resources and seek to position cancer asa central theme on the global health agenda. The readily
available infrastructure in the form of health classes inschools (13) would be one effective method of creating amodel for cancer-prevention education (14). Cancer, whichto date has been perceived as a disease affecting individuals in developed countries has now become an issue indeveloping countries, and disparities in medical andsocietal resources are providing further obstacles to therealization of justice and fairness. We must constructmeasures that do not require limitless quantities of money
to be outlaid to save lives, but that seek to provide nursing
care and medical treatment based on the rights and dignityof the individual (15).
Kenji Watanabe, Associate Professor of the Center for
Kampo Medicine of Keio University School of Medicine
spoke about the situation whereby in developing countries it
is not possible to use traditional medicines as a complementary therapy for living with cancer. In recent years interest in
the WHO has grown in traditional medicine and ways arebeing sought to add traditional medicines to the International
Classiﬁcation of Diseases (ICD). Traditional medicines
could become an effective resource for linking the Westernand Eastern hemispheres.
In the face of the common challenge presented tohumankind of winning the ﬁght against cancer, the Asia
Cancer Forum aims to build a discourse on ‘human security,’ which offers a means of applying concepts of‘justice,’ ‘human rights,’ ‘growth,’ and ‘sustainability’ in areal-world context.
In order to further develop global research on cancer, theAsia Cancer Forum will engage in strategic analysis focusing
on the ongoing work towards the revision of the Millennium
Development Goals of the United Nations in 2015, bearing
in mind the signiﬁcant inﬂuence the MDGs possess fori85

Jpn J Clin Oncol 2011;41(5)723 – 729
doi:10.1093/jjco/hyr036
Advance Access Publication 29 March 2011

Meeting Report

The 6th Asia Cancer Forum: What Should We Do to Place Cancer
on the Global Health Agenda? Sharing Information Leads to
Human Security
Norie Kawahara 1,*, Haruhiko Sugimura 2, Akira Nakagawara 3, Tohru Masui 4, Jun Miyake 5, Masanori Akiyama 6,
Ibrahim A. Wahid 7, Xishan Hao 8 and Hideyuki Akaza 1
1*For reprints and all correspondence: Norie Kawahara, Department of Strategic Investigation on Comprehensive
Cancer Network, Research, Center for Advanced Science and Technology (RCAST), 4-6-1 Komaba, Meguro-ku,
Tokyo 153-8904, Japan. E-mail: norie.kawahara@med.rcast.u-tokyo.ac.jp
Received January 12, 2011; accepted February 8, 2011

This forum discussed issues relating to the inclusion of cancer on the global health agenda,
with the ultimate aim of achieving human security for all people. The forum discussed what
methods are available to the cancer community in attempts to create a common data system
for the rapidly growing Asian region. Discussions also focused on the preparations that canbe made to consider and respond to the obstacles to the creation of an Asia-wide data andinformation network. It was also noted that in order to create a cancer information network,
support would need to be provided to low- and middle-income countries and efforts made toensure that data are comparable.
Key words: cancer information network – MDGs – human security – data comparability

OVERVIEWThe Asia Cancer Forum is a grouping that aims to discusscancer science and policy issues among Asian countries.
The basic concept of the forum is that discussion will
enhance sharing and awareness of the issues and each of theparticipants will gain their own take-home message to apply
to their own activities as the outcomes of the forum. The
forum is operated through the research funds of the participating members and receives support in the form of Healthand Labour Sciences Research Grants from the Ministry of
Health, Labour and Welfare of Japan, as part of the Third
Term Comprehensive Control Research for Cancer or its
ongoing work to create an Asian network. The organizer ofthe forum is N.K. and it is chaired by H.A., both of the

Research Center for Advanced Science and Technology(RCAST), the University of Tokyo.
The origins of the Asia Cancer Forum date back to 2004
when a group of Asian researchers launched a platform
called the Asia High Technology Network to discuss issues
in the ﬁeld of medicine. The grouping engaged in discussions on the formation of an Asia Cancer Information
Network. From 2008, the name of the research platform waschanged to the Asia Cancer Forum and the ﬁrst two meetings were held thereafter. The third meeting was held in
February 2009, on the theme of ‘Health, Information andDevelopment’. The third meeting was held jointly with
SciDev.Net and saw 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# The Author (2011). Published by Oxford University Press. All rights reserved.

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Department of Strategic Investigation on Comprehensive Cancer Network, Research Center for Advanced Scienceand Technology (RCAST), The University of Tokyo, Tokyo, 2Department of Pathology, Hamamatsu University
School of Medicine, Hamamatsu, 3Chiba Cancer Center, Chiba, 4Department of Disease Bioresources Research,
National Institute of Biomedical Innovation, Osaka, 5Graduate School of Engineering Science, Osaka University,
Osaka, 6Policy Alternatives Research Institute, The University of Tokyo, Tokyo, Japan, 7Malaysian OncologicalSociety, Malaysia and 8Tianjin Medical University, China

724

The 6th Asia Cancer ForumINTRODUCTION TO THE ASIA CANCER
FORUM
N.K. (RCAST) gave an introduction to the ongoing activities
and initiatives of the Asia Cancer Forum. She noted that theincidence of infectious diseases in developing countries andthe delay in formulating measures to respond to these diseases are recognized as issues requiring the attention ofindustrialized nations. Accordingly, infectious diseases are
given due recognition on the global health agenda. However,cancer has still to gain the recognition it rightly deserves in
the world of global health. This is due to the fact that it isgenerally viewed as a disease speciﬁc to individuals inindustrialized nations, which occurs as a result of the individual’s approach to personal health management.
Last year, the Fifth Asia Cancer Forum discussed issues
relating to cancer and concluded that the highest priority
should be for expert groups to share a common recognitionof the necessity for cancer to be raised on the global healthagenda. In the international community, there has also been
increasing recognition of the necessity to ‘begin discussion
on placing cancer on the global health agenda’, as evidenced
by the Resolution of the United Nations on 13 May 2010 tohold a United Nations General Assembly Summit on
Non-Communicable Diseases (NCDs).
However, the results of a survey implemented by the Asia
Cancer Forum in April 2010, on the occasion of the 101st
Annual Meeting of the American Association for Cancer

Research (AACR), entitled ‘Survey on Inclusion of Cancer
in the Global Health Agenda’, showed that interest in thisissue is not particularly high among a great majority of
specialists. Discussion on the inclusion of cancer on the
global health agenda does not stop merely at the advocacy ofhumanitarian principles. In fact, what is needed now is amove away from the linear debate such as that which has
dominated discussions of aid to developing nations in thepast, and a move toward more complex projections.
Therefore, it is necessary to gain the broad participation ofcancer researchers in working to decipher the current challenges faced by industrialized nations, which could then be
utilized in assistance to developing nations. In other words,
it is necessary to establish a framework for resolving issues
that face industrialized nations.
The world is now in an era in which developments inhealth innovation have a signiﬁcant impact on the direction
for global health.
In the initial stages of the genome-wide association study,
it was thought that genetic differences by race increased thepredisposition to the occurrence of a particular disease.
However, as research has advanced, it has shown that
although there are some statistics differences among races
according to the genetic background, the genetic factors predisposing a person to the occurrence of disease are clearlyshared by all humankind. In other words, any careful observations made in one speciﬁc region of the world are relevant
to other regions.
Owing to the tremendous improvements in genome analysis capabilities, it is now possible to analyze genetic information to an incredibly detailed level. Furthermore,
information technology (IT) has enabled quantitative tracking of the vast amounts of medical-related data that are
created in the modern world. By continuously and automatically collecting and gathering information from various
sources, including clinical data and medical records, andusing this information to realize the creation of a system thatwould produce the required evidence for the purpose of providing each patient with the most appropriate and latest
medical treatment, research could be used in a synergetic
partnership with treatment. Through such technologicalbreakthroughs, it would be possible to search out information
relating to the culturally diverse acquired lifestyle customs
that exist in Asia, even in persons of similar race, and work
to reduce risk factors and even help to prevent further epidemics. It is for this reason that rather than basing researchon persons of ethnicities removed from Asia, careful studyof the ﬁne differences that exist among the races and nationalities of the Asian region would result in a closer understanding of the nature of diseases in humanity as a whole.
Infectious diseases are characterized by their tendency toinfect many people, while the variation in the disease itself
is not so great. However, non-communicable diseases, andcancer in particular, have the characteristic of presenting differently from person to person. In other words, it can beseen that ‘to understand cancer it is important to look at the─8─Downloaded from http://jjco.oxfordjournals.org/ at University of Tokyo on October 27, 2011

‘Asian Challenges in Shifting the Disease Burdens’. In
November 2009, the ﬁfth meeting was held in collaboration
with the 20th Asia Paciﬁc Cancer Conference (APCC) under
the theme of ‘What Should We Do to Raise Awareness on
the Issue of Cancer in the Global Health Agenda?’ The
meetings to date have concentrated on ways to share information among Asian research colleagues, thus raising awareness of the importance of including cancer on the global
health agenda.
The Sixth Asia Cancer Forum was held in conjunction
with the World Cancer Congress UICC 2010, on 21 August
2010, in Shenzhen, People’s Republic of China. The
meeting consisted of two sessions consisting of six special
presentations, followed by detailed discussions.
Approximately 60 people were present and active discussions
took place. The forum was organized by H.A. and N.K.
(RCAST, the University of Tokyo). Invited speakers
included H.S. (Hamamatsu University School of Medicine),
A.N. (Chiba Cancer Center), T.M. (National Institute of
Biomedical Innovation) and J.M. (Osaka University). Also
in attendance were Joe Harford [National Cancer Institute(NCI)], Julia Schneider (NCI), X.H. (Chinese Anti-Cancer
Association, President of World Cancer Congress UICC
2010), Andreas Ullrich (World Health Organization), David
Hill (UICC) and I.A.W. (Asian and Paciﬁc Federation ofOrganization for Cancer Research and Control).

Jpn J Clin Oncol 2011;41(5)SESSION 1: INFORMATION FROM THE
HUMAN BODY
H.A. (RCAST) opened the meeting by requesting commentsfrom Andreas Ullrich (WHO) and David Hill (UICC).
Andreas Ullrich noted that the WHO is working very hard toinclude cancer in the context of NCDs on the global healthagenda. What needs to be done on a global scale is exactly
what is happening in the Asia-Paciﬁc region in fora like theAsia Cancer Forum, and these activities are very much inline with WHO strategies and policies. David Hill noted that
the Asia Cancer Forum is a series of important discussions
on the issue of cancer. He stated that the UICC is a globalorganization, but has a particular concern about cancer
control in low- and middle-income countries, many of which
are in Asia. There is enormous potential for cancer control,
which is currently not being fully implemented. As a
species, human beings are very wasteful of the beneﬁts of
discoveries. We are not very good at implementing the
beneﬁts of discoveries as rapidly, effectively and equitably
as we should. Forums such as the Asia Cancer Forum, which
focus not only on research and discovery, but more importantly focus on delivering the beneﬁts of research and discovery to populations, are extremely important and are to becommended. The solutions to cancer control lie in people
connecting with each other and with their communities toimplement the beneﬁts of knowledge that we already have,and that is exactly what the Asia Cancer Forum is doing
here.
H.A. presented the concept for this Asia Cancer Forum.
The previous APCC was held in Japan and resulted in theissuance of the Asian-Paciﬁc Consensus Statement byworking groups, which aims to improve cancer healthscience in the Asia-Paciﬁc region. At this discussion lastyear, it was concluded that cancer must be on the global
health agenda and the Asia-Paciﬁc region is ready to work
toward this goal. The issues being currently faced are a rapid
increase in population in Asian countries, an aging society
and increased longevity, together with increased speed indiagnosis. For example, the population of China has a different demographic to that of Japan, but it will gradually cometo look like the demographic pyramid of Japan in the future.
Expenditure is also rapidly increasing in Asia. Comparisons
between the E7 and G7 countries show that medical expenditure is rapidly increasing in E7 countries. Japan has a trackrecord of good healthcare and low spending in terms ofGDP. The low spending in Japan has created a number ofissues, particularly with regard to the quality of life for
medical staff. In other words, Japan has faced a number ofcancer issues ahead of other Asian countries and Japan
could provide a source of reference for other countries thatwill face these issues in the future. The aim of the Asia
Cancer Forum is to come up with good proposals.
N.K. noted that ‘Genetic Solidarity and Altruism’ is a
powerful phrase that features in the ‘Inside Information’
documents of the Human Genetics Commission (HGC) of
the UK. The progress of innovation means that the signiﬁcance of holding information and data is changing greatly.
What is most important, however, is to ensure that each andevery person transforms their awareness about the importance of information in an innovative world.
The Asia Cancer Forum is a body that is committed to
strategic analysis in the area of cancer research. The current
objective of the Forum is to achieve the inclusion of cancer
in the Millennium Development Goals (MDGs) of theUnited Nations. A long-term perspective must be taken thatlooks ahead to the issues that will face future generations. It
is important to start to consider the design of a social systemfor collecting and storing the information and data we ourselves posses.
PATHOLOGY NETWORKING IN ASIA
H.S. (Hamamatsu University School of Medicine) noted thatcancer diagnosis is based on histopathological pictures andhuman pathology and cancer diagnosis is a mature scientiﬁcﬁeld. Histopathological language is common to all oncologists and other cancer specialists and it is now possible technologically to present histopathological pictures. Data can be
stored and uploaded on a virtual slide website for joint use.
Using this website, scientists worldwide could input theirown opinions. Archives stored in digital format can last foralmost forever. The virtual slide website is easy to use andbrowsable. There are many folders on the website featuringhistopathological archives, for educational and research purposes, as well as for quality control. Each hospital can send
images to a central hospital for diagnosis and compare
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differences among individuals’. In a region with genetic
similarities, in which a diversity of acquired lifestylecustoms co-exist, would it not be possible therefore to gather
signiﬁcant data through cohort research in the region?
Progress in science bestows upon people the promise oflimitless possibilities and the means to live longer.
Humankind has devoted much time and effort in the ﬁght
against disease.
In the near future, the international community is likely toface an unjust situation in which some people with the samedisease will be cured while others will suffer and die.
It is this grave reality that must be addressed.
The Asia Cancer Forum bases its activities on the
Universal Declaration of Human Rights, which states thateveryone has the right to share in scientiﬁc advancement andits beneﬁts equally. In aiming to utilize scientiﬁc advancement to address the issue of what we can do to ensure thatthe challenges that have been faced by industrialized nations
are not faced by developing nations, the Asia Cancer Forumis engaging in discussion on the challenge common to bothindustrialized and developing nations, namely the inclusionof cancer in the global health agenda.

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The 6th Asia Cancer Forumis much higher than conventional cameras. With high-speed
Internet, it is possible to scan images to high resolutions. For
virtual slides, no microscope is necessary, only a highresolution CCD camera. The problem at the moment we faceconcerns Internet speed. Eventually, with the disseminationof broadband, this system will be able to be further improved
around the region. Scanners are installed in 300 institutions
at the moment. Histopathological diagnosis can therefore be
performed 24 h around the clock using the worldwide
network. In order to expand the network further, it will benecessary to develop infrastructure, including high-speed
broadband Internet.

A.N. (Chiba Cancer Center) talked about the urgent demand
to establish bio-resource and tumor banks in order to better
cure sick children. The cure rate of pediatric cancer is very
low in many countries in Asia. Epidemiology of childhood
cancer in developing countries is largely unknown. It is notknown what genetic and environmental factors affect pediatric cancers, in contrast to the knowledge available on adultcancer. It is important to establish a standardized therapeuticand diagnostic system, which would be helpful for the development of epidemiology of pediatric cancers. In 2008, at themeeting of the Advances in Neuroblastoma Research(ANR2008) held in Chiba, Japan, the Steering Committee
and the Advisory Board Committee of the ANR Association
decided to take an action to establish the international neuroblastoma tumor bank (INTB). The INTB task force includes
the establishment of a standardized diagnostic and databasesystem. Neuroblastoma is a very enigmatic tumor, with mostbeing very aggressive. Prognosis is very poor, even now. In
order to solve this problem, a staging system was proposed.
In order to promote new translational research in the ﬁeld ofcancer, it is necessary to establish a tumor bank system.
More than 90% of neuroblastoma tumors in Japan are being
sent to Chiba University for analysis. Chiba Cancer Centerengages in genomic analysis of these tumors. Efforts arebeing made to propagate our standardized system to othercountries in Asia. All countries agreed to establish a tumor
bank; however, the central tumor bank and molecular diagnosis systems are still immature in Asian countries.
WHY DO WE NEED GLOBAL COLLABORATION IN CANCERRESEARCH? ESTABLISHING CROSS-BORDER TRANSFER OFRESEARCH MATERIALS AND INFORMATION
T.M. (National Institute of Biomedical Innovation) introduced one example of networking and commented on why anetwork is required, particularly in the Asian context. NCI isworking to develop a bio-bank system in the USA. This is avery important attempt to share information and materials
among cancer researchers, although it is currently limited to

SESSION 2: INFORMATION AS IT SIGNALSGLOBAL STRATEGIES FOR GENOME AND CELL-BASEDINFORMATICS: HIGH-PERFORMANCE DNA SEQUENCING AND
EXPRESSION ANALYSIS OPEN A NEW AREA
J.M. (Osaka University) explained the need for an Asian
network from the viewpoint of engineering. Fighting against
cancer is not simple. Everyone in the pharmaceutical industry is now seeking how to control the pathways and molecular systems of cancer cells. We require huge knowledge inorder to achieve this aim, as cancer molecules have an enormous number of variations. Four-dimensional data are
required to identify cancer pathways. In our laboratory, we
have 200TB of data processing capacity, in order to engage
in DNA processing, which provides us with a great deal ofdata. In Okinawa, we have 10 GB sequencers. We know that
medical research is already at a very high level, but R&D
remains at a low level, as a part of total expenditure. We
therefore have to have more information-based medical
systems. We need a system that all stakeholders would be
able and ready to use. We have been working on the creationof a network and would like to ask you to join us in ourefforts.
TACKLING THE ‘LIFESTYLE-RELATED CANCER’ WITH
CUTTING-EDGE IT
M.A. (University of Tokyo) talked about how to build consensus and share information using IT. Aging society is aserious issue as people are susceptible to other diseases in
addition to cancer. In general, the collection of information
data is generally done from the bedside. The next-generation
system would have to be an interactive system. Cutting-edge
systems including bar-code systems and wireless devices
would help to create and disseminate data. Another issue is
how to gather verbal information using IT. Next-generation
data entry systems will need to incorporate measures forgathering verbal information in data format. Cloud─ 10 ─

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URGENT DEMAND TO ESTABLISH ASIAN NETWORK OF PEDIATRIC
BIO-RESOURCE AND TUMOR BANKS FOR BETTER CURE OF THE
SICK CHILDREN

within the USA. Best practices are also issued by the NCI,
the ﬁrst version being issued in 2007. Diagnosis and treatment is not the end of a process, it should be the start for the
next generation of research. It is therefore important toachieve integrity between clinical practices and research
activities. The NCI also focuses on biomarkers, with the aimof providing transcripts for future use. The common practicefor conventional medical research requires a large number of
medical researchers and specialists. Researchers tend not to
see the bigger picture behind research and it is therefore
important to provide transparency in large projects so that
researchers can understand their place in the researchcontext. The creation of an international network would
therefore be very important. A greater degree of cross-border
ﬂuidity is required, working on the already good level ofinteraction between cancer specialists across borders.

Jpn J Clin Oncol 2011;41(5)computing could solve issues of data storage in the future, as
the storage capacity using cloud computing is virtually limitless and would enable further collaboration, including data
entries from patients’ homes, etc. If cloud computing is to
be used, it is essential that the systems are secure andtrusted.

DISCUSSION

and the Asian region to be thinking about how these technologies can be used to assist the low- and middle-income
countries where there are no or few pathologists. This could
be in the form of training, or it could be in the form of
reading the samples. In the case of Ghana, there was a pathologist in Norway who agreed to train the Ghanaian pathologists so that it became possible to get a much quicker
pathology report as a result of training. However, in thiscase, it required North – South cooperation. Efforts should bemade to share resources with the low- and middle-income
countries.
A second issue raised by Joe Harford was that of tumor
banking. The exchange of samples across borders presents
signiﬁcant problems. Each country has its own restrictions
on how samples ﬂow across borders. Hypothetically, there isno need to ever ship a sample across a border. All that isrequired is to have comparable sample collection everywhere, and the equipment to analyze those samples everywhere, and then the information could be shipped acrossborders. It ought not to be necessary to ship samples acrossborders, theoretically. This would require a certain amountof standardization. One of the things that the NCI has been
engaged in with the bio-banking effort is best practices andstandardization, which is an ongoing effort. In order toensure that there is comparability across borders requires asmall number of samples collected in Japan, for example, tobe tested in China or the USA, so that you can assure yourselves that comparability has been achieved. Once comparability has been assured then you ought not to need to shipsamples. All of the countries that are involved in a networkof collaborative bio-banking should be encouraged to workwith governments, and perhaps with the WHO, to makethese provisions that would at least allow for these small
studies in comparability to be implemented.
The term ‘comparability’ is an interesting word, but it does
not necessarily mean uniformity. This particularly applies toinformatics platforms and cancer registries and the softwarethat is used for cancer registries. These are not uniform, butthey can still be comparable. Databases in particular do nothave to be uniform, but it is important to create ‘adaptors’
that would enable data gained in one country to be usefullycompared in another country. It is not expected that the world
will uniformly follow US or other standards, but in the interests of collaboration, the opportunity to adapt between
systems and be able to compare is essential.
Julia Schneider (NCI, USA) congratulated the Asia
Cancer Forum for speciﬁcally talking about developing platforms for enhancing collaboration within and outside of
Asia. There is tremendous potential in the age of genomics
and proteomics to do meta-analysis of large collections ofspecimens. It is important to ensure that specimens are comparable. After the initial quality control is implemented, it
makes sense for specimens to be analyzed in the country inwhich they were gathered. It is very exciting that these sorts
of issues about creating and developing platforms and infrastructure are being discussed in this forum.

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H.A. (RCAST) noted that it is essential that all Asian
countries share information, technology and knowledge. He
invited comments from other participants.
X.H. (Chinese Anti-Cancer Association) noted that Asia
needs a forum to focus on the problems facing Asia. Fifty
percent of new cancer cases annually occur in Asia, andfrom the presentations made at the 21st UICC World Cancer
Congress, it is known that 80% of new cases of cancer are
from low- and middle-income countries, like China, India
and Pakistan and other countries in Asia. The issues raisedby the presenters are very important and require action.
Although there is a lot of knowledge and consensus on mostcancers, we still need further information and consultation
on some forms of cancer, including pediatric cancers, leukemia and central nervous system cancers, for example. The
possibilities for medical consultation through the Internet
would be of beneﬁt not only for Asia but for the world, andwould facilitate diagnosis for patients and help to diagnose
and identify the correct therapies for patients and save theirlives. The issue of a tissue bank is also very important. Six
years ago, with the support of the National Foundation forCancer Research (NFCR) from the United States, a Joint
Tissue Banking Facility was opened at the Tianjin Medical
University Cancer Institute and Hospital in China. Right
now there are about 40 000 specimens. An Asian network isessential and Japan is leading the way on this project.
H.S. (Hamamatsu University School of Medicine) notedthat Chinese pathologists have many more cases than ordinary Japanese pathological institutions, maybe due to thenumbers of people who have variations of tissues. The
Internet is a very comfortable way of developing relationships and colleagues in China and Asia should be encouraged to continue to develop such consultation systems.
Joe Harford (NCI, USA) pointed out that through the practice of tele-pathology, it is possible to have samples read in
the USA that were collected in Japan during the night andthereby operate around the clock. In contrast, it is instructive
to look at the situation that was encountered with pathology
services in Ghana. When the Breast Health Global Initiative
visited Ghana, the breast pathology reports were taking 6
months to complete, from the time the samples were collected, until the pathology report was submitted. The idea ofgetting a report in 18 – 24 h is very different from waiting for
6 months. Tele-pathology does have a great deal of potential
for assisting low- and middle-income countries, where there
are few pathologists. It is therefore incumbent on the USA

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The 6th Asia Cancer Forumdevices, essential medicines etc. The Asia Cancer Forum
could be one that goes beyond the diagnosis of cancer andcould be a forum for collecting data about infrastructure. It
could provide information through the Internet and othertools could be developed (or are already developed by theWHO) about capacity in countries. This information could
then be combined not only for academic purposes but also
for a policy forum, where intelligence is translated into
policy proposals to politicians. The politicians could thenbe shown data about incidence of cancer, mortality and survival rates etc. Survival data are very strong drivers in political decisions, as we have seen in Europe. They are notavailable universally across the Asian region. There is great
potential for this forum to set an agenda for what needs tobe achieved in terms of political decision-making and will
be required to achieve that target.
Massoud Samiei [International Atomic Energy Agency(IAEA)] noted that in order for donors to invest in cancer, it
is important to have convincing projects to show that something can be done about cancer. Cancer is perceived as avery expensive disease. The IAEA works with the WHO in
many developing countries, including in Asia, to establish
cancer centers, and often donors ask about investing incancer as it is a very expensive disease. In order to getcancer on the MDGs, it is essential to show that there are
strategies and solutions that are cost-effective. With a little
investment, progress can be made in terms of prevention,screening programs and focusing on speciﬁc types of cancer.
For this, we have already created examples through the
IAEA programs across the globe. The IAEA could collaborate with the Asia Cancer Forum to provide information forthe creation of a proposal to submit to the UN. Donors are
only interested in cost-effective solutions. The IAEA has
pilot projects in eight countries currently and could sharethese results with the Asia Cancer Forum.

CLOSING
H.A. and N.K. thanked the speakers and participants fortheir insightful comments and active participation. In
closing, it was noted that the ultimate goal is to utilize
advances in innovation to create a large database of knowledge and a global network for analyzing data and sharing
information. To this end, it is essential to make efforts tocollect all kinds of medical information. The opinions raisedat the forum concerning means of sharing data and raisingawareness among specialists and patients alike about theimportance of medical information in the ﬁght against
cancer demonstrated that there is a general awareness of theissue. It was recognized that further efforts must be made tocreate awareness among specialist organizations of the value
and necessity of setting the global health agenda for the sakeof scientiﬁc development. Approaches must also be developed that enable countries and regions at different levels ofdevelopment to share data in a comparable manner.

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With regard to the NCI best practices, the new version is
now published and is available on the website for comment.
NCI is very actively interested in receiving comments on
this new version. The process that was used for developing
the NCI best practices was very focused on the USA. It
would be good to continue the dialogue about developing
standards that can be implemented effectively in both Asiaand the USA and other parts of the world. In the USA alone,
many challenges were encountered in terms of the way thatdifferent institutions were engaging in analysis, both fromthe technical side and also the ethical and legal issues(informed consent, privacy protection etc.). These issues
become even more complex in the context of cross-bordercollaboration, but it is extremely important to develop andfacilitate such international collaboration.
M.A. (University of Tokyo) noted that with cutting-edge
IT, it is possible to create information not only for cancer
but also for diabetes and other diseases. Lifestyle-related
cancer is a chronic disease. The cost for hemodialysis andtreatment of cancer is very expensive. It would be possible
to use cutting-edge IT to create systems that would be applicable to a variety of lifestyle-related diseases.
I.A.W. (Asian and Paciﬁc Federation of Organization forCancer Research and Control) reported that in the Southeast
Asian context, it is necessary to look at more fundamental
issues, because there are discrepancies in the region withstandards of health care. There are some parts of the region
where there are no people who diagnose or even treat
patients. In order to look at the cancer agenda, we need tolook at the issue in global terms. For example, take acountry like Malaysia, in Kuala Lumpur, there are 15 – 20
cancer centers within a radius of 25 km, but in other regions,
there are no physicians who are qualiﬁed to provide cancercare. These are issues that need to be examined. Hospitals
treating cancer in the Southeast Asian region have to endure
a tremendous burden, where, in some cases, patients have toshare beds in a cancer hospital and 200 – 300 patients arehaving chemotherapy in a single day. It is therefore important to examine the manpower problem. Part of the issue
here is improving the standards of diagnostic care, sharing ofpathology and maybe radiology reports through the Internet,
but we must also consider how we address the issue of manpower shortage. There are parts of the region where there areno cancer specialists. It is important to think about theseimportant issues of manpower and consider how we can
improve this from an Asian perspective.
Andreas Ullrich (WHO) noted that it is important that
the Asia Cancer Forum is an open platform for all
countries, including low-, middle- and high-income
countries. Linking all these countries toward a common
goal is extremely important. One of the major drivers indecision-making in the political circles is the availability ofdata. It is important not only to know how many cases ofcancer are occurring, but also to know about the number ofstaff who are available in each country. Also, we must consider the availability of technology, including diagnostic

Jpn J Clin Oncol 2011;41(5)ROAD TO 7TH ASIA CANCER FORUM

scheduled to be held on 3 November 2010, with invited
speakers from the Asian region and major pharmaceuticals
coming together to discuss the way forward for a comprehensive cancer network in Asia. With the participation ofrepresentatives of academia, government and industry at the
7th Asia Cancer Forum, it is anticipated that the technicalissues, speciﬁcally relating to knowledge and know-how
gaps between front-runner and developing countries, will befurther discussed, with a view to crystallizing a future path
for a comprehensive cancer information network in the
Asian region.

Conﬂict of interest statement
None declared.

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The discussions at the 6th Asia Forum identiﬁed a numberof key issues that need to be tackled if a comprehensive
cancer network is to be achieved. Knowledge gaps exist
between the current status of cancer research and treatment
in front-runner countries, such as Japan, and the perceptionof issues in developing and emerging countries. It wasrecognized that the issue of obstacles to sharing common
challenges is one that requires further discussion and analysis. The Asia Cancer Forum will continue to examine means
for sharing information in a meaningful and comparable
manner. In particular, the role of IT in opening up cancer
issues for global health consideration will be focused on in
future meetings, with input being sought from policy-makers
in government and from the private sector, including
pharmaceutical companies. The 7th Asia Cancer Forum is729

Jpn J Clin Oncol 2011;41(6)825 – 831
doi:10.1093/jjco/hyr052
Advance Access Publication 28 April 2011

Meeting Report

The 7th Asia Cancer Forum: From the Perspective of Human
Security, How Can We Collaborate as Asians in Order to Place
Cancer on the Global Health Agenda? How Can We Fill in theGaps that Exist Among Us?
Norie Kawahara 1,*, Jae Kyung Roh 2, Hideyuki Akaza 1, Hajime Inoue 3, Kenji Shibuya 4, Masaru Iwasaki 5,
Tetsuo Tsuji 6, Masanori Nishiyama 7, Akira Nakagawara 8, Kenji Watanabe 9, Shinjiro Nozaki 10, Manami Inoue 11,
Haruhiko Sugimura 12, Jun Miyake 13 and Fu Li 14
Department of Strategic Investigation on Comprehensive Cancer Network, Research Center for Advanced Scienceand Technology (RCAST), the University of Tokyo, Tokyo, Japan, 2Yonsei University College of Medicine, Seoul,
Republic of Korea, 3Department of Health and Welfare, Chiba Prefecture, Japan, 4Graduate School of Medicine andFaculty of Medicine, The University of Tokyo, 5GlaxoSmithKline K.K., 6Institute of Gerontology, The University ofTokyo, Tokyo, Japan, 7Medical Platform Asia, 8Chiba Cancer Center, Chiba, 9Center for Kampo Medicine, Keio
University School of Medicine, Tokyo, 10Center for International Collaborative Research, Nagasaki University,
Nagasaki, 11Research Center for Cancer Prevention and Screening, National Cancer Center, Tokyo, 12Hamamatsu
University School of Medicine, Shizuoka, 13Department of Systems Science, School of Engineering, Osaka
University, Osaka, Japan and 14Tianjin Medical University, Tianjin, China*For reprints and all correspondence: Norie Kawahara, Department of Strategic Investigation on Comprehensive
Cancer Network, Research, Center for Advanced Science and Technology (RCAST), 4-6-1 Komaba, Meguro-ku,
Tokyo 153-8904 Japan. E-mail: norie.kawahara@med.rcast.u-tokyo.ac.jp
Received February 7, 2011; accepted March 22, 2011

This forum has continued to discuss the inclusion of cancer on the global health agenda, andspeciﬁcally the Millennium Development Goals. The seventh forum presented an overview ofactivities to date, supplemented by reports from Korea, local governments in Japan andrepresentatives from the pharmaceutical industry. Discussion focused on how to engage inmeasures to tackle cancer prevention and achieve early detection and effective treatment,using limited resources. It was recognized that with non-communicable diseases gaining
increasing attention in international dialogue, it is now of the utmost importance to share an
accurate recognition of cancer research and treatment throughout Asia and the wider world.
Participants concurred that cancer issues are decoupled from the development aid agenda
and that cooperation should be advanced on the basis of international cooperation without
recourse to governmental development aid.
Key words: technology gaps – information sharing – MDGs – maximizing resources

OVERVIEWThe Asia Cancer Forum is a grouping that aims to discusscancer science and policy issues among Asian countries.
The basic concept of the forum is that discussion will
enhance sharing and awareness of the issues and each of theparticipants will gain their own take home message to apply
to their own activities as the outcomes of the forum. The
forum is operated through the research funds of the participating members and receives support in the form of Healthand Labour Sciences Research Grants from the Ministry of# The Author (2011). Published by Oxford University Press. All rights reserved.

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1

826

The 7th Asia Cancer ForumPRESENTATION 1: SETTING THE ISSUES:DISCUSSION POINTS AND CHALLENGESFOR THE ASIA CANCER FORUM TO DATE
N.K. (RCAST) noted that with regard to the discussion
points and challenges raised by the Asia Cancer Forum todate, the primary challenge has been that cancer has yet to
be included in the Millennium Development Goals (MDGs).
It is extremely important for specialists to have a common

understanding of the issue of raising cancer on the global
health agenda. At the time of the 5th Asia Cancer Forum,
participants discussed the importance of cancer being
included in the MDGs. This has recently become an important issue globally. Surveys have been implemented onawareness of cancer as a global health issue. There seems to
be an awareness gap among cancer specialists about theimportance of including cancer on the global health agenda.
The WHO will be taking up non-communicable diseases(NCDs) as part of its efforts, with the holding of a UN
General Assembly Summit on NCDs in September 2011.
With regard to the implications of the awareness gap concerning challenges being faced, it is important to recognizethat we are no longer in an aid-based world. Cooperationand collaboration must be ensured in an equitable manner aspartners. It is necessary to gain the broad participation ofcancer researchers in order to decipher the current challenges
in industrialized nations.
With regard to future themes for consideration, it is important to transcend existing frameworks and take a multidisciplinary approach with the aim of getting as many people aspossible to understand the situation. It is also important tosearch for ways in which Japan, China and Korea cancooperate, focusing on relations with middle-income emerging economies. In the development of cancer prevention,
diagnosis, treatment and care, we need to remind ourselvesof stratiﬁed strategies for different situations. To date,especially in Japan, the prevailing concept is that patients
must be cured, whatever costs may be incurred. It is very
important to bear in mind resource limitations in various
countries, however, and tailor responses to match budgetary
realities.
H.A. (RCAST) thanked N.K. for her overview to theactivities of the Asia Cancer Forum.

PRESENTATION 2: THE RAPID CHANGINGPATTERNS OF CANCER IN KOREA DURING
THE LAST THREE DECADES WITH SOMESUGGESTIONS FOR CANCER PREVENTIONEARLY DETECTION AND TRANSLATIONAL RESEARCHES FOR NOVELTHERAPY AS A MEDICAL ONCOLOGIST’S VIEW POINT
J.K.R. (Yonsei University College of Medicine) provided
Korean data about the changing patterns of cancer and what
they mean for cancer control. Cancer has been the mostcommon cause of death in Korea since 1983. Cancer incidence is now 250 per 100 000 population. Korea hasachieved dramatic economic development during the last
several decades. Cancer incidence is increasing rapidly andthe prevalence rate is changing variously. The cancer survival rate has improved considerably during the last two
decades.
Korea has industrialized during the last several decades,
and until relatively recently, most people lived in rural areas.
However, most people now live in urban areas. Seventy to─ 15 ─

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Health, Labour and Welfare of Japan, as part of the Third
Term Comprehensive Control Research for Cancer or its
ongoing work to create an Asian network. The organizer ofthe forum is N.K. and it is chaired by H.A., both of the
Research Center for Advanced Science and Technology(RCAST), the University of Tokyo.
The origins of the Asia Cancer Forum date back to 2004
when a group of Asian researchers launched a platform
called the Asia High Technology Network to discuss issues
in the ﬁeld of medicine. The grouping engaged in discussions on the formation of an Asia Cancer Information
Network. From 2008, the name of the research platform waschanged to the Asia Cancer Forum and the ﬁrst two meetings were held thereafter. The third meeting was held in
February 2009, on the theme of ‘Health, Information andDevelopment’. The third meeting was held jointly with
SciDev.Net and saw 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 the20th Asia Paciﬁc Cancer Conference (APCC) under
the theme of ‘What Should we do to Raise Awareness on theIssue of Cancer in the Global Health Agenda?’ The meetings, to date, have concentrated on ways to share information
among Asian research colleagues, thus raising awareness of
the importance of including cancer on the global healthagenda.
In the Sixth Asia Cancer Forum, discussion had focusedon the difﬁculties in achieving a comprehensive cancer information network in Asia, due to technology and know-how
gaps between frontrunner countries and developing
countries. These discussions led to the theme of the Seventh
Asia Cancer Forum being set as ‘From the perspective ofhuman security, how can we collaborate as Asians in orderto place cancer on the global health agenda? How can we ﬁll
in the gaps that exist among us?’.
The Seventh Asia Cancer Forum was held at the Universityof Tokyo, Japan, on 3 November 2010. The meeting consistedof two sessions consisting of six special presentations, followed by detailed discussions. Approximately 20 people were
present and the meeting provided a forum for active discussions. H.A. [Research Center for Advanced Science andTechnology (RCAST), the University of Tokyo] presided,with organization being implemented by N.K. (RCAST).

Jpn J Clin Oncol 2011;41(6)overall. Yonsei University Hospital has an equivalent or
superior cure and survival rate compared with westerncountries. However, there are still few novel therapeutic techniques and few novel anti-cancer drugs. There is a further
need for world-class research and global collaboration.
In terms of clinical trials and translational research, goodclinical practice (GCP) guidelines were created in the 1990s
in Korea. International GCP guidelines were adopted in
2001. There are a number of centers and trial groups implementing clinical trials. Yonsei University has international
collaborations with various institutions, including the Mayo
Clinic and the University of Rochester and others in Europe
and Latin America. It is also a member of OncoNet, which
includes preeminent cancer-related institutions around theworld. Efforts are also concentrating on personalized
therapy, focusing on accurate diagnosis and tumor stating,proper evaluation of host status and selective tumor kill withminimal damage to normal tissues. In addition, the personalized method helps in the selection of patients for target
drugs. Cancer requires a genome-wide approach, incorporating tumor heterogeneity, multistep processes and complex
intracellular processes, and also conﬁrmative clinical trials.
In order to overcome the current status and to cure cancer,
primary prevention is most important. Smoking cessation ismost important, particularly in Japan, China and Korea,
especially with regard to passive smoking. Early detection is
also essential, including national cancer screening programs
and novel universal tumor markers. There is a need also tobridge the difference between the bench and the bed, which
requires translational research and collaboration between
basic, translational and clinical researchers. Cooperation
between Asia-Paciﬁc countries is essential for future progress to be achieved.

PRESENTATION 3: BASED ON DISCUSSIONSAT THE 6TH ASIA CANCER FORUM(SHENZHEN, CHINA), WHAT DOES THE GAP
BETWEEN THE CURRENT STATUS OFCANCER RESEARCH AND TREATMENT IN
JAPAN, A FRONTRUNNER IN THE FIELD, AND
THE PERCEPTION OF ISSUES IN
DEVELOPING COUNTRIES MEAN FOR
FUTURE ACTIONS?
H.A. (RCAST) posed the question as to why there has been
no recent advancement in cancer research in Japan. It could
be that Japan is preparing for the next big leap. If Korea’s
situation matures, it is possible that Korea could face theissues that Japan is currently facing. The situation in highincome countries could be presented to middle-income
countries as examples of what it is good to do and whatshould not be done.
The Japanese Journal of Clinical Oncology, v.40, supplement 1, 2010, includes a summary of discussions held at
the working groups at the 20th Asia Paciﬁc Cancer

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80% of Korean people live in apartments and enjoy
improved standards of hygiene. Diet has become increasingly westernized, moving to high calorie, high fat and lower
ﬁber foods. Koreans have a dynamic and positive attitude fornovel therapies and new drugs.
In 1960, the annual income of Korea was $100 per capita.
In 2009, that had increased to US$25 000. Mandatory
national health insurance has achieved almost 100% coverage of the population and complete check-ups are provided
as standard. There is a national cancer screening programand voluntary check-ups for early detection. In addition,
there is aggressive competition between ﬁve mega hospitals
in cancer treatment.
In 1983, cancer became the most common cause of deathin Korea and has increased since then, being the cause ofdeath for 27% of all deaths. Korea’s population is now
almost 50 million, representing 0.76% of the global population, but accounts for 1.31% of all cancers around theworld. Prostate cancer is increasing in males. In females,
cervical cancer used to be the most common form of cancer,
but this has since been surpassed by other types, including
breast and thyroid cancer. The number of expected newcancer cases is also increasing. In men, the incidence of
stomach cancer is decreasing, but colorectal cancer isincreasing dramatically. In women, the most dramaticincrease has been in breast cancer. The 5-year survival rate
has also seen marked improvements.
The number of cancer patients is increasing by about 8%
annually. Patterns of cancer prevalence have been changing
rapidly during the last two decades. Survival has increased
over the last two decades due to: (i) primary prevention,
including an anti-smoking campaign, (ii) a national screening program for early detection and (iii) improvement oftreatment modalities, including multidisciplinary and multimodality approaches.
In the western world, the cure rate for cancer stands at
about 60% due to improved diagnosis and treatment modalities. This is thanks to surgery, radiotherapy and chemotherapy. The issues are as follows: (i) How to prevent
tumorigenesis? (ii) How to improve early detection? (iii)
How to predict and detect recurrences and metastasis? (iv)
How to predict the tumor response or resistance? (v) How to
predict therapy-related toxicities? To solve these problems,
genome-wide research and data are required.
Yonsei University was the ﬁrst westernized hospital in
Korea and since its establishment in 1884 has continued todevelop. The Cancer Center was established in 1969. In orderto understand tumors, a tumor registry and tumor bank werecreated 15 years ago. There is also a computerized follow-up
system. The data bank now contains a total of 95 166 cases
and this number continues to grow year by year. In terms oftumor registration trends in recent years, the number ofthyroid cancer cases has recently increased. Yonsei
University Hospital is treating �5% of all cancer patients in
Korea. Five-year survival rates are particularly good forstomach cancer and 5-year survival rates have increased

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The 7th Asia Cancer ForumPRESENTATION 4: CANCER AS A NEW
GLOBAL HEALTH AGENDA
H.I. (Department of Health and Welfare, Chiba Prefecture)explained that in recent years, health experts have cometogether to highlight the global nature of cancer issues.

With regard to the worldwide trends in cancer, it is noticeable that cancer prevalence is increasing and it is expectedthat cancer will continue to be the leading cause of death in
the world, along with ischemic heart disease and stroke.
Cancer used to be a disease isolated to developed countries,
but today, the situation has changed and most cancer cases
are now found in developing countries and that the ratio isgoing to increase. In terms of the ratio of mortality to incidence in 1 year, the mortality is highest in low-income
countries and lowest in high-income countries. There is adisequilibrium in cancer whereby the disease burden caused
by cancer is very great in developing countries, but global
resources for cancer are concentrated in the developed
countries.
In recent years, cancer has gained increasing attention in theinternational community. Concerning cancer in developing
countries, the Global Task Force on Expanded Access toCancer Care and Control in Developing Countries (GTF.CCC)
was established in 2009. A UN General Assembly Summit on
NCDs will be held in 2011. In comparison, relating to motherand child health, UNAIDS was established in 1996, which was
followed by the MDGs in 2000 and the establishment of a
global fund in 2002. It is encouraging that a similar movement
is now happening with cancer. Following the creation of the
MDGs and the global fund in 2002, there was a great improvement in access to funding and it is to be hoped that a similar
trend will be seen with cancer. However, the countries mainly
affected by NCDs are not low-income countries, but
middle-income countries, and therefore, it is unlikely thatsimilar funding will be made available for cancer. Cancer isdecoupled from poverty issues and this fact could impede
efforts to gain further funding for a global ﬁght against cancer.
The epicenter of cancer is in Asia, with approximately
half of all deaths from cancer being located here. Japanboasts the lowest mortality rate for the three major diseases
among the G7 countries. Japan is facing the issue of cancer
head-on compared with other nations and is also facing a
rapidly aging society. The expectations for the Asia Cancer
Forum are to promote an accurate recognition of the realities
of cancer and the global health agenda for cancer. It should
be recognized that Asia is at the epicenter of cancer and that
non-governmental players should increase their involvement.
With limited resources, it is important to create a structure
for combating cancer under ﬁnancial restrictions, as it islikely that funding will become increasingly tight in futureyears.
T.T. (Institute of Gerontology, The University of Tokyo)
noted that cancer is a disease that will probably be left untilthe very end of the global agenda. Japan is experiencing an
unprecedented aging of the population, which presents issues
not merely about growing old, but also about quality of life.
Quality of life is closely related to quality of medical care.
From that perspective, the prolongation of life is very important for cancer treatment. Different kinds of care including
palliative care are very important. Korea, China and Taiwan
are also experiencing aging of their populations. Recently, a─ 17 ─

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Conference (APCC). Through these discussions, it wasrecognized that cancer must be a global health agenda item
and that the Asia-Paciﬁc is ready to start towards this goal.
The purpose of the Asia Cancer Forum is to share knowledge and experience between Japan, China and Korea.
In Asia, the population is rapidly growing and there is a
rapid migration of age distribution towards a greater proportion of aged population as longevity increases. There has
also been an increase in quality of diagnosis and treatment
and an increase in new drug development. There are disparities in economic development among the countries of Asia,
which presents challenges for the future.
In Japan, the population demographic and disease structure have rapidly changed. The cost of medical care is also
rapidly increasing and the pharmaceutical market is expanding. In Japan, there is a particular problem with drug lag,which is generally twice as long as the drug lag in the USA.
In order to develop new treatments, it is important to havelarge-scale clinical trials, but this cannot be implemented by
Japan alone. It is important to recognize the ethnic differences between Asians and western populations and work
together with China and Korea on therapies and treatmentthat are best suited for Asian people. Japan is engaged ininternational clinical trials, together with China and Korea.
‘Expansion of cancer care and control in countries of low
and middle income: a call to action’ is a recent article in theLancet, which advocates activities similar to what the Asia
Cancer Forum is aiming to achieve.
Substantial inequalities exist in cancer survival rates
across countries. In 2009, the Global Task Force on
Expanded Access to Cancer Care and Control in Developing
Countries was established.
With regard to what can be done by academia, we need to
improve medical education and the distribution of medicalcare. We need to improve access to clinical trials andmanage these trials effectively. We need also to make concerted efforts to collect information from clinical trials.
The Asia Cancer Forum examines means for sharing information in a meaningful and comparable manner. To establish
an information technology network for opening up cancer
issues for global health consideration will be an important
approach. It is reasonable to collaborate with policy-makers
in government and from the private sector, including pharmaceutical companies. Post-marketing surveillance, which is
ongoing in Japan, is an example to establish tailor-made uses
for drugs and treatments that are best suited to patients. Suchinformation will be useful not only for Japanese but also forother Asian patients belonging to a similar ethnicity.

Jpn J Clin Oncol 2011;41(6)meeting of specialists from Asia shared the same awarenessof the aging issue and how our economies should respond to
the problem. Economic development in Asia comes hand inhand with the problem of aging in Asia. The issue of cancer
is not just about developmental assistance, and knowledge
held by non-governmental agencies will also be vital.

PRESENTATION 5: CANCER CONTROL:LESSONS FROM GLOBAL HEALTH
INITIATIVES

discrepancy between the ﬁnancial commitment and public/
political support means that there is a system failure in termsof reﬂecting public views on policy.
The fundamental problem of modern Japan is the lack ofconnectedness. First, the fragmented nature of relations
between the different ministries and agencies within Japan
prevents any form of coordination between foreign andnational health policies. Experts in global health are also
detached from those working in the ﬁeld of national health,when they should be working together. Second, Japan has
expertise within its own borders, but this is seldom transferred to the global health arena. Finally, a robust scientiﬁcassessment of Japan’s national and foreign health policy has
been lacking, and therefore, lessons and knowledge about
best practice are not transferred effectively. The Lancet
series on Japan is perhaps the ﬁrst opportunity we have had
to discuss and evaluate Japan’s national and international
health policy in a scientiﬁc manner.
The concept of global health will help to identify the needfor restructuring domestic health policies and systems, which
in turn will reinvigorate Japanese domestic and global healthstrategies including cancer control.

PRESENTATION 6: DEVELOPMENT AND
DELIVERY OF ANTI-CANCER AGENTS IN
ASIAN COUNTRIES
M.I. (GlaxoSmithKline K.K.) explained that the current situation for pharmaceutical companies is that R&D funding anddrug approvals are decreasing. There is a need to identify
the real clinical beneﬁts and long-term safety. In order to do
this, it is necessary to conduct a large-scale study and recruit
sufﬁcient patients internationally. There is a need to prepare
large investment. Multiregional clinical trials (MRCT) are
increasing in Japan and are needed as Japan alone is unable
to implement large-scale trials. Korea is an active promoterof MRCT and both Taiwan and China are moving toward
increased numbers of clinical trials.
Research is also required for the individual differences indrug response. One example of this is progression-free survival in epidermal growth factor receptor (EGFR) mutationpositive and -negative patients for which the effects of geﬁtinib were investigated. This drug proved to be very effectivein Asia and it was therefore deemed to implement another
MRCT trial called ‘IPASS’. This IPASS demonstrated that
geﬁtinib was effective in treating EGFR mutation-positive
patients, which includes many Asian people.
Safety is another aspect that needs to be focused on. In
the case of sunitinib, for renal cell cancer, the Japan study
showed considerably elevated ﬁgures over those gained fromforeign trials. This demonstrates that safety concerns canvary from region to region.
In terms of opportunities for Asia collaboration, thesimilar ethnic, dietary and social habits of people in Asia aregood for joint efforts. The global pharmaceutical market is─ 18 ─

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K.S. (Graduate School of Medicine and Faculty of Medicine,
The University of Tokyo) noted that although the global
health community is accelerating its efforts to achieve thehealth-related MDGs, there is a growing momentum to push
NCDs, including cancer, onto the global health agenda,
notably at the UN General Assembly summit in September
2011.
There are several myths about cancer in developing
countries. A common perception is that cancer is not everybody’s problem but a disease of afﬂuence and of the elderly.
Another common notion is that the provision of cancer treatment and prevention is not feasible and too expensive in
low-resource settings. Such perceptions are clearly wrong.
One of the greatest challenges confronting the global
health community working toward the MDGs has been theﬁght against HIV/AIDS. A decade ago, critics who argued
against the feasibility of anti-retroviral (ARV) treatment withsecond-line drugs asserted that complex care could not be
scaled up within weak health-care systems. This was provento be wrong given the enormous success of the ARV
roll-out. The question is whether it is possible to apply theanalogy to cancer control in middle- and low-income
countries.
The global cancer community, including the Asia Cancer
Forum, needs to consider at least three things to make thishappen as regards cancer control. First, there has to be ademonstration of results through the development andimplementation of a cost-effective delivery strategy, which
requires a paradigm shift away from an emphasis on scientiﬁc discovery to the implementation and evaluation of a
package of preventive and curative interventions. Second, amultiple-stakeholder approach is needed, including policymakers and pharmaceutical companies for global andregional drug pricing and procurement mechanisms. Finally,
the development of an innovative mechanism for both external and domestic ﬁnancing in developing countries is also
required. All of these innovations are a real challenge and acentral theme of the current global movement toward universal coverage.
Next year, Japan will celebrate the 50th anniversary of its
universal health insurance coverage. According to Horton,1Japan is ‘a mirror of our future’. It seems that Japan is in acomparatively good position to take the lead and help set the
future global health agenda (e.g. post-MDGs). However, the

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The 7th Asia Cancer ForumDISCUSSION
M.N. (Medical Platform Asia) noted that it is necessary to
identify what steps to take on achieving the inclusion ofcancer on the global health agenda. He stated that he has
great expectations for the Asia Cancer Forum to grow.
A.N. (Chiba Cancer Center) noted that listening to the presentations and viewing the reality on the frontlines of cancer
are very exciting. There is a move to personalize and equalize treatment in Japan and each prefectural cancer center
plays a signiﬁcant role in cancer treatment. In the future, thequality of life will be a key consideration and methods arebeing sought to boost the quality of life for cancer patients.
Cancer treatment is advancing and the 5-year survival rate
has also increased considerably in recent years, rising to
70% in Japan, according to the latest results. Improvementsin pediatric cancer have also been similarly signiﬁcant.
K.W. (Center for Kampo Medicine, Keio University
School of Medicine) stated that it is probably advisable toseparate younger patients from older patients and tailor careto suit the needs of each patient.
S.N. (Center for International Collaborative Research,
Nagasaki University) stated that it is important to distinguishbetween MDGs and Asian cancer. It is important not tofocus unduly on MDGs, as cancer in Asia is a complex issue
that goes beyond the MDGs. Japan has the power to inﬂuence the WHO and it is very important to work toward otherissues in addition to the MDGs. It is important to engage inglobal networking to boost awareness of the issues.
M.I. (Research Center for Cancer Prevention andScreening, National Cancer Center) stated that it is importantto promote better collaboration among Asian researchers.
Asia, excluding Japan, used to be an area that received
research grants from the West and that data were collectedby the West. Japan tended to function separately. However,

it is now essential for everyone in Asia to engage in collaboration and work on common issues.
H.S. (Hamamatsu University School of Medicine) statedthat the job of cancer specialists is to look carefully atcancer over an extended period of time. In terms of the pathology of cancer, there are various detailed research projects
ongoing in Japan that utilizes data gained from patients.
However, it can be said that with the stratiﬁcation of cancer
research and cancer treatment into separate ﬁelds, there has
been a lack of awareness about the actual applications forcancer drugs. Pathology is a very mature ﬁeld in Japan and
Korea is also engaged in cancer research and treatment on asimilar level to Japan, together with disease prevalence andtreatment methods that are also comparable. In China,
however, there is still a considerable gap between rural andurban areas, although the level already attained in urban
areas and the openness of government organization to theuse of trial drugs means that there are a number of areas
where Japan, China and Korea can collaborate together. If
broadband access improves in the future, there is also thepromise of telepathology, which will aid pathologists indifferent countries in sharing information.
J.M. (School of Engineering, Osaka University) stated that
the Asia Cancer Forum has focused on the situation inhigher level countries. However, in low-income countries,
cancer has the power to devastate not only the patient but
also the livelihoods of the patient’s family members. It is
important to highlight such issues that are relevant to lowincome countries if there is to be a serious chance of placing
cancer in the MDGs.
H.I. (Department of Health and Welfare, Chiba Prefecture)
noted that there are enormous differences in the funds spentper patient on treating cancer in various countries. For
middle-income countries, with several hundred dollars per
year, as opposed to several thousand dollars per year for highincome countries, there are some things that cannot be done,
but nonetheless there are a number of possibilities.
F.L. (Tianjin Medical University) praised the great levelof development made in Korea. She stated that there is great
potential for joint clinical trials among Japan, China andKorea. The customs and lifestyles are different in Japan and
China and it is important to follow WHO standards in orderfor results to be accepted in the international arena. Japan,
China and Korea should work together to develop new drugs
that are ideal for Asia.
J.K.R. stated that while Japan, China and Korea are theleading countries in Asia, the USA remains the preeminent
country in cancer research. It is important to respect the
research styles and realities in each country when engaging
in collaboration. It is important to engage in comprehensive
efforts to educate and train personnel.
H.A. thanked all participants for their insightful comments. Regarding the way forward, in broad terms, it isimportant to gather information and focus on the issues. It is
not the role of the Asia Cancer Forum to provide assistanceto low-income countries. The Asia Cancer Forum therefore

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continuing to grow, although the percentage of the market
accounted for by the USA has decreased slightly. The
pharmaceutical markets in emerging economies are growing
rapidly and the forecast is that the Asian countries will continue to grow. Several anti-cancer agents have already developed through collaboration in Asia, and Asian contribution
to new drug launches is now very clear. Looking at thedelivery of those newly developed agents, however, it isrecognized that there could be high hurdles for their smoothdelivery to patients, mainly due to the high drug price andthe limited reimbursement process in each insurance system.
International consideration to overcome them and deliver
new drugs for all patients appropriately will be an urgent
matter, in order to achieve a good balance between the
supply of the resources at the development phase and thedelivery of the approved anti-cancer drugs after launch, andto keep equalities across countries in this region. The
pharma-industry has to develop several measures to tackle
this need from the society.

Jpn J Clin Oncol 2011;41(6)needs to examine the weaknesses and strengths of cancer
research in Asia and look at how we can share our knowledge with various countries in a meaningful way.

CONCLUSION AND FUTURE DIRECTION FOR
THE ASIA CANCER FORUM

options available and the past experiences of frontrunnercountries can provide valuable lessons. Participants concurred that the issue of cancer should be decoupled fromdevelopment issues. H.I. also pointed out that measures tocounter cancer, particularly awareness-raising, prevention,
early detection and improvement of medical systems, could
equally be applied to other NCDs (cerebrovascular disease,cardiovascular disease, metabolic syndrome). This raises thequestion of whether cancer should be handled as astand-alone issue in the context of measures that aim to deal
with NCDs as a whole.
Whether cancer is treated separately or within the contextof NCDs, it is essential to create measures that can be feasibly implemented in each country, duly reﬂecting resource
limitations (budget, human resources and expertise) and forthis continued cooperation and information sharing will be
required.
In the future, the importance of prevention, early detectionand effective treatment will continue to increase, puttingpressure on already limited resources in both high- andmiddle-income countries. In the information age, it is essential to share information through all means possible as a way
to maximize resources in all countries and help to counterthe increasing threat of cancer in the developing and emerging economies.

LOOKING TO 2011
The 8th Asia Cancer Forum is scheduled to be held in theautumn of 2011, following the High-level Meeting on thePrevention and Control of Non-communicable Diseases. It is
anticipated that the outcomes of the UN meeting will present
further clarity to the positioning of cancer on the global
health agenda and the eighth meeting of the Asia Cancer
Forum will aim to further distill discussions on how thediverse countries of Asia can cooperate in research andactions that will help to tackle the spread of cancer in theregion.

Conﬂict of interest statement
None declared.

Reference
1. Horton R. Ofﬂine: Japan: a mirror for our future. Lancet 2010;376:858.

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During the history of the Asia Cancer Forum, since its inception in 2004, there has been a growing awareness of theimportance of cancer as a global health agenda issue. Thisawareness continues to spread through the international
health community and is gathering momentum, as seen by
the formation of a number of cancer-related fora and organizations, and the readiness of international organizations toaddress the issue. As cancer is under the spotlight as a
global health issue, now is the essential time to engage inefforts to share an accurate recognition of cancer researchand treatment throughout Asia and the wider world.
The Asia Cancer Forum places great emphasis on maintaining contact and collaboration with existing organizations
and newly formed international bodies to share awarenessand information on cancer-related issues. The mainstream of
discussion is now squarely addressing the inclusion ofcancer in the MDGs, as evidenced by the preparations
leading toward the United Nations General AssemblyHigh-level Meeting on the Prevention and Control of
Non-communicable Diseases in September 2011. This is precisely the stance that has been taken by the Asia Cancer
Forum in its meetings up to and including the seventhmeeting in November 2010. However, as they currently
stand, the MDGs frame the issue of health as a development
issue, focusing predominantly on mother and child healthand infectious diseases. Cancer, on the other hand, is not apoverty-related issue. As the participants at the 7th Asia
Cancer Forum have recognized, it is essential to positioncancer as a mainstream global health agenda issue. However,the focus should be on international cooperation withcountries that are at the epicenter of growing cancer incidence, including middle-income countries in Asia, without
recourse to governmental development assistance, which has
been the main source of health assistance to date.
At the 7th Asia Cancer Forum, the participants highlighted the important issue of providing care that is appropriate to the budgetary means of each country. It wasrecognized that while possibilities for countries with anannual budget of several hundred dollars per patient per year
will be necessarily more limited than countries with thousands of dollars to spare, there are nonetheless various

831

ASNETポータルトップ (ASNET TOP)｜日本・アジア学プログラムトップ (JAS Program TOP) ｜Japanese

TOP/トップページ

Schedule

Guide

Old program

Links
SATOTAMA
Education Initiative
Contemporary
Chinese Studies

Ohter Universitywide Education
ProgramMedia Content(Undergraduate)

Course Detail

Course Name

Advanced Lecture in Area Studies II)

ThemeSurviving Cancer in Asia

Field

Liberal Arts & Sciences

Academic Year

AY：2011

Graduate School/Faculty

Graduate School of Arts and Sciences

Course ID Number【夏】Master：31M220-1325S Doctor：31D220-1325S 【冬】Master：31M220-1325W
Doctor：31D220-1325W

Name of Supervising Lecturer

Hideyuki Akaza (RCAST)

Semester

All year

Credit

4

week

Fri

PeriodPeriod6 18:00-19:30

Date

Apr 8 2011 ～ Jan 27 2012

Venue

1st or 8th Seminar Room, Faculty of Medicine Experimental Research Bldg., Hongo
Campus [MAP]

Language

Japanese

Description

Against the backdrop of a global transformation in the structure and nature ofdisease, with focus shifting from infectious diseases to non-communicable diseases,
cancer incidence in Asia is rapidly increasing. Cancer is a pernicious disease thatdevelops 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 and activities. To
date in Asia there has been great divergence in medical standards, and also in thevalues of physicians 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 and a stark disjoint
between globalism and nationalism can also be perceived. The Department ofStrategic Investigation on Comprehensive Cancer Network aims to develop new drug
therapies as well as safe and effective 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 areaccordingly engaged in various policy proposal formulation activities, aimed atachieving 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 tocancer in Asia to leading figures and create a forum for dialogue on how Japan
should engage with Asia in fighting cancer.

Academic Field(s)Medical science, Political science, Economics, Sociology,Cultural Anthropology

Keyword(s)Strategic investigation on comprehensive cancer network,International clinical study,
Super aged society, Understanding of history, Global health agenda

Gerontology(Undergraduate)
Ocean Alliance(Postgraduate)

Important points concerning enrollment
Notes

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