APPENDIX 61
Letter to the Committee Specialist from
the Parliamentary Clerk, Department of Health, following the Evidence
Session of 22 March
CANCER INQUIRY: FURTHER INFORMATION ON INTERNATIONAL
SPENDING
At the evidence session with Sir John Pattison
and Professor Mike Richards, the Committee Chairman asked Sir
John Pattison if the Department could help the Committee identify
any information on international expenditure on cancer research,
by both government and by charities.
The Department has made a number of enquiries
which are reported below but in short, have not been able to produce
the information the Committee sought.
INTERNATIONAL COMPARISONS
OF EXPENDITURE
IN CANCER
RESEARCH
The Committee cited figures of 60-95 per cent
of cancer research expenditure in the US, France, Germany and
Japan being provided by government.
We understand that the source of the data was
an article produced in 1991. Searches on Medline and other databases
have not been able to identify the paper. We asked the author
of the submission to the Committee in which the data was cited
if he could provide us with a copy but he has not been able to
do so. We cannot therefore comment on the validity of the figures
in that paper.
GOVERNMENT EXPENDITURE
ON CANCER
R&D
We have not been able to track down any official
figures on levels of government expenditure on cancer research
internationally. EuroStat (Statistical Office of the European
Community) provides figures for health R&D expenditure by
member states but this is not broken down by disease areas.
We asked UK scientific attaches in the US, Canada
and other embassies if they could obtain any figures locally.
Our embassy in Japan provided a paper on cancer R&D activity
which they had prepared in March and which the Committee may have
already seen, but in case you have not I have enclosed a copy.
The figure given for annual government expenditure on cancer research
is 33 billion yen (about £200 million).
We have also directly contacted key research
organisations in Canada, Australia, Sweden and Italy but are still
waiting to hear from them. We will let you have any information
they provide.
The submission to the Committee from the CRC
refers to levels of European Expenditure on cancer research but
we have checked with the CRC and they do not have any detailed
data. Neither do the MRC nor the ICRF who we have also contacted.
CHARITY SPEND
ON CANCER
R&D
We have discussed this with the UK Association
of Medical Research Charities (AMCR). I am afraid there are no
official sources of information on charitable expenditure on cancer
research internationally. The AMRC do not have any international
data and they have also advised us that there are no comparable
umbrella organisations to the AMRC elsewhere from whom we might
seek data.
The AMRC estimates that charitable spend on
research (not just cancer research) accounts for about 30 per
cent of UK R&D spend compared to about 7-8 per cent in the
US and less than 10 per cent in Europe. The figures are not surprising.
The UK has a long history of charitable giving and charitable
spending on medical research, together with a system that facilitates
and supports the establishment of charities, which is not found
elsewhere. The larger the charitable funding for research is in
any country then by definition the smaller the overall proportion
of research funded by government will be. The Cancer Charities
in the UK have been and continue to be particularly successful
in raising public funds for research (compared to other areas).
Inevitably therefore UK government expenditure on cancer research
will be a smaller proportion of the total expenditure. However
cancer research still accounts for the largest proportion of DH/NHS
expenditure on a single disease area.
The AMRC have said they would be happy to give
the Committee more detail about charitable support for R&D
generally if the Committee wished to approach them.
We have also approached the Charities Aid Foundation
and the ICRF neither of whom have or are aware of international
data on cancer research expenditure by charities.
I am sorry these efforts have not produced the
information the Committee sought.
3 July 2000
CANCER RESEARCH IN JAPAN
EXECUTIVE SUMMARY
Cancer became the number one cause of death
in Japan almost 20 years ago and the Japanese Government responded
by launching a series of national programmes to investigate the
causes of cancer and identify treatment. Rather like the American
"war on cancer", the national effort, while contributing
much valuable information on cancer and its origins, has failed
to deliver a "simple" understanding or cure and the
research programme has not, as a result, grown at the same rate
as other life science research projects in Japan. Nevertheless
the scale of support is substantial by UK standards at 33 billion
yen a year—some 200 million pounds per annum. Where cancer
research can be linked to genomics, there have also been some
increases recently as a result of the increased focus on the human
genome and its applications. In terms of major cancer incidents,
the overall levels of cancer remain lower than Western countries,
but the gap is narrowing as more Western life styles spread in
eating habits and smoking remains common. Stomach cancer has declined
as the need for high-salt foods has reduced with refrigeration.
Lung cancer is now the number one killer and will continue to
increase due to continued high rates of smoking. Other trends
are continued incidents of liver cancer associated with previous
hepatitis C infection.
Japan has been responsible for some interesting
developments—particularly in micro diagnostics and surgery,
multi-gene mechanisms, chemical carcinogenesis, 3-dimensional
imaging and viral-initiated cancers. They are also well advanced
in telemedicine linking together various cancer treatment centres.
The emphasis on public education campaign is
similar to that of the UK except that the targets of reducing
smoking have been influenced by economic and industrial interests
and lag behind those of the UK in terms of warnings on cigarette
packs and restrictions on tobacco advertising.
1. BACKGROUND
Japan's cancer research can be traced back to
1908 when the Japanese Foundation for Cancer Research was set
up. This subsequently led to the establishment of the Cancer Research
Institute with its own attached hospital in 1934. Some 30 years
later the Ministry of Health and Welfare (MHW) set up the National
Cancer Research Centre in 1962. Both institutes now play important
roles in Japan's cancer research, collaborating with universities
and regional cancer centres.
When cancer became the top cause of death in
1981 (Figure 1), the government responded by launching a "10
Year Comprehensive Strategy for Cancer Control" from 1984-93.
By the end of this programme cancer was still the major cause
of death (with about 500,000 people developing cancer each year
and one out of three patients dying due to cancer in a rapidly
ageing society). The "Second Term Comprehensive 10 Year Strategy
for Cancer Control" was thus launched by the government to
take over from the first plan in 1994. The various ministeries
involved include the National Institute of Radiological Sciences
(STA), the MHW for clinical research and the Ministry of Education
(MoE) for basic research in universities.
In addition to the two "10-year programmes",
the MHW and MoE have been allocated funds for various other cancer
research projects; budgets for FY2000 are Y= 4.2 billion and Y=
4.5 billion, respectively.
The MHW has also developed campaigns to raise
public awareness of the various life style factors that affect
cancer, such as the effects of smoking on lung cancer and diet
on stomach cancer; other areas to receive attention have been
quality of life issues and patient guidance information.
This paper provides a short description of the
above programmes and current trends in cancer incidence and research
in Japan.
2. CANCER INCIDENCE
IN JAPAN
The main cancer statistics are published by
the Foundation for Promotion of Cancer Research; Figure 2 shows
the change in incidence for the major cancer types.
Figure 2 shows the following trends:
(i) the most common causes of death are lung
cancer in males and stomach cancer in females;
(ii) cancer mortality increases with age,
particularly after 30;
(iii) stomach cancer is common amongst both
males and females in Japan and
(iv) cases of breast cancer are on the rise,
however overall rates remain lower than in western countries
3. RESEARCH &
DEVELOPMENT PROGRAMMES
In addition to the official "10-year programmes"
(namely the "First 10 Year Comprehensive Strategy for Cancer
Control Programme" and the "Second Term Comprehensive
10 Year Strategy for Cancer Control"), the MHW, MoE and the
STA also support other cancer-related research. Each of the "10-year
programmes" has specific research targets that are listed
in Table 1.
Research budgets for the two programmes are
included in Table 2, and the major government research institutes
involved in the programmes are included in Figure 3.
Table 1
PRIORITY RESEARCH CATEGORIES
| First 10-year Strategy
| Second Term 10-year Strategy |
(i) human oncogenes;
(ii) virus-related cancer in humans;
(iii) tumour control;
(iv) technologies for early diagnosis;
(v) new therapeutic procedures;
(vi) immunomodulation and immunomodulators.
| (i) molecular mechanisms of carcinogenesis;
(ii) invasion, metastasis and characteristics of cancer cells;
(iii) cancer susceptibility and immunity;
(iv) cancer prevention;
(v) new methods for cancer diagnosis;
(vi) new methods for cancer therapy;
(vii) quality of life (QOL) of cancer patients.
|
| Research supporting systems including international collaboration.
| Research supporting systems including international collaboration.
|
Table 2
RESEARCH BUDGET FOR TEN-YEAR PERIOD
| | Total (Y=
billion)
| MHW | MoE
| STA |
| First Term 10-year Programme | 102.5
| 18.0 | 23.4
| 61.1 |
| Second Term 10-year Programme (first 6 years budget)
| 130.9 | 26.2
| 31.0 | 73.7
|
Director generals from the "Japanese Foundation for
Cancer Research" and the "National Cancer Centre"
are the project leaders for the Monbusho and MHW groups, respectively.
Major tasks for the STA include:
(i) the construction and operation of the "heavy
ion medical accelerator" in the National Institute of Radiological
Sciences for Cancer Treatment; and
(ii) RIKEN's research into molecular oncology.
Broadly, the role of the MoE is to undertake basic research,
the MHW undertakes clinical research, and the STA is developing
the application of heavy ion beams to treat cancer located in
relatively inaccessible areas of the body. Current research themes
at the MoE and associated grants are included in Table 3.
Table 3
MOE GRANT HOLDERS AND THEIR RESEARCH THEMES (FY 1999-2003)
| Grant holder | Research theme
| Budget
(Y= billion)
|
| Prof Takashi Tsuruo, Tokyo University | Promotion of cancer awareness in Japan
| 2.5 |
| Prof Tehehiko Sasazuki, Kyushu University |
Mechanisms of oncogenesis and anti-oncogenesis |
2.8 |
| Prof Yoshimi Takai, Osaka University | Cancer cell biology
| 2.8 |
| Prof Yusuke Nakamura, Tokyo University |
Diagnosis and treatment of cancer | 2.8
|
| Dr Kazuo Tajima, Aich Cancer Research Institute
| Epidemiological studies regarding impact of environmental and host factors on human cancer
| 0.5 |
| Prof Tadatsugu Taniguchi, Tokyo University |
Advanced research into cancer, focusing on the basic mechanisms of cell growth, differentiation and death
| 2.8 |
Overall cancer related research budgets (research and various
related measures) are included in Table 4.
Table 4
TOTAL EXPENDITURE ON CANCER RESEARCH AND RELATED MEASURES
| | First term 10 year programme (1984-1993)
| | Second term 10 year programme (1994-2000)
|
| Organisation | MHW
| MoE | STA
| MHW | MoE
| STA |
| Expenditure (Y= billion) | 369.0
| 111.0 | 80.0
| 385.8 | 130.9
| 83.0 |
| Total |
| | 561.4
| |
| 600.0 |
One particular project supported by the MHW is the nation-wide
"Cancer Information Network" that uses the "National
Cancer Centre Supercomputer System" to link seven regional
cancer research centres and five major hospitals. The network's
services include:
(i) artificial intelligence expert consultation system;
(ii) medical virtual reality system;
(iii) systems for analysing cancer-related genes with
their three dimensional modelling system;
(iv) reference data base; and
(v) cancer information services.
4. CONTROLLING CANCER
In an effort to combat "life style affecting diseases"
(the treatment of which increases national medical costs), the
MHW set up the "Office for measures for life style diseases"
which include cancer, diabetes, heart disease and strokes. Measures
for cancer include the dissemenation of cancer-related information,
screening to detect cancer at an early stage and raising the awareness
of the effects of genetic background, environment and life style
on the onset of cancer. The MHW commissioned the "Foundation
for Promotion of Cancer Research" in 1968 as an external
body to implement the MHW's 10-year cancer research programmes
as well as public campaigns.
4.1 Screening for early detection
The MHW has provided subsidies to about 3,250 local government
offices in various villages, towns and cities so as to provide
cancer screening along with existing annual health checks. In
line with MHW guidelines, the following cancers are screened for
in individuals over 40:
(i) stomach cancer (medical consultations and X-rays);
(ii) lung cancer (X-rays and sputum cell check);
(iii) breast cancer (palpation and X-rays for those above
50);
(iv) colon cancer (examining faeces for fresh blood) and
(v) uterine cancer (uterine cell examination).
Over 95 per cent of the local government offices (around
3,200) undertake cancer screening; individuals cover about 30
per cent of the cost, whilst national medical insurance covers
those who require second stage tests. Guidelines call for screening
for breast and uterine cancer to be extended to women above 30.
4.2 MHW's "Healthy Japan 21" campaign
MHW's "Healthy Japan 21" campaign (FY 2000-2010)
was launched due to the following factors:
(ii) increase in "life style diseases" such
as diabetes, cardiovascular disorders, obesity and cancer;
(ii) increase in the number of people requiring care,
and
(iv) rising medical costs.
The Objectives of the MHW are to realise a healthy society,
to decrease the death rate amongst the middle-aged and to improve
the quality of life of the elderly. The campaign will set numerical
targets for nine categories, including cancer, teeth and gum diseases,
diabetes, alcohol intake, tobacco and cardiovascular disorders.
A MHW panel intends to finalise the details of the "Healthy
Japan 21" programme in spring 2000; specific cancer related
targets include:
| (i) | increase awareness of the hazards of smoking,
|
| (ii) | increase awareness regarding nutrition and diet,
|
| (iii) | move to an appropriate level of alcohol (about 20g of pure alcohol) and
|
| (iv) | increase the number of individuals being provided with cancer screening
|
A key part of the campaign is to stress the "12-point
precautions for cancer prevention" outlined by the Foundation
for Promotion of Cancer Prevention, these include:
| (i) | balanced diet; |
| (ii) | variety of foods; |
| (iii) | avoid over-eating and reduce fat intake;
|
| (iv) | drink an appropriate level of alcohol;
|
| (v) | refrain from smoking; |
| (vi) | increase intake of vitamins and fibre from fresh foods;
|
| (vii) | reduce intake of salty, bitter and hot foods;
|
| (viii) | avoid burnt food;
|
| (ix) | avoid mouldy food; |
| (x) | avoid overexposure to sunlight;
|
| (xi) | regular exercise; |
| (xii) | maintain a clean body.
|
5. TRENDS IN
R&D, DIAGNOSTICS & CLINICAL
TREATMENTS
It is beyond the scope of this short report to cover all
the results of the R&D programmes and impact on diagnostics
and treatment, however some of the highlights include:
Genetic approach
Professor Yusuke Nakamura from Tokyo University identified
the "APC" gene in 1991, which is responsible for causing
familial adenomatour polyposis (FAP); furthermore, his recent
finding shows that the "p53" gene (a tumour suppression
gene) plays a role in repairing DNA in addition to including apoptosis
and suspending cell cycles.
Completion of the sequencing of the human 22nd chromosome
by the Japan-US-UK team in December 1999, and the human 21st chromosome
by a Japan-German group in February 2000 will further accelerate
the identification of cancer-related genes.
Pathway Signalling
The RIKEN group has identified the defence mechanism of cancer
in apoptosis.
Cancer caused by virus and bacteria
— The Adult T-cell Leukaemia Virus (ATLV) (Identified
by Prof. Takatsuki, Kyushu University) is common in the Kyushu
area. Since the ATLV and the Human T-cell Leukaemia Virus-I (HTLV-I)
are identical, the ATLV is to be renamed HTLV-I,
— 70 per cent of Japanese hepatitis patients are
infected by the hepatitis C virus (HCV) which causes cancer,
— the human papilloma virus (HPV 16 & HPV18)
causes cervix uteri cancer and
— helico bacter pylori causes stomach cancer.
On diagnostics
— Helical CT scanning for lung cancer has been applied
since 1993—this enhances the detection rate three-fold and
allows smaller size lung cancer to be detected;
— improved x-ray screening for stomach cancer has
contributed to earlier detection;
— an advanced bronchus fibrescope has also enabled
early detection of lung cancer and
— a diagnostic kit for detecting ProGRP in serum,
a marker for lung cancer.
On treatment
— various efforts to maintain patients' quality
of life; minimising open body operations;
— improve effectiveness and reduce side effects
by providing appropriate combination of therapy (surgery, drug
and radiation) according to the characteristics of the cancer;
— proton beam radiation (liver cancer) available
at NCC;
— gene therapies to cure brain tumours, lung and
breast cancers (applications submitted to MHW and MoE by university
and hospital research groups); and
— the Japan Clinical Oncology Group (JCOG) supports
clinical studies to develop new methods for cancer diagnostic,
treatment and prevention with 190 medical institutions nation-wide
participating in the studies.
6. INTERNATIONAL COLLABORATION
Japan's primary collaboration on cancer research is with
the US National Cancer Institute which is facilitated between
NCI and the JSPS under the US-Japan co-operative cancer research
programme. These have traditionally met every year in Hawaii but
have recently moved to much larger meetings alternating between
national institutes of health in Bethesda and Japan.
Japan also has regular annual meetings between cancer researchers
in Germany and France, although these are not conducted under
a formal government to government agreement. Previous attempts
by the British Council to encourage collaboration between the
Japanese National Cancer's Centre Research Institute and various
UK centres have not led to a similar level of collaboration although
some contact continue in advanced endoscopy, including other fields.
7. IN CONCLUSION
Japan continues to place medium priority on cancer research
and is half way through its second 10-year programme. While health
advice also tackles the life-style causes of cancer, these have
yet to be accompanied by UK-style restrictions on smoking advertising
or health-based tax policies on cigarettes.
| 
