The Mortality of Cancer and its Effect on Life Expectancy in Taiwan-Fuchien Area

May 15, 2001

I. Preface

The general public are used to calling a malignant neoplasm of any kind a cancer. Cancer is a serious disease in which abnormal cells in a person’s body increase rapidly in an uncontrolled way, affecting and invading normal tissues and organs, producing compression, ulceration, infection or any other factor, and eventually causing hemorrhage, pain or dysfunction of organs. It is a common disease that threatens human life and health to a great extent.

The mortality from cancer has soared swiftly. Cancer has become the most important cause of death and an increasing menace to the health of our people, imposing a negative effect on life expectancy in Taiwan-Fuchien Area. To gain insight into the issue, related statistics, such as the Health Statistics of the Department of Health, was compiled and analyzed. A summary of the findings is as follows:

II. Statistics of the Mortality from Cancer

1. The mortality from cancer soared swiftly in Taiwan-Fuchien Area. In 1999, one death out of four was caused by cancer, and the “per 100,000 persons” mortality rate of cancer in males was 1.7 times that in females.

According to the statistics of the Department of Health, Executive Yuan, the annual mortality from cancer tended to increase year by year in the past ten years. In 1989, the number of deaths from cancer was 18,878 (12,152 males (64.4%) and 6,726 females (35.6%)), representing 18.5% of the total number of deaths, 102,242, and it indicated that 94.4 persons (117.4 males and 69.7 females) out of 100,000 died from cancer. Although the increase of mortality rate from cancer was –1.8% in 1990, the mortality of cancer increased rapidly after 1990. The rising trend reached its peak in 1995 when the mortality of cancer was 25,841 with a 10.8% annual rate of increase in mortality of cancer. Since 1997, the rising trend of the rate of increase in the mortality of cancer has slowed down. In 1999, the number of deaths from cancer was 29,784 (19,137 males (64.3%) and 10,647 females (35.7%)), representing 23.8% of the total number of deaths, 124,991, and it indicated that 135.3 persons (169.7 males and 99.2 females) out of 100,000 died from cancer. It shows that the mortality from cancer increased by 57.8% in the past ten years, with a 4.7% average annual rate of increase in mortality of cancer, which is more than two times the 2.0% average annual rate of increase in mortality in the past ten years.

2. Lung cancer, liver cancer and colon and rectum cancer were the most important types of cancers in Taiwan-Fuchien Area. The total number of deaths caused by the three types of cancers represented up to 50% of the mortality from cancer in Taiwan-Fuchien Area.

The statistics indicate that liver cancer, lung cancer and stomach cancer ranked the first, the second and the third in the mortality of cancer in Taiwan-Fuchien Area in 1991, respectively. The total number of deaths caused by the three types of cancers represented 49.9 % of the mortality from cancer. In 1999, lung cancer, liver cancer and colon and rectum cancer ranked the first, the second and the third in the mortality of cancer, respectively. The total mortality from the three types of cancers amounted to 49.9 % of the mortality from cancer. Although there was not any noticeable change in the proportion of the total mortality of the three types of cancers to the mortality of cancer during the eight years, lung cancer replaced liver cancer as the biggest killer to cancer patients in Taiwan-Fuchien Area, claiming the life of one cancer patient out of five. In addition, an issue worthy of our concern is that the number of colon and rectum cancer patients was increasing rapidly. In 1991, a total of 1,674 persons died from colon and rectum cancer, indicating that 8.2 persons out of 100,000 died from colon and rectum cancer or 8.5% of the mortality of cancer was attributable to colon and rectum cancer. However, in 1999, the total number of deaths from colon and rectum cancer increased to 3,128, indicating that 14.2 persons out of 100,000 died from colon and rectum cancer or 10.5% of the mortality of cancer was attributable to colon and rectum cancer. It shows that the mortality from colon and rectum cancer increased by 80% during the eight years.

3. Males’ mortality from liver cancer was three times that of the females. Males’ mortality from lung cancer was 2.5 times that of the females.

As shown in the statistics, males had higher incidence of cancer and mortality of cancer than females. The phenomenon was distinctly found in the two most important types of cancers. In 1999, liver cancer killed a total of 5,762 persons, of which 4,352 (75.5%) were males and 1,410 (24.5%) were females, showing that the male mortality from liver cancer was about three times the female mortality of liver cancer. In 1999, lung cancer claimed 5,959 lives, of which 4,240 (71.2%) were males and 1,719 (28.9%) were females, showing that the male mortality from lung cancer was about 2.5 times the female mortality of lung cancer.

4. Liver cancer was still the biggest killer to male cancer patients, claiming the lives of 23 % of the males who died from cancer.

There was a change in the top ten cancers that killed males from 1991 to 1999. In 1991, as regards the 12,752 males who died from cancer, the top ten cancers were, namely liver cancer (24.4%), lung cancer (21.1%), stomach cancer (11.0%), colon and rectum cancer (7.3%), oesophagus cancer (4.7%), nasopharynx cancer (4.5%), leukaemia (3.1%), non-Hodgkin’s lymphoma (2.8%), pancreas cancer (2.4%) and bladder cancer (2.0%). As regards the 19,137 males who died from cancer in 1999, the top ten cancers were, namely liver cancer (22.7%), lung cancer (22.2%), colon and rectum cancer (9.4%), stomach cancer (8.2%), oral cancer (6.2%), esophagus cancer (4.1%), nasopharynx cancer (3.3%), non-Hodgkin’s lymphoma (3.1%), prostate cancer (2.9%) and pancreas cancer (2.8%). The change showed that liver cancer and lung cancer still ranked the first and the second in the mortality of cancer, but colon and rectum cancer rose to the third, while stomach cancer dropped to the fourth. However, the number of males died from liver cancer, lung cancer, colon and rectum cancer and stomach cancer in each of the eight years always represented more than 60% of the male mortality of cancer. A phenomenon worthy of notice is that oral cancer and prostate cancer had already replaced leukaemia and bladder cancer as two of the top ten cancers for males in Taiwan-Fuchien Area.

5. Lung cancer is still the biggest killer to female cancer patients, claiming the lives of 16% of the females who died from cancer.

There was a change in the top ten cancers that killed females from 1991 to 1999. In 1991, as regards the 6,878 females who died from cancer, the top ten cancers were, namely lung cancer (15.6%), cervical cancer (12.7%), liver cancer (11.1%), colon and rectum cancer (10.9%), female breast cancer (9.7%), stomach cancer (9.3%), leukaemia (3.9%), pancreas cancer (2.9%) and brain cancer (2.5%) and nasopharynx cancer (2.5%). In 1999, as regards the 10,647 females who died from cancer, the top ten cancers were, namely lung cancer (16.2%), liver cancer (13.2%), colon and rectum cancer (12.5%), female breast cancer (10.2%), cervical cancer (9.1%), stomach cancer (7.5%), gallbladder cancer (3.5%), pancreas cancer (3.2%), non-Hodgkin’s lymphoma (3.2%) and leukaemia (2.8%). The change showed that lung cancer still ranked the first in the mortality of cancer, but liver cancer claimed more lives than it did before. In recent years, the female mortality from lung cancer, liver cancer, female breast cancer, colon and rectum cancer and cervical cancer amounted to more than 60% of the female mortality of cancer. In addition, gall bladder cancer and non-Hodgkin’s lymphoma had already replaced brain cancer and nasopharynx cancer as two of the top ten cancers for females in Taiwan-Fuchien Area. A matter worthy of delight is that recently the health authority took a positive approach to the promotion of the cervical smear test. The effort of the health authority has gradually become distinct – in 1991 cervical cancer ranked the second in the female mortality from cancer, claiming the lives of 12.7 % of the females who died from cancer, but in 1999 cervical cancer ranked the fifth in the female mortality from cancer, claiming the lives of only 9.1 % of the females who died from cancer. Nevertheless, no noticeable improvement was made in the prevention of, and treatment for, female breast cancer. Therefore, it is important for our dear female compatriots to be concerned about their own bodies and have medical checkups regularly.

III. The Effect of Cancer on Life Expectancy

1. In the past ten years, the average annual rate of increase in the mortality of cancer is 4.7%, much higher than the 1.3% rate of non-cancer diseases.

As regards the annual rate of increase in mortality from cancer in the past ten years, although the rate of the increase in mortality from cancer was –1.8% in 1990, the rate of the increase in mortality from cancer fluctuated between 4.5% and 6.8% from 1991 to 1994. The rising trend reached its peak in 1995 when it had a 10.8% rate of increase in mortality of cancer. Since 1997, the rising trend of the annual rate of increase in the mortality of cancer has slowed down. In 1999, the number of deaths from cancer was 29,784, with the rate of the increase in mortality from cancer dropped to 1.8%. However, during the ten years, the number of deaths from cancer increased by 57.8%, with a 4.7% average annual rate of the increase in mortality from cancer.

As regards the rate of the increase in mortality from non-cancer diseases in the past ten years, although the rate of the increase in mortality from non-cancer diseases was –0.8%, -1.0% and -2.5% in 1991, 1993 and 1997, respectively, the rate of the increase in mortality from non-cancer diseases in the remaining years fluctuated between 0.6% and 3.6%. In 1999, a total of 95,207 persons died from non-cancer diseases, indicating a 2.7% rate of the increase in mortality from non-cancer diseases. During the ten years, the number of deaths from non-cancer diseases increased by 14.2%, with a 1.3% average annual rate of the increase in mortality from non-cancer diseases.

The aforesaid data show that, in the past ten years, the average annual rate of increase in mortality from cancer in Taiwan-Fuchien Area is 4.7%, which is higher than the 2.0% average annual rate of increase in mortality in Taiwan-Fuchien Area and much higher than the 1.3% average annual rate of increase in mortality from non-cancer diseases in Taiwan-Fuchien Area.

2. Mortality of cancer increases with age. However, the mortality of cancer patients under 60 remains high, amounting to 31.9% of the mortality of cancer.

As regards the structure of the age groups of the people who died from cancer in the country in the past ten years, among the 18,878 persons who died from cancer in 1989, 1.7% of them were under 20, 1.6% of them were between 20 and 29, 6.0% of them were between 30 and 39, 9.3% of them were between 40 and 49, 18.4% of them were between 50 and 59, 30.3% of them were between 60 and 69, 25.1% of them were between 70 and 79, and 7.6% of them were over 80. There was not any significant change in the structure of the age groups of those people who died of cancer from 1990 to 1998. In 1999, cancer claimed the lives of 29,784 persons, of which 0.9% were under 20, 1.0% were between 20 and 29, 4.3% were between 30 and 39, 11.0% were between 40 and 49, 14.7% were between 50 and 59. 24.7% were between 60 and 69, 29.6% were between 70 and 79, and 13.8% were over 80. The aforesaid data indicate that mortality of cancer increases with age. In 1989, 63.0% of the persons who died from cancer were over 60. The percentage of the persons who died from cancer at 60 or over increased to 68.1% in 1999. The 5.1 percentage increase in ten years indicates that the number of the elderly who died from cancer is increasing. In addition, it is worthy of the concern of our people and the related units that up to 31.9% of the persons who died from cancer were under 60.

3. Cancer is an increasing menace to life expectancy in the country, shortening the life expectancy of our people by 3.2 years.

According to the abridged life tables collected over the years and kept by the Department, cancer had a negative effect on the life expectancy for our people. In 1989, the life expectancy (the average age at which one will die, a figure calculated by statistics) in Taiwan-Fuchien Area was 73.5 years for both sexes on average, 71.1 years for males and 76.5 years for females. After removing the cancer factor, a calculation about life expectancy in Taiwan-Fuchien Area will give our people longer life expectancy, that is, 75.9 years for both sexes on average, 73.6 years for males and 78.5 years for females. Hence, in Taiwan-Fuchien Area cancer deprives the both sexes of 2.4 years on average, shortening the life expectancy for males by 2.5 years and that for females by 2.0 years. In 1999, the life expectancy in Taiwan-Fuchien Area was 75.0 years for both sexes on average, 72.5 years for males and 78.1 years for females. After removing the cancer factor, a calculation about life expectancy in Taiwan-Fuchien Area will give our people longer life expectancy, that is, 78.2 years for both sexes on average, 76.0 years for males and 80.7 years for females. Hence, in Taiwan-Fuchien Area cancer deprives the both sexes of 3.2 years on average, shortening the life expectancy for males by 3.5 years and that for females by 2.6 years.

The aforesaid data show that, in the ten years, life expectancy in Taiwan-Fuchien Area increased by 1.5 years for both sexes on average, increased by 1.4 years for males and 1.6 years for females. After removing the cancer factor, a calculation about life expectancy in Taiwan-Fuchien Area will give our people more years to live, that is, 2.3 years for both sexes on average, 2.3 years for males and 2.2 years for females. The aforesaid data show that cancer imposed a negative effect on the life expectancy in Taiwan-Fuchien Area. The negative impact made by the cases of malignant neoplasm, which increase year by year, on the life expectancy of males is much greater than that of females. Therefore, in Taiwan-Fuchien Area, the life expectancy will be enhanced by reducing the number of people who died from cancer.

4. The top five cancers shortened the life expectancy of males by 2.4 years and that of females by 1.6 years.

In 1999, the top five cancers shortened the life expectancy of both sexes by 1.9 years on average, that of males by 2.4 years and that of females by 1.6 years. The negative impact of the top five cancers on the life expectancy in Taiwan-Fuchien Area was as follows: The life expectancy for both sexes was shortened by 0.63 year by liver cancer, 0.61 year by lung cancer, 0.33 year by stomach cancer, 0.25 year by cervical cancer and 0.11 year by colon and rectum cancer. The life expectancy for males was shortened by 0.80 year by liver cancer, 0.78 year by lung cancer, 0.33 year by colon and rectum cancer, 0.29 year by stomach cancer, and 0.22 year by oral cancer. The life expectancy for females was shortened by 0.42 year by lung cancer, 0.35 year by liver cancer, 0.33 year by colon and rectum cancer, 0.27 year by female breast cancer, and 0.24 year by cervical cancer.

IV. Conclusion

There are noticeable differences in the incidences of particular human neoplasm between different areas and different races. According to some assessments, the differences are mainly attributable to environmental factors, though a minor part of them relate to genetics. In Taiwan-Fuchien Area, liver cancer claimed the greatest number of lives of male cancer patients, while lung cancer claimed the greatest number of lives of female cancer patients. In Taiwan-Fuchien Area, lung cancer is at the top of the list of the top ten cancers, and the average age of smokers is dropping. Medicine has already proved the close relationship among lung cancer, smoking and secondhand smoking. For the sake of our health, we should immediately echo the calls for the general public to quit smoking and refuse secondhand smoking. Harmful exhaust emitted excessively by vehicles and motorcycles is usually found in urban areas that are densely populated and thus urban residents are the potential lung cancer patients. In addition, recent researches discover that housewives are susceptible to lung cancer because they are often exposed to gaseous oil and fumes while cooking in kitchens. Hence, housewives should be aware of the risk factor.

Ranking the second in the mortality from cancer in Taiwan-Fuchien Area, liver cancer is not as common in Europe and America as in Taiwan-Fuchien Area, with the exception of African countries where the incidence of liver cancer is high because the people are so poor that many of them suffer from malnutrition. Related researches indicate that many people in Taiwan-Fuchien Area are hepatitis B antigen carriers, and that people in Taiwan-Fuchien Area are used to leading busy, urban living that is characterized by the habit of not having meals at home, smoking, drinking, chewing betel nuts, and the culture of having numerous social activities and being extravagant in eating and drinking. In addition, dangerous workplace and stressful living are also the potential risk factors of liver cancer. It is impossible for a liver to ache or itch, because it is not innervated at all. As a result, a person who is a hepatitis B antigen carrier seldom develops any noticeable symptom whenever the disease of her/his liver aggravates. If s/he pays little attention to take care of her/his liver, her/his liver will likely to develop cirrhosis or hepatoma and thus s/he will become a victim of liver cancer. Related units in Taiwan-Fuchien Area should attach importance to, and take a positive approach to coping with, the problem of increasing number of liver cancer cases and deaths of cancer patients over 70.