More people in Taiwan died from cancer in 2018 than ever before, the Ministry of Health and Welfare (MOHW) reported in June, but the mortality rate was actually down when adjusted for age.
According to MOHW figures, 48,784 people died of various types of cancer in Taiwan in 2018, up 747, or 1.56 percent, from the previous year. That translated to a cancer patient dying every 10 minutes and 46 seconds in Taiwan, 10 seconds shorter than in 2017.
Cancer accounted for 28.2 percent of Taiwan’s 172,859 deaths in 2018, making malignant tumors the leading cause of death in Taiwan for the 37th consecutive year, the figures showed.
As a percentage of the population, cancer took the lives of 206.9 people per 100,000 population in 2018.
When adjusted for age based on the World Health Organization’s world population structure in 2000, however, it was 121.8 cancer deaths per 100,000 population, down 1.3 percent from a year earlier, the MOHW said in a statement.
This age-adjusted rate helps factor out the influence of a country’s age distribution on mortality numbers, and were it to rise it would point to factors other than age causing more cancer deaths.
Its 1.3 percent decline in 2018 led the MOHW to conclude, however, that Taiwan’s aging population was in fact the biggest factor in the rising number of cancer deaths.
Among cancers in 2018, lung cancers were the leading cause of death, followed by liver cancer, colon and anal cancer, and breast cancer, oral cancer, prostate cancer, stomach cancer, pancreatic cancer, esophageal cancer, and cervical cancer.
The main causes of death in Taiwan after cancer in 2018 were heart disease, pneumonia, cerebrovascular diseases, diabetes, accidents, chronic lower respiratory diseases, hypertension, nephrotic syndrome, and liver cirrhosis, according to the MOHW.
By age, accidents were the main cause of death for people aged 1-24, cancer and suicide were the two main causes of death for people 25-44, and cancer and chronic heart disease were the two top causes of death for people aged 45 and older, the MOHW said.
A series of epidemiological studies on major risk factors for various common cancers in Taiwan have been carried out. These cancer risk factors may be classified as infectious agents, lifestyle variables, dietary factors and susceptibility factors. Both hepatitis B virus (HBV) and hepatitis C virus (HCV) are major risk factors for liver cancer, mainly HCC, in Taiwan ( 15 – 22 ). The relative risk of developing HCC was similar for chronic HBV carrier status and HCV infection, but the population attributable risk percentage was much higher for HBV carrier status than for HCV infection ( 22 ). Elevated serological titers of antibodies against Epstein–Barr virus (EBV)-specific DNase (anti-EBV DNase) and IgA antibodies against EBV-specific viral capsid antigen (anti-EBV VCA IgA) were associated with an increased risk of NPC ( 23 – 26 ). Human papillomavirus (HPV) has been documented as a major risk factor for cervical cancer in Taiwan ( 27 , 28 ). However, the association between stomach cancer and seropositivity of antibodies against Helicobacter pylori was less striking ( 29 – 31 ).
Major lifestyle variables associated with an increased cancer risk in Taiwan include habits of cigarette smoking, alcohol drinking and betel nut chewing. Cigarette smoking habit has been found to increase the risk of lung cancer, HCC, oral cavity, NPC, esophageal, urinary bladder and cervical cancer in a dose–response relationship ( 17 , 19 , 22 , 23 , 25 , 26 , 32 – 35 ). Alcohol drinking habit has been documented as a risk factor for oral cavity cancer and HCC in Taiwan ( 17 , 19 , 34 ), while the habit of betel nut chewing is also associated with an increased risk of oral cavity cancer ( 34 ).
Consumption of preserved food has been associated with an increased risk of HCC ( 19 ), NPC ( 26 ) and stomach cancer ( 36 ). Frequent consumption of preserved soy beans was found to increase the risk of HCC ( 19 ) and NPC ( 26 ). Molecular epidemiological studies have shown an increased HCC risk associated with an elevated urinary ( 37 , 38 ) or serum level of aflatoxin ( 14 , 38 ). There was a dose–response relationship between risk of HCC and serum level of albumin adducts of aflatoxin B 1 ( 39 ). Frequent consumption of salted food has been found to be associated with an increased risk of stomach cancer in Taiwan ( 36 ). Low consumption of vegetables and low serum levels of β-carotene/retinol have been documented as risk factors for lung cancer ( 33 ), HCC ( 19 , 40 ), stomach cancer ( 36), NPC ( 26 ) and arsenic-induced skin cancer ( 41 ). Similarly, low serum selenium level has also been found to be a risk factor for HCC ( 42 ).
Through proper education cancer can be prevented, life expectancy can be increased, and quality of life both during and after treatment can be improved exponentially. The Cancer Exercise Training Institute (CETI), a United States-based organization, has trained over 10,000 health and fitness professionals to become Cancer Exercise Specialists since 2004. The language barrier has been an obstacle until now. CETI and it’s regional affiliates are bringing the Cancer Exercise Specialist Advanced Qualification training to China, Taiwan, Hong Kong, and Malaysia in November 2019. This live training will be conducted by Andrea Leonard, 35-year cancer survivor, PFP 2019 Personal Trainer of the Year, and President/Founder of the Cancer Exercise Training Institute.
Through the comprehensive training health and fitness professionals seeking to attain a higher level of mastery and work with cancer patients during and after cancer surgery and treatment and into survivorship. Participants will expand their skills as a CES and gain a complete understanding of the entire cancer process from diagnosis and treatment to reconstruction and survivorship. The unique and individualized programming will help to improve the patient’s ability to cope with the mental and physical stress following cancer diagnosis and treatment. The comprehensive programming covers 26 types of cancer, as well as pediatrics, with special emphasis on breast cancer and breast reconstruction.
“The Cancer Exercise Specialist is to CANCER what Cardiac Rehab. is to the HEART PATIENT.” – Andrea Leonard
After the two-day workshop, students will continue their studies through written manuals, video, and power point presentations followed by a 125-question final examination. Regular continuing education is required to maintain the high-standard of expertise required to work with this population.
The benefits of exercise during treatment include:
- Increased energy
- Improved treatment tolerance
- Decrease in pain
- Decrease in depression
- Better sleep
- Improved self-esteem/self-confidence
- Prevent weight gain and obesity
- Prevent.manage lymphedema
- Prevent cancer cachexia
- Maintain independence
- Improved balance and strength
- Makes treatment more effective at destroying cancer cells
The benefits of exercise during recovery include:
- Increased range of motion
- Correct muscle imbalances that lead to pain and degeneration
- Increased energy
- Increased stamina
- Increases in strength and cardiovascular endurance
- Prevent osteoporosis, diabetes, lymphedema, future cancer, and damage to the heart and lungs
- Decrease body fat and increase lean muscle mass
- Improve balance and fall prevention
- Improved self-esteem/self-confidence
Based on the tremendous amount of evidence to support the aforementioned lists, it is mind-boggling that so few cancer patients are told to exercise. For those who are given the green light to exercise, the big problem is not knowing where to start, how to safely progress, and how to prevent many of the complications associated with cancer treatment.
By training more allied health professionals worldwide, CETI is creating a global resource for medical professionals to be able to confidently refer their patients.
“Cancer strips you of everything. Your hair, your body parts, your dignity, your self-confidence, your strength and stamina, your finances, sometimes even your job or spouse. A Cancer Exercise Specialist can help the cancer patient regain control of their life and their body at a time that the patient feels they have no control.” – Andrea Leonard
If you are interested in learning more about our upcoming workshops in China, Hong Kong, Taiwan, and Singapore, or would like to learn about bringing CETI’s training to your country, please contact CETIguru@gmail.com
References
Department of Health. Health Statistics. Vol. II. Vital Statistics. Taipei: Department of Health, Executive Yuan
(in Chinese).
Department of Health. Annual Report of Cancer Registry, 1995. Taipei: Department of Health, Executive Yuan
(in Chinese).
Cancer Incidence in Five Continents, Vol. VI. Lyon: International Agency for Research on Cancer,
.
Chen CJ, Chang CL, Liaw YP, Shia CF, Huang KL, You SL, et al. Atlas of Cancer Mortality in Taiwan, 1982–1991. Taipei: Department of Health, Executive Yuan
Chen CJ, Chuang YC, Lin TM, Wu HY. Malignant neoplasms among residents of a blackfoot disease-endemic area in Taiwan: high-arsenic artesian well water and cancers.
Chen CJ, Kuo TL, Wu MM. Arsenic and cancers.
Chen CJ, Wang CJ. Ecological correlation between arsenic level in well water and age-adjusted mortality from malignant neoplasms.
Chen CJ, Chen CW, Wu MM, Kuo TL. Cancer potential in liver, lung, bladder and kidney due to ingested inorganic arsenic in drinking water.
Chen CJ, Chuang YC, You SL, Lin TM, Wu HY. A retrospective study on malignant neoplasms of bladder, lung and liver in blackfoot disease endemic area in Taiwan.
Chiou HY, Hsueh YM, Liaw KF, Horng SF, Chiang MH, Pu YS, et al. Incidence of internal cancers and ingested inorganic arsenic: a seven-year follow-up study in Taiwan.
Chen CJ, Wu MM, Lee SS, Wang JD, Cheng SH, Wu HY. Atherogenicity and carcinogenicity of high-arsenic artesian well water: multiple risk factors and related malignant neoplasms of blackfoot disease.
Chen CJ. Blackfoot disease.
Lin JT, Wang LY, Wang JT, Wang TH, Chen CJ. Ecological study of association between Helicobacter pylori infection and gastric cancer in Taiwan.
Chen CJ, Wang LY, Lu SN, Wu MH, You SL, Li HP, et al. Elevated aflatoxin exposure and increased risk of hepatocellular carcinoma.
Lu SN, Lin TM, Chen CJ, Chen JS, Liaw YF, Chang WY, et al. A case-control study of primary hepatocellular carcinoma in Taiwan.
Chen DS, Kuo GC, Sung JL, Lai MY, Sheu JC, Chen PJ, et al. Hepatitis C virus infection in an area hyperendemic for hepatitis B and chronic liver disease: the Taiwan experience.
Chen CJ, Liang KY, Chang AS, Chang YC, Lu SN, Liaw YF, et al. Effects of hepatitis B virus, alcohol drinking, cigarette smoking and familial tendency on hepatocellular carcinoma.
Yu MW, You SL, Chang AS, Lu SN, Liaw YF, Chen CJ. Association between hepatitis C virus antibodies and hepatocellular carcinoma in Taiwan.
Chen CJ, Yu MW, Wang CJ, Huang HY, Lin WC. Multiple risk factors of hepatocellular carcinoma: a cohort study of 13737 male adults in Taiwan.
Chang CC, Yu MW, Lu CF, Yang CS, Chen CJ. A nested case-control study on association between hepatitis C virus antibodies and primary liver cancer in a cohort of 9775 men in Taiwan.
Sun CA, Farzadegan H, You SL, Lu SN, Wu MH, Wolfe L, et al. Mutual confounding and interactive effects between hepatitis C and hepatitis B viral infections in hepatocellular carcinogenesis: a population-based case-control study in Taiwan.
Chen CJ, Yu MW, Liaw YF. Epidemiology and multifactorial etiology of hepatocellular carcinoma.
Lin TM, Yang CS, Tu SM, Chen CJ, Kuo KC, Hirayama T. Interaction of factors associated with cancer of the nasopharynx.
Chen JY, Chen CJ, Liu MY, Cho SM, Hsu MM, Lynn TC, et al. Antibodies to Epstein–Barr virus-specific DNase in patients with nasopharyngeal carcinoma and control groups.
Chen CJ, Liang KY, Chang YS, Wang YF, Hsieh T, et al. Multiple risk factors of nasopharyngeal carcinoma: Epstein–Barr virus, malarial infection, cigarette smoking and familial tendency.
Chen CJ, Wang YF, Shieh T, Chen JY, Liu MY. Multifactorial etiology of nasopharyngeal carcinoma: Epstein–Barr virus, familial tendency and environmental cofactors. In: Wolf GT, Carey TE, editors. Head and Neck Oncology Research. Amsterdam: Kugler Publications
Liaw KL, Hsing AW, Chen CJ, Schiffman MH, Zhang TY, Hsieh CY, et al. Human papillomavirus and cervical neoplasia: a case-control study in Taiwan.
Liaw KL, Hsing AW, Schiffman MH, You SL, Zhang T, Burk R, et al. Human papillomavirus types 52 and 58 are prevalent in cervical cancer from Chinese woman.
Lin JT, Wang LY, Wang JT, Wang TH, Yang CS, Chen CJ. A nested case-control study on the association between Helicobacter pylori infection and gastric cancer risk in a cohort of 9775 men in Taiwan.
Wu MS, Chen SY, Shun CT, Lee WJ, Wang HP, Wang TH, et al. Increased prevalence ofHelicobacter pylori infection among patients affected with intestinal-type gastric cancer at non-cardia locations.
Wu MS, Shun CT, Lee WC, Chen CJ, Wang HP, Lee WJ, et al. Gastric cancer risk in relation to Helicobacter pylori infection and subtypes of intestinal metaplasia.
Chen CJ, Wu HY, Chuang YC, Chang AS, Luh KT, Chao HH, et al. Epidemiologic characteristics and multiple risk factors of lung cancer in Taiwan.
Chen CJ. Epidemiology of lung cancer in Taiwan. In: Proceedings of Scientific Congress and 1995 Annual Meeting of the Society of Internal Medicine of Taiwan (ROC). Taipei: Society of Internal Medicine of Taiwan (ROC)
Hung HC, Chuang J, Chien YC, Chern HD, Chiang CP, Kuo YS, et al. Genetic polymorphisms of CYP2E1, GSTM1 and GSTT1, environmental factors and risk of oral cancer.
Liaw GM, Chen CJ. Health hazards caused by cigarette smoking: a ten-year follow-up study in Taiwan.
Lee HH, Wu HY, Chuang YC, Chang AS, Chao HH, Chen KY, et al. Epidemiologic characteristics and multiple risk factors of stomach cancer in Taiwan.
Hatch MC, Chen CJ, Levin B, Ji BT, Yang GY, Hsu SW, et al. Urinary aflatoxin levels, hepatitis B virus infection and hepatocellular carcinoma in Taiwan.
Wang LY, Hatch M, Chen CJ, Levin B, You SL, Lu SN, et al. Aflatoxin exposure and the risk of hepatocellular carcinoma in Taiwan.
Chen CJ, Yu MW, Liaw YF, Wang LW, Chiamprasert S, Matin F, et al. Chronic hepatitis B carriers with null genotypes of glutathione S-transferase M1 and T1 polymorphisms who are exposed to aflatoxins are at increased risk of hepatocellular carcinoma.
Yu MW, Hsieh HH, Pan WH, Yang CS, Chen CJ. Vegetable consumption, serum retinol level and risk of hepatocellular carcinoma.
Hsueh YM, Chiou HY, Huang YL, Wu WL, Huang CC, Yang MH, et al. Serum beta-carotene level, arsenic methylation capability and incidence of arsenic-induced skin cancer.
Yu MW, Horng IS, Hsu KH, Chiang YC, Liaw YF, Chen CJ. Plasma selenium levels and risk of hepatocellular carcinoma among men with chronic hepatitis B virus infection.
Hildesheim A, Anderson LM, Chen CJ, Cheng YJ, Brinton LA, Daly AK, et al. CYP2E1 genetic polymorphisms and risk of nasopharyngeal carcinoma in Taiwan.
Wang KY, Lin JT, Chen CJ, Hsieh LL. The relationship between the genotypes of cancer susceptibility genes and the development of gastric cancer.
Yu MW, Gladek-Yarborough A, Chiamprasert S, Santella RM, Liaw YF, Chen CJ. Cytochrome P-450 2E1 and glutathione S-transferase GSTM1 polymorphisms and susceptibility to hepatocellular carcinoma.
Yu MW, Chiu YH, Chiang YC, Chen CH, Lee TH, Santella RM, et al. Plasma carotenoids, glutathione S-transferases M1 and T1 genetic polymorphisms and risk of hepatocellular carcinoma risk: independent and interactive effects.
Hsieh FI, Pu YS, Chern HD, Hsu LI, Chiou HY, Chen CJ. Modifying effects of genetic polymorphisms of N -acetyltransferase 1 and 2 of cigarette smoking-related urothelial carcinoma in Taiwan.
Yu MW, Chiu YH, Yang SY, Santella RM, Chern HD, Liaw YF, et al. Cytochrome P450 1A1 genetic polymorphisms and risk of hepatocellular carcinoma among chronic hepatitis B carriers.
;
:
–603.
Wu SB, Hwang SJ, Chang AS, Hsieh T, Hsu MM, Hsieh RP, et al. Human leukocyte antigen (HLA) frequency among patients with nasopharyngeal carcinoma in Taiwan.
Chang MH, Chen CJ, Lai MS, Kong MS, Wu TC, Liang DC, et al. Nationwide hepatitis B vaccination and the incidence of hepatocellular carcinoma in children in Taiwan.
Liu MY, Chang YL, Ma J, Yang HL, Hsu MM, Chen CJ, et al. Evaluation of multiple antibodies to Epstein–Barr virus as markers for detecting patients with nasopharyngeal carcinoma.
Lin YS, Chen CJ. A cohort study on multiple risk factors of nasopharyngeal carcinoma.