Cancer Markets in Asia

During the last decade, rates of cancer have increased dramatically in Asia. Asia accounts for nearly half of all new cancer cases in the world. Some cancers that are common in Western countries—such as lung, breast, and colorectal cancers—also are common in Asia. Others, such as stomach and liver cancer, are not as widespread in the rest of the world, but frequently diagnosed in Asia.

More than 6 million new cancer cases are diagnosed in Asia every year, according to the World Health Organization (WHO). WHO also estimates that cancerous tumors now account for 2 million deaths each year in China. In Japan, Ministry of Health, Labor and Welfare (MHLW) statistics show that one out of every three deaths can be attributed to the disease. In South Korea and Taiwan, it has been the leading cause of death for at least two decades. Meanwhile, in developing countries such as Malaysia, Indonesia, the Philippines, Thailand and India, cancer incidence rates also areincreasing annually.

Due to the large population of smokers, lung cancer is the most common type of cancer in Asia. For instance, China has the world’s largest population of smokers and lung cancer incidence rates have increased almost 500 percent in the last 25 years. Similar trends are found throughout Asia.

Some cancers occur infrequently in Western countries but are more common in Asia. For example, while stomach cancer is relatively rare in the rest of the world, it occurs at double the incidence in Asia. According to WHO, more than half of all new cases of stomach cancers worldwide are diagnosed in China and Korea. In Korea, the elevated rate of stomach cancer has been attributed to the high consumption of salt and pickled food.

Nasopharyngeal cancer (NPC) is a nose cancer and another example of a cancer that is rare in Western countries but is much more common in Asia. NPC particularly is common in Southeast China and Southeast Asia. Recent research suggests genetic as well as dietary and environmental factors may account for the elevated rates of NPC in Asia.

Breast, colorectal, ovarian, and head and neck cancers also have high incidence rates in Asian countries. Researchers in Singapore found that the rate of new ovarian cancer cases in the country has more than doubled in the last 30 years. Breast cancer incidence rates in Japan, Taiwan, and urban Chinese cities such as Shanghai and Hong Kong also have been increasing yearly.

Overview of Treatment Approaches

As cancer incidences have risen dramatically during the past two decades in Asia, governments there have begun to invest heavily in initiatives to address this issue. Such initiatives are intended to improve public awareness of risk, increase treatment availability and increase the number of treatment options.

Many clinics, hospitals and research centers especially devoted to cancer therapy have opened throughout Asia.These include the Shanghai Breast Health Resource Center, Korea’s National Cancer Center (NCC), and the National Cancer Centre Singapore (NCCS). The majority combine both research and treatment programs. Some, such as NCCS and NCC, are the result of governmental policy and funding. Increasingly, Asian organizations are partnering with Western counterparts to further cancer research and treatment. For instance, the Shanghai Breast Health Resource Center was established jointly by the Shanghai Center for Drug Control and the Fred Hutchinson Cancer Research Center, a leading research center located in Seattle, Wash.

The cancer treatment strategies in Asia are similar to those used in the rest of the world, and include surgery, chemotherapy, radiation therapy, or a combination of methods. Gradually, oncologists also are experimenting with hormone and biological therapies as well.Chemotherapy also is a common cancer treatment option in Asia. In China, at least one cancer center in each province has the capability to deliver chemotherapy treatment. In the last decade, many clinical trials testing chemotherapy drugs have been conducted in Japan, Korea and China. Combined treatment methods such as chemotherapy with surgery or radiation therapy increasingly are used, even in the developing poorer countries in Asia.

Radiation therapy is another treatment option in Asia that has become increasingly available.China, for example, has progressed rapidly in the acquisition of advanced methods of radiotherapy. A study on the growth of radiotherapy in China found that in a decade, the number of radiation oncology centers in China has more than doubled to about 1,000 centers across the country. The number of radiation therapy centers in Korea has climbed steadily in the last decade too. Meanwhile, developing countries such as Thailand, which currently only have a few centers with radiation therapy capabilities, are looking to expand their facilities in the near future.

Cancer centers in Asia increasingly are well-equipped and rival their Western counterparts in technical sophistication. Treatments such as Gamma Knife, three-dimensional conformal radiotherapy and intensity-modulated radiation therapy are routinely performed. For instance, in 2010, Korea’s National Cancer Center began to offer proton therapy. While proton therapy is not a new technology, its availability has expanded gradually. In 2011, Taiwan unveiled the country’s first positron emission tomography (PET) system designed especially to detect breast cancer. Clinical trials at Taiwan’s National University Hospital found the device to be more accurate than mammograms. Meanwhile, the emergence of domestic tomography manufacturing companies such as China’s Shinva and Yuyue Medical Equipment and Supply Co. Ltd., signal Asia’s growing ability to make their own sophisticated medical technology.

Western Strategies in Asia

Due to the large increase in cancer in Asia, demand for quality cancer treatments also has risen dramatically. Many Western firms are looking to expand their products into the Asian markets and have seen tremendous growth in their Asian sales. The lower dollar also has helped fuel medical device exports.

Large medical technology companies—GE Healthcare, for example—have taken dramatic steps to enter the Chinese market. In 2011, GE began a partnership with Concord Medical Services Holdings Ltd, a Beijing-based company with a network of radiation therapy and diagnostic imaging centers throughout China. Last year, the company opened a research and development facility for X-ray technology in Chengdu, the capital of Sichuan province. GE also plans to move its X-ray unit headquarters from the United States to Beijing, to better serve the Chinese market. However, the company still plans to keep its 120 employees in Wisconsin, where the division currently is based. GE Healthcare wants to expand its X-ray business into rural and smaller Chinese cities where the highest future growth is projected. For that purpose, GE has been increasing its number of Chinese sales and service offices. The company also actively has been releasing new, lower-cost products tailored to the Chinese market, such as a scaled-down computed tomography (CT) scanner called Brivo CT in 2010, and an X-ray device called Linglong in 2009.

Another example of a Western company succeeding in China is Elekta, which has been expanding into the Korean radiation therapy market. At the end of 2010, Elekta reported that 16 of the company’s Gamma Knife systems were installed across South Korea. To satisfy growing demand for cancer treatment, Elekta opened its seventh Asia-Pacific office at the end of 2010 near Seoul, Korea. The company also is partnering with two of the top medical centers in the country. One of the first radiotherapy treatments performed as a result of this partnership was for a patient diagnosed with nasopharyngeal (nose) carcinoma.

A third example is Varian Medical Systems, which in 2011 received approval from the Chinese State Food and Drug Administration to market its TrueBeam product—an image-guided radiation therapy system. The first system in China was installed in July at Shantou University Medical College’s cancer treatment center. The system also was granted approval in Japan this year.

Paying for Cancer Treatment

Although access to cancer treatments is increasing across Asia, significant differences in the structure of health insurance and reimbursement exist between countries.

Japanese government health insurance is the most generous in Asia and offers the highest rates of reimbursement. The government offers coverage for approved treatments, including treatments for cancer, to all citizens.Treatments are eligible for coverage as long as they have been approved by Japan’s MHLW.

Korea and Taiwan offer government health insurance at lower reimbursement rates than Japan. Korean citizens pay for services on a fee-for-services basis and have the option of buying private insurance to help cover out-of-pocket costs. For patients with chronic conditions such as cancer, this option has grown in popularity. A recent study of the Korean health system found that about half of all cancer patients in Korea have private insurance. In Taiwan, the National Health Insurance Program provides coverage for inpatient care, as well as diagnostic imaging and healthcare exams.

Singapore and Thailand, unlike the countries above, offer substantially less government reimbursement. Many Singaporeans have private health insurance provided by their employers. Some smaller amounts of reimbursement in Thailand help cover the costs for chemotherapy, radiation therapy, and surgical procedures for cancer.However, Thai reimbursement is extremely low compared to wealthier countries in Asia.

Doing Business in Asia

Individuals and companies accustomed to doing business in the United States and Europe may be surprised to find that business deals in Asia are backed not by legal principles, but by the strength of relationships. Business agreements in Asia usually are initiated and conducted through personal networks and introductions between individuals, and more commonly sealed through a handshake than through litigation.