For the 143rd HGPI Seminar, we welcomed Dr. Fumihiko Wakao, Deputy Director of the Center for Cancer Control and Information Services Headquarters at the National Cancer Center Japan. Since being involved in the launch of the Cancer Information Service in 2006, the same year the Cancer Control Act was enacted, Dr. Wakao has been at the forefront of bringing cancer care to the public for over 20 years through cancer information provision, patient support, cancer education, and public awareness. As Japan marks 20 years since the enactment of the Cancer Control Act in 2006, Dr. Wakao reflected on the trajectory of cancer control over the past two decades and discussed the challenges and outlook for cancer control over the next 20 years. He also drew on the findings of “A Nationwide Survey on Cancer in Japan: 20 Years Since the Enactment of the Cancer Control Act,” which Health and Global Policy Institute (HGPI) conducted in February 2026 with 10,000 citizens across Japan, including patients and affected individuals.

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• In the 20 years since the enactment of the Cancer Control Act, Japan has made significant progress in both institutional development and medical technology, including the nationwide establishment of designated cancer care hospitals, the launch of the National Cancer Registry, and the inclusion of cancer genomic medicine under health insurance coverage. However, these efforts remain only halfway there, and continued evaluation and improvement are essential.
• Looking toward 2040, with the working-age population in decline and specialist shortages projected, the centralization and equitable access to cancer care delivery have become major policy issues. The number of surgeons is estimated to decrease by approximately 40% from 2025 levels, making it essential to clarify the division of roles at the regional level and to advance discussions at the prefectural level.
• Under the Fourth Basic Plan to Promote Cancer Control Programs, a logic model has been introduced, and a data-driven evaluation framework for cancer control is being established. While the measurement tools such as the National Cancer Registry, hospital-based cancer registries, the Patient Experience Survey, and the Bereaved Family Survey are gradually being aligned, further strengthening of the data infrastructure that supports the PDCA cycle is needed, including increased participation of designated hospitals in the Patient Experience Survey.
• According to a nationwide survey conducted by HGPI in February 2026, 46.8% of citizens were in favor of the centralization of medical functions, 21.6% opposed it, and 31.6% answered “don’t know.” This indicates that just over 30% of respondents have not yet formed an opinion and that views are still developing. Future policy design will therefore require accessible presentation of issues, greater patient and citizen participation, and ongoing monitoring through public opinion surveys.
• To realize sustainable cancer care, the keys will be clarifying the roles of healthcare institutions, providing information to citizens, ensuring primary care physicians for appropriate referral, providing support to ease the burden of travel, and building public consensus based on citizen understanding. These challenges are common not only to cancer care but to Japan’s entire healthcare system.

The Path to the Enactment of the Cancer Control Act and the 20 Years Since

Since malignant neoplasms (cancer) became the leading cause of death among Japanese people in 1981, various cancer control initiatives have been implemented, including the Comprehensive 10-Year Strategy for Cancer Control. The Designated Cancer Care Hospital System was launched in 2002, and the Cancer Control Action Plan 2005 was formulated in August 2005, leading to the establishment of consultation support centers. Then in June 2006, driven by the urgent and earnest voices of cancer patients and their families, the Cancer Control Act was enacted through member-initiated legislation in Japan’s parliament. Recognizing cancer as one of the nation’s most pressing health challenges, this landmark legislation established core principles for cancer control, clarified the responsibilities of the national and local governments, health insurers, healthcare professionals, and citizens, and stipulated the formulation of the Basic Plan to Promote Cancer Control Programs.

Following the enactment of the Cancer Control Act, the First Basic Plan to Promote Cancer Control Programs was formulated in 2007, and the plan has been revised approximately every five years, leading up to the Fourth Plan (formulated in 2023). The revised Cancer Control Act came into effect in December 2016, adding the promotion of employment and education for cancer patients to its basic policies. The revision also added a new basic principle aimed at building a society in which cancer patients can live with dignity and peace of mind, and receive not only appropriate cancer medical care but also welfare, educational, and other necessary support. It further called for fostering public awareness and understanding of cancer patients and establishing social environments that enable patients to participate fully in society. Notably, the term “palliative care” was also explicitly included in the law for the first time through this revision. In addition, related legislation has continued to develop, including the Cancer Registry Promotion Act in 2013, strengthened passive smoking prevention measures under the revised Health Promotion Act in 2018, the Genome Medicine Promotion Act in 2023, and the revised Act on Comprehensive Promotion of Labor Policies that came into effect in April 2026, which requires employers to make efforts to support employees in balancing treatment and work.

Advances in Cancer Prevention: Declining Smoking Rates and the Development of Screening Systems

Of the major cancer risk factors in Japan, among men, active smoking accounts for 23.6% and infections account for 18.1%; among women, infections account for 14.7%, making these the most impactful preventable causes of cancer. Japan’s smoking rate has declined from a combined 28.5% for men and women in 2004 to 14.8% in 2024. Under the Fourth Basic Plan to Promote Cancer Control Programs, the government aims to reduce the combined rate to 12% by 2032 (in alignment with Health Japan 21 (Third Term)). Efforts to prevent passive smoking were also strengthened through the revised Health Promotion Act of 2018, which progressively implemented indoor smoking bans in schools, hospitals, government facilities, offices, restaurants, and other facilities.

Cancer screening was incorporated into national health promotion programs under the Health Promotion Act in 2008 and has since been operated under the “Guidelines for Cancer Prevention Priority Health Education and the Implementation of Cancer Screening.” Recent years have seen ongoing evidence-based revisions, including the introduction of primary Human Papillomavirus (HPV) testing in 2024, the July 2025 revision of the guidelines to capture cancer screening information from workplaces and other settings, and the removal of sputum cytology from screening guidelines in December of the same year. Despite these advances, the screening participation rate remains in the 40% range, which is lower than in Western countries and South Korea. The Fourth Plan sets targets of a 60% screening participation rate and a 90% diagnostic follow-up rate, though accurately tracking the actual screening status, including workplace screenings, also remains an ongoing challenge.

Strengthening Cancer Care and the Debate over Centralization and Equitable Access Toward 2040

Since the designated cancer care hospital system was launched in 2002, Japan has steadily expanded its cancer treatment infrastructure. In 2006, a two-tiered structure of prefectural designated hospitals and regional designated hospitals was established, and from 2014 onward, regional cancer care hospitals with more flexible requirements were introduced. As of April 2026, the system has expanded to a total of 468 designated institutions, comprising 51 prefectural designated hospitals, 357 regional designated hospitals, 1 specific-area designated cancer care hospital, and 59 regional cancer care hospitals.

However, looking ahead to 2040, major structural challenges are expected due to the declining working-age population and regional disparities in the aging population. According to supply-demand estimates for the three main cancer therapies, compared to 2025, the number of patients receiving initial treatment is expected to decrease by approximately 5% for surgery, increase by approximately 24% for radiation therapy, and increase by approximately 15% for pharmacotherapy. Meanwhile, the number of physicians is projected to decline significantly, with the number of surgeons estimated to be approximately 61% of 2025 levels (a 40% decrease), while the number of radiation oncologists is expected to rise to approximately 143%. This suggests that the uneven regional distribution of resources for surgical cancer care in particular may worsen significantly.

Given this situation, efforts are underway to identify which types of care should be centralized and which should be more equitably accessible, from the perspectives of medical technology (care that requires clinical judgment or specialized equipment) and medical supply and demand (clinical areas with limited case volumes and a shortage of specialists). Specifically, a four-tiered framework has been proposed: rare cancers and pediatric cancers should be centralized at the prefectural or wider regional level; care requiring advanced techniques should be centralized at the prefectural level; the main components of surgery, radiation therapy, and pharmacotherapy should be centralized at the regional level (secondary medical area level); and cancer prevention, supportive care, palliative care, and similar services should be made more widely accessible.

Prefectural Cancer Care Coordination Councils play an important role in advancing these discussions. Under the 2025 revisions to the guidelines for the development of designated cancer care hospitals (hospitals certified by the national government to provide specialized cancer care) and related provisions, prefectural governments themselves now serve as secretariats for the councils alongside prefectural designated cancer care hospitals, and the participation of patient organizations and other relevant organizations has been made mandatory. The revisions also positioned the following as items for council deliberation: the division of roles among medical institutions by cancer type, the consolidated reporting of clinical performance data based on hospital-based cancer registries, and the review of medical areas. However, a survey conducted under the Ministry of Health, Labour and Welfare (MHLW) Health, Labour and Welfare Sciences Research project “Research contributing to the promotion of equitable provision and centralization of cancer care delivery” found that, of the 47 prefectures, only about half (52.2%) have begun such discussions, and only three councils (6.5%) have reached the planning stage. Barriers cited include limited resources, difficulties coordinating among medical institutions, and a shortage of personnel with data analysis expertise.

Expansion of “Living with Cancer”: Consultation Support, Work-Treatment Balance Support, and Appearance Care

In the area of “living with cancer”, progress has been made in the development of consultation support centers, survivorship support, and palliative care starting at the time of cancer diagnosis. According to the FY2023 Patient Experience Survey, awareness of cancer consultation support centers was 55.1%, utilization 21.1%, and satisfaction 72.4%. While satisfaction among patients who used the centers was high, significant disparities in awareness and utilization were observed across prefectures.

Regarding information provision, the National Cancer Center Japan operates the Cancer Information Service (ganjoho.jp), which provides evidence-based information about cancer including 26 types of brochures and PDFs. The patient handbook “A Guide for Those Diagnosed with Cancer” has been revised multiple times since its first edition in 2011, with the third edition published in 2025. Brochures compiling regional care information have also been developed in 44 prefectures.

In terms of employment support, the 2016 “Guidelines for Supporting the Balance of Treatment and Work in the Workplace” positioned diseases such as cancer not merely as personal medical conditions unrelated to work, but as part of broader workers’ health management. Furthermore, the revised Act on Comprehensive Promotion of Labor Policies, which came into effect in April 2026, requires employers to make efforts to support employees in balancing treatment and work. Regarding support managing changes in physical appearance caused by cancer treatment (appearance care in Japanese), the “Appearance Care System Development Support Project” was launched in FY2026, advancing the assignment of personnel and the establishment of review committees at prefectural designated cancer care hospitals.

Developing the Foundation for Data-Driven Evaluation of Cancer Control

As a foundation for evaluating cancer control measures, the National Cancer Registry (launched in 2016) and hospital-based cancer registries are being developed in parallel. Whereas earlier evaluations had relied almost entirely on mortality data from vital statistics, with little incidence or survival data available, continuous provision of incidence and survival rate data has become possible since the Third Plan. However, the coverage rate of facilities implementing hospital-based cancer registries varies significantly among prefectures, and coordination through Prefectural Cancer Care Coordination Councils is required to obtain data that can inform deliberations.

Patient Experience Surveys and Bereaved Family Surveys are also important evaluation tools. Conducted every five years since the first survey in 2015, the third survey, published in 2025, was expanded to cover all designated cancer care hospitals. However, hospital participation rates still vary significantly among prefectures, with some prefectures having less than half of designated hospitals participating. Since many of the indicators in the logic model of the Fourth Basic Plan to Promote Cancer Control Programs draw on the Patient Experience Survey, broader participation among designated hospitals is desirable.

The Fourth Plan also formally introduced a logic model. A logic model is a systematic visualization that connects inputs, activities, outputs, and outcomes with arrows to map out the pathway by which measures lead to their ultimate intended outcomes, providing the foundation for a data-driven PDCA (Plan-Do-Check-Act) cycle.

Cancer education has also advanced steadily following the revision of national curriculum guidelines for elementary and junior high schools in 2017 and for high schools in 2018, with full implementation beginning in FY2020 for elementary schools, FY2021 for junior high schools, and FY2022 for high schools.

Public Perceptions Revealed by HGPI’s Nationwide Survey

“A Nationwide Survey on Cancer in Japan: 20 Years Since the Enactment of the Cancer Control Act,” conducted by HGPI in February 2026 (with 10,000 valid responses), provided valuable insights into public perceptions of cancer control.

Regarding the centralization of medical functions, 46.8% of respondents were in favor, 21.6% were opposed, and 31.6% answered “don’t know.” This indicates that just over 30% of respondents have not yet formed an opinion, suggesting that views are still developing. Reasons cited by those opposed to centralization included physical strain (60%), financial burden (47%), and access to transportation (33%). When asked what conditions would make traveling long distances more acceptable, three factors — access to transportation, financial support for travel costs, and coordination with primary care physicians — were each mentioned by around 40% of respondents. This suggests that, rather than relying on a single measure, a comprehensive support system is needed.

Regarding questions about healthcare cost burdens and the direction of public insurance, 30% of respondents answered “don’t know / can’t say either way” across all questions, including the financial burden of innovative treatments, the expansion of mixed medical services (combined insured and uninsured care), and the future direction of public insurance. This highlights the reality that institutional discussions have not yet sufficiently reached the public.

Toward the Next 20 Years: Restructuring Healthcare Delivery and Building Public Consensus

Over the past 20 years, a wide range of measures have steadily advanced, including the development of designated cancer care hospitals (multidisciplinary team meeting (cancer boards in Japanese), team-based care, cancer consultation support centers, palliative care, cancer genomic medicine), survivorship support (work-treatment balance support, appearance care), cancer registries (National Cancer Registry, hospital-based cancer registries), cancer education, passive smoking prevention, and cancer control evaluation (the National Cancer Registry, Patient Experience and Bereaved Family Surveys, logic models). However, much work remains.

New challenges that have emerged in recent years include the centralization of healthcare delivery, the provision of sustainable healthcare (addressing high-cost new medical technologies, the early integration of genomic medicine, and maintaining the universal health insurance system), and addressing drug lag and drug loss (the delayed approval of drugs already available in other countries, and the failure to develop or approve such drugs in Japan at all). These challenges are not unique to cancer; they reflect broader issues facing Japan’s entire healthcare system.
Going forward, four directions should be emphasized to strengthen cancer control measures that leave no one behind: (1) continuation of current measures; (2) data-driven evaluation of measures (the National Cancer Registry, quality control of screening, status reports, building continuous and efficient systems for the Patient Experience Survey, use of the PDCA cycle, and benchmarking in principle at the prefectural level); (3) clarification of the roles of medical institutions (at the prefectural level, based on data and tailored to local circumstances; provision of information to citizens; appropriate referral by general practitioners or primary care physicians; and support patients facing increased travel demands); and (4) consensus-building based on public understanding (accessible explanation of issues, timely communication of current information, patient and citizen participation, monitoring through public opinion surveys, and the simplification of complex systems). As Japan’s healthcare system as a whole faces growing sustainability challenges, mechanisms to gather and reflect the voices of patients, citizens, and the public in policymaking will become more important than ever.

 

[Event Overview]

• Speaker: Dr. Fumihiko Wakao (Deputy Director, Center for Cancer Control and Information Services Headquarters, National Cancer Center Japan)
• Date & Time: Tuesday, April 28, 2026, 18:30-19:45 JST
• Format: Online (Zoom webinar)
• Language: Japanese
• Participation Fee: Free
• Capacity: 500 participants

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■Profile:

Dr. Fumihiko Wakao (Deputy Director, Center for Cancer Control and Information Services Headquarters, National Cancer Center Japan)
In 1986, Dr. Fumihiko Wakao graduated from School of Medicine, Yokohama City University. His previous roles include Clinical Resident at Yokohama City University Hospital, Resident in the Department of Diagnostic Radiology at the National Cancer Center Hospital, Physician and Medical Director at the National Cancer Center Hospital, and Director of the Center for Cancer Control and Information Services at National Cancer Center Japan. He assumed his current position in April 2023.
He also serves as a visiting researcher at the Department of Public Health at the University of Tokyo and as a part-time lecturer at the Graduate School of Medicine at Kyoto University.

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