[Report] 143rd HGPI Seminar: "20 Years Since the Enactment of the Basic Act on Cancer Control: Reflecting on the Past and Mapping the Next 20 Years"

In this HGPI seminar, we welcomed Dr. Fumihiko Wakao, Deputy Director of the Center for Cancer Control and Information Services at the National Cancer Center.

Since his involvement in the launch of the "Cancer Information Service" in 2006, when the Basic Act on Cancer Control was enacted, Dr. Wakao has spent 20 years at the forefront of delivering cancer medical care to citizens, including cancer information provision, patient support, education, and public awareness.

At this seminar, marking the 20th anniversary of the enactment of the Basic Act on Cancer Control in 2006, Dr. Wakao reflected on the journey so far. He also discussed challenges and prospects for the next 20 years, incorporating results from the "National Survey on Cancer: 20 Years Since the Enactment of the Basic Act on Cancer Control," conducted by HGPI in February 2026, which covered 10,000 citizens nationwide, including patients and affected individuals.

## Key Points

- Twenty years after the enactment of the Basic Act on Cancer Control, significant progress has been made in both institutional and medical technological aspects, such as the development of designated cancer care hospitals, the start of the National Cancer Registry, and insurance coverage for cancer genomic medicine. However, these are still at the "started but halfway there" stage, requiring continuous evaluation and improvement.

- Looking ahead to 2040, as a decrease in the working-age population and a shortage of specialists are predicted, the consolidation and equalization of the cancer care provision system have become major policy issues. In surgical therapy, the number of surgeons is estimated to decrease by approximately 40% compared to 2025, making the clarification of regional roles and discussions at the prefectural level essential.

- In the 4th Basic Plan for Cancer Control, a logic model has been introduced, and the development of a data-based evaluation system for cancer control is underway. Although the "yardsticks" such as the National Cancer Registry, hospital-based cancer registries, patient experience surveys, and bereaved family surveys are finally coming together, further strengthening of the data infrastructure supporting the PDCA cycle, such as increasing the participation rate of designated hospitals in patient experience surveys, is necessary.

- A national survey conducted by the Health and Global Policy Institute in February 2026 revealed that 46.8% of citizens "approve" of the consolidation of medical functions, 21.6% "disapprove," and 31.6% "do not know," with over 30% withholding judgment, indicating that public opinion formation is still in progress. Future institutional design will require clear presentation of points at issue, patient and citizen participation, and continuous monitoring through public opinion surveys.

- To realize sustainable cancer care, clarification of the functions of medical institutions, provision of information to citizens, triage by primary care physicians, support for burdens such as transportation, and consensus building based on public understanding are key. These are challenges common to the entire Japanese medical system, not just cancer.