【Opinion Column】“Liberty Square” — Facing the Accelerating Cancer Clock: Strategies Beyond Screening and Expensive New Drugs
2026/01/01
◎ Lee Po-Chang (Chair Professor, College of Public Health, Taipei Medical University)
Taiwan’s cancer clock has sped up again. According to the 2023 Cancer Registry Report released by the Health Promotion Administration, the number of newly diagnosed cancer cases has reached another record high. On average, one person is diagnosed with cancer every 3 minutes and 48 seconds, which is 14 seconds faster than the previous year. It must be acknowledged that the government has not been idle. Over the years, cancer screening programs have been continuously expanded—from cervical, breast, and colorectal cancer to the recent promotion of low-dose computed tomography (LDCT) screening for lung cancer. The National Health Insurance (NHI) system has also continued to introduce expensive new cancer drugs, aiming to improve survival through “early diagnosis and aggressive treatment.” These policies have indeed contributed to reducing mortality from certain cancers and deserve recognition.
However, why does cancer incidence continue to rise year after year? While cancer strategies have focused on “earlier detection” and “stronger treatment,” they must simultaneously address the upstream management of cancer risks. Only then can the efforts of the healthcare system keep pace with the accelerating cancer clock. One long-neglected risk, yet highly related to the healthcare system itself, is medical radiation exposure. Under the NHI system, imaging examinations such as CT scans involve virtually no user cost-sharing, so the public does not perceive the cost. Physicians, influenced by defensive medicine and reimbursement incentives, are more likely to opt for “more tests for peace of mind.” When short-term diagnostic benefits are completely decoupled from long-term radiation risks, the overuse of imaging becomes an expected outcome of the system.
CT scans do not cause immediate discomfort, and both patients and physicians rarely “feel” any harm in the short term. Yet empirical studies clearly show that as cumulative radiation dose increases, the risk of certain cancers does not rise sporadically but follows a clear dose–response relationship. Our research indicates that the odds ratios for malignant lymphoma and leukemia can increase to more than twofold, and for hepatobiliary and pancreatic cancers, the risk in high-dose groups can even exceed threefold. These risks do not stem from a single examination, but from years of repeated, routine medical exposure that is often taken for granted.
As a physician, I understand that patients feel safer with “more tests.” Imaging is often seen as the safest and least controversial option. What is troubling is that the harm from medical radiation comes too slowly and too quietly. Cancer may only appear ten or twenty years later, and by then, almost no one will look back and ask whether it was related to repeated imaging in the past. When the NHI system makes imaging examinations virtually free at the point of use, this “short-term insensitivity, long-term unawareness” is institutionally amplified. Cost-sharing is not merely a financial consideration; it serves to bring risk back into medical decision-making, forcing us to pause before each test and ask, “Is this really necessary?”
A useful comparison is liver cancer, which is one of the few cancer types that has shown a long-term decline. The key is not increasingly expensive drugs, but the government’s sustained investment in hepatitis B and C vaccination, screening, and treatment—reducing carcinogenic risk at its source. This demonstrates that effective cancer control relies not only on diagnosis and treatment, but also on confronting risk management itself.
As the cancer clock continues to accelerate, in addition to asking “Can we detect it earlier?” and “Can we use better drugs?”, we must also honestly face this question: Which cancer risks are being created by the system itself, yet continue to be collectively ignored? The cumulative exposure to medical radiation should no longer be excluded from cancer prevention strategies.
