Country context

South Korea, a high-income country in East Asia, has one of the fastest-aging populations in the world. With a population of 51.6 million as of 2022, South Korea is set to become a “super-aged” society by 2025 when 20 percent of the population is projected to be 65 years or older. This aging trend coincides with a high prevalence of noncommunicable diseases (NCDs), which already constitute the greatest disease burden among South Koreans. Lung cancer, specifically, was the top cause of cancer deaths for both men and women in 2022 and the fourth-highest cause of total deaths in South Korea in 2021.

Smoking is a significant cancer risk factor in South Korea, with wide disparities in tobacco use between genders. In 2022, 34.1 percent of South Korean men aged 15 years and older were smokers, compared to just 5.8 percent of women. Nevertheless, South Korea is on track to meet the SDG target of 30 percent relative reduction in tobacco use by 2030, as the average smoking rate has decreased significantly over time, particularly among men. There is, however, a recent increase in the usage of e-cigarettes among the youth population (age 13–18) from 1.9 percent in 2020 to 3.3 percent in 2022. In addition to smoking, other lifestyle, environmental, and hereditary risk factors contribute to the development of lung cancer among South Koreans: In 2014, a study by the Korean Association of Lung Cancer Registry showed that 36.4 percent of newly diagnosed patients were never-smokers. Additionally, the rate of lung cancer diagnoses among women—who constitute the majority of never-smokers—has been increasing in recent years, at 16.4 per 100,000 women in 2022. A 2020 study attributed this trend to lifestyle factors such as frequent alcohol consumption, lack of exercise, and unhealthy dietary habits, among others. 

Despite the unprecedented lung cancer prevalence (Figure 1), the probability of surviving lung cancer has also risen significantly over the past two decades. Specifically, five-year lung cancer survival rates in South Korea have almost doubled from 16.5 percent from 2001 through 2005 to 30.2 percent from 2013 through 2017, attributed to the reduction in smoking rates, lung cancer screening programs, and advances in treatment such as target therapy. Furthermore, South Korea has a universal health coverage (UHC) score of 89 out of 100, the highest in the region alongside Singapore. It has made progress in expanding health insurance coverage for cancer patients’ medical expenses, increasing from 49.6 percent in 2004 to 78.5 percent in 2019, covering all types of cancer. Notwithstanding the country’s progress in its fight against cancer, a 2020 study suggested that the socioeconomic burden of cancer, including costs due to productivity losses, is still significant. Cancer cost the South Korean economy USD 13.9 billion in 2015, almost 1 percent of that year’s GDP, with lung cancer accounting for 14 percent of the total cancer costs. Moreover, the highest costs were incurred by those aged 50 through 59, at 30.7 percent of the total cancer costs. This finding indicates a substantial economic burden on working-age populations, considering the losses incurred from being out of the workforce due to cancer.

Assessing policies and programs

South Korean cancer policies and programs have developed consistently over the past 30 years. The country first launched a National Cancer Control Plan (NCCP) in 1996—active until 2005—which enabled the establishment of the National Cancer Center and the enactment of the Cancer Control Act in 2003. The Act became the legal basis for the Ministry of Health and Welfare to formulate cancer control programs as well as a cancer statistics system. Expanding upon the first NCCP’s objectives, the second NCCP from 2006 to 2015 had comprehensive cancer control objectives, with concrete goals of reducing cancer mortality by 19.4 percent and increasing cancer survival by 17.6 percent. The second NCCP strengthened practices in controlling cancer management and established policies on hospice and palliative care. Meanwhile, the third NCCP from 2016 to 2020 sought to benchmark the cancer control objectives of South Korea against OECD countries and introduced annual implementation and monitoring systems of NCCPs. It also enabled the expansion of cancer research and development by 13.7 percent annually, paving the way for 2,400 cancer research patents by 2020.

The country is currently implementing its fourth NCCP for the years 2021–2025, with an overall objective of reducing occurrence of preventable cancer by 20 percent. Central to meeting its objective is the advancement of cancer research through the creation of a national cancer data center. South Korea aims to harness big data, utilizing the health data of approximately three million people, for the development of anticancer drugs and treatment technologies and the customization of cancer control programs, catering to diverse social groups within the country. In 2020, the Cancer Control Act was amended to provide a legal basis for the establishment of the cancer data center, known as K-Cancer DW. Building upon its goal to advance the use of precision oncology and digital tools, in 2017 the government approved the provision of health insurance coverage for select populations to undertake next-generation sequencing (NGS) to diagnose ten common cancers. South Korean surgeons have also begun performing robot-assisted thoracic surgery for lung cancer. However, while advanced medical technologies are already present in the country, a critical skills gap among medical professionals remains to be filled to ensure their widespread adoption. Multi-stakeholder collaboration, particularly with the private sector and academia, is needed to support the upskilling of health care professionals in harnessing these advanced techniques. 

South Korea launched the first population-based, nationwide lung cancer screening trial in Asia, the Korean Lung Cancer Screening Project (K-LUCAS), in 2017, which increased the effectiveness of detecting early-stage lung cancer by three times the rate observed in the national cancer registry. Thus, in 2019, the government started to implement a population-based, nationwide low-dose computed tomography (LDCT) lung cancer screening program in the country, targeting high-risk individuals identified via the national health screening program records. However, the latest recorded uptake of the program was still low, with only 23 percent of the 690,000 eligible high-risk individuals undergoing screening between 2019 and 2020. Smokers who received lung cancer screenings were required to undergo smoking counselling provided by public programs and were given access to medications to combat smoking addiction, for minimal cost. For optimal lung cancer care, many cancer centers in South Korea employ a multidisciplinary team (MDT) approach, convening medical experts from various specializations to develop well-rounded diagnosis and treatment plans for cancer patients.

FIGURE 2

GRIP: Gains, Risks, Innovations, Prospects in Policies and Programs

There is growing concern over the fiscal sustainability of UHC. The National Health Insurance Service faces the risk of depleting cumulative reserves, driven by increased health care spending, due to an aging population that is susceptible to NCDs. In 2018, South Koreans aged 65 and above accounted for 41 percent of total health care spending in the country, despite comprising only 14 percent of the total population. The fourth NCCP recognizes this risk to fiscal sustainability and emphasizes increasing efficiency of cancer treatment and insurance coverage, mitigating the challenge of excessive insurance coverage. Another challenge the country faces is the prolonged duration required for drug approval and the provision of pricing and reimbursement guidelines, as the process involves multiple agencies, delaying patient access to new and potentially life-saving treatments.  

Opportunities ahead

The South Korean experience in tackling cancers, particularly lung cancer, offers lessons for peers in the region, as well as further opportunities for South Korea to build upon its achievements. Guided by its fourth NCCP, South Korea is harnessing big data and advanced procedures to customize its cancer care. Tailoring cancer control strategies and patient care according to socioeconomic and health profiles is crucial for reducing lung cancer incidence, particularly as a 2023 study has shown that lower income groups face a higher risk of lung cancer and as incidence among women and never-smokers has been increasing in recent years. Nevertheless, such innovations come with significant cybersecurity risks and require responsible data stewardship.

Current limitations in medical professionals’ experience and capacity primarily hinder the widespread adoption of cutting-edge technologies in the fight against lung cancer. To bridge this gap, the capacity of medical professionals needs to be strengthened to maximize the use of advanced techniques and available data, which may benefit from cross-sectoral collaboration, particularly with academia and the tech industry. However, the long-term financial implications of integrating these technologies need to be evaluated to ensure that they are cost-effective, considering the growing concerns about the sustainability of health insurance reserves in an aging society. One cost-effective policy intervention could be streamlining patient drug approval and reimbursement guidelines to reduce the gap between the adoption of global best practices in cancer diagnosis and treatment and their introduction in South Korea’s health care system. Still, over the past three decades, with its consistent innovation and strategic adaptation of policies given emerging challenges, South Korea has established itself as one of the global leaders in improving cancer control and patient outcomes.