Photo/Illutration Dr. Mayu Kitamoto, foreground right, performs colorectal cancer surgery at Yokosuka Kyosai Hospital in Yokosuka, Kanagawa Prefecture. (Asahi Shimbun file photo)

Japan faces a looming crisis in cancer care with a shortage of around 5,000 gastrointestinal surgeons by the year 2040, an industry report warned.

Young doctors are leaving the field as a demographic change is presenting new patterns of cancer cases, causing health officials to talk of consolidating cancer staff, equipment and departments.

In a report presented to the health ministry, the Japanese Society of Gastroenterological Surgery projected that Japan will lose 40 percent of its gastrointestinal surgeons by 2040, down to 9,200 from the current number of around 15,200.

This would represent a shortfall of 5,200 at a time when the nation will need around 14,400 surgeons in the field.

Gastrointestinal surgery is an intervention for stomach, colorectal and other cancers involving the digestive tract.

The number of doctors affiliated with the society has been steadily declining. Younger physicians increasingly avoid the field, discouraged by the long working hours and other demanding conditions.

The society presented its report at a panel convened by the health ministry to assess cancer care infrastructure.

The ministry plans to urge prefectural governments to look at restructuring their medical facilities. This might include merging institutions to use resources more efficiently.

In a draft report broadly endorsed by the panel on July 25, the health ministry warned that continuing with the current cancer care model could lead to a critical shortage of doctors.

“Even surgical treatments currently available may no longer be sustainable,” the report said.

The document identified medical services for which “there is especially strong need” for considering consolidation, including gastrointestinal surgery. It also pointed to geographic areas with few patients or a severe lack of specialists.

In addition, the report called for centralizing services that use costly equipment such as radiation therapy machines, in view of both future demand and resource sustainability.

At the same time, it underscores the need to keep the public on board.

“Ongoing, clear communication is essential,” the document said.

It also highlighted the importance of ensuring continued access to cancer care centers by patients.

The next step is to issue the finalized document to prefectural governments.

Then it will fall to regional councils to discuss what to do, using projections of future patient numbers and medical needs.

These councils will involve several stakeholders. They will be operated jointly by the prefectural government and hospitals designated by the ministry as "cancer treatment cooperation centers."

Local cancer care providers and patient advocacy groups will also participate in the councils.

Meanwhile, demographic change will also reshape the need for cancer care.

By 2040 the number of cancer patients will increase in 16 urban prefectures but decline in 31 others, according to health ministry projections. However, among patients aged 85 and older, the number is expected to rise in nearly all regions, except for a few remote rural areas.

These demographic shifts are expected to reshape demand for the three pillars of cancer treatment by 2040. The need for surgery is projected to decline by 5 percent. But radiation therapy and drug therapy, both commonly used for older patients, are anticipated to rise by 24 percent and 15 percent, respectively.

There is some good news. The panel’s report indicates no shortfall in radiation therapy doctors through 2040. However, it may be financially unsustainable to provide expensive equipment in areas facing population decline and fewer patients.

As for drug therapy, there are no concrete estimates of a potential surplus or shortage of physicians. Unlike surgery, drug therapy requires ongoing, scheduled treatments. The report recommends pursuing “equitable access through measures such as telemedicine,” particularly in regions with limited resources.

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