Breast cancer has become the most common cancer among women in Taiwan, accounting for more than 17,000 new cases annually. Yet despite advances in diagnosis and treatment, mortality rates continue to rise — a trend that stands in stark contrast to the steady declines seen in the United States and Europe over the past three decades.
According to Dr. Tseng Ling-ming, vice superintendent at Taipei Veterans General Hospital, reversing this trajectory requires a multifaceted approach combining early detection, comprehensive treatment, data-driven policy, and equitable access to innovative therapies.
“In Taiwan, although treatment outcomes have improved, the mortality rate has not fallen — mainly because the incidence rate has risen almost fourfold in the past 25 years,” he says. Some people in the country are unwilling to seek formal medical treatment, and the proportion of cases diagnosed at Stage 4 is as high as 7% to 8%, which is twice that of Europe and the United States. In addition, incomplete treatment is also an important reason why the mortality rate of breast cancer has not declined.
Lifestyle shifts play a major role in this trend — changes in reproductive patterns, high-calorie diets, and sedentary habits have all contributed the incidence continues to increase. “Environmental pollutants and alcohol consumption add to the risk,” says Dr. Tseng. “Our policy of mass screening helps us detect more cases but also highlights how much more common the disease is becoming.”
While screening efforts have expanded, uptake remains low — barely 40% of eligible women participate, and nearly the same proportion have never been screened. Early-stage invasive breast cancer detection rates hover around 60% to 70%, compared to roughly 80% in other advanced economies.
“Taiwan has a higher proportion of pre-menopausal patients with dense breast tissue,” says Dr. Tseng. “For them, standard mammography may not be sufficient. We need smarter, personalized screening policies that reflect our local population.”
Among early-stage cases, recurrence remains a persistent challenge, for example, for hormone-receptor-positive breast cancer, which accounts for about 65% of all cases. “Even after completing surgery and adjuvant therapy, Stage 3 patients face a 10-year recurrence rate of up to 36%,” Dr. Tseng says. “Over 20 years, the risk of distant metastasis can reach nearly 50%.”
The best defense, he stresses, is complete and continuous care. “Prevention of recurrence starts with full treatment — surgery, medication, and radiotherapy where indicated,” he explains. “But equally critical is long-term follow-up. When the immune system weakens, dormant cancer cells may become active again. Regular outpatient follow-ups over many years are essential.”
Dr. Tseng underscores the importance of patient education and shared decision-making. “We need to present data clearly,” he says. “With today’s technology and AI tools, we can show each patient their personalized prognosis based on stage and biomarkers. Once patients see the numbers, most are willing to complete the recommended treatment.”
To close the outcome gap between Taiwan and other high-income economies, the National Health Insurance Administration (NHIA) is collaborating with the Taiwan Breast Cancer Society to overhaul Taiwan’s pay-for-performance (P4P) program. The revised scheme aims to raise care quality by linking reimbursement to comprehensive, guideline-based treatment and consistent patient follow-up.
“The upgraded P4P program requires hospitals to report key quality indicators that reflect prognosis and care consistency,” says Dr. Tseng. “However, collecting and managing this information demands manpower that many hospitals currently lack.” Policies should also include related support for the implementation of P4P to effectively achieve care goals.
Artificial intelligence, he adds, can further improve efficiency. “The NHIA already holds all claims data. With AI and large-language-model technology, we can automatically calculate performance indicators and identify hospitals that deviate from standards. This will make the system smarter and less labor-intensive.”
Novel therapies have transformed breast-cancer outcomes globally, but many reached Taiwanese patients later due to reimbursement delays. That started to change in 2024, when nine new breast-cancer drugs were approved for coverage, efforts are currently ongoing to address and fill the treatment gaps. “This was a major milestone,” says Dr. Tseng. “If every patient can receive the right drug at the right time, survival will improve.”
Still, he warns that sustainability remains a concern. “New treatments are expensive, and Taiwan’s healthcare budget is limited — only a bit over 6% of GDP. While we now have a Cancer Drugs Fund to bridge the gap, long-term funding is uncertain. We must consider increasing the healthcare budget and exploring more flexible payment models, such as partial copay mechanisms, to maintain alignment with international standards.”
In parallel with policy reform and reimbursement expansion, Dr. Tseng emphasizes the need for continued public education and cross-sector collaboration. Ultimately, he says, Taiwan is well-positioned to make progress.
“We have a world-class healthcare system, comprehensive data infrastructure, and dedicated medical professionals,” he says. “If we can strengthen awareness, ensure access to innovative drugs, and use data intelligently, we can bring Taiwan’s breast-cancer outcomes in line with the world’s best.”
