[암유병자 200만 시대①] “필자도 전립선암 환자”

[아시아엔=박명윤 <아시아엔> ‘보건영양’ 논설위원, 보건학박사, 한국보건영양연구소 이사장]

보건복지부와 중앙암등록본부는 ‘2018년 국가암등록통계’를 2020년 12월 30일 발표했다.

국가암등록통계는 암관리법 제14조에 근거하여 매년 의료기관의 진료기록을 바탕으로 암환자 자료를 수집·분석하여 전전년도(前前年度)의 암발생률, 생존률, 유병률을 산출하고 있으며, 국가 암관리정책 수립 및 국제비교의 근거자료로 활용된다.

2018년 발생한 신규 암환자는 24만3837명(남자 12만 8757명, 여자 11만 5080명)으로 전년(23만5547명)에 비해 8290명(3.5%) 증가하였다. 인구 10만명 당 연령표준화발생률은 290.1명으로 전년 대비 3.2명(1.1%) 증가하였다.

남자 암 발생률은 역시 10만명 당 306.1명이며, 여자는 288.5명으로 전년 대비 남자는 0.2명 증가하였으나, 여자의 경우 5.8명 증가하여 증가폭이 상대적으로 높았다. 전체 암 발생률의 추세를 고려할 때 인구 고령화가 최근 암 발생자 수 증가에 영향을 주고 있다.

2018년 남녀 전체에서 가장 많이 발생한 암은 위암이었으며, 이어서 폐암, 대장암, 유방암, 간암, 전립선암 순이었다. 남자의 암 발생 순위는 위암-폐암-대장암-전립선암-간암-갑상선암 순이었으며, 여자는 유방암-갑상선암-대장암-위암-폐암-간암 순이었다.

우리나라 국민이 기대수명(83세)까지 생존할 경우 암에 걸림 확률은 37.4%였으며, 남자(80세)는 5명 중 2명(39.8%), 여자(86세)는 3명 중 1명(34.2%)에서 암이 발생할 것으로 추정된다.

최근 5년간(2014-18년) 진단받은 암환자의 5년 상대생존율(生存率)은 70.3%로, 암환자 10명 중 7명은 5년 이상 생존하는 것으로 볼 수 있다. 남녀별 5년 생존율은 여자(77.1%)가 남자(63.8%)보다 높았다. 암 종류별로 보면, 갑상선암(100.0%), 전립선암(94.4%), 유방암(93.3%)이 높은 생존율을 보였고, 간암(37.0%), 폐암(32.4%), 담낭 및 기타담도암(28.8%), 췌장암(12.6%)은 상대적으로 낮은 생존율을 보였다.

지난 10년(2009-2018년) 동안 암 종별 발생률을 보면, 위·대장·간·폐·자궁경부암 등은 꾸준히 줄었으나, 유방암·전립선암·췌장암은 늘었다. 대장·유방·전립선·췌장암은 서구화된 식습관과 관련이 있는 암이다.

대장암은 국가 암 검진에 포함돼 악성으로 넘어가기 전 발견될 확률이 높아져 감소했지만, 나머지는 여전히 증가 추세에 있다. 유방암도 국가 검진 대상에 들어가면서 증가세가 둔화되고 있다.

암 유병자(有病者), 즉 1999년 이후 암 확진을 받아 2018년 현재 치료 중이거나 완치된 사람은 약 201만명으로, 전년(약 187만명) 대비 증가하였다. 이는 2018년 우리나라 국민(5130만 888명) 25명당 1명(전체인구 대비 3.9%)이 암유병자라는 것을 의미한다.

암 진단 후 5년 초과 생존한 암환자는 전체 암유병자의 절반 이상(57.8%)인 약 116만명으로, 전년(약 104만명) 대비 약 12만명이 증가했다.

필자도 암 유병자다. 2018년 11월 5일 신촌 세브란스병원 비뇨의학과에서 전립선 조직검사를 한 결과 전립선암(前立腺癌, Prostate Cancer) 진단을 받고 곧 호르몬 치료(남성호르몬 억제요법)를 시작하여 3개월에 한번씩 복부에 루프린(Leuplin) 주사를 맞은 결과, PSA(전립선특이항원) 수치가 8ng/ml에서 0.4로 떨어졌으나 호르몬 주사를 맞지 않으면 PSA 수치는 다시 올라가므로 완치된 것은 아니다.

이에 연세암병원 방사선종양학과 조재호 교수의 처방에 따라 토모테라피(Tomotherapy) 방사선 치료를 2019년 12월 23일부터 2020년 2월 4일까지 총 28회를 받아 PSA 수치가 0.0이 되었다. 방사선치료(radiation therapy)란 고에너지 방사선을 이용하여 암세포를 죽이는 치료를 말한다. 암세포에 집중적으로 방사선을 조사하면 암세포를 파괴하고 더 이상 증식되는 것을 막아준다.

췌장암(膵臟癌, Pancreatic Cancer) 투병 중인 이어령 교수의 근황이 조선일보 인터뷰를 통해 알려졌다. 체중이 50kg대로 내려왔다고 하며, 항암치료를 거부하고 1주일에 한번 기(氣) 치료만 받으면서 집필에 몰두해온 그는 살아갈 날이 6개월에서 3개월, 다시 1개월로 줄어들 수 있다는 의사의 진단을 받고 최근 분신(分身)과 다름없던 ‘한중일(韓中日)비교문화연구소’의 문을 닫았다고 한다.

이어령 교수는 ‘이 시대의 지성’이라 불리는 한국의 대표적인 석학으로 서울대 국문과 및 동 대학원을 졸업하였다. 1967년 이화여대 교수로 부임했으며, 1990년 초대(初代) 문화부장관을 역임하면서 학교를 떠났다가 1995년 이화여대 석좌교수로 강단에 복귀했다. 88서울올림픽 개막식에서 ‘굴렁쇠 소년’을 연출한 것과 ‘벽을 넘어서’란 구호도 유명하다.

&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;img src="http://kor.theasian.asia/wp-content/uploads/1311.jpg" width="50" height="50" alt="박명윤" class="avatar avatar-60 wp-user-avatar wp-user-avatar-60 alignnone photo" /&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; 한국보건영양연구소 이사장, 서울대 보건학박사회 고문  

http://kor.theasian.asia/archives/283834 

[암유병자 200만 시대②] ‘암예방 수칙 10계명’

January 19, 2021 박명윤 사회-문화, 칼럼

[아시아엔=박명윤 <아시아엔> ‘보건영양’ 논설위원, 보건학박사, 한국보건영양연구소 이사장] 이어령 교수가 투병중인 췌장암은 비교적 드물게 발생하는 암이지만 우리의 생활방식이 서구화되면서 췌장암 환자가 꾸준히 증가하고 있으며 연령이 높을수록 발생 빈도가 높아진다. 췌장은 길이 15cm의 가늘고 긴 모양을 가진 장기로 소화액(췌액)을 분비해 십이지장으로 보내주는 역할을 한다. 암을 조기진단하기 위해 폐암은 가슴 CT, 간암은 초음파검사 등 여러 방법이 쓰이지만 췌장암의 경우 아직은 조기진단 방법이 없다. 최근 AI 메디컬 스타트업에서 AI가 모은 방대한 데이트로 췌장암 조기진단을 시도하고 있다.

올해 우리 나이로 미수(米壽)인 88세를 맞은 이어령 교수는 “어떤 고통이 와도 글을 쓰고 싶다. 그 의지가 나를 살게 하는 혈청제(血淸劑)”라고 말했다. 올해 81세인 필자도 지난해 금혼식(金婚式)을 기념하여 발간한 <행복한 여정 50년> 머리말에 “나는 이 세상에서 현역 ‘건강 칼럼니스트’로 평생 살다가 저 세상으로 떠나고 싶다”고 적었다.

현재 한국인 사망원인 1위인 암에 걸린 환자들은 암과 힘겨운 싸움을 벌이고 있으며, 암을 이겨낸 사람들도 재발의 위험 속에서 살아가고 있다. 하나의 암이 완치되었다 하더라도 또 다른 암이 발생할 가능성이 늘어나고 있다. 이에 장기생존에 따라 다른 암이 추가적으로 발생할 수 있음을 이해할 필요가 있다.

따라서 암의 조기 발견과 치료뿐 아니라 재발 방지와 예방에 더 노력해야 한다. 암의 대표적인 위험인자인 흡연, 음주, 비만, 잘못된 식습관 등을 교정하고, 규칙적인 운동과 올바른 식생활을 유지하여야 한다. 암 완치판정 이후에도 연령이 높아지면서 암이 발생할 가능성도 높아지므로 정기 검진을 적극적으로 받아야 한다.

암은 환경적 요인뿐만 아니라 유전적 요인에 의해서도 발병하므로 가족력이 있거나 고위험군에 속하는 경우에는 암예방센터를 통해 예방적 치료를 받도록 한다. 또한 재발 방지를 위한 다양한 프로그램도 제공받을 수 있다. 예를 들면, 연세암병원은 팀 중심의 치료 전문성을 높인 13개 암센터를 운영하고 있으며, 여러 진료과 의료진과 환자와 보호자가 한 자리에 모여 암을 진단하고 최적의 맞춤 치료를 결정하는 베스트팀 진료를 도입하고 있다.

최근 미국의 연구 결과를 보면 암 환자 중 약 40%가 다양한 대체요법으로 암을 완치할 수 있다고 믿는다고 한다. 그러나 검증된 표준 치료를 받은 환자에 비해 대체요법을 받은 환자들의 재발 및 사망위험이 약 3배 높다는 연구 결과가 있다. 암 환자라고 하면 주변에서 몸에 좋다는 여러 가지를 권장하는데, 검증된 치료를 받지 않고 그런 것에 의존하는 것은 바람직하지 않다.

정부는 암 예방 및 조기검진을 강화하기 위해 2016년부터 자궁경부암 예방접종을 만 12세 여성청소년을 대상으로 필수접종 중이며, 2019년부터 폐암검진을 국가암검진으로 도입하여 운영하고 있다. 또한 암 치료가 완료된 환자 및 가족에 대해 건강관리 및 심리상담 등을 종합적으로 지원하는 암 생존자 통합지지사업도 2017년부터 시범사업을 거쳐 운영해 오고 있다.

많은 사람들이 암은 유전적 요인에 의해 발생한다고 생각하여 가족 중 암 환자가 있으면 유전력을 피해갈 수 없다고 생각한다. 하지만, 세계보건기구(WHO)는 암의 유전적인 원인은 물론 유방암이나 대장암처럼 유전적인 요인으로 인한 암 발생 비율이 높은 암도 있지만, 전체 암 발생의 5% 수준이라고 한다.

암의 주요 원인은 생활습관을 포함한 환경적인 요인이 더 크다. 따라서 올바른 생활습관을 유지하려는 노력을 하면 암을 예방할 수 있다. 즉, 암은 금연, 금주, 식습관, 운동 등 평소 건강한 생활습관을 실천하면 예방할 수 있는 질환이다. 그런데 무심코 유지해온 나쁜 습관이 계속되면 암 세포가 성장하기 좋은 환경이 된다.

보건복지부와 국가암정보센터가 권고하는 ‘암예방 수칙 10계명’은 다음과 같다.

 ▲담배는 피우지 말고, 남이 피우는 담배 연기도 피한다. ▲채소와 과일을 충분히 먹고, 다채로운 식단으로 균형 잡힌 식사를 한다. ▲음식을 짜지 않게 먹고, 탄 음식은 먹지 않는다. ▲술은 암 예방을 위하여 하루 한두 잔의 소량 음주도 피한다. ▲주 5회, 하루 30분 이상 땀이 날 정도로 운동한다. ▲자신의 체격에 맞는 건강 체중을 유지한다. ▲간단한 접종으로 암을 예방할 수 있으므로 예방접종 지침에 따라 접종을 받는다. ▲성(性)매개 감염병에 걸리지 않도록 안전한 성생활을 한다. ▲발암성 물질에 노출되지 않도록 작업장에서 안전 보건 수칙을 지킨다. ▲암 조기 검진 지침에 따라 검진을 빠짐없이 받는다.

2021년 새해를 맞아 건강한 생활습관을 생활화하여 100세 시대를 맞을 준비를 하여야 한다. 금연과 절주를 실천하고 균형 잡힌 식생활과 규칙적으로 운동을 하며, 정기 암 검진을 빠짐없이 받도록 한다. 특히 올해는 전 국민을 대상으로 실시하는 코로나19 백신 접종을 받아 우리 사회가 집단면역이 형성되어 코로나의 긴 터널을 벗어나는 데 협조하여야 한다

http://kor.theasian.asia/archives/283838

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