🇹🇭 Cancer in Thailand

Cancer in Thailand Vol. XI gives mean annual estimates for the whole country for 2019 to 2021: 13,561 liver and bile duct cancers in men (age-standardised rate 27.2 per 100,000) and 5,930 in women, 11,060 lung cancers in men and 6,887 in women, 18,421 breast cancers in women, 10,021 colon and rectal cancers in men and 8,166 in women, 5,219 cervical cancers and 4,701 prostate cancers. Against Volume X (2016 to 2018), the all-sites age-standardised rate fell from 147.5 to 137.6 per 100,000 in men and from 141.8 to 132.9 in women, while estimated new cases rose from 139,206 to 140,799 on a population of 65,988,354. The report attributes a larger than projected fall in liver and bile duct cancer to the long-standing hepatitis vaccination policy, screening of people with chronic hepatitis and liver fluke prevention; it records rises in colorectal cancer in both sexes, breast cancer and prostate cancer, which it links to an ageing population and modern lifestyles, and a continuing fall in cervical cancer it attributes to screening and HPV vaccination.

The first population-based registry started in Chiang Mai in 1986, followed by Khon Kaen in 1988, Bangkok in 1990 and Lampang in 1993, and the first volume of Cancer in Thailand was published in 1993 with the International Agency for Research on Cancer. The country now has 19 population-based registries; Volume XI uses 16 (Chiang Mai, Lampang, Lamphun, Nan, Khon Kaen, Ubon Ratchathani, Udon Thani, Lop Buri, Suphan Buri, Pathum Thani, Bangkok, Chon Buri, Rayong, Chanthaburi, Surat Thani and Songkhla), with Nan, Pathum Thani and Chanthaburi new in this volume. Registrars collect cases from hospitals, laboratories and death certificates, match deaths to registered cases, code to ICD-O-3 and register but do not count in situ cancers. For the national estimate, each region's registries are pooled, age and sex specific rates are applied to the region's population, and the expected cases of the five regions are added to Bangkok's actual cases. The National Cancer Institute's own hospital-based registry, kept since 1985, counted 3,159 new cancer patients at the institute in 2025; that is one hospital's caseload, not a national count.

The Khon Kaen registry's summary in Volume XI reports 1,775 new cancers in men and 1,677 in women registered in 2020, with liver and bile duct cancer ranking first in men at an age-standardised rate of 42.9 per 100,000, followed by lung (16.0) and colon and rectum (16.0). Bangkok's registry table gives a rate of 20.0 per 100,000 for liver and bile duct cancer in men over 2019 to 2021, and the national estimate is 27.2. The national report attributes the fall in this cancer to hepatitis vaccination, screening and management of chronic hepatitis, and prevention of liver fluke disease. The registries of Udon Thani (38.9) and Ubon Ratchathani (36.8), also in the north-east, have the next highest rates in men. Cholangiocarcinoma trials with Thai sites in OnCo's records include KEYNOTE-966, TOPAZ-1, FIGHT-202 and a phase 3 trial of futibatinib in biliary tract cancer.

The National Health Security Office reported in June 2026 that 633,866 people with cancer used services under the gold card (บัตรทอง 30 บาท) in fiscal year 2025, up from 357,737 in fiscal year 2021, with new patients rising from about 166,000 to about 248,000 a year, outpatient visits from 1,677,509 to 3,522,486 and inpatient admissions from 490,519 to 627,165. Its secretary-general listed the cancer benefits added since 2013: stem cell transplants for leukaemia and lymphoma (2013), one national standard for cancer treatment (2014), wider cervical screening (2017), HPV vaccination for girls in grade 5 and colorectal screening (2018), HPV DNA testing and a home chemotherapy pilot for colorectal cancer (2020), Cancer Anywhere (2021), BRCA1 and BRCA2 testing for high-risk breast cancer patients and relatives (2022), mammography and ultrasound screening, proton therapy and robotic surgery (2024), the 9-valent HPV vaccine and transport costs (2025), and MR-Linac radiotherapy and 3D-printed brachytherapy applicators (2026). The office also reported that the death rate among gold-card cancer patients fell from 20.3% in fiscal 2021 to 11.8% in fiscal 2025; that is its own administrative measure, not a survival statistic. A 2015 study gives the split for 2013: the Universal Coverage Scheme 76.3% of the population, the Civil Servant Medical Benefit Scheme 7.6% and the Social Security Scheme 16.1%; no more recent split could be read (see gaps). The Civil Servant Medical Benefit Scheme pays for high-cost cancer medicines through its own direct-billing system, OCPA, described under assessment below.

The Minister of Public Health announced the policy on 11 November 2020 as one of five New Normal Medical Care measures, to let cancer patients be treated at any ready hospital, cut queues and treat sooner, starting on 1 January 2021. In February 2025 the Minister stated that the National Health Security Office's secretary-general had signed an order cancelling a revised set of Cancer Anywhere rules due to apply from 1 April 2025, returning to the 2023 to 2024 rules: patients go to a hospital with cancer capability without a referral letter, the NHSO pays the hospital directly, and the hospital can bill for radiotherapy, chemotherapy, surgery, complications of the cancer and other diseases the patient has. Patient data move between hospitals through the National Cancer Institute's Thai Cancer Base (TCB Plus) and the digital ministry's Health Link. The policy dates from 2021; 2018 is the year HPV vaccination and colorectal screening entered the gold card.

The National Drug Policy Division of the Thai FDA defines R2, equivalent to the former list E(2), as medicines for patients with specific needs: medicines suited to only some indications, at risk of incorrect prescribing, needing disease-specific expertise or advanced technology, and very expensive or with a large effect on what society and patients can afford. They therefore need an authorisation system run by the benefit agency or a designated central agency, hospitals must monitor and record their use, and every health insurance fund is to develop financing so that patients can get them without a high financial burden on providers. The list is issued by the National Drug System Development Committee; the division's list of notices, as archived on 10 July 2026, gives the notice in force as the National List of Essential Medicines 2026, dated 12 February 2026, replacing the list of 4 January 2024 and its amendment of 30 August 2024. A 2015 study dates the special high-cost category to 2007 to 2009, when it came with compulsory licences, price negotiation, pooled procurement and company programmes, and estimated that patients treated with letrozole rose from 645 to 3,683 and with trastuzumab from 68 to 412. A 2026 comparison found Thailand's list holds 58 of the 64 cancer medicines on the World Health Organization's 2023 list and 127 cancer medicines in all.

HITAP's July 2015 policy brief states that the value of a quality-adjusted life year used to screen medicines for the National List of Essential Medicines in 2013 was 160,000 baht, approximately 1.2 times gross national income per head, and that medicines costing less than that are considered cost-effective. Its 2012 survey of 4,320 people in 11 provinces, part of an Asian collaborative study with South Korea, Japan and Malaysia, found Thais willing to pay 195,000 to 325,000 baht for a year of life gained but 113,000 to 156,000 baht for a gain in quality of life only, and the brief recommends that the value should vary with the situation. A 2009 history by HITAP researchers traces how demands after 2006 to add expensive technologies to the public benefit package made health technology assessment part of national decisions. The 2026 comparison of cancer medicine lists calls Thailand's route a technical-negotiation model, using assessment-informed selection and price negotiation. Whether the 2013 figure has since been revised was not verified and is named under gaps.

In July 2018 the Director-General of the Comptroller General's Department described the OCPA system for direct billing of medicines for cancer and haematology patients that need high-cost drugs. A working group including the Thai Society of Clinical Oncology and the Thai Society of Hematology reviews the medicines and indications; where interchangeable medicines exist, prices are negotiated and one is chosen for the system, which the department said cut some prices by more than half. That revision raised the medicines covered from 6 to 9 and the indications from 7 diseases to 17, which the department expected to increase access about 1.5 times for lung cancer patients and twice for breast cancer patients. Six of the OCPA medicines were also on list E(2), but with wider indications: rituximab, for example, was payable in OCPA for diffuse large B-cell, follicular, mantle cell and marginal zone lymphoma and chronic lymphocytic leukaemia, against diffuse large B-cell lymphoma alone on E(2). The department stated that scheme members can still obtain medicines outside the essential list if medically necessary, under Ministry of Finance rules. The current OCPA list was not read for this page.

The Thai FDA's slides for the 11th Thailand-Japan Symposium cite its public manual for modern drug registration submitted electronically (1 September 2025) and a notification on registration guidance dated 8 October 2025. Target times in working days are: new drugs and new biologics 220 full and 154 abridged; vaccines 280 and 154; biological products 160 and 110; new generics and generics 135 and 115; and 90 for the World Health Organization prequalification and stringent regulatory authority collaborative procedures; where an application deviates from the reference approval, the deviations must be notified and, in the slides' words, the timeline will be reduced by 30% from standard review. The clock starts once a valid application is received and access to the reference regulator's confidential information is granted. The abridged route accepts unredacted assessment reports submitted and certified by sponsors, certified by Japan's PMDA, or sent by Australia's TGA with a letter of consent, and the Thai FDA reserves the right to perform a full assessment. Reviewers then weigh factors specific to Thailand: ethnicity and disease patterns, whether required gene tests are available, interactions with traditional herbal medicines and Asian fruits, clinical practice guidelines and stability under the hot, very humid storage conditions of ASEAN climatic zone IVb. The September 2025 revision added pre-submission and pre-review meetings for abridged reviews.

The symposium slides present the Alzheimer's case as an accelerated review through bilateral cooperation with the PMDA and the Thai FDA's subcommittee on drug regulatory science and innovation, completed in 179 working days against the 220-day standard. They do not give figures for cancer medicines, and OnCo did not find a Thai FDA report of median approval times by therapeutic area. For a cancer medicine, registration is the first step: payment by the public schemes depends on listing on the National List of Essential Medicines (often on its R2 list) or on the civil servants' scheme's OCPA list, each with its own process and timing. In May 2025 the Thai FDA registered Imcranib 100, a targeted cancer tablet made in Thailand, which was added to the Thai Innovation List on 30 March 2026.

The National Health Security Office's deputy secretary-general reported in July 2026 that the test is a health promotion and prevention benefit covering Thais aged 50 to 70 under every scheme, once every two years, with counselling and referral for colonoscopy, biopsy or polyp removal after a positive result. People tested numbered 1,450,656 in fiscal year 2023, 1,331,915 in 2024 and 1,387,573 in 2025. In 2025, 102,450 results (7.38%) were positive. Among gold-card members, 1,104,325 were tested, 81,066 were positive and 37,314 of those (46.03%) had a colonoscopy, up from 30.27% in 2023 and 38.51% in 2024, against a target of at least 50%. For fiscal 2026 to 2 May 2026, 857,266 people had been tested and 81,296 were positive. The office named follow-up colonoscopy capacity as the system's challenge. OnCo found no published figure for the share of the eligible population tested.

The National Health Security Office reported in July 2026 that cervical screening rose from 869,831 women in fiscal year 2022 to 1,049,610 in 2023 and 1,514,891 in 2024, and was 1,414,771 in 2025, 64.34% of its target. HPV DNA tests were 1,207,640 of the 2025 screens (85.35%); 30,819 women (2.55%) had HPV types 16 or 18 and 90,781 (7.52%) other high-risk types. Self-sampling has been funded since 2023. Among gold-card members, 15,156 women had a colposcopy in 2025, 38.99% of those who needed one, and confirmatory testing found 827 cervical cancers, 697 of which (84.28%) had started treatment. A 2023 report describes the self-sampling kit as a benefit for Thai women aged 30 to 59, ordered free through the Paotang app, returned to a health unit, with results sent through the app and a repeat test every five years after a negative result. The gold card has paid for HPV vaccination of girls in grade 5 since 2018, switching to the 9-valent vaccine in 2025. Breast screening by mammography and ultrasound was added to the gold card in 2024; its eligibility criteria were not read for this page.

A 2011 assessment by HITAP researchers records that the Ministry granted government use licences for seven patented drugs between 2006 and 2008 to improve access, estimates that an additional 84,158 patients received the seven drugs over five years and 12,493 quality-adjusted life years were gained, and finds no relationship between the licences and foreign investment over 2002 to 2008, though exports of three products to the United States fell after it withdrew trade preferences. A 2015 study of targeted cancer medicines describes what happened around them in 2007 to 2009: the government created a special category on the national list with different coverage requirements for payers and issued compulsory licences, payers negotiated prices and pooled procurement, and companies expanded patient assistance programmes and lowered prices. Estimated patients treated rose for letrozole from 645 to 3,683, for imatinib from 103 to 350 and for trastuzumab from 68 to 412. That special category is today's R2 list.

Thai PBS reported on 4 June 2026 that Princess Chulabhorn, president of the Chulabhorn Royal Academy, had granted 690,000 tablets of Imcranib 100 to the National Health Security Office, on the occasion of her birthday on 4 July, and that on 2 June the academy's plant delivered the first lot to the Government Pharmaceutical Organization's distribution centre, which distributes medicines for the NHSO, for onward distribution to hospitals for gold-card patients. The report calls it the first targeted cancer medicine produced in Thailand, made at the academy's royal-initiative pharmaceutical plant, established in 2020, which it describes as the country's first cancer medicine plant certified to PIC/S good manufacturing and distribution practice. The Thai FDA registered it on 20 May 2025 and it was added to the Thai Innovation List on 30 March 2026. The report describes it as a tyrosine kinase inhibitor and lists its uses as chronic myeloid leukaemia, Philadelphia-positive acute lymphoblastic leukaemia, gastrointestinal stromal tumour and dermatofibrosarcoma protuberans, the indications of imatinib; the report read does not name the active ingredient, so OnCo does not link it to a drug record.

The National Health Security Office states that its faecal immunochemical test benefit covers Thais aged 50 to 70 under every scheme, not only gold-card members, and its secretary-general said in June 2026 that bowel, cervical and breast cancer screening under the health promotion and prevention benefit is available to all Thais of every scheme without charge. This puts screening in one fund for the whole population rather than splitting it across three schemes, and gives one national dataset of who was tested and who was followed up: the office publishes colonoscopy and colposcopy follow-up rates for gold-card members, 46.03% and 38.99% in 2025. The self-sampling route uses the Paotang app to order the kit and return results.

Counted from ClinicalTrials.gov participation data in OnCo's graph on 4 November 2026: 237 trials list Thailand among their countries, 186 of them phase 3, 24 phase 2, 13 phase 1/2, 13 phase 2/3 and 1 phase 1. OnCo's records mark 80 as recruiting and 84 as active. ClinicalTrials.gov names AstraZeneca as lead sponsor of 66 and Merck Sharp & Dohme of 43; non-small cell lung cancer is the first-listed cancer for 82. By first-listed cancer, 11 are in hepatocellular carcinoma and 7 in cholangiocarcinoma, including HIMALAYA, REFLECT, EMERALD-1, KEYNOTE-966 and TOPAZ-1, and 4 in cervical cancer, including KEYNOTE-A18. A few are small and regional: a phase 1/2 trial of JIN-A02 in EGFR-mutant lung cancer and a phase 3 trial of golidocitinib in peripheral T-cell lymphoma each list three countries, and a personalised neoantigen vaccine trial lists Thailand alone. OnCo's OpenAlex snapshot of 8 September 2026 also records 4,324 ClinicalTrials.gov studies of all conditions with a site in Thailand.

OpenAlex, counting works whose primary topic is oncology and counting a paper for every country among its authors' affiliations, gives Thailand 310 works in 2021, 343 in 2022, 319 in 2023, 355 in 2024 and 383 in 2025, 1,710 in total, of which 1,284 are open access and 56 highly cited. Cancer in Thailand Vol. XI was prepared with statistics and graphics from the Khon Kaen Cancer Registry and Wattanosoth cancer hospital in Bangkok, with contributors at Chiang Mai University, Khon Kaen University and the cancer hospitals of Lampang, Ubon Ratchathani, Udon Thani and Lop Buri, and data from hospitals including Chon Buri and Surat Thani cancer hospitals and Songklanagarind Hospital. Siriraj, Ramathibodi and Chulabhorn hospitals, all in Bangkok, appear on this page's institution list.

Every request to www.nhso.go.th and eng.nhso.go.th on 4 November 2026 timed out without a response, and the Internet Archive answered 429 to the copy of the English site. The gold-card cancer figures, the Cancer Anywhere rules and the screening counts were read from the raw text of PPTV, InfoQuest and Thai Post reports quoting the NHSO's secretary-general, deputy secretary-general and the Minister of Public Health by name. Hfocus and Matichon, which also carried these statements, refused our requests with 403. The NHSO's annual report, its registered population by scheme and the full text of the Cancer Anywhere notification were not read.

Cancer in Thailand reports incidence only; the Ministry of Public Health's public health statistics, which tabulate deaths by cause, were not found in a readable edition for 2024, and secondary tables seen in search results disagreed with each other, so no national death figure is given and the GLOBOCAN deaths are modelled estimates. No national population-based survival figure was found. Current scheme membership counts were not read because the NHSO site was unreachable; the 2013 shares on this page come from a 2015 study. The Comptroller General's Department site (cgd.go.th) refused our request with 403, so OCPA is described from the department's 2018 statement as reported in Thai Post. The Social Security Office's site returned only a landing page. Whether HITAP's 2013 threshold of 160,000 baht per quality-adjusted life year has been revised was not verified, and HITAP's paper on the effect of raising it returned 404.

The 220-day and 154-day figures on this page are the Thai FDA's targets in working days from a valid application, from its own symposium slides; its single published case is an Alzheimer's medicine at 179 working days. The National Drug Policy Division's site links to an NLEM dashboard, which was not read. Industry surveys of time to availability in Asia were not used as a source. The live National Drug Policy Division site returned 502, so its pages were read from Internet Archive copies of 8 September 2025 and 10 July 2026.