Key Points
・Keigo Higashino, Japan’s most widely read mystery novelist, died of colorectal cancer in the early hours of July 23, 2026, at the age of 68, and news of his death was carried as breaking coverage in China, Taiwan and South Korea.
・Colorectal cancer is the most frequently diagnosed cancer in Japan and produces almost no symptoms at its early stages, which is precisely why the country built a national screening programme around a stool test for people who feel nothing at all.
・Japan’s screening system works only as a chain, and the chain breaks near its end: roughly three in ten people who test positive never go on to the diagnostic colonoscopy the programme is designed to send them to.
Kodansha Announces the Death, and Names the Cause
Kodansha, Higashino’s principal publisher, announced on July 27 that the novelist had died of colorectal cancer in the early hours of July 23 at the age of 68. The funeral was held privately by his family. According to the announcement, Higashino published 106 books excluding co-authored titles, his work has been published in 41 countries and regions, and his domestic print run stands at roughly 109 million copies. His final book, *Eien no Kioku*, is scheduled for release by Bungeishunju on August 5. The stage at which the cancer was found, the timing of its discovery and the course of treatment have not been disclosed.
The news travelled quickly outside Japan. Chinese state media reported the death, and searches for his name briefly topped the trending ranking on the social platform Weibo. Major outlets in Taiwan and South Korea also carried the news as breaking coverage, describing him as a novelist who represented Japanese detective fiction and as a master of the Japanese mystery.
Colorectal cancer, the cause of death made public, is one of the few cancers in Japan for which the state operates a screening programme aimed at people with no symptoms at all.
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A Forty-Year Career, and a Screening System Built Around a Stool Test
From an amateur prize to the face of Japanese mystery fiction
Higashino studied electrical engineering at Osaka Prefecture University and worked as an engineer while writing. His debut novel, *Hokago* (After School), won the Edogawa Rampo Prize in 1985, the standard entry point for new Japanese mystery writers, and he turned professional on the strength of it.
Two series carried his name. The Galileo books put a physicist at the centre of cases solved through scientific reasoning, and the Kyoichiro Kaga books followed a detective through the human wreckage around each crime. Alongside them he wrote novels that were read far outside the mystery audience, including *Byakuyako* (Journey Under the Midnight Sun), *Himitsu* (Naoko) and *The Miracles of the Namiya General Store*.
| Year | Milestone |
|---|---|
| 1985 | Debuts with *Hokago*, winner of the Edogawa Rampo Prize |
| 2006 | *The Devotion of Suspect X* wins the Naoki Prize and the Honkaku Mystery Award |
| 2012 | English edition of *The Devotion of Suspect X* shortlisted for the Edgar Award for Best Novel |
| 2019 | English edition of *Newcomer* nominated for the CWA International Dagger |
| 2023 | Receives the Kikuchi Kan Prize and the Medal with Purple Ribbon |
Source: Kodansha’s announcement
Kodansha’s announcement notes that Higashino was the first Japanese writer to be nominated for both the Edgar Award and the Dagger. His work was adapted repeatedly for Japanese television and film, and *The Devotion of Suspect X* and *The Miracles of the Namiya General Store* were also adapted into Chinese-language films. That accumulated record of translation and adaptation is the background to the unusually large East Asian response to his death.
The cancer Japanese people are most likely to get is nearly silent when it starts
According to cancer statistics compiled by the National Cancer Center Japan, about 150,000 people a year are diagnosed with colorectal cancer, more than for any other site. More than 50,000 die of it each year, second only to lung cancer, and among women it is the leading cause of cancer death.
Early colorectal cancer produces almost no symptoms. Blood in the stool and changes in bowel habits, the signs a person would notice, tend to appear only once the disease has progressed to some degree. A system that waits for patients to present with complaints will therefore tend to catch the disease late, which is the reason this particular cancer is tied so tightly to screening.
How Japan’s programme works: age 40, once a year, a stool test done at home
Japan’s national screening guideline, issued by the Ministry of Health, Labour and Welfare, directs municipalities to offer colorectal cancer screening to residents aged 40 and over, in principle once a year. Readers outside Japan should note that this is a population-based programme delivered by local government, not a decision made in a doctor’s office.
The screening itself consists of a brief interview and a fecal immunochemical test, or FIT, using a two-day sampling method. Participants collect the samples themselves at home and return them. The guideline defines only two possible results: negative, or “requires further examination.”
That second result does not mean cancer has been diagnosed. By design it is the entry point to a diagnostic colonoscopy. The guideline also states plainly that screening carries harms as well as benefits, listing false negatives, false positives, overdiagnosis and procedural complications.
In practice the system does not run as designed. Participation sits in the forties as a percentage, and of those who test positive, about seven in ten actually go on to the diagnostic examination. Roughly three in ten stop at the threshold.
The United States moved its starting age down to 45
In 2021 the US Preventive Services Task Force, which issues the country’s public recommendations on preventive care, lowered the age at which it recommends colorectal cancer screening from 50 to 45. The stated background was a rise in colorectal cancer incidence among Americans in their forties.
The two systems cannot be compared by starting age alone. Japan begins at 40 with a stool test at its centre, while the United States begins at 45 and lets people choose among several methods including stool tests and colonoscopy. The architectures are different.
A Disease That Does Not Fit the Habit of Waiting for Symptoms
Screening is judged by deaths avoided, not by cancers found
When early detection is discussed, the question that actually matters is not how many cancers were found but how many deaths were prevented.
The Japanese figures make the stakes visible. According to the Ministry of Health, Labour and Welfare’s report on five-year survival from the national cancer registry, five-year net survival for colorectal cancer diagnosed in 2017 was 90.8 percent when the disease was localised, 72.8 percent when it had spread to regional lymph nodes or adjacent organs, and 17.2 percent once it had reached distant organs.
Same disease, same name, and a gap between roughly nine in ten and fewer than two in ten depending on when it was caught. That gap is what gives a system aimed at people without symptoms its reason to exist.
The survival gap itself, however, does not prove that screening works. Finding a cancer earlier lengthens the measured interval from diagnosis onward even when nothing about the outcome has changed, an artefact known as lead-time bias. So the evidence that matters is whether mortality fell in populations offered the test. FIT is recommended in the National Cancer Center’s guideline because that mortality evidence exists, not because screened patients post better survival figures.
Japan’s chain breaks at two points, and the second one is less known
Two separate failures sit on either side of the test. Fewer than half of the eligible population takes it, and among those who test positive, a substantial minority never completes the follow-up.
On the entry side, the 2022 Comprehensive Survey of Living Conditions puts participation among people aged 40 to 69 at 49.1 percent for men and 42.8 percent for women. Two caveats matter for reading these numbers: they are self-reported, and they include screening received through workplace health checks and privately purchased full medical checkups, not only municipal programmes. Even with that generous definition, the figure hovers around half.
How easily a person reaches screening depends on whether they are covered by an employer’s scheme or by their municipality, and on which municipality that is. Notification, cost and convenience all vary. Low participation is not adequately explained as a failure of individual motivation.
The exit side is the less familiar problem. According to the National Cancer Center’s compilation of process indicators, 71.5 percent of people whose FIT result required further examination actually underwent the diagnostic colonoscopy. All 47 prefectures fall short of the national benchmark on this measure.
Why the other three in ten stop cannot be determined from that statistic alone. Anxiety about treating a positive result as a verdict, the burden of booking a colonoscopy and completing bowel preparation, and how effectively reminders reach people are all plausible contributors.
A positive stool test is a signal, not a verdict, and there is a number for that
One reason people freeze at a positive result is the assumption that positive means cancer. The distance between those two things can be measured.
The National Cancer Center’s 2024 guideline puts the number needed to scope at 13 for a FIT-based programme: about 13 diagnostic colonoscopies are performed for each colorectal cancer found. Twelve of those thirteen people do not have cancer, though some will have polyps removed in the process.
Read the other way, the letter that says “further examination required” is closer to a message that something is worth checking than to a diagnosis. That framing does not remove the inconvenience of the follow-up, but it changes what a person is bracing for.
The harms are real, which is why Japan does not simply scope everyone
The opposite error is to treat more testing as always better.
FIT has a sensitivity of 84 percent, meaning roughly 16 percent of people who do have colorectal cancer will test negative. A negative result is not a licence to skip the next several years, and the design compensates by repeating the test annually rather than by making any single test definitive. Because some people without cancer also test positive, most positives turn out not to be cancer, and the anxiety and inconvenience in between are genuine costs.
Colonoscopy carries its own risks, chiefly bleeding and perforation, though they are uncommon. A national tally by the Japan Gastroenterological Endoscopy Society covering 2008 to 2012 put the rate of complications at 0.011 percent. That figure combines diagnostic examinations with therapeutic procedures such as polyp removal, so it does not isolate the risk of observation alone.
Japan’s national guideline formally lists false negatives, false positives, overdiagnosis and procedural complications as harms of screening. The decision not to start every asymptomatic adult with a colonoscopy follows from weighing those harms against the benefit, not from indifference to early detection.
What a screening programme is, then, is a balance: a cheap and low-burden test spread widely, with the invasive examination reserved for those whose test returns a signal. The American move to 45 was that same balance redrawn in response to changing incidence among younger adults. There is no single correct place to draw it, and the answer differs by country and by age.
Screening Belongs to the Days When Nothing Feels Wrong
Nothing is publicly known about when Higashino was diagnosed or at what stage, and nothing in this article should be read as a judgement about what was possible in his case. What can be examined from the outside is the statistics and the system.
What those show is a disease structurally mismatched with a habit most people share, which is to act once something feels wrong. Early colorectal cancer usually feels like nothing. Waiting for a symptom is therefore not a reliable route to early detection, and the programme is aimed squarely at people who feel fine.
A writer read across dozens of countries died, and the cause was named. That name can be treated as a source of fear, or as an occasion to look at how the screening system around it is actually built. The invitation letter and the sampling kit sit on the side of ordinary, symptom-free life, which is one of the few doors into this system that opens before anything has gone wrong.
Reference Links
- Notice of the Passing of Keigo Higashino｜Kodansha (in Japanese)
- Keigo Higashino’s death reported as breaking news in China, Taiwan and South Korea｜Nikkei (in Japanese)
- Cancer Statistics in Japan; Table download｜Cancer Information Service, National Cancer Center Japan
- Cancer Statistics in Japan 2026｜Cancer Information Service, National Cancer Center Japan
- Five-Year Survival Report from the National Cancer Registry, 2017 Diagnoses (PDF)｜Ministry of Health, Labour and Welfare (in Japanese)
- Guideline for Cancer Screening Implementation (PDF)｜Ministry of Health, Labour and Welfare (in Japanese)
- Colorectal Cancer Screening Guideline｜Institute for Cancer Control, National Cancer Center Japan (in Japanese)
- Screening for Colorectal Cancer｜US Preventive Services Task Force
