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Diagnostic accuracy of conventional Pap test, liquid-based cytology and human papillomavirus DNA testing in cervical cancer screening in Korea: a meta-analysis.
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Jin Kyoung Oh, Hai Rim Shin, Gyungyub Gong, Jin Hee Sohn, Shin Kwang Khang
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Korean J Epidemiol. 2008;30(2):178-187. Published online December 31, 2008
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DOI: https://doi.org/10.4178/kje.2008.30.2.178
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Abstract
Objective: The aim of this study was to compare the diagnostic accuracy of the Pap test, liquid-based cytology (LBC), and human papillomavirus (HPV) testing used as screening methods for the early detection of cervical cancer in Korea.
Materials and Methods: Articles reporting the sensitivity and specificity of each screening method that were published between 1995 and March 2008 were retrieved from MEDLINE and KoreaMed. A meta-analysis was conducted to calculate pooled estimates for the sensitivity and specificity of each method. Only cases with histological confirmation were included, and cervical cancer was defined as samples exhibiting cervical intraepithelial neoplasia 2 or worse. In cytological tests, findings of atypical squamous cells of undetermined significance or worse were considered positive.
Results Of the 24 studies, 15 studies of the Pap test, 3 studies of LBC, and 4 studies of HPV met the inclusion criteria and were included in the meta-analysis. The meta-analysis showed that the sensitivity was highest for LBC (92%), followed by HPV testing (83%) and the Pap test (76%), and the specificity of LBC was the highest (79%), followed by the Pap test (76%) and HPV testing (59%). However, except for the sensitivity of LBC (heterogeneity p-value = 0.682), significant heterogeneity was found among the results of the studies (heterogeneity p-value < 0.0001).
Discussion Due to the significant heterogeneity among the studies, the results of this meta-analysis are limited in representing the accuracy of each test method. The accuracy and cost-effectiveness of cervical cancer screening methods should be further evaluated.
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Citations
Citations to this article as recorded by  - A prospective pilot evaluation of vaginal and urine self-sampling for the Roche cobas 4800 HPV test for cervical cancer screening
Sang-Hyun Hwang, Hye Young Shin, Dong Ock Lee, Na Young Sung, Bomyee Lee, Do-Hoon Lee, Jae Kwan Jun
Scientific Reports.2018;[Epub] CrossRef - Comparison of Unsatisfactory Samples from Conventional Smear versus Liquid-Based Cytology in Uterine Cervical Cancer Screening Test
Hoiseon Jeong, Sung Ran Hong, Seoung-Wan Chae, So-Young Jin, Hye Kyoung Yoon, Juhie Lee, Eun Kyung Kim, Sook Tai Ha, Sung Nam Kim, Eun-Jung Park, Jong Jae Jung, Sun Hee Sung, Sung-chul Lim
Journal of Pathology and Translational Medicine.2017; 51(3): 314. CrossRef - The performance of multimodal hyperspectral spectroscopy in the detection of precancerous cervical lesions
Trahmono, N Lusiana, J Indarti
Journal of Physics: Conference Series.2017; 884: 012152. CrossRef - Usefulness of anti‐phosphohistone H3 immunoreactivity to determine mitotic rate in gastrointestinal stromal tumors
Ahrong Kim, Dong Han Im, Kyungbin Kim, Jee Yeon Kim, Mee Young Sol, Jeong Hee Lee, Kyung Un Choi
Basic and Applied Pathology.2012; 5(4): 91. CrossRef
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Introduction of Relative Survival Analysis Program: Using Sample of Cancer Registry Data with Stata Software.
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Kyu Won Jung, Hyun Joo Kong, Seon Hee Yim, Young Joo Won, Joohon Sung, Hai Rim Shin
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Korean J Epidemiol. 2007;29(2):222-229.
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Patient survival is one of the most important measures for the evaluation of progress in cancer patient care across the wide spectrum from diagnosis to treatment. The optimal monitoring method for cancer patient survival is to estimate survival based on representative data from cancer patients in the population, which is only achievable through using population-based cancer registration data. Relative survival is used to compare the survival experience in a study cohort that expected to result from background population mortality rates. This technique is useful when the cause of death is not accurate or not available, since it provides a measure of excess mortality in a group of patients with a certain disease. The purpose of this article is to demonstrate the procedures for estimating relative survival using the statistical software Stata. For this survival analysis to show the procedure, the example data set was randomly selected from the National Cancer Incidence Database, which was used in a recent article reporting the overall relative survival of cancer patients diagnosed during 1993-2002 in Korea.
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Regional Variation in Accessing Regional Hospitals for Cancer Patients.
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Yeon Ok Moon, Eun Cheol Park, Hai Rim Shin, Young Joo Won, Kyu Won Jung, Jin Hee Lee, Soon Young Hwang, Hyun Joo Kong, Seung Sik Hwang, Jong Koo Lee, In Sik Kong, Myung Il Hahm
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Korean J Epidemiol. 2006;28(2):152-161.
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OBJECTIVES
To investigate the differences in accessing regional hospitals and the utilization rate of hospitals located in other regions for cancer patients by regions.METHODS Data for the utilization of regional hospitals for cancer patients were obtained from the Korean National Cancer Incidence Databases in 1999 and 2002. We divided the regions into 16 provinces by administrative districts. We using the SAS 9.1.3 to analyze difference of regional self-sufficiency and the Arcview 3.2 to show in a schematize for regional variation of the regional self-sufficiency.RESULTS There were regional variations in the regional self-sufficiency of cancer patients. Especially, Jeollanam-do(1999 13.6%, 2002 12.8%), Gyeongsangbuk-do(1999 22.0%, 2002 20.7%), and Chungcheongnam-do(1999 27.8%, 2002 27.1%) had low regional self-sufficiency. The regional self-sufficiency in Gyeonggi-do and utilization rate of cancer patients who lived in other regions were increased between 1999 and 2002(regional self-sufficiency: 1999 37.2%, 2002 48.2%).CONCLUSION The results of this study showed that there were regional variation in utilization of regional hospitals for cancer patients. Accessibility of cancer patients in metropolitan areas was higher than in small size cities, medium size cities, and rural county areas. These results suggested that it should be considered support medical facilities for cancer patients in rural areas where have lower relevance rate.
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Long-term prediction of gastric cancer mortality in Korea.
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Jin Gwack, Yunhee Choi, Hai Rim Shin, Yun Chul Hong, Keun Young Yoo
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Korean J Epidemiol. 2005;27(1):163-172.
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PURPOSE
This study was carried out to predict the mortality rate for gastric cancer up to 2020 in Korea with forecasting model.METHODS The trends of the age-adjusted mortality rate was calculated from 1983 to 2003 using the mortality data of the past 20 years in Korea, and projected up to the year of 2020 with log-linear models for each gender. The number of deaths from gastric cancer was calculated from the predicted mortality rate.RESULTS Age-adjusted mortality rates for gastric cancer per 100,000 persons were 32.13 in 1983, 23.95 in 1990, and 15.99 in 2003 for women, and 70.37, 58.74, 41.04 for men, respectively. The expected age-adjusted mortality rates for gastric cancer were 16.50 in 2005, 14.27 in 2010, and 10.66 in 2020 for women, and 39.14, 33.83, 25.28 for men, respectively. In contrast to this decreasing trend, it is predicted that mortality rates for those aged 75 or over would increase steadily. The predicted number of deaths from gastric cancer was 6,519 for women and 13,743 for men in 2020.CONCLUSIONS This study suggests that gastric cancer mortality rate would decrease continuously except for some aged groups. The declining trends in gastric cancer mortality are regarded as a result of lifestyle changes, improvements in screening methods and treatments. Strategies for aged groups should be developed in order to control increasing mortality rates.
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Relationship among risk factors related to Human Papillomavirus infection among youth.
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Jin Kyoung Oh, Young Hee Ju, Dong Young Yoon, Kap Yeol Jung, Se Il Jung, Hai Rim Shin
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Korean J Epidemiol. 2005;27(1):118-128.
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PURPOSE
To investigate the prevalence and related risk factors of infection with human papillomavirus(HPV) in young adults, and the interrelationships among the risk factors, school-based survey was conducted in Busan.METHODS A total of 1,430 male and female students(aged 16~25) participated in the survey that included self-administered questionnaire and, for males, physician-performed collection of exfoliated genital cells, for females, self-collection of vaginal cells. The prevalences of 25 HPV types were evaluated by a polymerase chain reaction-based assay.RESULTS HPV DNA detected more frequently in female students(15.2%) than in male students(8.7%). In female students, currently smoking cigarettes(OR=3.8, 95% CI=1.7~8.3) and having had penetrative sexual intercourse(OR=12.7, 95% CI=7.2~22.2) were the significant risk factors for HPV infection; in male students, there was nothing to show statistical significance. Smoking rate was 53.8% in males and 17.7% in females, and 55.6% of male students and 25.9% of female students reported having had a sexual intercourse. Smokers were more likely to have had a sexual intercourse than nonsmokers(OR=4.0, 95% CI=2.5~6.2, males; OR=9.1, 95% CI=5.6~14.7, females).CONCLUSIONS According to the strong interrelationship between sexual intercourse and smoking, multilateral behavioral intervention is needed to prevent infection with HPV.
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Reliability and Validity of the Modified Korean Version of Baecke Questionnaire on Physical Activity.
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Ji Young Lee, Young Ho Yun, Eun Cheol Park, Hong Wan Seo, Ju Huk Lee, Hai Rim Shin, Kui Son Choi
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Korean J Epidemiol. 2004;26(2):20-31.
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PURPOSE
Our main goal is to test the reliability and validity of the Korean version of Baecke questionnaire on physical activity by using 507 men and women aged 20-70 years.METHOD This study was carried out using the cancer screening participants of the National Cancer Center. All subjects were sent the Korean version of Baecke questionnaire by mail to measure their physical activity.RESULTS The mean score on the sport index during leisure-time for men was significantly higher than that for women. In contrast, the mean score of the work index for men was significantly lower than that for women. Cronbach`s alphas for work, sport and leisure-time index were 0.75, 0.81 and 0.39 for men, respectively, and 0.67, 0.75 and 0.35 for women respectively. By a principal components analysis the three conceptually meaningful factors were distinguished, except for the leisure-time factor. Due to the low cronbach`s alphas and undistinguished factors, work and sports factors were used on the final analysis, excluding the leisure time factor, in the Korean version of Baecke`s questionnaire. Two-factor analysis was used to assess the validity of work items and sports items. Work factor and sports factor were definitely distinguished as two factors. Multiple regression analysis showed that lean body mass was significantly related the work index(p<0.0001) and sports index (p<0.05).CONCLUSION Our results suggest that the modified Korean version of Baecke`s questionnaire is appropriate to assess the physical activity in Koreans.
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Cancer Epidemiology and Prevention.
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Keun Young Yoo, Hai Rim Shin
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Korean J Epidemiol. 2003;25(1):1-15.
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Cancer is one of the main cause of death worldwide. There are about 10 million new cases every year, and more than 6 million persons will die of the disease in a year. Many factors are responsible for the recent increase in cancer.
Changing lifestyles, in particular as regards tobacco smoking, alcohol drinking and diet, also play a crucial part. Several different types of scientific studies contribute to identifying the causes of human cancer. IARC's prestigious series of Monographs on the Evaluation of Carcinogenic Risks to Humans publishes authoritative reports on the risks posed by potentially carcinogenic agents and exposures. Most cancers are thought to be caused by factors related to lifestyle and environment. In particular, tobacco, chronic infections and diet are involved in a substantial number of new cancers. Tobacco is responsible for about 15% of all cancers throughout the world. Chronic infections with viruses, bacteria and parasites are responsible for 16% of all cancers. It has been hypothesized that 30% of all cancers could be prevented by appropriate diet and physical activity. Other known causes of cancer, such as occupational, genetic, and reproductive factors, plays a lesser role in the global burden of cancer. Many types of cancer seem to be cluster in families, occurring more often in close relatives of affected individuals. The risks that a person inheriting a defect in a person inheriting a defect in a cancer susceptibility gene will develop a certain type of cancer must be estimated, and the role of environmental factors in modifying these risks must be ascertains. Researches into the causes of cancer has revealed how many of the most common cancers can be prevented. Detection of many forms of the disease at an early stage can greatly improve the prospects for effective treatment, reducing deaths and enhancing quality of life.
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An Epidemiological Investigation of Bacterial Dysentery Outbreak in Busan(Pusan), 1999.
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Hai Rim Shin, Duk Hee Lee, Heung Man Sul, Sang Won Lee, Young Ju Huh
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Korean J Epidemiol. 2000;22(2):93-100.
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BACKGROUND
In March 1999, six children who attended a nursery school became ill with acute gastroenteritis by Shigella sonnei. The majority of the children became sick one day after sharing a snack which was served from one of the children's home. By the time the outbreak of dysentery was recognized, the rest of family members of the children became also sick. The nursery school was located in a crowded residential area.
EPIDEMIOLOGIC INVESTIGATION: After active and passive surveillance was established on patients with diarrhea, 438 patients were registered. Among them, 252 patients were considered to have simple diarrhea, but the rest (186 patients) suffered from more than three consecutive diarrheas. Shigella sonnei was isolated from 75 patients.
The first attack rate was estimated at 50.0%, the second, 25.6%-34.3% and the third, 13.5%. The epidemic lasted for two months spreading further from person to person in the highly populous area. The active surveillance was implemented after the occurrence of the secondary attack of dysentery among the residents, who had no obvious direct contact with people associated with the nursery school.CONCLUSION This investigation demonstrates the need for prompt implementation of active surveillance when Shigella infection is recognized in a highly populous city.
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Current Status of Multicenter Cancer Cohort Study with Biological Materials Bank in Korea.
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Keun Young Yoo, Hai Rim Shin, Song Hun Chang, Jung Myung Choi, Chang Yup Kim, Kun Sei Lee, Won Jin Lee, Dae Hee Kang, Bu Ok Lee, Duck Hee Lee, Sue Kyung Park, Joo Hon Sung, Yeong Su Ju, Dae Sung Kim, Jong Won Kang, Soo Hun Cho
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Korean J Epidemiol. 1998;20(2):275-278.
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This cohort study is a collaborative effort of 8 institutions. The goal is to establish a large scale cohort that can be followed for 10 or more years to assess the relationship between life-styles and cancer occurrence, and to evaluate the role of environmental exposures in the development of six major sites of cancers(stomach, liver, lung, colorectum, uterine cervix and female breast) in the rural population. Since 1993, 11,304 men and women aged over 35 living in four areas have been recruited. The number of target population is 30,000 persons, which is expected to be successfully recruited until 1999. Each subject has completed a detailed questionnaire on general life-styles, reproductive factors, and agricultural chemical exposures through the interview. Anthropometric measurements with body fat composition and the routine clinical laboratories were examined. For the cancer-free cohort, physical examination by the physicians and serologic tests for hepatitis markers, some tumor markers, and lipid profile have been done, but not all. In order to provide an opportunity to incorporate barious biomarkers of exposure and effect as well as genetic susceptibility, a biologic tissue bank has been established from blood and urine sample(plasma, WBC buffy-coat, RBC clots, and urine supernatant) stored at-70degrees C.
Re-examination of changes in exposere to risk factors will be done periodically. Disease occurrence will be ascertained by the active(mainly through diagnosis by physicians) and the passive surveillance(through both death certificate and screening of medical utilization records).
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Reproductive Factors Related to Serum Estrogen, Progesterone, and Sex Hormone Binding Globulin in Postmenopausal Women in Korea.
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Chul Hwan Kim, Sue Kyung Park, Heon Kim, Mi Na Ha, Hai Rim Shin, Bu Ok Lee, Dae Sung Kim, Dae Hee Kang, Keun Young Yoo
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Korean J Epidemiol. 1998;20(1):70-81.
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The etiology of breast cancer is not yet clear. Several epidemiologic studies have supported the concepts that endogenous female sex hormones, i.e., estrogen and progesterone, may play a central role in the development of breast cancer. Female reproductive factors such as menstruation, pregnancy, and breast feeding are well-known risk factors of breast cancer. There have been many suggestions that all these factors are midiated by female sex hormeones. However, only a few studies have evaluated the relationship between the reproductive factors and endogenous female sex hormones. This study was designed to evaluate the relationship between the reproductive factors and endogenous female sex hormones in Korean women. We analyzed the relationship between reproductive factors and female sex hormones in 153 premenopausal women 153 postmenopausal women who participated in a community health promotion program in Haman County, Korea. The questionnaires about reproductive factors were completed by personal interview. Serum level of total estradiol(E2), progesterone(:g), and sex hormone binding globulin(SHBG) were measured by radioimmunoassay. There was no significant correlation between age at menarche and E2 in both premenopausal and postmenopausal groups. In postmenopausal subjects, E2 level increased significantly with the age at menopause increasing(r=0.25, p=0.009), adjusting for the potential confounding effect of both age and body mass index. There was a positive correlation between E2 and the intervals between age at menarche and age at menopause(r=0.25, p=0.009). Moreover, the serum level of SHBG was significantly correlated with total months of breast feeding(r=0.19, p=0.048), as well as with age at first fullterm pregnancy(r=-0.24, p=0.01). However, Pg was correlated with none of reproductive factors in both groups.
This study observed that female reproductive factors, e.g., age at menopause, breast feeding, age at first fullterm pregnancy, were correlated with serum female hormones, particularly E2 and SHBG. The results provide an evidence that the relationship between the reproductive factors and breast cancer risk may be mediated, at least in part, through serum female hormones, especially estradiol in Korean women.
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An Epidemiologic Investigation of Typhoid Fever Outbreak in Pusan, 1996.
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Hai Rim Shin, Byung Seong Suh, Jue Bok Song, Duk Hee Lee, Meang Bok Lee, Jin Hyung Park, Man Su Kim, Young Hack Shin, Sang Won Lee, Hee Choul Ohrr
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Korean J Epidemiol. 1997;19(2):122-130.
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An epidemiologic investigation was carried out to identify the source of infection of typhoid fever outbreak, which was occurred in Nam-Gu, Pusan city from April 20 to June 28, 1996. The distribution of 83 reported cases (55 confirmed cases and 28 suspected cases) by sex and age group showed that this epidemic would be occurred by the exposure to a common source with low toxic pathogen because 55.4% of cases were under 20 years old and most of the adults cases were female. The epidemic curve showed a unimodel curve with a peak on about 15 May and tailed down to 23 June, suggesting that the exposure was constant. These results supposed that the contamination of a public water supply would be the source of infection. The analysis of reported cases and population survey conducted to household members and community contacts living in the epidemic area, led the conclusion that the source of infection was tap water supplied through the Dae Youn pumping station, based on the following findings: (1) There were singificant differences of incidence rate among regions (Tong) even though in the same Dong and the spot map of incident cases distributed in accord with the water supply by Dae-Youn pumping station.
(2) Among reported cases, 21 cases, including 17 confirmed cases, stated they had used only tap water. (3) The analysis of tap water from the house which had seven typhoid cases, revealed the contamination of E coli and the dilution of residual chlorinated concentration. (4) The outbreak of typhoid fever was stopped after the replacement of The worn-out pipe line of tap water supply to the new one.
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Prevalence of Hepatitis C Virus Genotype in Pusan, Korea.
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Hai Rim Shin, Jue Bok Song, Byung Seong Suh, In Sik Kim, Yun Young Huh, Kap Yeol Jung, Joon Youn Kim, In Hoo Kim, Jung Man Kim, Wo Won Shin, Hak Do Yang, Myung Kee Lee
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Korean J Epidemiol. 1997;19(2):111-121.
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The authors investigated the distribution of Hepatitis C virus (HCV) genotype in blood donors with positive for anti-HCV (n=34), health check-up examiness with positive for anti-HCV (n=29), and in patients with various chronic liver disases positive for anti-HCV (n=63) in Pusan, Korea. HCV genotype was determined by using the molecular typing method through the reverse transcription - polymerase chain reaction (RT - PCR) with four type specific primers. Among 116 anti-HCV positive study subjects, 66.4% were positive HCV RNA by RT-PCR. The major HCV genotype was type II (31.9%) and it was followed by type III (27.6%). Two cases were type IV (1.7%). Double infection with two different HCV genotypes (mixed type) was found in three cases (2.6%).
Three cases (2.6%) were not determined by the four type specific primers, it may have different subtype. Type II was more prevalent than type III in the blood donors and health check-up examinees, but the reverse was true in the chronic liver disease patients including hepatocellular carcinoma patients. Type II was more prevalent than type III among the anti-HCV positive subjects with risk factors such as acupuncture history, surgical operation history, and trans-fusion history. In contrast type III was more prevalent than type II among the subjects without the above risk factors. It is supposed that the pathogenicity of different kind of HCV genotype might be different. The results of this study suggest that the type II and type III may be the major CV genotype in Korea. The differences of HCV genotype distribution between the study groups support that the clinical significance according to the HCV genotype may be different.
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Positivity of Hepatitis B Virus(HBV) Markers and Changes of HBV Markers After Vaccination Among Healthy Works.
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Hai Rim Shin, Jae Beom Kim
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Korean J Epidemiol. 1994;16(2):163-171.
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Hepatitis B Virus(t-IBV) infection is one of the major health problems in Korea and HBsAg positive rate was known to be as 6-10% in general population. This study was carried out to determine HBV infection rate of workers who worked in one company and to assess the conversion rate of HBV markers(HBsAg: by RPHA method, Anti-HBs: PHA method) from 1990 to 1992. A total number of study subject was 1,972 male workers who were interviewed during health check up at 1992.
Healthy workers were defined those who have none of the past histories of transfusion, hepatitis, abnormal liver function. The results were as follows: 1. HBsAg positive rate among healthy workers in 1990 was 2.7% and it was highest in age group thirties as 3.0% with no statistically significance by age group. 2. HBsAg positive conversion rate was 3.0% and negative conversion rate was 7.7% from 1990 to 1992. 3. The rate of Anti-HBs formation was 32.5% after 3 doeses hepatitis B vaccination.
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A study on the relationship between HBeAg and hepatitis B virus DNAamong healthy HBsAg carries.
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Yoo Sik Hahm, Hai Rim Shin, Hyung Jong Park, Sung Ryul Kim
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Korean J Epidemiol. 1992;14(1):48-58.
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The study was carried out at 3 health centers in Ulsan city to investigate the relationship between HBeAg, which is considered to be associated with infectivity, and hepatitis B viral DNA, which seems to be related with viral replication, among those who received health examination.
Two hundred of HBsAg carriers, randomly sampled, from populatin 6,408 who have received health examination were examined serological tests including HBeAg, liver function test(AST, ALT and γ-GTP), IgG Anti-HBc, DNA probe(Dot blot hybridization method) to detect HBV DNA and Anti-HCV to investigate coinfection rate with hepatitis C virus simultaneously from December 18, 1991 to April 10, 1992.
Results are as follows :
1. The prevalence of HBs Antigenemia(HBsAg Positive) was 6.2% (400 persons) and the prevalence of Anti-HBc was 28.1% (1,798 persons) among 6,408 population who are examined by serological test with HBsAg and Anti-HBs.
2. Male to female ratio was 0.9 : 1 and average age was 29.5 in male, 30.9 in female among study subjects.
3. Among 200 HBsAg carriers, HBeAg positive rate was 36% (72 subjects).
4. The result of LFT carried out HBeAg positive 72 subjects was not significant statistically. (ALT : x2=3.64 p>0.05, AST : x2=3.85 p>0.05, γ-GTP：X2=0.12 p=0.73).
5. Among 72 HBeAg carriers, positive rate of IgG Anti-HBc was 88.9% (64 subjects) : it is likely to be chronic hepatitis.
6. Among 200 HBsAg carriers, HBV DNA was detected in 44 HBsAg carriers, 20 in male and 24 in female by using DNA probe(Dot blot hybridization method) : the level of HBV DNA was 31.2 pg/75μl~4.00 pg/75 μl.
7. Among 72 HBeAg carriers-generally repressents hepatitis B viral infectivity, hepatitis B virus(HBV) DNA-marker of hepatitis B virus replication was detected in 37 subjects : HBV DNA level under 500 pg/75 μl was highest frequency(14 subjects).
8. Though the LFT of HBV DNA positive sera was not significant statistically, the lower was level of HBV DNA, the more abnormal was LFT ; it represents chronic active hepatitis.
9. The co-infection rate of HBV and hepatitis C virus(HCV) was 4% (8 subjects) in HBsAg carriers.
Consequently, it was general concept that HBeAg is the marker of infectivity in HBsAg carriers but HBV DNA was detected in some HBeAg negative sera, and not detected in some HBeAg positive sera ; because of the gap between HBeAg-marker of infectivity generally, and replication of HBV DNA-actually infective, it is unreasonable to determine the infectivity by HBeAg only.
The infectivity of HBV in HBsAg carriers was may be determined by detection of HBV DNA only, not HBeAg in clinical fields and various examinations.
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