Epidemiology and Health

Original article

Trends in breast cancer screening rates among Korean women: results from the Korean National Cancer Screening Survey (KNCSS), 2005-2020: Soo Yeon Song, Yun Yeong Lee, Hye Young Shin, Bomi Park, Mina Suh, Kui Son Choi, Jae Kwan Jun; Epidemiol Health. 2022;e2022111. Published online November 24, 2022; DOI: https://doi.org/10.4178/epih.e2022111 [Accepted]

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Abstract Summary PDF: Abstract
Objectives
Since 2002, the Korean government has provided breast cancer screening as part of the National Cancer Screening Program. This study reported the screening rate trends among Korean women from 2005 to 2020, including organized and opportunistic screening for breast cancer.
Methods
Data from the Korean National Cancer Screening Survey, an annual cross-sectional nationwide survey, was collected using a structured questionnaire between 2005 and 2020. The study population included 23,702 women aged 40–74 years with no history of cancer. We estimated the screening rate with the current recommendation of biennial mammographic screening for breast cancer. In addition, a joinpoint trend analysis was performed for breast cancer screening rates using subgroup analysis.
Results
In 2020, the breast cancer screening rate was 63.5%, which showed an annual increase of 7.72% (95% confidence interval 5.53% to 9.95%) between 2005 and 2012, followed by non-significant trends thereafter. In particular, a significant decrease in the breast cancer screening rate was observed in the subgroups aged 50–59 years old, with 12–15 years of education, and living in rural areas.
Conclusions
Although there has been substantial improve in breast cancer screening rates in Korean women, the recent trend has flattened. Therefore, efforts are continually required to find out unmet subgroups and solve barriers for uptake of breast cancer screening.; Summary

Korean summary
본 연구는 2005년에서 2020년까지 암검진수검행태조사 자료를 이용하여 40세 이상의 우리나라 여성의 유방암 검진 수검률이 추이에 대해 분석하였다. 우리나라 유방암 검진 수검률은 2020년 현재 63.5%이다. 하지만 지속적으로 증가하던 유방암 검진 수검률의 추이는 2012년 이후 정체되어 있으며 일부 사회경제적 계층에서는 감소하는 경향을 보였다.

Key Message
In Korea, despite of the high level of breast cancer screening rate, decreasing trends in some socioeconomic classes after 2012. Continual efforts are required to identify subgroup with unmet needs and barriers to the uptake of breast cancer screening.

Systematic review

Non-cancer health risks in firefighters: a systematic review: Jeong Ah Kim, Soo Yeon Song, Wonjeong Jeong, Jae Kwan Jun; Epidemiol Health. 2022;e2022109. Published online November 16, 2022; DOI: https://doi.org/10.4178/epih.e2022109 [Accepted]

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Abstract PDF: Abstract
Firefighters are occupationally exposed to hazardous factors which may increase their risk of disease. Non-cancer disease risk in firefighters has not been systematically examined. This systematic review aimed at identifying non-cancer disease risk in firefighters and determining whether a risk difference exists according to job characteristics. We searched the Cochrane Library, Embase, PubMed, and KoreaMed databases using relevant keywords from their inception to April 30, 2021. The Risk of Bias Assessment Tool for Non-randomized Studies version 2.0 was used to assess the quality of evidence. Because of study heterogeneity, a narrative synthesis was presented. The systematic literature search yielded 2491 studies, of which 66 met the selection and quality criteria. We confirmed that the healthy worker effect is strong in firefighters as compared to the general population. We also displayed a significant increase in the incidence of lumbar disc herniation, lower back pain, angina pectoris, acute myocardial infarction, and post-traumatic stress disorder in firefighters compared to other occupational groups. Contradicting results around PTSD and anxiety disorders risks related to rank were reported. Sufficient evidence for increased risk of lumbar disc herniation, lower back pain, angina pectoris, acute myocardial infarction, and post-traumatic stress disorder was available. There was a difference in the risk of non-cancer disease depending on job type, years of service, and rank. However, caution should be exercised when interpreting the results because the classification criteria for firefighters' jobs and ranks differ by country.; Summary

Korean summary

Key Message

Original Articles

Effect of mammography screening on the long-term survival of breast cancer patients: results from the National Cancer Screening Program in Korea: Xuan Quy Luu, Kyeongmin Lee, Jae Kwan Jun, Mina Suh, Kyu-Won Jung, Kui Son Choi; Epidemiol Health. 2022;44:e2022094. Published online October 26, 2022; DOI: https://doi.org/10.4178/epih.e2022094

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Abstract PDF Supplementary Material: Abstract
OBJECTIVES
This study investigated the effect of mammography screening on the long-term survival of breast cancer (BC) patients aged 40 years or older according to their screening history and duration since screening.
METHODS
The study cohort was organized from 3 nationwide databases of the Korean National Cancer Screening Program, the Korean Central Cancer Registry, and death certificates. We included 24,387 women diagnosed with invasive BC or ductal carcinoma in situ in 2008 and 2009 and followed up until December 31, 2019. Cox proportional-hazards regression was used to investigate the effect of BC screening on the risk of death.
RESULTS
Overall, 20,916 of 24,387 patients (85.8%) were alive at the end of the follow-up period (median: 10.5 years). The long-term survival rate was significantly lower in the never-screened group (80.3%) than in the screened group (88.9%) (p<0.001). A 35% reduction in the risk of BC death (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.60 to 0.70) from screening was observed. A subgroup analysis according to the cancer stage showed 62%, 36%, and 24% lower risks of BC death for the localized stage, regional stage, and distant stage, respectively. Women aged 40-49 years received the least benefit from BC screening (HR, 0.71; 95% CI, 0.62 to 0.81).
CONCLUSIONS
Mammography screening was effective in reducing the risk of BC-specific death in Asian women across all cancer stages. However, this effect was relatively small among women in their 40s, suggesting that more detailed and specialized screening strategies are needed for that age group.; Summary

Korean summary

Key Message

Effect of Pap smears on the long-term survival of cervical cancer patients: a nationwide population-based cohort study in Korea: Xuan Quy Luu, Kyeongmin Lee, Jae Kwan Jun, Mina Suh, kyu-won Jung, Myong Cheol Lim, Kui Son Choi; Epidemiol Health. 2022;44:e2022072. Published online September 7, 2022; DOI: https://doi.org/10.4178/epih.e2022072

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study aimed to investigate the effect of cervical cancer screening by Papanicolaou (Pap) smears on the long-term survival of cervical cancer patients.
METHODS
We constructed a retrospective cohort of 14,903 women diagnosed with invasive cancer or carcinoma in situ in 2008 and 2009 and followed up until December 31, 2019, by using individual-level data from 3 national databases of the Korean National Cancer Screening Program, the Korean Central Cancer Registry, and death certificates. Cox proportional-hazards regression was used to investigate the effect of cervical cancer screening on mortality.
RESULTS
In total, 12,987 out of 14,867 patients (87.4%) were alive at the end of the follow-up period (median: 10.5 years). Screened patients had a 38% lower risk of cervical cancer death than never-screened patients (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.54 to 0.70). Screening was associated with 59% and 35% lower risks of death, respectively, in screened patients with localized and regional stages. Furthermore, lower HRs among women who received screening were observed in all age groups, especially women aged 50–59 years (HR, 0.54; 95% CI, 0.42 to 0.69). The lowest HR for cervical cancer death was reported among patients screened within the past 2 years (HR, 0.54; 95% CI, 0.47 to 0.63), and the HRs increased with increasing time intervals.
CONCLUSIONS
Pap smear screening significantly reduced the risk of cervical cancer-specific death in Korean women across all cancer stages.; Summary

Korean summary
한국은 자궁경부암 발생과 사망을 낮추기 위하여 국가암검진사업으로 자궁경부암 검진을 실시하고 있다. 이 연구는 2008-2009년 자궁경부암 진단을 받은 30세-79세 14,903명을 대상으로 과거 자궁경부세포검진 여부에 따른 장기생존율을 추적 조사하였다. 그 결과 자궁경부암 검진을 받은 환자에서 사망 위험비가 약 38% 낮았으며, 2년 이내에 검진을 받은 환자군에서 사망 위험이 가장 낮았다.

Key Message
The Korean National Cancer Screening Program (KNCSP) has provided cervical cancer screening by Pap smear test. However, the survival, particularly long-term survival of cervical cancer patients, has never been evaluated in the KNCSP. This study reports a significant improvement in the long-term survival of screened cervical cancer patients, which persist in subgroup analysis by cancer stage. Patients who were screened within two years before the diagnosis had the best survival.

Changes in cancer screening before and during COVID‐19: findings from the Korean National Cancer Screening Survey 2019 and 2020: Thao Thi Kim Trinh, Yun Yeong Lee, Mina Suh, Jae Kwan Jun, Kui Son Choi; Epidemiol Health. 2022;44:e2022051. Published online May 30, 2022; DOI: https://doi.org/10.4178/epih.e2022051

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
The coronavirus disease 2019 (COVID-19) pandemic has negatively affected every aspect of medical care. However, information regarding the impact of the pandemic on cancer screening is lacking. This study aimed to explore cancer screening changes by geographic region before and during the pandemic in Korea.
METHODS
Korean National Cancer Screening Survey data for 2019 and 2020 were used. Changes in the screening rate before and during the COVID-19 pandemic were calculated by subtracting the rate in 2020 from the rate in 2019. Multivariate logistic regression analyses examined the differences in screening rates at the national and 16 provincial levels before and after the COVID-19 outbreak.
RESULTS
The 1-year screening rates for the four types of cancer decreased during the pandemic (stomach cancer: -5.1, colorectal cancer: -3.8, breast cancer: -2.5, cervical cancer: -1.5%p). In metropolitan areas, the odds of undergoing screening tests during the pandemic were significantly lower than before the pandemic for stomach (adjusted odds ratio [aOR], 0.66; 95% confidence interval [CI], 0.56 to 0.76), colorectal (aOR, 0.63; 95% CI, 0.50 to 0.79), and breast cancers (aOR, 0.75; 95% CI, 0.60 to 0.94). Furthermore, the likelihood of undergoing stomach cancer screening during the pandemic was significantly lower than before the pandemic in non-metropolitan urban areas (aOR, 0.81; 95% CI, 0.70 to 0.94), while it was higher in rural areas (aOR, 1.54; 95% CI, 1.10 to 2.16).
CONCLUSIONS
Since the COVID-19 pandemic, the cancer screening rate has decreased significantly, especially in large cities. Public health efforts are required to improve cancer screening rates.; Summary

Korean summary
• 코로나 대유행 이전과 이후의 최근 1년간 암검진 수검률을 비교한 결과, 위암 (5% 포인트), 대장암 (3.8% 포인트), 유방암 (2.5% 포인트), 자궁경부암 (1.5% 포인트) 수검률이 통계적으로 유의하게 감소하였음 • 특히 위암, 대장암, 유방암의 경우 대도시 지역에서의 수검률이 현저하게 감소하였음

Key Message
The 1-year screening rates for stomach, colorectal, breast, and cervical cancer decreased significantly during the pandemic in Korea, especially in large cities.

Effects of a cancer prevention education program on elementary school students’ knowledge, attitude, self-efficacy, and intentions in South Korea: Su Yeon Kye, Soon-Yong Hwang, Kyung Hee Oh, Jae Kwan Jun; Epidemiol Health. 2019;41:e2019027. Published online June 16, 2019; DOI: https://doi.org/10.4178/epih.e2019027

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6 Citations

Abstract Summary PDF

Abstract

OBJECTIVES
Most children and adolescents have low levels of cancer knowledge and awareness, and infrequently engage in preventive behaviors. This study examined the effects of a short classroom-based intervention for cancer prevention on knowledge, attitude toward cancer preventability, self-efficacy, and behavioral intentions of fifth-grade elementary school students.

METHODS

The study was based on a pre-post-follow-up, 2-group, quasi-experimental design. Participants in the intervention group attended two 40-minute sessions on cancer prevention education and watched a music video about cancer prevention, while participants in the control group were only exposed to the music video. Self-reported knowledge, attitude toward cancer preventability, self-efficacy, and behavioral intentions were assessed 1 week pre-intervention and post-intervention, as well as 3 months post-intervention.

RESULTS

The 3-month post-intervention results revealed partial effects, indicating that the education intervention improved knowledge and attitudes toward cancer preventability; however, no effects were observed on self-efficacy and behavioral intentions 3 months after the intervention.

CONCLUSIONS

Long-term regular booster sessions are required to improve not only social-cognitive factors, but also behavioral intentions, which could result in behavior changes promoting cancer prevention.

Summary

Korean summary
대부분의 아동과 청소년들은 암예방행동 실천을 잘 하지 못하고 있을뿐만 아니라 낮은 암지식 수준을 보인다. 본 연구는 초등학교 5학년 학생들을 대상으로 단기간의 교실 중심의 암예방중재가 지식, 암예방가능성에 대한 태도, 자기효능감, 행동의도에 미치는 영향을 살펴보았다. 사전-사후-3개월이후 추후조사의 형태로 두 집단 유사실험설계로 구성되었다. 중재집단의 참여자들은 2회의 40분으로 구성된 암예방교육에 참여하였고 암예방뮤직비디오를 시청하였다. 대조집단의 참여자들은 암예방뮤직비디오만 시청하였다. 지식, 암예방가능성에 대한 태도, 자기효능감, 행동의도가 중재전, 중재직후, 중재3개월후에 자가보고형식으로 측정되었다. 3개월 이후 추후조사에서 지식과 암예방가능성에 대한 태도가 향상되었으나, 자기효능감과 행동의도에서는 통계적으로 유의한 차이가 나타나지 않았다. 인지적 요소뿐만 아니라 행동적 요소를 변화하기 위해서는 장기간의 추가교육이 필요할 것으로 판단된다.

Key Message

Citations

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Effectiveness of an Educational Program on Awareness of Breast Cancer Risk Factors, Symptoms, and Barriers to Seeking Medical Help among Adolescent Omani School Students—An Interventional Study
Khadija Al-Hosni, Moon Fai Chan, Mohammed Al-Azri
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What Children and Adolescents Know and Need to Learn about Cancer
Carol Sigelman, Imani Jami, Eleanor D’Andria
The Journal of Genetic Psychology.2022; 183(4): 294. CrossRef
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Physician’s awareness of lung cancer screening and its related medical radiation exposure in Korea: Seri Hong, Suyeon Kim, Mina Suh, Boyoung Park, Kui Son Choi, Jae Kwan Jun; Epidemiol Health. 2018;40:e2018002. Published online January 20, 2018; DOI: https://doi.org/10.4178/epih.e2018002

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Through a survey on perception of lung cancer screening and accompanying medical radiation exposure in Korea, the present study was to investigate its current situations and evaluate various perception of physicians regarding it in order to propose measures for improvements.

METHODS

Medical specialists in national cancer screening institutions selected through stratified random sampling were subjected to face-to-face interview using a structured questionnaire. We investigated physicians’ perception on effectiveness of lung cancer screening depending on screening modality, selection criteria for subjects of screening, types of equipment used to screen, and perception for seriousness of adverse effects following the test. In addition, odds ratios to underestimate risk of radiation exposure from screening were calculated through logistic regression analysis.

RESULTS

Each response that chest X-ray is effective for lung cancer screening and that smoking history is not considered prior to screening recommendation accounted for more than 60% of respondents, suggesting the chance of unnecessary screening tests. Regarding adverse effects of lung cancer screening, about 85% of respondents replied that false positive, radiation exposure, and overdiagnosis could be ignored. About 70% of respondents underestimated radiation dose from lung cancer screening, and a low proportion of physicians informed patients of radiation exposure risk.

CONCLUSIONS

It was found that most physicians underestimated harms of lung cancer screening including radiation exposure and were lack of awareness regarding lung cancer screening. It should be noted that physicians need to have proper perceptions about screening recommendation and accompanying possible harms, for successful implementation of the screening program.

Summary

Korean summary
전국 100여개 국가암검진 기관을 대상으로 폐암검진 관련 설문을 수행한 결과, 효과적인 폐암검진의 수단이나 방법에 대한 이해 및 검사에 수반되는 각종 부작용에 대한 의사들의 인식이 확연히 부족한 것으로 조사되었다. 그 중에서도 특히 의료방사선 노출에 대한 낮은 인지도는, 촬영 시 피폭량에 대한 전반적인 과소평가 및 방사선 노출 위험과 관련한 환자 교육의 부재를 통해 확인할 수 있었다. 인구집단 대상 선별검사의 도입에 따른 잠재적인 위해 가능성과 그 결과에 대한 고민은 반드시 필요하며, 이와 관련된 의료제공자들의 인식 개선을 촉구하는 본 연구는 정책 도입에 앞서 선결되어야 할 과제로서 공중보건학적 측면에서 중요한 의의를 지닌다.

Key Message

Citations

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Why clinicians overtest: development of a thematic framework
Justin H. Lam, Kristen Pickles, Fiona F. Stanaway, Katy J. L. Bell
BMC Health Services Research.2020;[Epub] CrossRef

Factors affecting satisfaction with cancer information provided through the social networking services of the National Cancer Information Center in Korea: Su Yeon Kye, Min Hee Lee, Jisu Yoo, Kyung Hee Oh, Jae Kwan Jun; Epidemiol Health. 2017;39:e2017057. Published online December 11, 2017; DOI: https://doi.org/10.4178/epih.e2017057

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Abstract Summary PDF

Abstract

OBJECTIVES
This study aimed to identify the characteristics of social networking service (SNS) users and to assess the relationship of those factors to user satisfaction with the SNSs of the National Cancer Information Center (NCIC) in South Korea.

METHODS

A Web-based survey was completed by 1,670 users of the NCIC SNSs, who provided data on the sources they consulted for information about cancer, determinants of SNS use, sources of NCIC SNS awareness, the time of day they used the SNS, and their satisfaction level.

RESULTS

Facebook users mainly became aware of the NCIC SNSs through an acquaintance’s recommendation, while Twitter was accessed through other SNSs or blogs. Users in their 30s were less satisfied with the NCIC SNSs than those in their teens and 20s. Browsing for cancer-related information on the Internet, prioritizing information quality, and engaging in active use were related to a high level of satisfaction with the NCIC SNSs. Individuals who were exposed to the NCIC SNSs through other SNSs or printed materials were less satisfied with their experience of the NCIC SNSs than those who received a recommendation from an acquaintance.

CONCLUSIONS

These findings may act as a catalyst to guide public health agencies to enhance their use of SNSs.

Summary

Korean summary
본 연구는 소셜네트워크서비스 사용자의 특성을 파악하고 우리나라 국가암정보센터 소셜네트워크서비스 사용자의 만족도에 영향을 주는 요인을 파악하고자 하였다. 국가암정보센터 소셜네트워크서비스 사용자 1,670명을 대상으로 암정보원, 서비스사용동기, 서비스를 알게된 경위, 사용시간대, 서비스 사용 만족도를 조사하였다. 분석결과, 페이스북은 주로 주변 아는 사람들의 권유로 사용하기 시작하였고, 트위터는 다른 사람의 소셜네트워크서비스를 통해 접근하고 있었다. 국가암정보센터에 대한 만족도에 영향을 주는 요인을 살펴보면, 10-20대에 비하여 30대의 만족도가 낮았으며, 인터넷을 통해 암정보를 얻고 있는 경우, 암정보의 질을 중시 여기는 경우, 활발하게 소셜네트워크서비스를 사용하고 있는 경우에 만족도가 높았다. 또한, 다른 사람들의 소셜네트워크서비스나 인쇄물을 통해 국가암정보센터 소셜네트워크서비스를 알게 된 경우 주변 사람들의 권고로 사용하게 된 경우에 비해 만족도가 낮았다. 공공보건의료기관들은 자 기관의 소셜네트워크 서비스 접근도 및 만족도 향상을 위하여 본 결과를 활용할 수 있을 것이다

Key Message

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Association Between Loneliness and the Frequency of Using Online Peer Support Groups Among Cancer Patients With Minor Children: A Cross-Sectional Web-Based Study
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Journal of Pain and Symptom Management.2021; 61(5): 955. CrossRef
Awareness, attitude and barriers of colorectal cancer screening among high-risk populations in China: a cross-sectional study
Ruo-lin Huang, Qi Liu, Ying-xin Wang, Jin-yu Zou, Li-feng Hu, Wen Wang, Ying-hui Huang, Yi-zhuo Wang, Bo Zeng, Xi Zeng, Ying Zeng
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Cancer screening rate in people with diabetes in the Korean population: results from the Korea National Health and Nutrition Examination Survey 2007-2009: Kumban Walter Chuck, Minji Hwang, Kui Son Choi, Mina Suh, Jae Kwan Jun, Boyoung Park; Epidemiol Health. 2017;39:e2017036. Published online August 10, 2017; DOI: https://doi.org/10.4178/epih.e2017036

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13 Citations

Abstract Summary PDF

Abstract

OBJECTIVES
To investigate the screening rates for gastric, breast, and cervical cancer in people with diabetes compared with people without diabetes.

METHODS

Data from the Korea National Health and Nutrition Examination Survey (2007-2009) were used. Cancer-free men who were 40 years old and over and cancer-free women who were 30 years old and over were included. The lifetime screening rate and regular screening rate were compared in people with and without diabetes.

RESULTS

Fewer people with diabetes than people without diabetes had ever received cancer screening (53.5 vs. 59.5%, p<0.001 for gastric cancer; 60.5 vs. 71.5%, p<0.001 for breast cancer; and 49.1 vs. 59.6%, p<0.001 for cervical cancer). Fewer people with diabetes than people without diabetes received the recommended screenings for gastric cancer (38.9 vs. 42.9%, p<0.001), breast cancer (38.8 vs. 44.6%, p<0.001), and cervical cancer (35.1 vs. 51.2%, p<0.001). In subgroup analyses according to socioeconomic factors, the lifetime and recommended screening rates were lower in the diabetic population in most socioeconomic subgroups. In the multivariate analysis adjusted for socioeconomic factors, people with diabetes showed lower lifetime screening rates for gastric and cervical cancer (odds ratio [OR], 0.8; 95% confidence interval [CI], 0.7 to 0.9 and OR, 0.7; 95% CI, 0.6 to 0.9), and lower regular screening rates for breast and cervical cancer (OR, 0.7; 95% CI, 0.6 to 0.9 and OR, 0.7; 95% CI, 0.5 to 0.9).

CONCLUSIONS

The cancer screening rate in people with diabetes was lower than in people without diabetes. Considering the higher cancer risk in people with diabetes, efforts to increase the screening rate in this high-risk population should be implemented.

Summary

Korean summary
기존의 여러 연구에서 당뇨병이 있는 사람에서 당뇨병이 없는 경우에 비해 암 발생의 위험이 증가하는 것이 확인되었다. 본 연구에서 당뇨병이 있는 사람과 없는 사람에서 암 수검률을 비교했을 때, 당뇨병이 있는 사람의 위암, 유방암, 자궁경부암의 평생 수검률과 권고안 이행 수검률은 모두 낮았다. 당뇨병 환자가 암 발생의 고위험군임을 고려하였을 때 이들을 대상으로 암 검진 수검률을 높이려는 노력이 필요하다.

Key Message

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Cancer mortality-to-incidence ratio as an indicator of cancer management outcomes in Organization for Economic Cooperation and Development countries: Eunji Choi, Sangeun Lee, Bui Cam Nhung, Mina Suh, Boyoung Park, Jae Kwan Jun, Kui Son Choi; Epidemiol Health. 2017;39:e2017006. Published online February 5, 2017; DOI: https://doi.org/10.4178/epih.e2017006

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Abstract PDF

Abstract

OBJECTIVES
Assessing long-term success and efficiency is an essential part of evaluating cancer control programs. The mortality-to-incidence ratio (MIR) can serve as an insightful indicator of cancer management outcomes for individual nations. By calculating MIRs for the top five cancers in Organization for Economic Cooperation and Development (OECD) countries, the current study attempted to characterize the outcomes of national cancer management policies according to the health system ranking of each country.

METHODS

The MIRs for the five most burdensome cancers globally (lung, colorectal, prostate, stomach, and breast) were calculated for all 34 OECD countries using 2012 GLOBOCAN incidence and mortality statistics. Health system rankings reported by the World Health Organization in 2000 were updated with relevant information when possible. A linear regression model was created, using MIRs as the dependent variable and health system rankings as the independent variable.

RESULTS

The linear relationships between MIRs and health system rankings for the five cancers were significant, with coefficients of determination ranging from 49 to 75% when outliers were excluded. A clear outlier, Korea reported lower-than-predicted MIRs for stomach and colorectal cancer, reflecting its strong national cancer control policies, especially cancer screening.

CONCLUSIONS

The MIR was found to be a practical measure for evaluating the long-term success of cancer surveillance and the efficacy of cancer control programs, especially cancer screening. Extending the use of MIRs to evaluate other cancers may also prove useful.

Summary

Korean summary

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Mortality Trends in Colorectal Cancer and Breast Cancer in Korea: Birth Cohort Effects?.: Jae Kwan Jun, Yeon Ju Kim, Jin Gwack, Yunhee Choi, Yun Chul Hong, Keun Young Yoo; Korean J Epidemiol. 2005;27(1):154-162.

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Abstract PDF: Abstract
PURPOSE
Cancer has been the leading cause of deaths since 1980s in Korea. Among them, colorectal cancer and breast cancer shows steadily increasing pattern, being the fourth and the fifth common site of cancer death in Korea, respectively. This analysis aimed to evaluate potential contribution of birth cohort effects to the recent increases in mortality of colorectal cancer and breast cancer since 1983 in Korea.
METHODS
Mortality statistics on deaths of both cancers for the past 20 years of 1983~2002 were obtained from the National Statistical Office. The age-standardized mortality rates were calculated based on the census population of 1992 as a standard.
RESULTS
Age-standardized mortality rate for colorectal cancer increased 4.7-fold in men and 3.6-fold in women, whereas 2.1-fold increase in breast cancer mortality during 1983~2002. Age-specific mortality rates for colorectal cancer were steadily increasing by age before 1991 in both genders. However, the mortality rates showed an exponentially increasing pattern for the age group of 70 and over during 1993~2001, which was more prominent in female. The birth cohort curves showed that there were 2- to 3-fold increases in the mortality rates of people who were born in 1931 for colorectal cancer compared to those of people who were born in 1921. Differences in mortality for breast cancer by birth cohort were 1.7-fold among age group of 45~49 and 50~54 between 1936 and 1946.
CONCLUSIONS
This analysis suggests that recent increases in mortality of colorectal cancer and breast cancer could potentially be due to birth cohort effects, i.e. rapid changes in life-style in younger generation. The quantitative approach using age-period-cohort model should be pursued.; Summary

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