Epidemiology and Health

Original Articles

Socioeconomic inequality in organized and opportunistic screening for colorectal cancer: results from the Korean National Cancer Screening Survey, 2009-2021: Xuan Quy Luu, Kyeongmin Lee, Jae Kwan Jun, Mina Suh, Kui Son Choi; Epidemiol Health. 2023;45:e2023086. Published online September 17, 2023; DOI: https://doi.org/10.4178/epih.e2023086

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Abstract

OBJECTIVES
This study aimed to investigate socioeconomic status (SES)-based inequality in colorectal cancer (CRC) screening in Korea. We assessed whether the rates of opportunistic and organized CRC screening differed according to income and education levels.

METHODS

We analyzed data from the Korean National Cancer Screening Survey of 27,654 cancer-free individuals, aged 50-74 years, from 2009 to 2021. The weighted cancer screening rates with trends were estimated with the average annual percentage change using joinpoint regression. Inequality was calculated in both relative and absolute terms, based on a Poisson regression model.

RESULTS

The organized screening rate increased significantly from 22.1% in 2009 to 53.1% in 2020 and 50.6% in 2021, with an average annual change of 8.6% (95% confidence interval [CI], 4.9 to 12.5). In contrast, no significant trend was observed for opportunistic screening. The SES inequality in opportunistic screening uptake was indicated by a slope index of inequality (SII) of 9.74% (95% CI, 6.36 to 13.12), relative index of inequality (RII) of 2.18 (95% CI, 1.75 to 2.70) in terms of education level; and an SII of 7.03% (95% CI, 4.09 to 9.98), RII of 1.81 (95% CI, 1.41 to 2.31) in terms of measured income. Although there was an increasing trend in income inequality, no significant SES inequalities were observed in the overall estimates for organized screening.

CONCLUSIONS

Organized CRC screening is effective in improving the participation rate, regardless of SES. However, significant inequalities were found in opportunistic screening, suggesting room for improvement in the overall equity of CRC screening.

Summary

Korean summary
이번 연구는 한국의 대장암 검진에서 사회경제적 수준에 따른 불평등이 있는지를 분석했다. 국가암검진사업 도입 이래로 2009-2021년 연구기간 동안 공공검진을 통한 대장암 수검률은 지속적으로 증가한 반면, 개인검진의 증가는 관찰되지 않았다. 특히 공공 검진의 경우 소득이나 교육수준에 따른 수검률에 차이는 없는 반면, 개인검진에서는 상당한불평등이 관찰되었다.

Key Message
"The study investigated socioeconomic status (SES)-based inequality in colorectal cancer (CRC) screening in Korea. We found that the introduction of the National Cancer Screening Program for CRC effectively increased the participation rate, regardless of the SES of the individuals throughout the study period. However, significant inequalities were observed in opportunistic screening related to education and income."

Citations

Citations to this article as recorded by

Language as a barrier to colorectal cancer screening in Flanders: an ecological study
Simon Van den bergh, Lidia Casas, Gökhan Ertaylan, Guido Van Hal, Jos Bessems
Archives of Public Health.2025;[Epub] CrossRef
Health screening disparities in people living with HIV; A nationwide organized screening setting
Boyoung Park, Yoonyoung Jang, Taehwa Kim, Yunsu Choi, Kyoung Hwan Ahn, Jung Ho Kim, Hye Seong, Youn Jeong Kim, Jun Yong Choi, Joon Young Song, Shin-Woo Kim, Sang Il Kim
Journal of Infection and Public Health.2024; 17(12): 102567. CrossRef
Disparities in Cancer Incidence across Income Levels in South Korea
Su-Min Jeong, Kyu-Won Jung, Juwon Park, Nayeon Kim, Dong Wook Shin, Mina Suh
Cancers.2023; 15(24): 5898. CrossRef

Parental intention to vaccinate daughters with the human papillomavirus vaccine in Korea: a nationwide cross-sectional survey: Yejin Ha, Kyeongmin Lee, Bomi Park, Mina Suh, Jae Kwan Jun, Kui Son Choi; Epidemiol Health. 2023;45:e2023076. Published online August 17, 2023; DOI: https://doi.org/10.4178/epih.e2023076

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Abstract

OBJECTIVES
We aimed to identify and compare the characteristics and factors associated with parental intention to vaccinate daughters under 12 years old against human papillomavirus (HPV), examining data from 2016 and 2020.

METHODS

Data were obtained from the Korean National Cancer Screening Survey conducted in 2016 and 2020. The present study included 3,510 parents with daughters under 12 years old. Changes in parental intention-to-vaccinate rates were calculated. To identify factors associated with parental intention to vaccinate their daughters, the chi-square test and logistic regression analysis were used.

RESULTS

The percentage of respondents intending to vaccinate their daughters increased from 33.4% in 2016 to 58.9% in 2020, constituting a 25.5 percentage point (%p) increase. Since 2016, the proportion of men expressing positive intention towards HPV vaccination increased by 31.5%p, while that of women demonstrated a 20.9%p increase. Logistic regression analysis indicated that parents with a strong intention to vaccinate their daughters tended to be younger, more educated, and aware of the free vaccination program available, as well as to have a history of HPV vaccination and to have undergone cervical cancer screening within 2 years, compared to those who did not intend to vaccinate. Being a mother with a history of HPV vaccination was the strongest predictor of positive intention to vaccinate a daughter.

CONCLUSIONS

The intention among parents to vaccinate daughters remains relatively low, although it is rising. To increase the HPV vaccination rate, strong recommendations and education should be provided to parents and the younger generation.

Summary

Korean summary
한국정부는 2016년부터 HPV 백신을 국가예방접종사업으로 도입하여 만 12세 여아를 대상으로 무료접종을 실시하고 있다. 12세 여아가 접종대상인만큼 부모의 HPV 백신에 대한 인식과 태도가 실제 예방접종에 중요한 영향을 미친다. 이 연구를 통해 2016년과 2020년을 비교했을 때 딸의 백신접종에 대한 의향이 증가하였음을 알 수 있었고, 특히 HPV 백신접종 경험이 있는 경우 딸의 백신접종에 대한 의향이 유의하게 높음을 확인하였다.

Key Message
In Korea, HPV vaccination was included in the national immunization program in 2016 for 12-year-old girls. The decision to undergo the HPV vaccination is closely associated with their parents’ perceptions of and attitudes toward the HPV vaccine. This study identified that parental intention increased from 2016 to 2020, and maternal history of HPV vaccination was the strongest predictor of positive intention to vaccinate a daughter.

Citations

Citations to this article as recorded by

Indonesian Mothers’ Experience of Their Daughter’s HPV Vaccination, and Factors Associated with Their Willingness to Recommend HPV Vaccination for Girls
Setiyani Marta Dewi, Ariane Juliana Utomo, Linda Rae Bennett, Siswanto Agus Wilopo, Anna Barrett
Vaccines.2024; 12(9): 998. CrossRef

Trends in breast cancer screening rates among Korean women: results from the Korean National Cancer Screening Survey, 2005-2020: Soo Yeon Song, Yun Yeong Lee, Hye Young Shin, Bomi Park, Mina Suh, Kui Son Choi, Jae Kwan Jun; Epidemiol Health. 2022;44:e2022111. Published online November 24, 2022; DOI: https://doi.org/10.4178/epih.e2022111

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Abstract

OBJECTIVES
Since 2002, the Korean government has provided breast cancer screening as part of the National Cancer Screening Program. This study reported trends in the screening rate 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, were 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 based on the current recommendation of biennial mammographic screening for breast cancer. In addition, a joinpoint trend analysis was performed for breast cancer screening rates among various subgroups.

RESULTS

In 2020, the breast cancer screening rate was 63.5%, reflecting 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 improvement in breast cancer screening rates in Korean women, the trend has flattened in recent years. Therefore, continual efforts are required to identify subgroups with unmet needs and solve barriers to the 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.

Citations

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A cross-national investigation of CT, MRI, PET, mammography, and radiation therapy resources and utilization
Takahiro Aoyama, Yutaro Koide, Hidetoshi Shimizu, Atsushi Urikura, Tomoki Kitagawa, Shingo Hashimoto, Hiroyuki Tachibana, Takeshi Kodaira
Japanese Journal of Radiology.2025; 43(1): 109. CrossRef
Current and future burden of breast cancer in Asia: A GLOBOCAN data analysis for 2022 and 2050
Mengxia Fu, Zhiming Peng, Min Wu, Dapeng Lv, Yanping Li, Shuzhen Lyu
The Breast.2025; 79: 103835. CrossRef
Determining risk‐adapted starting age and interval for breast cancer screening based on reproductive and hormonal factors
Tung Hoang, Jeonghee Lee, So‐Youn Jung, Jeongseon Kim
International Journal of Cancer.2025; 156(9): 1692. CrossRef
Global patterns and trends in breast cancer incidence and mortality across 185 countries
Joanne Kim, Andrew Harper, Valerie McCormack, Hyuna Sung, Nehmat Houssami, Eileen Morgan, Miriam Mutebi, Gail Garvey, Isabelle Soerjomataram, Miranda M. Fidler-Benaoudia
Nature Medicine.2025;[Epub] CrossRef
Intakes of saturated and unsaturated fat and circulating levels of inflammatory markers among breast cancer survivors
Jiwoo Kim, Hyun Jeong Cho, Zisun Kim, Hyun Jo Youn, Jihyoung Cho, Jun Won Min, Yoo Seok Kim, Jung Eun Lee
Scientific Reports.2025;[Epub] CrossRef
Exploring age-standardized cancer incidence rates and regional disparities: A retrospective cohort study of 8 major cancers in South Korea
Dagyeong Lee, Hye-won Yun, Nayeon Kim, Juwon Park, Kyu-won Jung, Mina Suh, Dong Wook Shin
Cancer Epidemiology.2024; 91: 102594. CrossRef
Contrasting income-based inequalities in incidence and mortality of breast cancer in Korea, 2006-2015
Jinwook Bahk, Hee-Yeon Kang, Young-Ho Khang, Kyunghee Jung-Choi
Epidemiology and Health.2024; 46: e2024074. CrossRef
Why is the screening rate in lung cancer still low? A seven-country analysis of the factors affecting adoption
Charlotte Poon, Tim Wilsdon, Iqra Sarwar, Alexander Roediger, Megan Yuan
Frontiers in Public Health.2023;[Epub] CrossRef
Mammographic Breast Density and Risk of Ovarian Cancer in Korean Women
Thi Xuan Mai Tran, Soyeoun Kim, Boyoung Park
Cancer Epidemiology, Biomarkers & Prevention.2023; 32(12): 1690. CrossRef

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;44:e2022109. Published online November 16, 2022; DOI: https://doi.org/10.4178/epih.e2022109

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Abstract

osFirefighters are occupationally exposed to hazardous factors that may increase their risk of disease. However, non-cancer disease risk in firefighters has not been systematically examined. This systematic review aimed to identify non-cancer disease risk in firefighters and determine whether the risk differs 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. Due to study heterogeneity, a narrative synthesis was presented. The systematic literature search yielded 2,491 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 identified a significant increase in the incidence of lumbar disc herniation, lower back pain, angina pectoris, acute myocardial infarction, and post-traumatic stress disorder (PTSD) in firefighters compared to other occupational groups. Contradictory results for the risk of PTSD and anxiety disorders related to rank were reported. Sufficient evidence for increased risk of lumbar disc herniation, lower back pain, angina pectoris, acute myocardial infarction, and PTSD was available. The risk of non-cancer diseases varied 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
본 연구는 소방관과 비암성 질환과의 직업관련성을 파악하기 위해 체계적 문헌고찰을 수행하였다. 소방관은 근골격계 질환, 협심증, 심근경색, 외상후 스트레스 장애 등 일부 질환에서 일관된 직업관련성이 보고되었다. 하지만 대부분의 연구에서 연구결과가 건강근로자효과의 영향을 보정하지 못하였고 근무형태, 근무조건, 근무강도 등에 따라 일관되지 못한 결과를 보고하고 있다.

Key Message
In firefighters, risks of lumbar disc herniation, lower back pain, angina pectoris, acute myocardial infarction, and post-traumatic stress disorder were increased constantly. Due to the failure to avoid the healthy-worker effect, consistent relationship between firefighters and non-cancerous diseases has not been reported.

Citations

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Physiological responses to repeated heat exposure under equal work load conditions
Renan Augusto Bortolassi de Oliveira, Anderson Caetano Paulo, Leonardo Farah, Ariel Orlei Michaloski
International Journal of Occupational Safety and Ergonomics.2025; : 1. CrossRef
Organizational health culture in the Korean firefighter intervention studies: a scoping review
Hanbit Jin, Hyungsun Jun, Jisu Ha, Inae Youn, Jungtae Leem
Frontiers in Public Health.2025;[Epub] CrossRef
Associations between Recognition and Behaviors Regarding the Use, Washing and Management of Firefighting Protection Suits and Public Health Awareness of Occupational Exposure Risks among Firefighters
Soo Jin Kim, Seunghon Ham
Fire.2024; 7(5): 156. CrossRef

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

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

Citations

Citations to this article as recorded by

Determining risk‐adapted starting age and interval for breast cancer screening based on reproductive and hormonal factors
Tung Hoang, Jeonghee Lee, So‐Youn Jung, Jeongseon Kim
International Journal of Cancer.2025; 156(9): 1692. CrossRef
A Retrospective Analysis of Breast Cancer Mortality among Jewish and Muslim Arab Women in Israel: The Role of Sociodemographic Factors
Ronit Pinchas-Mizrachi, Dan Bouhnik
Cancers.2024; 16(15): 2763. CrossRef
Random forest algorithm identifies miRNA signatures for breast cancer detection and classification from patient urine samples
Jochen Maurer, Matthias Rübner, Chao-Chung Kuo, Birgit Klein, Julia Franzen, Julia Wittenborn, Tomas Kupec, Laila Najjari, Peter Fasching, Elmar Stickeler
Therapeutic Advances in Medical Oncology.2024;[Epub] CrossRef

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

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.

Citations

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The significance of uterine artery embolization in the treatment of utero‐cervical cancer: A single case report
Preeti Kumari Yadav, Abhimanyu Sharma, Muhammad Ali, Nida Khan, Jubran Al Balushi, Hajrah Farooq, Sree Abhilekha Purohit, Sofia Ali, Malavika Jayan, Archit Kumar Nigam, Mansi Singh
Clinical Case Reports.2024;[Epub] CrossRef
Time to death from cervical cancer and its predictors in hospitalized patients: a survival approach study in Mato Grosso, Brazil
Sancho Pedro Xavier, Kátia Moreira da Silva, Noemi Dreyer Galvão, Marco Aurélio Bertúlio das Neves, Adila de Queiroz Neves Almeida, Ageo Mario Cândido da Silva
World Journal of Surgical Oncology.2024;[Epub] CrossRef

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

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.

Citations

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Health screening disparities in people living with HIV; A nationwide organized screening setting
Boyoung Park, Yoonyoung Jang, Taehwa Kim, Yunsu Choi, Kyoung Hwan Ahn, Jung Ho Kim, Hye Seong, Youn Jeong Kim, Jun Yong Choi, Joon Young Song, Shin-Woo Kim, Sang Il Kim
Journal of Infection and Public Health.2024; 17(12): 102567. CrossRef
Mining Google Trends data for nowcasting and forecasting colorectal cancer (CRC) prevalence
Cristiana Tudor, Robert Aurelian Sova
PeerJ Computer Science.2023; 9: e1518. CrossRef

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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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.

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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.

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Assessment of radiation knowledge and awareness among radiology staff in tertiary hospitals: a study in Wuxi, China
J. Yuan, D. Liu, J. Ni
Radioprotection.2024; 59(3): 184. CrossRef
Why is the screening rate in lung cancer still low? A seven-country analysis of the factors affecting adoption
Charlotte Poon, Tim Wilsdon, Iqra Sarwar, Alexander Roediger, Megan Yuan
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Why clinicians overtest: development of a thematic framework
Justin H. Lam, Kristen Pickles, Fiona F. Stanaway, Katy J. L. Bell
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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

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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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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.

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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

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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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