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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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AbstractAbstract PDFSupplementary 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
The impact of COVID-19 on screening for colorectal, gastric, breast, and cervical cancer in Korea
Hyeree Park, Seung Hee Seo, Jong Heon Park, Shin Hye Yoo, Bhumsuk Keam, Aesun Shin
Epidemiol Health. 2022;44:e2022053.   Published online June 21, 2022
DOI: https://doi.org/10.4178/epih.e2022053
  • 5,431 View
  • 411 Download
  • 5 Citations
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
The coronavirus disease 2019 (COVID-19) pandemic has affected the utilization of healthcare services, including participation in cancer screening programs. We compared cancer screening participation rates for colorectal, gastric, breast, and cervical cancers among participants in the National Cancer Screening Program (NCSP) in 2019 and 2020 to address the potential distraction effect of COVID-19 on cancer screening.
METHODS
Data from the NCSP for 4 cancer types (stomach, colorectal, breast, and cervical) in 2019 and 2020 were used to calculate cancer screening participation rates by calendar month, gender, age group, and geographical region. Monthly participation rates were analyzed per 1,000 eligible individuals.
RESULTS
The screening participation rate decreased in 2020 compared to 2019 for all 4 cancers: colorectal (40.5 vs. 35.3%), gastric (61.9 vs. 54.6%), breast (63.8 vs. 55.8%), and cervical (57.8 vs. 52.2%) cancers. Following 2 major COVID-19 waves in March and December 2020, the participation rates in the 4 types of cancer screening dropped compared with those in 2019. The highest decline was observed in the elderly population aged 80 years and older (percentage change: -21% for colorectal cancer; -20% for gastric cancer; -26% for breast cancer; -20% for cervical cancer).
CONCLUSIONS
After the 2 major COVID-19 waves, the screening participation rate for 4 types of cancer declined compared with 2019. Further studies are needed to identify the indirect effects of the COVID-19 pandemic on cancer patients, such as delayed diagnoses of cancer or excess cancer deaths.
Summary
Korean summary
본 연구는 코로나 대유행 기간 전과 후 대장암, 위암, 유방암, 자궁경부암 검진 수검률 차이를 비교하고자 하였다. 첫 코로나 확진자가 발생한 2020년을 코로나 대유행 기간, 전년도 기간인 2019년을 코로나 대유행 전 기간으로 설정하며 국민건강보험공단에서 집계된 전수자료를 이용하여 암 검진 대상자 수와 수검자 수를 비교 분석하였다. 4개 암종 모두에서 2019년도와 비교하여 2020년도에 전국적으로 수검률이 감소하는 경향이 있었으며, 1차 대유행이 있었던 3월과 3차 대유행 시기인 12월에 2019년도 동기간과 비교하여 수검률이 크게 감소하였고, 80대 이상 노인 인구에서 감소폭이 다른 연령대와 비교하여 크게 나타났다.
Key Message
We found decline of the colorectal, gastric, breast and cervical cancer screening participation rates in 2020 following the two major COVID-19 waves, compared with those of 2019, and the highest decline was observed in the elderly population aged 80 years and older.

Citations

Citations to this article as recorded by  
  • Analysis of the current situation and related influencing factors of cervical precancer screening under the COVID-19
    Xiaohong Song, Yongbin Yang
    Biotechnology and Genetic Engineering Reviews.2023; : 1.     CrossRef
  • Willingness to Undergo Gastroscopy for Early Gastric Cancer Screening and Its Associated Factors During the COVID-19 Pandemic – A Nationwide Cross-Sectional Study in China
    Kejia Ma, Xuejie Chen, Xin Xiang, Xueyi Mao, Ningxin Zhu, Tianyu Wang, Shuyu Ye, Xiaoyan Wang, Minzi Deng
    Patient Preference and Adherence.2023; Volume 17: 505.     CrossRef
  • Impact of coronavirus disease 2019 pandemic on breast cancer surgery using the National Database of Japan
    Misuzu Fujita, Hideyuki Hashimoto, Kengo Nagashima, Kiminori Suzuki, Tokuzo Kasai, Kazuya Yamaguchi, Yoshihiro Onouchi, Daisuke Sato, Takehiko Fujisawa, Akira Hata
    Scientific Reports.2023;[Epub]     CrossRef
  • Impact of the COVID-19 Pandemic on Gastric Cancer Screening in South Korea: Results From the Korean National Cancer Screening Survey (2017–2021)
    Kyeongmin Lee, Mina Suh, Jae Kwan Jun, Kui Son Choi
    Journal of Gastric Cancer.2022; 22(4): 297.     CrossRef
  • Impact of frailty on survival and readmission in patients with gastric cancer undergoing gastrectomy: A meta-analysis
    Xiaoyan Wang, Yimeng Sun, Pei Wang, Yu Jie, Guodong Liu, Dandan Gong, Yu Fan
    Frontiers in Oncology.2022;[Epub]     CrossRef
Systematic Review
Quantifying the duration of the preclinical detectable phase in cancer screening: a systematic review
Sandra M. E. Geurts, Anne M. W. M. Aarts, André L. M. Verbeek, Tony H. H. Chen, Mireille J. M. Broeders, Stephen W. Duffy
Epidemiol Health. 2022;44:e2022008.   Published online January 3, 2022
DOI: https://doi.org/10.4178/epih.e2022008
  • 5,896 View
  • 401 Download
  • 1 Citations
AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
The aim of this study was to provide an overview of published mathematical estimation approaches to quantify the duration of the preclinical detectable phase (PCDP) using data from cancer screening programs.
METHODS
A systematic search of PubMed and Embase was conducted for original studies presenting mathematical approaches using screening data. The studies were categorized by mathematical approach, data source, and assumptions made. Furthermore, estimates of the duration of the PCDP of breast and colorectal cancer were reported per study population.
RESULTS
From 689 publications, 34 estimation methods were included. Five distinct types of mathematical estimation approaches were identified: prevalence-to-incidence ratio (n=8), maximum likelihood estimation (n=16), expectation-maximization algorithm (n=1), regression of observed on expected (n=6) and Bayesian Markov-chain Monte Carlo estimation (n=5). Fourteen studies used data from both screened and unscreened populations, whereas 19 studies included only information from a screened population. Estimates of the duration of the PCDP varied between 2 years and 7 years for breast cancer in the Health Insurance Plan study (annual mammography and clinical breast examinations in women aged 40-64 years) and 2 years and 5 years for colorectal cancer in the Calvados study (a guaiac fecal occult blood test in men and women aged 45-74 years).
CONCLUSIONS
Different types of mathematical approaches lead to different estimates of the PCDP duration. We advise researchers to use the method that matches the data available, and to use multiple methods for estimation when possible, since no method is perfect.
Summary
Korean summary
Key Message
Quantifying the duration of the preclinical detectable phase is important for the design and evaluation of cancer screening programs. Different types of mathematical estimation approaches lead to different estimates of the preclinical detectable phase duration. We advise researchers to use the method that matches the data available, and to use multiple methods for estimation when possible, since no method is perfect.

Citations

Citations to this article as recorded by  
  • Estimating the Length of the Preclinical Detectable Phase for Open-Angle Glaucoma
    Johan Aspberg, Anders Heijl, Boel Bengtsson
    JAMA Ophthalmology.2023; 141(1): 48.     CrossRef
Health Statistics
A comparison of breast cancer survival across different age groups: a multicentric database study in Penang, Malaysia
King Fang Tan, Farzaana Adam, Hasmah Hussin, Noor Mastura Mohd Mujar
Epidemiol Health. 2021;43:e2021038.   Published online May 25, 2021
DOI: https://doi.org/10.4178/epih.e2021038
  • 9,619 View
  • 338 Download
  • 5 Citations
AbstractAbstract PDF
Abstract
This study compared breast cancer survival and the prognostic factors across different age groups of women in Penang, Malaysia. Data on 2,166 women with breast cancer who had been diagnosed between 2010 and 2014 were extracted from the Penang Breast Cancer Registry and stratified into 3 age groups: young (< 40 years old), middle-aged (40-59 years old), and elderly (≥ 60 years). The overall and relative survival rates were calculated using the life table method, median survival time was calculated using the Kaplan-Meier method, and comparisons between groups were conducted using the log-rank test. Prognostic factors were analyzed using a Cox proportional hazards model. The 5-year overall and breast cancer-specific survival rates for women with breast cancer in Penang were 72.9% and 75.2%, with a mean survival time of 92.5 months and 95.1 months, respectively. The 5-year breast cancer-specific survival rates for young, middle-aged, and elderly women were 74.9%, 77.8%, and 71.4%, respectively, with a mean survival time of 95.7 months, 97.5 months, and 91.2 months. There was a significant difference in breast cancer survival between age groups, with elderly women showing the lowest survival rate, followed by young and middle-aged women. Disease stage was the most prominent prognostic factor for all age groups. Survival rates and prognostic factors differed according to age group. Treatment planning for breast cancer patients should be age-specific to promote better cancer care and survival.
Summary
Korean summary
Key Message
The relationship between breast cancer survival and age at diagnosis has been explored, but information between survival at different age groups remains unclear, in addition to conflicting study results. This multicentre study was conducted to compare breast cancer survival across different age groups in an Asian setting.

Citations

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  • Cancer–related symptoms among young and middle–aged women undergoing chemotherapy for breast cancer: Application of latent class analysis and network analysis
    Tingting Cai, Tingting Zhou, Qingmei Huang, Fulei Wu, Feixia Ni, Changrong Yuan
    European Journal of Oncology Nursing.2023; 63: 102287.     CrossRef
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    Bryan Valcarcel, J. Smith Torres-Roman, Daniel Enriquez-Vera, Gabriel De-la-Cruz-Ku
    Journal of Adolescent and Young Adult Oncology.2023;[Epub]     CrossRef
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    Jun Lu, Pinbo Liu, Ran Zhang
    Frontiers in Molecular Biosciences.2022;[Epub]     CrossRef
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    Mohd Nasrullah Nik Ab Kadir, Najib Majdi Yaacob, Siti Norbayah Yusof, Imi Sairi Ab Hadi, Kamarul Imran Musa, Seoparjoo Azmel Mohd Isa, Balqis Bahtiar, Farzaana Adam, Maya Mazuwin Yahya, Suhaily Mohd Hairon
    International Journal of Environmental Research and Public Health.2022; 19(22): 15335.     CrossRef
Original Article
Exploring neighborhood inequality in female breast cancer incidence in Tehran using Bayesian spatial models and a spatial scan statistic
Erfan Ayubi, Mohammad Ali Mansournia, Ali Ghanbari Motlagh, Alireza Mosavi-Jarrahi, Ali Hosseini, Kamran Yazdani
Epidemiol Health. 2017;39:e2017021.   Published online May 17, 2017
DOI: https://doi.org/10.4178/epih.e2017021
  • 12,403 View
  • 215 Download
  • 11 Citations
AbstractAbstract PDF
Abstract
OBJECTIVES
The aim of this study was to explore the spatial pattern of female breast cancer (BC) incidence at the neighborhood level in Tehran, Iran.
METHODS
The present study included all registered incident cases of female BC from March 2008 to March 2011. The raw standardized incidence ratio (SIR) of BC for each neighborhood was estimated by comparing observed cases relative to expected cases. The estimated raw SIRs were smoothed by a Besag, York, and Mollie spatial model and the spatial empirical Bayesian method. The purely spatial scan statistic was used to identify spatial clusters.
RESULTS
There were 4,175 incident BC cases in the study area from 2008 to 2011, of which 3,080 were successfully geocoded to the neighborhood level. Higher than expected rates of BC were found in neighborhoods located in northern and central Tehran, whereas lower rates appeared in southern areas. The most likely cluster of higher than expected BC incidence involved neighborhoods in districts 3 and 6, with an observed-to-expected ratio of 3.92 (p<0.001), whereas the most likely cluster of lower than expected rates involved neighborhoods in districts 17, 18, and 19, with an observed-to-expected ratio of 0.05 (p<0.001).
CONCLUSIONS
Neighborhood-level inequality in the incidence of BC exists in Tehran. These findings can serve as a basis for resource allocation and preventive strategies in at-risk areas.
Summary
Korean summary
Key Message

Citations

Citations to this article as recorded by  
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Brief Communication
Reinterpretation of the results of a pooled analysis of dietary carotenoid intake and breast cancer risk by using the interval collapsing method
Jong-Myon Bae
Epidemiol Health. 2016;38:e2016024.   Published online June 2, 2016
DOI: https://doi.org/10.4178/epih.e2016024
  • 13,064 View
  • 208 Download
  • 11 Citations
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
A pooled analysis of 18 prospective cohort studies reported in 2012 for evaluating carotenoid intakes and breast cancer risk defined by estrogen receptor (ER) and progesterone receptor (PR) statuses by using the “highest versus lowest intake” method (HLM). By applying the interval collapsing method (ICM) to maximize the use of the estimated information, we reevaluated the results of the previous analysis in order to reinterpret the inferences made.
METHODS
In order to estimate the summary effect size (sES) and its 95% confidence interval (CI), meta-analyses with the random-effects model were conducted for adjusted relative risks and their 95% CI from the second to the fifth interval according to five kinds of carotenoids and ER/PR status.
RESULTS
The following new findings were identified: α-Carotene and β-cryptoxanthin have protective effects on overall breast cancer. All five kinds of carotenoids showed protective effects on ER− breast cancer. β-Carotene level increased the risk of ER+ or ER+/PR+ breast cancer. α-Carotene, β-carotene, lutein/zeaxanthin, and lycopene showed a protective effect on ER−/PR+ or ER−/PR− breast cancer.
CONCLUSIONS
The new facts support the hypothesis that carotenoids that show anticancer effects with anti-oxygen function might reduce the risk of ER− breast cancer. Based on the new facts, the modification of the effects of α-carotene, β-carotene, and β-cryptoxanthin should be evaluated according to PR and ER statuses.
Summary
Korean summary
Carotenoids 가 항암기전이 있다면 steroid hormone에 무관한 estrogen receptor negative (ER-) 혹은 progesterone receptor negative (PR-) 유방암의 발생을 억제할 것이란 가설에 따라, 18개의 코호트에 대한 pooled analysis 결과가 2012년도에 발표되었다. 이를 재분석한 결과, 5 종류의 carotenoids 모두 ER- 유방암 억제하는 것을 확인하였다.
Key Message

Citations

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Original Article
Distribution of dense breasts using screening mammography in Korean women: a retrospective observational study
Jong-Myon Bae, Sang Yop Shin, Eun Hee Kim, Yoon-Nam Kim, Chung Mo Nam
Epidemiol Health. 2014;36:e2014027.   Published online November 4, 2014
DOI: https://doi.org/10.4178/epih/e2014027
  • 14,387 View
  • 134 Download
  • 11 Citations
AbstractAbstract PDF
Abstract
OBJECTIVES
This retrospective observational study evaluated the distribution of dense breasts by age group among healthy Korean women.
METHODS
Participants were women aged 30 years and older who voluntarily underwent screening mammography between January 2007 and December 2011. Women who received the Breast Imaging Reporting and Data System for mammographic density of 3 or 4 were defined as having dense breasts. The proportion of women with dense breasts (PDB, %) was calculated by dividing the number of participants with dense breasts by the total number of participants.
RESULTS
Among the 231,058 women who participated, 78.15% were classified as having dense breasts. PDB was highest in the youngest age group (PDB=94.87%) and lowest in the oldest age group. The greatest difference in PDB between adjacent age groups was observed in the group aged 60-64 years.
CONCLUSIONS
The results show that the proportion of dense breasts by age group increased in all age groups, except in those aged 35-39 years. These findings suggest an association between the age distribution of dense breasts and trends in breast cancer incidence. Further studies are needed to estimate the change in breast cancer incidence rate by age and the accumulation of fatty breast tissue in Korean women.
Summary
Korean summary
Key Message

Citations

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