Epidemiology and Health

Original Articles

The associations of tobacco use, sexually transmitted infections, HPV vaccination, and screening with the global incidence of cervical cancer: an ecological time series modeling study: Luyan Zheng, Yushi Lin, Jie Wu, Min Zheng; Epidemiol Health. 2023;45:e2023005. Published online December 13, 2022; DOI: https://doi.org/10.4178/epih.e2023005

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
We aimed to quantify the temporal associations between cervical cancer incidence and cervical cancer-related factors and to predict the number of new cervical cancer cases averted under counterfactual scenarios compared to the status quo scenario.
METHODS
We described temporal trends in cervical cancer and associated factors globally from 1990 to 2019. We then used generalized linear mixed models to explore the impact of tobacco use, sexually transmitted infections (STIs), human papillomavirus (HPV) vaccination, and cervical screening on cervical cancer incidence. A counterfactual analysis was performed to simulate the most effective scenario for reducing cervical cancer incidence.
RESULTS
The worldwide incidence of cervical cancer showed a downward trend over the past 3 decades (estimated annual percentage change, -0.72%), although the incidence remained high (>30 cases per 100,000 persons) in sub-Saharan Africa, Latin America, and the Caribbean. Higher smoking and STI prevalence showed significant direct associations with the incidence of cervical cancer, whereas HPV vaccination and screening coverage showed significant inverse associations. If the strategic goals for accelerating the elimination of cervical cancer and tobacco control programs had been achieved in 2019, the largest decrease in the number of new cervical cancer cases would have been observed, with 54,169 fewer new cases of cervical cancer in 2019.
CONCLUSIONS
Our counterfactual analysis found that a comprehensive intervention program emphasizing scaled-up cervical screening coverage (70%), HPV vaccination coverage (90%), and tobacco control (30% relative reduction) would be the most effective program for reducing cervical cancer incidence.; Summary

Key Message
A comprehensive intervention program emphasizing scaled-up cervical screening coverage (70%), HPV vaccination coverage (90%), and tobacco control (30% relative reduction) would be the most effective program for reducing cervical cancer incidence in our counterfactual analysis.

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.

Income-based disparities in the risk of distant-stage cervical cancer and 5-year mortality after the introduction of a National Cancer Screening Program in Korea: Erdenetuya Bolormaa, Seung-Ah Choe, Mia Son, Myung Ki, Domyung Paek; Epidemiol Health. 2022;44:e2022066. Published online August 11, 2022; DOI: https://doi.org/10.4178/epih.e2022066

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study assessed the socioeconomic gradient in the risk of distant-stage cervical cancer (CC) at presentation and 5-year mortality for new CC patients after the introduction of a national Cancer Screening Program (NCSP) in Korea.

METHODS

All new CC cases from 2007 to 2017 were retrieved from the Korea Central Cancer Registry database linked with the National Health Information Database of the National Health Insurance Service. The age-standardized cumulative incidence of CC, adjusted odds ratios (ORs) of distant metastasis at presentation, and adjusted all-cause mortality hazard ratios (HRs) within 5 years post-diagnosis were assessed according to the income gradient.

RESULTS

The 11-year age-standardized cumulative incidence of CC ranged from 48.9 to 381.5 per 100,000 women, with the richest quintile having the highest incidence. Of 31,391 new cases, 8.6% had distant metastasis on presentation, which was most frequent among Medical Aid beneficiaries (9.9%). Distant-stage CC was more likely when the income level was lower (OR, 1.46; 95% confidence interval [CI]), 1.28 to 1.67 for the lowest compared to the richest) and among Medical Aid beneficiaries (OR, 1.50; 95% CI, 1.24 to 1.82). The 5-year mortality was greater in the lower-income quintiles and Medical Aid beneficiaries than in the richest quintile.

CONCLUSIONS

The incidence of CC was higher in the richest quintile than in the lower income quintiles, while the risk of distant-stage CC and mortality was higher for women in lower income quintiles in the context of the NCSP. A more focused approach is needed to further alleviate disparities in the timely diagnosis and treatment of CC.

Summary

Korean summary
새로이 자궁경부암을 진단받은 여성에서 소득수준에 따른 진단시 원격 전이가 있을 위험도와 진단 이후 5년 사망위험도를 연령과 체질량 지수등의 개인 수준의 위험 요인을 보정하여 구했다. 소득 수준이 낮을수록, 의료급여 환자일수록 진단시 원격 전이가 있을 위험과 5년 내 사망 위험이 높은 것으로 나타났다. 자궁경부암에 대한 전국민 대상 선별 검사가 있지만 여전히 소득 수준에 따른 자궁경부암의 적시 진단과 진단 후 생존의 불평등이 남아 있으며 이에 대한 추가 정책이 필요하다.

Key Message
This study adds empirical evidence for an income-based disparity in the cancer stage at presentation and five-year survival among cervical cancer patients even in the presence of a universal screening program.

Citations

Citations to this article as recorded by

Individual and joint effect of socioeconomic status and lifestyle factors on cancer in Korea
Chi Lan Tran, Kui Son Choi, Sun‐Young Kim, Jin‐Kyoung Oh
Cancer Medicine.2023; 12(16): 17389. CrossRef
Menopausal hormone therapy and risk of dementia: health insurance database in South Korea-based retrospective cohort study
Jin-Sung Yuk, Jin San Lee, Joong Hyun Park
Frontiers in Aging Neuroscience.2023;[Epub] 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

Incidence and mortality of cervical cancer in Vietnam and Korea (1999-2017): Kim Ngoc Tran, Yoon Park, Byung-Woo Kim, Jin-Kyoung Oh, Moran Ki; Epidemiol Health. 2020;42:e2020075. Published online December 16, 2020; DOI: https://doi.org/10.4178/epih.e2020075

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6 Web of Science
5 Crossref

Abstract Summary PDF

Abstract

OBJECTIVES
Cervical cancer is a major disease burden in Vietnam. This study aimed to estimate the incidence and mortality rates of cervical cancer in Vietnam (1999-2017) in comparison to those in Korea, where a population-based cancer registry and national cervical cancer screening program have been implemented.

METHODS

The estimated incidence and mortality of cervical cancer in Vietnam and Korea (1999-2017) were collected from Global Burden of Disease 2017 study. Estimated age-standardized rates (ASRs) in both countries were calculated utilizing the 1999-2017 population of each country and the World Health Organization standard population. The reported ASRs in Korea were also computed using data on incidence and mortality (1999-2017) and the Korean population from the Korea Statistical Information Service.

RESULTS

In Vietnam, the estimated incidence and mortality of cervical cancer decreased annually by 0.84% and 1.01%. In Korea, the trend of reported incidence showed a dramatic drop (1999-2007 annual percent change [APC], -4.53%) before stably declining (2007-2017 APC, -2.71%). Reported mortality also significantly decreased (2003-2008 APC, -6.63%), and then maintained a stable decline (2008-2017 APC, -3.78%). The incidence and mortality rates were higher in Vietnam than in Korea. The declining trend of incidence and mortality in Vietnam was slower than the corresponding trends in Korea.

CONCLUSIONS

A national screening program should be implemented for Vietnamese women aged over 30 to maintain, or even hasten, the decline in cervical cancer incidence and mortality. A population-based cancer registry may help monitor the effectiveness of a cervical cancer screening program.

Summary

Korean summary
국가 암 등록 체계와 국가 암 검진 프로그램이 아직 마련되지 않은 베트남에서 자궁경부암에 대한 질병부담을 줄일 수 있는 방향성을 제시하고자, 한국의 암 관리 현황과 질병부담을 비교한 연구입니다. 국가 암 등록자료를 구축하고 자궁경부암에 대한 국가 암 검진 프로그램을 도입한 한국과 베트남의 자궁경부암 발생률과 사망률 추이를 비교함으로 베트남에서도 체계적인 암 관리와 예방의 필요성을 강조하고자 한 연구입니다.

Citations

Citations to this article as recorded by

A questionnaire study on disparity of cervical cancer prevention programs in Asia‐Oceania
Ka Yu Tse, Kimio Ushijima, Ai Ling Tan, Perapong Intasorn, Jitendra Pariyar, Chih‐Long Chang, Efren J. Domingo, Hiralal Konar, Suresh Kumarasamy, Brahmana Askandar Tjokroprawiro, Sarikapan Wilailak
Journal of Obstetrics and Gynaecology Research.2023; 49(4): 1230. CrossRef
N-Acetyl-L-Cysteine Reduces Cervical Carcinogenesis by Promoting Apoptosis
Wenping Guo, Wang Jing
Drugs in R&D.2023; 23(2): 165. CrossRef
A Study on the Health-Related Issues and Behavior of Vietnamese Migrants Living in Japan: Developing Risk Communication in the Tuberculosis Response
Sangnim Lee, Nhan Huu Thanh Nguyen, Shori Takaoka, An Dang Do, Yoshihisa Shirayama, Quy Pham Nguyen, Yusuke Akutsu, Jin Takasaki, Akihiro Ohkado
International Journal of Environmental Research and Public Health.2023; 20(12): 6150. CrossRef
Analysis of HR-HPV Prevalence among Unvaccinated Busan Women
Dong Hyeok Kim, Kyung Eun Lee
Biomedical Science Letters.2022; 28(4): 229. CrossRef
EGFR and ERK activation resists flavonoid quercetin‑induced anticancer activities in human cervical cancer cells in vitro
Xin Chen, Pengli Xu, Huijun Zhang, Xiaosan Su, Lihua Guo, Xuhong Zhou, Junliang Wang, Peng Huang, Qingzhi Zhang, Ruifen Sun
Oncology Letters.2021;[Epub] CrossRef

An Analysis on the Factors Associated with Cancer Screening in a City.: Woon Nyung Roh, Won Chul Lee, Young Bok Kim, Yong Mun Park, Hong Jae Lee, Kwang Ho Meng; Korean J Epidemiol. 1999;21(1):81-92.

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Abstract PDF: Abstract
This study is aimed at preparing basic data required for establishment of a cancer screening program by examining the status of cancer screenings performed by residents in a community and the factors that have an effect on determination for a cancer screening by residents. Cervix, breast and stomach cancers were chosen as target cancers of the study due to the fact that merits of screening for these cancers have been proved by studies done in different countries. In order to find out the status of cancer screening and the factors having an effect on the determination for a cancer screening, 10 Dongs and a total of 1988 people were selected as study area and subjects by a random cluster sampling method, and the subjects were questioned on different aspects by questionnaires. Additionally, in order to find out how cancer screening is performed at medical facilities and how cancer screening is recommended by doctors, medical facilities doing cancer screening were also questioned. The results of the study are as follows: 1. In the case of the screening of the stomach cancer, 16.1% of male subjects and 25.6% of female subjects turned out to have had one or more screening for the cancer. In the cases of the breast and the cervical cancers, 21.6% and 62.6% of the subjects turned out to have had one or more screenings respectively. 2. As to the screening for the stomach cancer, there was a tendency that more of the subjects with lower level education, excepting those without education, had themselves screened for the cancer. Higher screening rates were shown by the subjects in higher ages, those who visited doctors regularly. 3. As to the screening rate by education levels, a high rate of screening was shown by the subjects with above-university education level and there was not a big difference between the screenings done for high school graduates and for those with lower education levels. Regarding the rates of screening by age groups the screening rate turned out to be higher with the higher ages. Screening rates, checked on the basis of the income levels, did not show a big differences between income levels. 4. The highest rate of screening for the breast cancer was shown by the subjects with postgraduate level of education and regarding the rate by income level, a slightly higher level was shown by the subjects with the monthly income of the 2,010,000 won, but the difference between the rates of screening by subjects at different income levels was overall not significant. 5. The rates for selecting the health screening facilities were higher in orders of the reasons that 1) they were close: 2) service was excellent and 3) equipment and facilities were good. Based on the above-mentioned results obtained by the study, it is anticipated that this study will play a vital role as basic data for the development and execution of cancer screening program for a community, and the analysis, done on the basis of the status of the cancer screening, of the factors related to the determination for the cancer screening showed that for the development of a cancer screening program, factors like income levels, education levels, whether people consult doctors regularly and the local government' care for health in a community should be considered, and in addition to which active participation of doctors in the program is also requested.; Summary

Review

Methodological Review of Cost Effectiveness Analysis of Cancer Screening.: Ki Taig Jung; Korean J Epidemiol. 1998;20(1):13-31.

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Abstract PDF: Abstract
The role of economic evaluation for medical services can be summarixed as providing objective criteria for rational bgudget allocation. With medical and epidemiologial studies, cost effectiveness analysis of cancer screening will provide evidence for allocating more financial resources for cancer screening. This study reviewed comprehensive literature of cancer screening for cervical cancer and breast cancer. Through the extensive review of the literature, I suggest crucial issues of cancer screening and checkpoints in designing costeffectiveness analyses of cervical and breast cancers. The issues of cervical and breast cancer screening include ages of starting and terminating mass screening, screening interval and frequency, false positive rate, false negative rate, analytical models, and sensitivity analysis. In addition, cost effectiveness analysis of breast cancer should consider effects of screening methods-self examination, clinical examination, and mammography-that varies across different nations on cost effectiveness ratio. Study results of most issues would be relevant for performing cost effectiveness analysis of cancer screening in Korea. However, difference in incidence rate, medical fees and reimbursement by insurance across nations should be considered in designing cost effectiveness analysis.; Summary

Original Article

Studies on Risk Factors in Cancers of the Breast, Uterine Cervix and Ovary.: Soon Wha Moon, Soo Yong Choi, Tae Yong Lee, Young Chae Chung; Korean J Epidemiol. 1997;19(2):161-179.

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Abstract PDF: Abstract
This study presents the comparative pattern of risks for cancers of the breast, uterine cervix and ovary in relation to various risk factors based on the data from a case-control study conducted at the Korea Cancer Center Hospital in Seoul between August in 1996 and March in 1997. Included in the analysis were 128 women of breast cancer, 169 women of uterine cevical cancer and 45 of ovarian cancer confirmed by the historical diagnosis. Person interviews were conducted in all cases through standard questionnaire. Data were analyzed using multiple logistic regression, adjusting for potential confounding factors. In cancers of the uterine cervix and ovary, increasing risks were seen in earlier age at first menarch. Statistically significant associations were found with postmenopausal women in cancers of the breast(OR=2.0) and ovary(OR=8.5). The OR increased with late age at postmenopause in postmenopausal women of uterine cervical cancer(OR=7.0). Increasing number of pregnant and livebirths was associated with a higher risk of uterine cervical cancer(OR=2.7, 2.9). The risk of uterine cervical cancer was decreasing with increasing age at first birth(OR=0.2). Among postmenopausal women, the OR increased with BMI in breast cancer. A positive history of breastfeeding was associated with significantly lower risk of breast cancer(OR=0.4). There were no associations with anthropometric measurements(height, weight, BMI), smoking, alcohol intake, menstrual regularity, age at first marriage, number of marriage and induced abortion, and oral contraceptives in cancers of the breast, uterine cervix and ovary. In cancers of the breast and uterine cervix, decreasing risks were seen in intake of fresh fruits, carrot and cabbage.; Summary

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