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Original Article
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
  • 1,382 View
  • 118 Download
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
Methods
Overdiagnosis: epidemiologic concepts and estimation
Jong-Myon Bae
Epidemiol Health. 2015;37:e2015004.   Published online February 10, 2015
DOI: https://doi.org/10.4178/epih/e2015004
  • 20,889 View
  • 231 Download
  • 15 Citations
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
Overdiagnosis of thyroid cancer was propounded regarding the rapidly increasing incidence in South Korea. Overdiagnosis is defined as ‘the detection of cancers that would never have been found were it not for the screening test’, and may be an extreme form of lead bias due to indolent cancers, as is inevitable when conducting a cancer screening programme. Because it is solely an epidemiological concept, it can be estimated indirectly by phenomena such as a lack of compensatory drop in post-screening periods, or discrepancies between incidence and mortality. The erstwhile trials for quantifying the overdiagnosis in screening mammography were reviewed in order to secure the data needed to establish its prevalence in South Korea.
Summary
Korean summary
최근 갑상선암의 발생 증가는 과진단에 기인한 것이란 주장이 제기되었다. 과진단은 ‘평생동안 몰랐을 암을 검진으로 알아낸 경우’로 정의하는 바, 예상보다 늦은 진행으로 예후가 더 좋고 치료를 안해도 사망률 변동을 만들지 못하는 암에 대하여 반복되는 암검진에 더 잘 진단되는 기간차이 바이어스가 개입되는 것을 제대로 통제하지 못해서 생긴 것이다. 검진을 더 이상 하지 않았을 경우 발생률이 본래대로 되돌아오지 않는 현상을 보이거나, 사망률과 발생률 간의 변동에서 큰 차이를 보일 때 과진단이 있다고 판단한다. 국내에서 발생하는 과진단의 크기를 측정하기 위한 방법들을 알아보기 위하여, 기존의 유방암 조기검진용 유방촬영술에 대한 과진단 크기를 알아낸 연구방법들을 살펴보았다.
Key Message

Citations

Citations to this article as recorded by  
  • Overdiagnosis of hepatocellular carcinoma: Prevented by guidelines?
    Nicole E. Rich, Amit G. Singal
    Hepatology.2022; 75(3): 740.     CrossRef
  • Chest radiography surveillance for lung cancer: Results from a National Health Insurance database in South Korea
    Hyun Jung Koo, Chang-Min Choi, Sojung Park, Han Na Lee, Dong Kyu Oh, Won-Jun Ji, Seulgi Kim, Mi Young Kim
    Lung Cancer.2019; 128: 120.     CrossRef
  • Proteomic Biomarkers for Bisphenol A–Early Exposure and Women’s Thyroid Cancer
    Ho-Sun Lee, Yunkyeong Kang, Kyung Tae, Gyu-Un Bae, Jong Y. Park, Yoon Hee Cho, Mihi Yang
    Cancer Research and Treatment.2018; 50(1): 111.     CrossRef
  • Lessons from Fukushima: Latest Findings of Thyroid Cancer After the Fukushima Nuclear Power Plant Accident
    Shunichi Yamashita, Shinichi Suzuki, Satoru Suzuki, Hiroki Shimura, Vladimir Saenko
    Thyroid.2018; 28(1): 11.     CrossRef
  • Defining, Estimating, and Communicating Overdiagnosis in Cancer Screening
    Louise Davies, Diana B. Petitti, Lynn Martin, Meghan Woo, Jennifer S. Lin
    Annals of Internal Medicine.2018; 169(1): 36.     CrossRef
  • Getting personal on overdiagnosis: On defining overdiagnosis from the perspective of the individual person
    Bjørn Hofmann
    Journal of Evaluation in Clinical Practice.2018; 24(5): 983.     CrossRef
  • The Use of International Classification of Diseases Codes to Identify Patients with Pancreatitis: A Systematic Review and Meta-analysis of Diagnostic Accuracy Studies
    Amy Y. Xiao, Marianne L. Tan, Maria N. Plana, Dhiraj Yadav, Javier Zamora, Maxim S. Petrov
    Clinical and Translational Gastroenterology.2018; 9(10): e191.     CrossRef
  • Overdiagnosis of thyroid cancer in the Marne and Ardennes Departments of France from 1975 to 2014
    Caroline Saint-Martin, Moustapha Dramé, Sandrine Dabakuyo, Lukshe Kanagaratnam, Patrick Arveux, Claire Schvartz
    Annales d'Endocrinologie.2017; 78(1): 27.     CrossRef
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    Shunichi Yamashita, Vladimir A. Saenko
    Thyroid.2017; 27(5): 595.     CrossRef
  • Strategies for Appropriate Patient-centered Care to Decrease the Nationwide Cost of Cancers in Korea
    Jong-Myon Bae
    Journal of Preventive Medicine and Public Health.2017; 50(4): 217.     CrossRef
  • The impact of family history on non-medullary thyroid cancer
    I.J. Nixon, C. Suárez, R. Simo, A. Sanabria, P. Angelos, A. Rinaldo, J.P. Rodrigo, L.P. Kowalski, D.M. Hartl, M.L. Hinni, J.P. Shah, A. Ferlito
    European Journal of Surgical Oncology (EJSO).2016; 42(10): 1455.     CrossRef
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    Curtis E. Margo
    Cancer Control.2016; 23(2): 90.     CrossRef
  • Epidemiological evidences on overdiagnosis of prostate and kidney cancers in Korean
    Jong-Myon Bae
    Epidemiology and Health.2015; 37: e2015015.     CrossRef
  • Development and application of patient decision aids
    Jong-Myon Bae
    Epidemiology and Health.2015; 37: e2015018.     CrossRef
  • It needs adaptation to the 2015 Korean guideline for breast cancer screening
    Jong-Myon Bae
    Journal of the Korean Medical Association.2015; 58(9): 833.     CrossRef
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
  • 14,385 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

Citations to this article as recorded by  
  • Recent advances of small extracellular vesicle biomarkers in breast cancer diagnosis and prognosis
    Yujin Lee, Jie Ni, Julia Beretov, Valerie C. Wasinger, Peter Graham, Yong Li
    Molecular Cancer.2023;[Epub]     CrossRef
  • Comparison of ultrasound and mammography for early diagnosis of breast cancer among Chinese women with suspected breast lesions: A prospective trial
    Yingjiao Wang, Yuechong Li, Yu Song, Chang Chen, Zhe Wang, Linrong Li, Mohan Liu, Guanmo Liu, Yali Xu, Yidong Zhou, Qiang Sun, Songjie Shen
    Thoracic Cancer.2022; 13(22): 3145.     CrossRef
  • A multicenter, hospital-based and non-inferiority study for diagnostic efficacy of automated whole breast ultrasound for breast cancer in China
    Yujing Xin, Xinyuan Zhang, Yi Yang, Yi Chen, Yanan Wang, Xiang Zhou, Youlin Qiao
    Scientific Reports.2021;[Epub]     CrossRef
  • A deep learning-based automated diagnostic system for classifying mammographic lesions
    Takeshi Yamaguchi, Kenichi Inoue, Hiroko Tsunoda, Takayoshi Uematsu, Norimitsu Shinohara, Hirofumi Mukai
    Medicine.2020; 99(27): e20977.     CrossRef
  • The effect of sex hormones on normal breast tissue metabolism
    Yongsik Jung, Tae Hee Kim, Ji Young Kim, Sehwan Han, Young-Sil An
    Medicine.2019; 98(27): e16306.     CrossRef
  • Effect of Different Types of Mammography Equipment on Screening Outcomes: A Report by the Alliance for Breast Cancer Screening in Korea
    Bo Hwa Choi, Eun Hye Lee, Jae Kwan Jun, Keum Won Kim, Young Mi Park, Hye-Won Kim, You Me Kim, Dong Rock Shin, Hyo Soon Lim, Jeong Seon Park, Hye Jung Kim
    Korean Journal of Radiology.2019; 20(12): 1638.     CrossRef
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    Shinsuke Sasada, Norio Masumoto, Hang Song, Keiko Kajitani, Akiko Emi, Takayuki Kadoya
    Journal of Medical Imaging.2018; 5(02): 1.     CrossRef
  • Effect of mammography screening on stage at breast cancer diagnosis: results from the Korea National Cancer Screening Program
    Kui Son Choi, Minjoo Yoon, Seung Hoon Song, Mina Suh, Boyoung Park, Kyu Won Jung, Jae Kwan Jun
    Scientific Reports.2018;[Epub]     CrossRef
  • Sensitivity and specificity of mammography and adjunctive ultrasonography to screen for breast cancer in the Japan Strategic Anti-cancer Randomized Trial (J-START): a randomised controlled trial
    Noriaki Ohuchi, Akihiko Suzuki, Tomotaka Sobue, Masaaki Kawai, Seiichiro Yamamoto, Ying-Fang Zheng, Yoko Narikawa Shiono, Hiroshi Saito, Shinichi Kuriyama, Eriko Tohno, Tokiko Endo, Akira Fukao, Ichiro Tsuji, Takuhiro Yamaguchi, Yasuo Ohashi, Mamoru Fukud
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  • Retrospective observation on contribution and limitations of screening for breast cancer with mammography in Korea: detection rate of breast cancer and incidence rate of interval cancer of the breast
    Kunsei Lee, Hyeongsu Kim, Jung Hyun Lee, Hyoseon Jeong, Soon Ae Shin, Taehwa Han, Young Lan Seo, Youngbum Yoo, Sang Eun Nam, Jong Heon Park, Yoo Mi Park
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Hypothesis
Two hypotheses of dense breasts and viral infection for explaining incidence of breast cancer by age group in Korean women
Jong-Myon Bae
Epidemiol Health. 2014;36:e2014020.   Published online September 26, 2014
DOI: https://doi.org/10.4178/epih/e2014020
  • 17,777 View
  • 135 Download
  • 13 Citations
AbstractAbstract PDFSupplementary Material
Abstract
Breast cancer, the second leading type of cancer in Korean women, has shown increasing incidence over the past 10 years. However, the curves of incidence by age group cast doubt on the birth cohort effect hypothesis. To explain the curves, here I suggest two alternative hypotheses of breast density and viral infection based on pre-existing evidences. Evaluating these hypotheses would require important clues to find unknown risk factors of breast cancer and to plan more effective strategies for breast cancer control in Korean women.
Summary
Korean summary
Key Message

Citations

Citations to this article as recorded by  
  • A Historical Misconception in Clinical Trials of Drugs for Cancer—Age Grouping
    Jingyu Chen, Lan Yao, Abdulmohsin J. Alamoudi, Lotfi Aleya, Weikuan Gu
    Journal of Personalized Medicine.2022; 12(12): 1998.     CrossRef
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    Soyeoun Kim, Boyoung Park
    International Journal of Cancer.2021; 148(11): 2674.     CrossRef
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    Jong-Myon Bae
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    Archives of Clinical Infectious Diseases.2016;[Epub]     CrossRef
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  • Distribution of Dense Breasts using Screening Mammography in Korean Women: a Retrospecitive Observational Study
    Jong-Myon Bae, Sang Yop Shin, Eun Hee Kim, Yoon-Nma Kim, Chung Mo Nam
    Epidemiology and Health.2014; : e2014027.     CrossRef
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