Epidemiology and Health

Brief Communication

Epidemiological evidences on overdiagnosis of prostate and kidney cancers in Korean: Jong-Myon Bae; Epidemiol Health. 2015;37:e2015015. Published online March 7, 2015; DOI: https://doi.org/10.4178/epih/e2015015

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Abstract

OBJECTIVES
The prostate specific antigen test is widely used as the main method of screening prostate cancer in Korea. Additionally, the use of ultrasound sonography may lead to overdiagnosis of kidney cancer as well as thyroid cancer. This study aimed to highlight epidemiological evidences regarding overdiagnosis of prostate and kidney cancers in Korean.

METHODS

The annual trends of national incidence and mortality of prostate and kidney cancers provided by the Korean Statistical Information Service were evaluated.

RESULTS

The rate of increase in the incidence of prostate and kidney cancer was 6 and 5 times higher than that of mortality between 2000 and 2011, respectively. Additionally, the age group showing the highest incidence in prostate cancer shifted from 85 years and older to 75-79 years.

CONCLUSIONS

This evidence suggests that prostate and kidney cancers are overdiagnosed in Korea. Further research in this area, using national cancer registry databases, should be encouraged to prevent overdiagnosis.

Summary

Korean summary
갑상선암의 과진단은 목초음파검사의 시행에 따른 것이란 주장에 따라, 전립선암과 신장암은 각각 전립선특이항원검사와 복부초음파검사의 시행에 따라 과진단이 있을 것으로 예상된다. 과진단의 여부는 검사 시행 이후 발생률이 증가하는 반면, 사망률은 변동이 없는 것으로 판단할 수 있다. 통계청의 해당 암 발생률과 사망률 추이를 살펴볼 때, 국내에서도 전립선암과 신장암에서 과진단이 있음을 확인할 수 있었다.

Citations

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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

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Abstract Summary PDF Supplementary 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.

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Original Article

Cardiovascular Risk Factors for Incident Hypertension in the Prehypertensive Population: Soo Jeong Kim, Jakyoung Lee, Sun Ha Jee, Chung Mo Nam, Kihong Chun, Il Soo Park, Soon Young Lee; Epidemiol Health. 2010;32:e2010003. Published online May 1, 2010; DOI: https://doi.org/10.4178/epih/e2010003

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Abstract PDF

Abstract

<sec><title>OBJECTIVES</title>The aim of this study was to investigate the effect of changes in cardiovascular disease (CVD) risk factors on progression from prehypertension (PreHTN) to hypertension (HTN) using an 8-yr prospective Korean Cancer Prevention Study (KCPS) by the National Health Insurance Corporation (NHIC) in Korea.</sec><sec><title>METHODS</title>A total of 16,229 subjects, aged 30 to 54, with new onset preHTN at baseline (1994-1996) in a biennial national medical exam were selected and followed up till 2004 at 2-yr intervals. All subjects underwent a biennial health examination including biochemical measurements and behavior. The log-rank test was performed to assess the relationship between changes in CVD risk factors and progression to HTN. The Cox proportional hazard model was used to identify factors influencing progression to HTN.</sec><sec><title>RESULTS</title>With regards the progression rate in men, ex-smokers (42.9%), abstainers (37.5%), and regular exercisers (37.6%) showed a slower progression rate than continuous smokers (49.5%) and continuous drinkers (50.9%). In women, those who participated in regular exercise (22.6%) had a lower rate of progression than continuous non-exercisers (36.1%). According to the results of the Cox proportional hazard model, improvements in smoking (hazard ratio [HR], 0.756), drinking (HR, 0.669), regular exercise (HR, 0.653), body mass index (HR, 0.715), and total cholesterol (HR, 0.788) played a protective role in progression to HTN in men, while in women, participating in regular exercise (HR, 0.534) was beneficial.</sec><sec><title>CONCLUSION</title>Improvements in CVD-related behaviors diminished the progression rate of HTN. This study suggests that individuals with PreHTN should be targeted for specific health behavioral intervention to prevent the progression of HTN.</sec>

Summary

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