Epidemiology and Health

COVID-19: Brief Communication

Excess mortality from gastric cancer in Korea during the COVID-19 pandemic, 2020–2023: Gyeongil Kim, Ji-Yeon Shin, Yu-Mi Lee, Duk-Hee Lee; Epidemiol Health. 2026;48:e2026021. Published online May 26, 2026; DOI: https://doi.org/10.4178/epih.e2026021

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Abstract Summary PDF: Abstract
The coronavirus disease 2019 (COVID-19) pandemic substantially disrupted cancer care, leading to declines in screening, diagnosis, and treatment. Gastric cancer is particularly vulnerable to such disruptions because reductions in mortality depend largely on early detection and timely treatment. This study estimated excess mortality from gastric cancer in Korea during the COVID-19 pandemic. Expected gastric cancer deaths during the pandemic were estimated by applying linear regression to age-specific mortality trends from 2015 to 2019. Excess mortality was quantified using annual P-scores. Gastric cancer mortality declined steadily before the pandemic, but this decline attenuated during the pandemic period. Annual P-scores increased progressively, from +3.8% in 2020 and +5.5% in 2021 to +10.6% in 2022 and +20.7% in 2023. By age group, individuals aged 60–79 years showed the largest increases, reaching +46.6% in 2023, whereas minimal excess mortality was observed among those aged 20–59 years. Among adults aged ≥80 years, excess mortality became apparent only in 2023 (+12.8%). Overall, a progressive increase in excess mortality due to gastric cancer was observed in Korea during the COVID-19 pandemic, particularly among individuals aged 60–79 years. These findings suggest that the pandemic adversely affected gastric cancer control and underscore the need for continued monitoring.; Summary

Korean summary
- 코로나19 팬데믹은 암의 조기진단과 적기 치료에 큰 영향을 미친 것으로 알려져 있으며, 위암은 이러한 조기진단과 치료 여부에 따라 예후가 크게 좌우되는 대표적인 암종이다. - 본 연구는 팬데믹 이전(2015~2019년) 연령별 위암 사망률 추이를 바탕으로 2020~2023년의 기대사망자 수를 추정하고, 이를 이용하여 팬데믹 기간 동안 한국의 위암 초과사망을 P-score로 산출하였다. - 팬데믹 이전에는 한국의 연령표준화 위암 사망률이 뚜렷한 감소 추세를 보였으나, 팬데믹 기간 동안 이러한 감소 추세가 둔화되었다. 위암 초과사망은 2020년 3.8%에서 2023년 20.7%까지 지속적으로 증가하였으며, 이러한 증가는 주로 60~79세 연령군에서 관찰되었다.

Key Message
- The COVID-19 pandemic disrupted cancer screening and treatment, particularly for gastric cancer, where early diagnosis is critical for survival. - Using age-specific gastric cancer mortality trends from 2015–2019, we estimated expected deaths during 2020–2023 and quantified excess mortality in South Korea using P-scores. - The pre-pandemic decline in age-standardized gastric cancer mortality slowed during the pandemic. Excess mortality increased from 3.8% in 2020 to 20.7% in 2023, with the largest increases observed among adults aged 60–79 years.

Original Articles

Socioeconomic inequality in organized and opportunistic screening for breast cancer: results from the Korean National Cancer Screening Survey, 2009-2021: Yejin Ha, Xuan Quy Luu, Woorim Kim, Jae Kwan Jun, Mina Suh, Kui Son Choi; Epidemiol Health. 2025;47:e2025031. Published online May 30, 2025; DOI: https://doi.org/10.4178/epih.e2025031

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Abstract

OBJECTIVES
Breast cancer screening rates have increased since the introduction of the National Cancer Screening Program (NCSP) in Korea. However, it remains unclear whether socioeconomic inequalities have improved, particularly according to screening type. This study investigated inequalities in organized (government-led) and opportunistic (individually initiated) screening, stratified by education and income levels.

METHODS

Data were obtained from the Korean National Cancer Screening Survey, conducted annually from 2009 to 2021, involving approximately 1,700 women each year except in 2009. Trends were analyzed using joinpoint regression to calculate average annual percent changes (AAPCs). Socioeconomic inequalities were assessed using the slope index of inequality (SII) and relative index of inequality (RII).

RESULTS

Organized screening rates increased from 42.0% in 2009 to 60.2% in 2021 (AAPC, 1.9; 95% confidence interval [CI], 0.7 to 3.4), whereas opportunistic screening rates declined from 13.3% to 11.2% (AAPC, -5.4; 95% CI, -8.7 to -2.3). For organized screening, individuals with lower education levels exhibited higher participation, resulting in negative inequality indices (SII, -5.37%; RII, 0.80). No significant income-based inequality was found (SII, 1.60%; RII, 1.07). However, opportunistic screening demonstrated significant inequalities by both education (SII, 5.37%; RII, 1.92) and income (SII, 5.90%; RII, 1.96), with higher participation rates among more advantaged groups.

CONCLUSIONS

The NCSP has improved breast cancer screening rates and reduced income-related inequality in organized screening. However, educational and income-based inequalities persist in opportunistic screening. To reduce screening inequities, policy efforts are needed to further promote the NCSP, including improving program quality and providing financial support for follow-up examinations.

Summary

Korean summary
본 연구는 한국의 유방암 검진에서 검진 유형에 따른 사회경제적 불평등을 분석하였다. 국가 검진에서는 전체 수검률이 증가하고 소득 관련 불평등이 감소한 반면 개인 검진에서는 사회경제적 불평등이 여전히 존재하였다. 유방암 검진의 불평등을 줄이기 위해 지속적이고 집중적인 정책 노력이 필요하다.

Key Message
This study examined socioeconomic inequality in breast cancer screening in Korea by screening type. While organized screening has improved overall participation and reduced income-related inequality, socioeconomic inequalities remain in opportunistic screening. Continued and targeted policy efforts for the NCSP are necessary to further reduce inequality in breast cancer screening.

Citations

Citations to this article as recorded by

Income-related Inequalities in Cancer Screening Among Korean Adults Aged 40 and Above: A Cross-sectional Analysis of the Age-varying Mediation of Health Literacy
Hyejin Hong, Hyun-Jin Goo, Hyebin Choi, Sin Kam, Jong-Yeon Kim
Journal of Preventive Medicine and Public Health.2026; 59(2): 184. CrossRef

Influence of practice location on prescribing, diabetes care, and colorectal cancer screening among Czech general practitioners during the COVID-19 pandemic: Jan Bělobrádek, Luděk Šídlo, Tom Philipp; Epidemiol Health. 2024;46:e2024033. Published online February 23, 2024; DOI: https://doi.org/10.4178/epih.e2024033

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Abstract

OBJECTIVES
The provision of primary health care was not interrupted during the coronavirus disease 2019 (COVID-19) pandemic in Czechia, although the capacity and resources of providers changed. We examined how the pandemic affected individual general practices throughout 2017-2021, focusing on differences between urban and rural practices.

METHODS

We analysed data from the largest health insurance company in Czechia, which provides care to 4.5 million people (60% of the population). We evaluated the prescription volume, diabetes care procedures, and faecal immunochemical test (FIT) in preventive care and new pandemic-related procedures (remote consultations, testing, and vaccinations). For the spatial distribution of practices, we adapted the Organisation for Economic Cooperation and Development typology.

RESULTS

We observed minimal declines in 2020 in the rate of prescribing (-1.0%) and diabetes care (-5.1%), with a rapid resumption in 2021, but a substantial decline in FIT (-17.8% in 2020) with slow resumption. Remote consultations were used by 94% of all practices regardless of location, with testing and vaccinations more commonly performed by rural general practitioners (GPs).

CONCLUSIONS

Primary care in Czechia rose to the challenge of the COVID-19 pandemic, as shown by the finding that the volume of healthcare services provided through primary care did not decrease across most of the monitored parameters. This study also confirmed that rural GPs provide more care in-house, both in terms of prescribing and procedures performed in their practices. Future studies will need to focus on preventive care, which the pandemic has dampened in GP practices in Czechia.

Summary

Key Message
Primary care in Czechia has effectively adapted to the changes brought about by the COVID-19 pandemic. Minimal impact was observed in prescribtions and diabetic patient care. There was a significant decline in colorectal cancer screening, with a slow restitution after the pandemic subsided. Rural GPs consistently provided in-house treatment and have higher shares of both prescribing and diabetes care, as well as performing more COVID-19 specific procedures.

Citations

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Geographical Disparities in Faecal Immunochemical Test‐Based Colorectal Cancer Screening Participation and Positivity Rates: A Systematic Review and Meta‐Analysis
Melkalem Mamuye Azanaw, Erin L. Symonds, Geraldine Laven‐Law, Wudneh Simegn Belay, Syme Aftab, Muktar B. Ahmed, Molla M. Wassie
Health Promotion Journal of Australia.2026;[Epub] CrossRef
Effect of Age, Practice Location and Covid-19 on the Use of POCT Methods by General Practitioners in Czechia in 2017–2021
Jan Bělobrádek, Luděk Šídlo, Tom Philipp
Acta Medica (Hradec Kralove, Czech Republic).2025; 68(3): 87. CrossRef

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 Summary PDF Supplementary Material

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

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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
Changes in Uptake, Participant Disparities, and Screening Outcomes of the Korean National Lung Cancer Screening Program: A Five-Year Experience
Chang Kyun Choi, Na-Young Lee, Mina Suh, Kui Son Choi, Yeol Kim
Cancer Research and Treatment.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

Cohort Profile

Integrated database-based Screening Cohort for Asian Nomadic descendants in China (Scan-China): Insights on prospective ethnicity-focused cancer screening: Yuelin Yu, Liying Qiao, Jing Han, Weiwei Wang, Weiwei Kang, Yunjing Zhang, Shu Shang, Ruogu Meng, Lin Zhuo, Siyan Zhan, Yunfeng Xi, Shengfeng Wang; Epidemiol Health. 2023;45:e2023048. Published online April 18, 2023; DOI: https://doi.org/10.4178/epih.e2023048

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Abstract

Established in 2017, the Screening Cohort for Asian Nomadic descendants in China (Scan-China) has benefited over 180,000 members of a multi-ethnic population, particularly individuals of Mongolian descent compared with the general population (Han ethnicity), in the Inner Mongolia Autonomous Region, China. This cohort study aims to evaluate the effectiveness of cancer screening and serve as a real-world data platform for cancer studies. The 6 most prevalent cancers in China are considered—namely, breast, lung, colorectal, gastric, liver and esophageal cancer. After baseline cancer risk assessments and screening tests, both active and passive follow-up (based on the healthcare insurance database, cancer registry, the front page of hospital medical records, and death certificates) will be conducted to trace participants’ onset and progression of cancers and other prevalent chronic diseases. Scan-China has preliminarily found a disproportionately lower screening participation rate and higher incidence/mortality rates of esophageal and breast cancer among the Mongolian population than among their Han counterparts. Further research will explore the cancer burden, natural history, treatment patterns, and risk factors of the target cancers.

Summary

Key Message
- Scan-China is the first and largest electronic health data (EHD)-integrated cancer screening program for the Mongolian ethnicity in Inner Mongolia. - Scan-China aims to evaluate the effectiveness of screening interventions, particularly on ethnic minorities, portray the natural history, explore risk factors and summarize treatment patterns and updated outcomes of prevalent tumors/other chronic diseases. - Scan-China database comprises baseline cancer risk assessment, screening tests results, active follow-up investigation for participants at high risk and EHD-integrated passive follow-up. Data sources for passive follow-up include healthcare insurance database, cancer registry, front page of hospital medical record and death certificates.

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Comparison of survival outcomes between kidney transplant and dialysis in patients with previous cancer
Guohua He, Yunfeng Xi, Xiaoyun Jiang, Liying Qiao, Yunjing Zhang, Weiwei Kang, Lu Xu, Yingzi Yang, Huziwei Zhou, Guozhen Liu, Mingyuan Wang, Shengfeng Wang
Chinese Medical Journal.2026; 139(10): 1521. CrossRef
Pronounced ethnic and sex disparities in gastric cancer burden and healthcare utilization in Inner Mongolia: a 9-year population-based cohort study
Yuehan Duan, LiYing Qiao, Yunfeng Xi, Buqi Na, Weiwei Kang, Guozhen Liu, Yutong Wang, Sheng-feng Wang
Gastric Cancer.2026; 29(4): 702. CrossRef
Higher disease burden and lower utilization in Mongolian with breast cancer: a 9-year retrospective cohort study of 18.19 million adults in China
Jieying Chen, Liying Qiao, Meng Qi, Yunjing Zhang, Ying Yan, Weiwei Kang, Huziwei Zhou, Yuelin Yu, Yalei Ke, Yuling Jiang, Yingting Rao, Lu Xu, Guohua He, Jing Ren, Xue Yan, Siwei Deng, Xinyu Yang, Yutong Song, Yingzi Yang, Qiaorui Wen, Jing Han, Yiwei Wu
International Journal of Surgery.2024; 110(8): 4588. CrossRef

Original Articles

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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Supplemental automated breast ultrasound in negative screening mammography: early-stage cancer detection in dense breasts with limited yield in non-dense breasts
Soo-Yeon Kim, Sung Eun Song, Min Sun Bae, Kyu Ran Cho, Bo Kyoung Seo, Ok Hee Woo
Ultrasonography.2026; 45(1): 18. CrossRef
Breast cancer burden among women of reproductive age in China, Japan, and South Korea, 1990–2021: a systematic analysis from the Global Burden of Disease Study 2021
Zhiyuan Rong
International Journal of Clinical Oncology.2026; 31(4): 579. CrossRef
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
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Tung Hoang, Jeonghee Lee, So‐Youn Jung, Jeongseon Kim
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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
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Value in Health Regional Issues.2025; 48: 101112. CrossRef
Socioeconomic inequality in organized and opportunistic screening for breast cancer: results from the Korean National Cancer Screening Survey, 2009-2021
Yejin Ha, Xuan Quy Luu, Woorim Kim, Jae Kwan Jun, Mina Suh, Kui Son Choi
Epidemiology and Health.2025; 47: e2025031. CrossRef
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Jinwook Bahk, Hee-Yeon Kang, Young-Ho Khang, Kyunghee Jung-Choi
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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 PDF Supplementary 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

Citations

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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.

Citations

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Chiung-Shuan Huang, Bo-Yu Hsiao, Mei-Hsuan Wu, Chun-Ju Chiang, Pei-Chun Hsieh, Mei-Ju Chen, Wen-Fang Cheng, Wen-Chung Lee
Annals of Epidemiology.2025; 106: 75. CrossRef
Age and socioeconomic disparities in cervical cancer incidence and mortality: a SEER-based analysis
Yuyi Ou, Santosh Chokkakula, Sio Mui Chong, Hao Wang, Andrew In-Cheong Si, Yong Jiang, Liying Huang, Xiaohua Xu, Chengliang Yin, Jun Lyu, Xiaobin Huang, Hui-ling Shang
Frontiers in Public Health.2025;[Epub] CrossRef
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Kyeongmin Lee, Mina Suh, Kui Son Choi
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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

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

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Abstract Summary PDF Supplementary 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

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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 Summary PDF Supplementary Material

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.

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Melkalem Mamuye Azanaw, Erin L. Symonds, Geraldine Laven‐Law, Wudneh Simegn Belay, Syme Aftab, Muktar B. Ahmed, Molla M. Wassie
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The classification capability of the Asia Pacific Colorectal Screening score in Korea: an analysis of the Cancer Screenee Cohort: Xuan Quy Luu, Kyeongmin Lee, Jeongseon Kim, Dae Kyung Sohn, Aesun Shin, Kui Son Choi; Epidemiol Health. 2021;43:e2021069. Published online September 16, 2021; DOI: https://doi.org/10.4178/epih.e2021069

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
This study aimed to validate a simple risk assessment tool for estimating the advanced colorectal neoplasia (ACN) risk at colonoscopy screenings and potential factors relevant for implementing this tool in the Korean population.

METHODS

Our study analyzed data from the Cancer Screenee Cohort Study conducted by the National Cancer Center in Korea. The risk level was assessed using the Asia Pacific Colorectal Screening (APCS) score developed by the Asia-Pacific Working Group on Colorectal Cancer. Logistic regression models were used to examine the associations between colorectal-related outcomes and the risk level by APCS score. The discriminatory performance of the APCS score for various colorectal-related outcomes was assessed using C-statistics.

RESULTS

In 12,520 individuals, 317 ACN cases and 4,528 adenoma cases were found. The APCS tool successfully classified the study population into different risk groups, and significant differences in the ACN rate and other outcomes were observed. The APCS score demonstrated acceptable discrimination capability with area under the curve values ranging from 0.62 to 0.65 for various outcomes. The results of the multivariate logistic regression model revealed that the high-risk group had a 3.1-fold higher risk of ACN (95% confidence interval, 2.08 to 4.67) than the average-risk group. Body mass index (BMI) was identified as a significant predictor of ACN in both multivariate and subgroup analyses.

CONCLUSIONS

Our study highlighted significant differences in colorectal-related screening outcomes by colorectal risk level measured using the APCS score, and BMI could be used to improve the discriminatory capability of the APCS score.

Summary

Korean summary
검진의 위해성을 줄이면서 동시에 이득을 최대화할 수 있는 최적의 검진 프로그램은 암 발생 위험도를 고려하는 것이다. 이 연구는 Asia-Pacific Working Group on Colorectal Cancer에서 제안한 “Asia Pacific Colorectal Screening Score (APCS)”가 한국인에서 대장암 발생 위험도를 선별적으로 잘 구분해 낼 수 있음을 보여주었다. 나아가 대장암의 위험도 점수를 산출하는데 체질량지수가 중요한 예측 변수라는 것을 확인하였고, 한국인에서 대장암 발생 위험도의 변별력을 향상시키기 위해 기존의 APCS에 체질량지수를 추가할 것을 제안하였다.

Key Message
This study highlighted that the Asia Pacific Colorectal Screening Score by the Asia-Pacific Working Group on Colorectal Cancer could successfully classify Korean screenees into different risk groups with acceptable discriminatory capability. Furthermore, our study results also suggest that BMI is a significant predictor of colorectal-related health outcomes, which could be potentially added to the original APCS score for improving its discriminatory power.

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Editorial

Current status of hepatitis C virus infection and countermeasures in South Korea: Sook-Hyang Jeong, Eun Sun Jang, Hwa Young Choi, Kyung-Ah Kim, Wankyo Chung, Moran Ki; Epidemiol Health. 2017;39:e2017017. Published online April 13, 2017; DOI: https://doi.org/10.4178/epih.e2017017

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Abstract

Hepatitis C virus (HCV) infection is a major cause of liver cirrhosis, hepatocellular carcinoma, and liver-related mortality. The new antiviral drugs against HCV, direct acting antivirals, result in >90% cure rate. This review aimed to summarize the current prevalence, clinical characteristics, outcomes, and treatment response associated with HCV infection, and countermeasures for optimal HCV control in South Korea. Based on a literature review, the current anti-HCV prevalence in the Korean population is 0.6 to 0.8%, with increasing prevalence according to age. The major HCV genotypes in Korean patients were genotype 1b and genotype 2. Successful antiviral treatment leads to significantly reduced liver related complications and mortality. However, only about one third of the individuals with HCV infection seem to be managed under the current national health insurance system, suggesting a remarkable rate of underdiagnoses and subsequent loss of opportunity to cure. A recent study in South Korea showed that targeted population screening for HCV infection is cost-effective. To prevent recently developed clusters of HCV infection in some clinics, mandatory surveillance rather than sentinel surveillance for HCV infection is required and governmental countermeasures to prevent reuse of syringes or other medical devises, and public education should be maintained. Moreover, one-time screening for a targeted population should be considered and a cost-effectiveness study supporting an optimal screening strategy is warranted.

Summary

Korean summary
우리나라 C형간염 유병률은 1% 미만(0.6-0.8%)이며, 수혈에 의한 C형간염은 더 이상 발생하지 않을 것으로 보인다. 그러나 최근 의료기관에서 C형간염 집단감염이 발생하여 국가적 대응이 필요한 공중보건의 문제로 떠올랐다. 2016년 부터는 C형간염을 완치할 수 있는 효과적이고 안전한 약제가 건강보험급여로 인정되어 이미 진단된 환자들에서는 효과적인 치료가 시작되었다. 그러나 진단되지 않은 상태에서 간질환이 진행되고 있는 환자들을 발굴하기 위해 국가 검진체계와 연계하여 선별검사를 시행한다면, 단기적으로는 진단과 치료비용 부담이 커지겠지만 장기적으로 사망률을 감소시키고, 삶의 질을 높이는 비용효과적인 C형간염 퇴치 전략이 될 것이다.

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Review

The criteria for metabolic syndrome and the national health screening and education system in Japan: Kazumasa Yamagishi, Hiroyasu Iso; Epidemiol Health. 2017;39:e2017003. Published online January 6, 2017; DOI: https://doi.org/10.4178/epih.e2017003

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Abstract

Two major definitions of metabolic syndrome have been proposed. One focuses on the accumulation of risk factors, a measure used by the American Heart Association (AHA) and the National Heart, Lung, and Blood Institute (NHLBI); the other focuses on abdominal obesity, a measure used by the International Diabetes Federation (IDF) and the Japanese government. The latter definition takes waist circumference (WC) into consideration as an obligatory component, whereas the former does not. In 2009, the IDF, NHLBI, AHA, and other organizations attempted to unify these criteria; as a result, WC is no longer an obligatory component of those systems, while it remains obligatory in the Japanese criteria. In 2008, a new Japanese cardiovascular screening and education system focused on metabolic syndrome was launched. People undergoing screening are classified into three groups according to the presence of abdominal obesity and the number of metabolic risk factors, and receive health educational support from insurers. This system has yielded several beneficial outcomes: the visibility of metabolic syndrome at the population level has drastically improved; preventive measures have been directed toward metabolic syndrome, which is expected to become more prevalent in future generations; and a post-screening education system has been established. However, several problems with the current system have been identified and are under debate. In this review, we discuss topics related to metabolic syndrome, including (1) the Japanese criteria for metabolic syndrome; (2) metabolic syndrome and the universal health screening and education system; and (3) recent debates about Japanese criteria for metabolic syndrome.

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Original Article

Community mental health status six months after the Sewol ferry disaster in Ansan, Korea: Hee Jung Yang, Hae Kwan Cheong, Bo Youl Choi, Min-Ho Shin, Hyeon Woo Yim, Dong-Hyun Kim, Gawon Kim, Soon Young Lee; Epidemiol Health. 2015;37:e2015046. Published online October 23, 2015; DOI: https://doi.org/10.4178/epih/e2015046

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The disaster of the Sewol ferry that sank at sea off Korea’s southern coast of the Yellow Sea on April 16, 2014 was a tragedy that brought grief and despair to the whole country. The aim of this study was to evaluate the mental health effects of this disaster on the community of Ansan, where most victims and survivors resided.

METHODS

The self-administered questionnaire survey was conducted 4 to 6 months after the accident using the Korean Community Health Survey system, an annual nationwide cross-sectional survey. Subjects were 7,076 adults (≥19 years) living in two victimized communities in Ansan, four control communities from Gyeonggi-do, Jindo and Haenam near the accident site. Depression, stress, somatic symptoms, anxiety, and suicidal ideation were measured using the Center for Epidemiologic Studies-Depression Scale, Brief Encounter Psychosocial Instrument, Patient Health Questionnaire-15, and Generalized Anxiety Disorder 7-Item Scale, respectively.

RESULTS

The depression rate among the respondents from Ansan was 11.8%, and 18.4% reported suicidal ideation. Prevalence of other psychiatric disturbances was also higher compared with the other areas. A multiple logistic regression analysis revealed significantly higher odds ratios (ORs) in depression (1.66; 95% confidence interval [CI], 1.36 to 2.04), stress (1.37; 95% CI, 1.10 to 1.71), somatic symptoms (1.31; 95% CI, 1.08 to 1.58), anxiety (1.82; 95% CI, 1.39 to 2.39), and suicidal ideation (1.33; 95% CI, 1.13 to 1.56) compared with Gyeonggi-do. In contrast, the accident areas of Jindo and Haenam showed the lowest prevalence and ORs.

CONCLUSIONS

Residents in the victimized area of Ansan had a significantly higher prevalence of psychiatric disturbances than in the control communities.

Summary

Korean summary
본 연구는 2014년 4월 16일 발생한 세월호 침몰 사고가 지역사회의 정신건강 수준에 미친 영향을 평가하기 위해 실시하였다. 2014년 지역사회건강조사를 활용, 사고 후 6개월 시점에 조사를 시행하였다. 대부분의 희생자가 발생한 안산시 대상자의 11.8%가 우울군으로 분류되었으며, 18.4%가 자살생각을 호소하였고, 그 밖의 유병률도 대조 지역에 비해 높았다.

Citations

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Health Statistics

Changing trends in colorectal cancer in the Republic of Korea: contrast with Japan: Minjoo Yoon, Nicholas Kim, Byungho Nam, Jungnam Joo, Moran Ki; Epidemiol Health. 2015;37:e2015038. Published online August 17, 2015; DOI: https://doi.org/10.4178/epih/e2015038

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Abstract Summary PDF

Abstract

Colorectal cancer has a high worldwide incidence. Japan, a country that is geographically and culturally similar to the Republic of Korea (here after Korea), has recently reported a decreasing trend in the incidence of colorectal cancer. However, Korea had the highest incidence of colorectal cancer among Asian countries in 2012. Our aim was to observe the changing trends in incidence and mortality of colorectal cancer in Korea and to compare them to those in Japan. Incidence data were collected from the Korean Central Cancer Registry and mortality data were collected from Korean Statistical Information Service. Incidence and mortality data on colorectal cancer in Japan were acquired from the National Cancer Center in Japan. Age-standardized incidence and mortality rates were determined based on Segi’s world population. Screening data from both countries were collected from the national cancer center in each country. In Korea, the age-standardized incidence rate of colorectal cancer in both sexes was 20.9 to 38.0 per 100,000 from 1999 to 2012 and the rate in males increased more dramatically than in females. In addition, the increase between 2002 and 2012 was first observed in the age group over 40. In Japan, the incidence of colorectal cancer has been more constant over recent years than in Korea. The age-standardized mortality rate of colorectal cancer in both sexes in Korea was 8.5 to 9.3 per 100,000 from 2000 to 2013, and the trend in mortality was constant during this period. In Japan, the mortality rate decreased slightly during the same period. Crude screening rates were increased overall in both Korea and Japan during the period studied. Since the incidence of colorectal cancer has increased in Korea, the control of this cancer is an important public health issue. As Japan has achieved a reduction in colorectal cancer, adjustment of Korea’s current systems for screening and treatment of colorectal cancer according to those of Japan may contribute to improved colorectal cancer control in Korea.

Summary

Korean summary
우리나라와 지리적, 문화적으로 가까운 일본은 대장암 발생 및 사망이 감소하고 있는 반면, 한국의 대장암 발생은 증가하는 추세이다. 본 연구는 한국의 대장암 발생 및 사망의 경향을 관찰하고, 이를 일본의 경우와 비교하고자 한다

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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 Summary PDF Supplementary Material

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.

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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

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

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

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Abstract 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

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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

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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

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Methods

Methodological issues for determining intervals of subsequent cancer screening: Jong-Myon Bae; Epidemiol Health. 2014;36:e2014010. Published online July 30, 2014; DOI: https://doi.org/10.4178/epih/e2014010

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Abstract

The gap between nationwide recommendations of cancer screening and the related evidences obtained from Korean adults should be filled. Estimation of the mean sojourn time (MST) in a specific cancer is important to determine the intervals of subsequent screening. This author arranged the methods for calculating MST into 5 categories based on the parameters used. Under the legal barrier for protection of individual privacy and confidentiality in a Korean academic situation, the methods involving the use of transition rates or prevalence/incidence ratio would be applicable among these methods.

Summary

Korean summary
국가 암조기 검진사업에서 제시하는 검진지침은 우리나라 국민을 대상으로 한 역학연구 결과에 근거하여 개발해야 한다. 특정 암에 대한 조기검진 지침에는 검진방법, 시작 및 종료 연령과 함께 검사 주기를 담아야 한다. 이중 반복검사의 간격은 해당 암의 평균체류기간을 산출하여 결정한다. 저자는 특정 암의 평균체류기간을 구하는 방법을 5가지로 분류하여 제시하였다. 또한 현재 개인정보 보호를 강조하는 여건에서 수행이 가능한 방법을 검토하였다.

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Original Article

Risk Factors for Group B Streptococcus Colonization Among Pregnant Women in Korea: Eun Ju Kim, Kwan Young Oh, Moon Young Kim, Yong Soo Seo, Jung-Hwan Shin, Young Rae Song, Jae-Hyug Yang, Betsy Foxman, Moran Ki; Epidemiol Health. 2011;33:e2011010. Published online November 11, 2011; DOI: https://doi.org/10.4178/epih/e2011010

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Abstract

<sec><title>OBJECTIVES</title>To identify obstetric and maternal factors related to Group B Streptococcus (GBS) colonization in pregnant women in Korea.</sec><sec><title>METHODS</title>The study was conducted between the years 2006-2008 in four hospitals, Cheil and Eulji hospital in Seoul, and Motae and Eulji hospital in Daejeon. We recruited 2,644 pregnant women between 35 to 37 weeks of gestation who had visited for antenatal care. Participants completed a questionnaire, and urine, vaginal and rectal specimens were obtained and cultured using selective broth media. After delivery, medical records were reviewed.</sec><sec><title>RESULTS</title>GBS colonization was significantly associated with hospital, age group, education, frequency of pregnancy, and premature rupture of membranes (PROM, more than 18 hours). After adjustment for other variables, Cheil hospital (odds ratio [OR], 2.05; 95% confidence interval [CI], 1.20-3.52), and the first pregnancy (OR, 2.32; 95% CI, 1.12-4.81) remained significant. History of vaginitis showed marginal significance (OR, 1.50; 95% CI, 0.98-2.29).</sec><sec><title>CONCLUSION</title>To prevent GBS infection of neonates, clinicians should be alert to the potentially higher risk of GBS colonization in pregnant women in their first pregnancy, and women with premature rupture of membranes (PROM) (18 hours+) or who have a history of vaginitis.</sec>

Summary

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Note

Bias in Cancer Screening Evaluation.: Sang Heon Yoon, Hyeon Woo Yim, Won Chul Lee; Korean J Epidemiol. 2008;30(1):12-24. Published online June 30, 2008; DOI: https://doi.org/10.4178/kje.2008.30.1.12

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Abstract

Cancer screening evaluation will be a important issue in Korea in near future. Bias in cancer screening evaluation is well known by concept, but it is not applied yet using the data from screening program of Korea. So introducing the way how the bias is adjusted will be helpful. This review deals with the type, meaning, the way how the bias is adjusted, and examples. Especially, lead-time bias, length bias and self-selection bias were focused. Adjusting bias is one of the imperative step for epidemiologic analysis. Understanding the background concept and experience using the screening program data will be helpful for estimating the effectiveness of national screening program of Korea.

Summary

Citations

Citations to this article as recorded by

Evidence-based National Cancer Screening program of Korea
Won-Chul Lee
Journal of the Korean Medical Association.2011; 54(10): 1028. CrossRef

Original Articles

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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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

A Study on the Behavioral Factors Related to Stomach Cancer Screening among Adults in a Rural Area.: Young Bok KIM, Won Chul Lee; Korean J Epidemiol. 1999;21(1):20-30.

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The purpose of this study was to investigate the behavioral factors related to stomach cancer screening among adults in a rural area. The number of subjects were 270 who were consisted of 133(49.3%) of male and 137(50.7%) of female. To predict the behavior, we used the health belief model. Using methodology was self-questionnaire which included the perceived health status, the severity for stomach cancer, preventive knowledge for stomach cancer, the threat for stomach cancer, the experience of cue to action, the benefit of cancer screening and the barrier of participating screening. The associations between the behavioral factors and the experience and intention of examination of endoscopy were evaluated by the odds ratio(OR). The results were as follows : 1. 78.1% of subjects responded that they had the good health, and 56.3% of them perceived the severity of stomach cancer. The 49.6% of them were evaluated as the moderate on the preventive knowledge for stomach. Also 39.3% had the threat for stomach cancer, and 79.2% had the experience of cue to action. The almost of respondents thought the endoscopy as available method for stomach cancer screening. The major barrier factors on stomach cancer screening were fear to endoscopy, discomfort for endoscopy, high cost of examination and lack of time. 2. Although the experience for examination of endoscopy was showed to the difference by sex, age, educational level and BMI, it was not significant. However, the experience for examination of endoscopy was showed to the significant difference by the perceived health status(OR:3.47, 95% CI:1.27-9.51), the preventive knowledge for stomach cancer(OR:0.42, 95% CI:0.19-0.96) and the experience of cue to action(OR:2.57, 95% CI:1.05-6.34). 3. Also although the intention for examination of endoscopy was showed to the differences by sex, age and BMI, it was not significant. However, the intention for examination of endoscopy was showed to the significant difference by the benefit for endoscopy(OR:2.35, 95% CI:1.02-5.42) and the experience of stomach cancer screening(OR:3.47, 95% CI:1.78-6.78). In case of the preventive knowledge for stomach cancer and the experience of cue to action, it did not influence to the intention for examination of endoscopy.; Summary

Reviews

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

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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

Current Status of Cancer Screening Rate and Epidemiologic Study for Evaluating the Effectiveness of Cancer Screening in Korea.: Won Chul Lee; Korean J Epidemiol. 1998;20(1):1-9.

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Current status of cancer screening rate and epidemiologic study for evaluating the effectiveness of cancer screening in Korea are reviewed. There are only few studies for an analysis of the current cancer screening status and associated factors in a community. Among these, a study which were done at Uijongbu city, showed the results on follows ; in the case of the screening of the stomach cancer, 16.1% of male subjects and 25.8% of female subjects turned out to have had one or more screenings for the cancer. In the cases of the breast and cervical cancers, 21.6% and 62.6% of the subjects turned out to have had one or more screenings respectively. The main epidemiologic studies which were for cancer screening effectiveness evaluation were case-control studies for stomach, cervix and breast cancer. According to these studies ; odds ratio was 0.71(95% confidence interval 0.36-1.40) for stomach cancer, 0.53(95% confidence interval 0.33-0.85), cervix cancer and 0.43(95% confidence interval 0.25-0.75) for breast cancer. Establishing cancer screening recommendation to promote national cancer control program and increasing cancer screening rate are needed to reach the goal of reducing cancer mortality and morbidity.; Summary

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