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Kim JY, Hong JY, Kim SM, Ryu KH, Kim DS, Lee SH, Na JH, Cho HH, Yu J, Lee J. Socio-economic factors and medical conditions affecting regular stomach cancer screening in Korea: a retrospective longitudinal study using national public health data for 11 years. Public Health 2024; 227:70-77. [PMID: 38128357 DOI: 10.1016/j.puhe.2023.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/03/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE This study aimed to explore socio-economic factors and medical conditions that affect regular stomach cancer (SC) screening among Korean adults. STUDY DESIGN This was a retrospective observational study. METHODS Study subjects were 5545 adults aged ≥40 years who participated in the 2007-2012 Korean National Health and Nutrition Examination Survey and were followed up to year 2017 based on data linking to the Korean National Health Insurance Service and Korean Health Insurance Review and Assessment. Socio-economic factors included sex, age, residential area, education, occupation, marital status, disability, public and private health insurance, service through local public health organizations, history of cancer except for SC, and family history of SC. Medical factors included six gastric lesions with the possibility of facilitating SC screening, including benign gastric neoplasm, chronic atrophic gastritis, gastric polyp, Helicobacter pylori infection, intestinal metaplasia, and peptic ulcers. The outcome was adherence to SC screening, which was divided into non-adherence, irregular adherence, and regular adherence. RESULTS After adjusting for the effects of socio-economic factors, multivariate ordinal logistic regression revealed that participants with a history of four types of gastric lesions were more likely to regularly participate in SC screening: chronic atrophic gastritis (odds ratio [OR] 1.567; 95% confidence interval [CI] = 1.276-1.923), gastric polyps (OR 1.565; 95% CI = 1.223-2.003), H. pylori infection (OR 1.637; 95% CI = 1.338-2.003), and peptic ulcer (OR 2.226; 95% CI 1.750-2.831). CONCLUSIONS To improve participation in SC screening, it is necessary to implement personalized strategies for individuals at risk for gastric cancer in addition to population-based strategies for vulnerable groups.
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Affiliation(s)
- J-Y Kim
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, South Korea; Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang University, Daejeon, South Korea
| | - J Y Hong
- Department of Biomedical Informatics, College of Medicine, Konyang University, Daejeon, South Korea
| | - S M Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, South Korea.
| | - K H Ryu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, South Korea
| | - D S Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, South Korea
| | - S H Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, South Korea
| | - J H Na
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, South Korea
| | - H H Cho
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, South Korea
| | - J Yu
- Medical Data Research group, Konyang University Hospital, Daejeon, South Korea
| | - J Lee
- Medical Data Research group, Konyang University Hospital, Daejeon, South Korea
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Trinh TTK, Lee K, Oh JK, Suh M, Jun JK, Choi KS. Cluster of lifestyle risk factors for stomach cancer and screening behaviors among Korean adults. Sci Rep 2023; 13:17503. [PMID: 37845248 PMCID: PMC10579218 DOI: 10.1038/s41598-023-44470-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023] Open
Abstract
This study aimed to investigate clustering patterns of lifestyle risk factors for stomach cancer and examine the association of risk factor clusters with stomach cancer screening adherence. Data from the 2019 Korean National Cancer Screening Survey, an annual cross-sectional nationwide survey, were used. The study population included 3539 adults aged 40-74 years with no history of cancer. Six stomach cancer risk factors, including smoking, drinking, physical inactivity, obesity, meat intake, and salted food intake, as well as stomach cancer screening behaviors, were assessed. The most frequent risk factor for stomach cancer was physical inactivity, followed by smoking in males and high salted food intake in females. Compared with participants subjects with no risk factors, those with three or more risk factors were less likely to adhere to screening guidelines (males: adjusted odds ratio [aOR] = 0.35, 95% confidence interval [CI] 0.23-0.53; females: aOR = 0.32, 95% CI 0.21-0.48). Our findings indicate a disparity in stomach cancer screening, such that those with more risk factors are less likely to get screened. Increasing public awareness, providing behavioral counseling, and targeting high-risk populations for screening interventions are critical for promoting cancer screening adherence and reducing the disparity in cancer screening.
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Affiliation(s)
- Thao Thi Kim Trinh
- Graduate School of Cancer Science and Policy, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea
| | - Kyeongmin Lee
- Graduate School of Cancer Science and Policy, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea
| | - Jin-Kyoung Oh
- Graduate School of Cancer Science and Policy, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea
- National Cancer Control Institute, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Mina Suh
- Graduate School of Cancer Science and Policy, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea
- National Cancer Control Institute, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Jae Kwan Jun
- Graduate School of Cancer Science and Policy, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea
- National Cancer Control Institute, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea.
- National Cancer Control Institute, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.
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Luu XQ, Lee K, Jun JK, Suh M, Choi KS. Socioeconomic inequality in organized and opportunistic screening for gastric cancer: results from the Korean National Cancer Screening Survey 2009-2022. Front Public Health 2023; 11:1256525. [PMID: 37876718 PMCID: PMC10591186 DOI: 10.3389/fpubh.2023.1256525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/15/2023] [Indexed: 10/26/2023] Open
Abstract
Objectives This study aimed to evaluate the socioeconomic inequality in gastric cancer (GC) screening in Korea. Socioeconomic inequality was assessed using both organized and opportunistic screening according to income and educational level. Methods GC screening data were obtained from the 2009-2022 Korean National Cancer Screening Survey. The final analysis included 47,163 cancer-free men and women. The weighted cancer screening rate was estimated using joinpoint regression. The inequality indices were measured in terms of both the absolute slope index of inequality (SII) and the relative index of inequality (RII) using the Poisson regression model. Results The organized screening rate for GC increased from 38.2% in 2009 to 70.8% in 2022, whereas the opportunistic screening rate decreased from 18.8 to 4.5%. Regarding educational inequality, a negative SII value was observed [-3.5, 95% confidence interval (CI), -7.63-0.83%] in organized screening, while a positive SII (9.30%; 95% CI, 6.69-11.91%) and RII (1.98%; 95% CI, 1.59-2.46) were observed in opportunistic screening. Furthermore, income inequality was not found in organized GC screening; however, overall SII and RII for opportunistic screening were 7.72% (95% CI, 5.39-10.5) and 1.61 (95% CI, 1.42-1.81), respectively. Conclusion Organized screening rates have grown gradually over time and account for the majority of GC screenings in South Korea. While no socioeconomic inequalities were found in organized screening, significant socioeconomic inequalities were found in opportunistic screening.
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Affiliation(s)
- Xuan Quy Luu
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Kyeongmin Lee
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Kui Son Choi
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea
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Huang Z, Liu W, Marzo RR, Hu Z, Wong LP, Lin Y. High-risk population's knowledge of risk factors and warning symptoms and their intention toward gastric cancer screening in Southeastern China. Front Public Health 2022; 10:974923. [PMID: 36033804 PMCID: PMC9403326 DOI: 10.3389/fpubh.2022.974923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/21/2022] [Indexed: 01/25/2023] Open
Abstract
Background As the incidence of gastric cancer (GC) increases sharply in adults aged over 40 years, screening of this high-risk population is important. This study aimed to explore knowledge level of GC related risk factors and symptoms, and to identify influencing factors associated with intention toward GC screening among people aged 40 years old and above in China. Methods A cross-sectional, web-based survey was conducted among people aged 40 years old and above between October 2021 and March 2022 in Southeastern China. The participants' knowledge was assessed by a series of questions about risk factors (24-item scale) and warning symptoms (14-item scale). Results A total of 2547 complete responses were received. The mean age was 47.72 (±7.20) years and near 60% were male. Respondents had a moderate level of knowledge about risk factors and warning symptoms of GC. The total mean knowledge score was 23.9 (±9.8) out of a possible score of 38. Majority (80%) of respondents reported intention to be screened for GC in the next 5 years. The most influential predictors of screening intention were income level (OR = 2.13, 95% CI: 1.36-3.32), perceived benefits (OR = 1.99, 95% CI: 1.33-2.73), perceived severity (OR = 1.68, 95% CI: 1.20-2.34), ever took GC screening (OR = 1.63, 95% CI: 1.28-2.08), perceived poor overall health (OR = 1.59, 95% CI: 1.19-2.11), and perceived barriers (OR = 1.56, 95% CI: 1.17-2.09). Other significant factors were ever diagnosed with chronic gastric diseases, total knowledge score, and cues-to-action. The major reasons for not willing to take screening were "endoscopy is uncomfortable" (29.6%), "worry about screening results" (23.6%), and "have no symptoms" (21.3%). Conclusion High-risk population aged 40 years and above expressed high intention to receive GC screening. Intervention to improve health promotion and reduce the barriers to uptake of GC screening among high-risk populations in China is warranted.
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Affiliation(s)
- Zhiwen Huang
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Wei Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Roy Rillera Marzo
- Department of Community Medicine, International Medical School, Management and Science University, Shah Alam, Selangor, Malaysia,Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia,Roy Rillera Marzo
| | - Zhijian Hu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Li Ping Wong
- Department of Social and Preventive Medicine, Faculty of Medicine, Centre for Epidemiology and Evidence-Based Practice, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Yulan Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China,*Correspondence: Yulan Lin
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Association of Late Marriage and Low Childbirth with Cervical Cancer Screening among Korean Women: Results from a Nationwide Survey. Cancers (Basel) 2022; 14:cancers14020327. [PMID: 35053489 PMCID: PMC8773928 DOI: 10.3390/cancers14020327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/15/2021] [Accepted: 01/08/2022] [Indexed: 11/27/2022] Open
Abstract
Simple Summary Marriage and childbirth may affect adherence to cervical cancer screening. We have examined whether marriage and childbirth were associated with the adherence to cervical cancer screening among young adult women in Korea. Among 3925 women aged 20–39 years, 39.1% undertook cervical cancer screening within two years of eligibility. Compared with unmarried women, married women were more likely to adhere cervical cancer screening (adjusted odds ratio = 2.80, 95% CI: 2.99–3.44). And, as the number of births in married women increased, the adherence to cervical cancer screening increased. Abstract This study aimed to identify the association of marriage and childbirth with the adherence to cervical cancer screening among young adult women. Data across four years (2017–2020) of the cross-sectional Korean National Cancer Screening Survey were used. For measuring the adherence to cervical cancer screening, we used the cervical cancer screening rate with recommendation, which was defined as the percentage of women in the population eligible for screening who have had a cervical cancer screening within the past two years. Multiple logistic regression analysis was conducted to identify the association between marriage and adherence to cervical cancer screening. Overall, 3925 women aged 20–39 years were analyzed. Of these, 39.1% were screened for cervical cancer (26.6% unmarried and 57.1% married women). The married women had significantly higher adherence to cervical cancer screening than unmarried women (adjusted odds ratio = 2.80, 95% CI: 2.99–3.44). Compared with unmarried women, adherence to cervical cancer screening was significantly more likely to increase (p for trend, <0.001) in married women with an increased number of births. Our study confirmed that marriage and childbirth influence adherence to cervical cancer screening, suggesting that unmarried women may be vulnerable to cervical cancer.
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Oswal K, Kanodia R, Pradhan A, Nadkar U, Avhad M, Venkataramanan R, Sethuraman L, Caduff C, Purushotham A. Assessment of Knowledge and Screening in Oral, Breast, and Cervical Cancer in the Population of the Northeast Region of India. JCO Glob Oncol 2021; 6:601-609. [PMID: 32302235 PMCID: PMC7193798 DOI: 10.1200/jgo.19.00257] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE The burden of cancer is increasing globally, with poor outcomes in terms of morbidity and mortality in patients, especially in low- and middle-income countries. Lack of awareness of the risk factors, symptoms, and signs of common cancers in addition to inadequate cancer prevention programs at the community level are a major hindrance to the early detection of cancer. METHODS A cross-sectional study was conducted in the North East Region (NER) of India, with a sample population of 1,400 participants from Assam (n = 1,000), Meghalaya (n = 200), and Nagaland (n = 200). The questionnaire developed for the study consisted of sociodemographic profile, knowledge about cancer (oral, breast, and cervical), its warning signs, risk factors, and attitude toward cancer screening. Statistical analysis was performed using STATA version 13.0. RESULTS Among all the participants, 59% had heard about oral cancer, 50% about breast cancer, and 31% about cervical cancer. A limited understanding of risk factors, symptoms, and signs was reported for oral cancer (45%), breast cancer (54%), and cervical cancer (63%). A total of 34% of participants were aware of cancer screening. Among those who were aware of cancer screening, only six people had undergone any form of cancer screening, and 71% cited media as the major source of information. CONCLUSION The level of cancer awareness is low in the NER. A multipronged approach is needed with assistance from government and nongovernment organizations for training, providing adequate human resources and equipment, and developing cancer screening infrastructure. This needs to be coupled with mass media communication and interpersonal communication through frontline health workers.
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Affiliation(s)
- Kunal Oswal
- Tata Trusts Cancer Care Program, Mumbai, India
| | | | | | | | | | | | | | - Carlo Caduff
- Global Health and Social Medicine, King's College London, London, United Kingdom
| | - Arnie Purushotham
- Tata Trusts Cancer Care Program, Mumbai, India.,King's College London, London, United Kingdom
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Wang J, Ploner A, Sparén P, Lepp T, Roth A, Arnheim-Dahlström L, Sundström K. Mode of HPV vaccination delivery and equity in vaccine uptake: A nationwide cohort study. Prev Med 2019; 120:26-33. [PMID: 30593796 DOI: 10.1016/j.ypmed.2018.12.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 10/31/2018] [Accepted: 12/24/2018] [Indexed: 11/28/2022]
Abstract
Ten years after its introduction, equity in human papillomavirus (HPV) vaccine uptake remains unattained, not least for the groups at highest risk of cervical cancer. In Sweden, three different delivery modes of the vaccine have been in effect since May 2007. We used this as a natural experiment to investigate girls' HPV vaccine uptake in relation to parental country of birth and socioeconomic characteristics, by mode of delivery. Our nationwide study cohort comprised 689,676 girls born between 1990 and 2003. Data on HPV vaccination of the girls and parental birth/socioeconomic characteristics were retrieved from national registers. We examined the association between girls' vaccine uptake and parental characteristics, stratified by mode of delivery. The cumulative uptake of at least one dose of HPV vaccine was 37%, 48% and 79% for subsidised opportunistic, free-of-charge catch-up outside-school and free-of-charge school-based vaccination, respectively. In the subsidised vaccination, having parents born outside of Sweden, with low education and low family income was strongly associated with lower uptake [HR (95% confidence interval (CI)) = 0.49 (0.48-0.50), 0.32 (0.31-0.33), 0.53 (0.52-0.54), respectively]. The associations were partially reduced in catch-up outside-school, and strongly reduced in school-based vaccination delivery [HR (95% CI) =0.82 (0.81-0.83), 0.92 (0.91-0.94), 0.87 (0.85-0.88), respectively]. Free-of-charge school-based HPV vaccination achieved the highest uptake and displayed the least disparity in country of birth and socioeconomic background of the parents. This appears to be the most effective and equitable delivery mode for reaching high population vaccination coverage, including high-risk groups for cervical cancer.
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Affiliation(s)
- Jiangrong Wang
- Dept. of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 65 Stockholm, Sweden; Dept. of Laboratory Medicine, Karolinska Institutet, SE-141 86 Stockholm, Sweden.
| | - Alexander Ploner
- Dept. of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 65 Stockholm, Sweden
| | - Pär Sparén
- Dept. of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 65 Stockholm, Sweden
| | - Tiia Lepp
- Dept. of Communicable Disease Control and Health Protection, Public Health Agency of Sweden, SE-171 81 Solna, Sweden
| | - Adam Roth
- Dept. of Communicable Disease Control and Health Protection, Public Health Agency of Sweden, SE-171 81 Solna, Sweden; Dept. of Translational Medicine, Lund University, SE-205 02 Malmö, Sweden
| | - Lisen Arnheim-Dahlström
- Dept. of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 65 Stockholm, Sweden
| | - Karin Sundström
- Dept. of Laboratory Medicine, Karolinska Institutet, SE-141 86 Stockholm, Sweden; Karolinska University Laboratory, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
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Lee EY, Lee YY, Suh M, Choi E, Mai TTX, Cho H, Park B, Jun JK, Kim Y, Oh JK, Ki M, Choi KS. Socioeconomic Inequalities in Stomach Cancer Screening in Korea, 2005-2015: After the Introduction of the National Cancer Screening Program. Yonsei Med J 2018; 59:923-929. [PMID: 30187698 PMCID: PMC6127424 DOI: 10.3349/ymj.2018.59.8.923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/20/2018] [Accepted: 08/10/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE This study aimed to investigate socioeconomic inequalities in stomach cancer screening in Korea and trends therein across income and education groups. MATERIALS AND METHODS Data from the Korean National Cancer Screening Survey, a nationwide cross-sectional survey, were utilized. A total of 28913 men and women aged 40 to 74 years were included for analysis. Prior experience with stomach cancer screening was defined as having undergone either an endoscopy or gastrointestinal series within the past two years. The slope index of inequality (SII) and relative index of inequality (RII) were evaluated to check inequalities. RESULTS Stomach cancer screening rates increased from 40.0% in 2005 to 74.8% in 2015, with an annual percent change of 5.8% [95% confidence interval (CI) 4.2 to 7.5]. Increases in stomach cancer screening rates were observed for all age, education, and household income groups. Inequalities in stomach cancer screening were noted among individuals of differing levels of education, with a pooled SII estimate of 6.14% (95% CI, 3.94 to 8.34) and RII of 1.26 (95% CI, 1.12 to 1.40). Also, income-related inequalities were observed with an SII of 6.93% (95% CI, 4.89 to 8.97) and RII of 1.30 (95% CI, 1.17 to 1.43). The magnitude of inequality was larger for income than for education. CONCLUSION Both education and income-related inequalities were found in stomach cancer screening, despite a continuous increase in screening rate over the study period. Income-related inequality was greater than education-related inequality, and this was more apparent in women than in men.
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Affiliation(s)
- Eun Young Lee
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Yoon Young Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eunji Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Tran Thi Xuan Mai
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Hyunsoon Cho
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Boyoung Park
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jin Kyung Oh
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Moran Ki
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
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Castro F, Shahal D, Tarajia M, Velásquez IM, Causadias MT, Herrera V, Gómez B, Cukier M, Motta J. Baseline characteristics, survival and direct costs associated to treatment of gastric cancer patients at the National Oncology Institute of Panama from 2012 to 2015: a hospital-based observational study. BMJ Open 2017; 7:e017266. [PMID: 28947456 PMCID: PMC5623512 DOI: 10.1136/bmjopen-2017-017266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Comprehensive epidemiological and economic studies of gastric cancer (GC) in Panama are limited. This study aims to evaluate the association between socioeconomic and clinical variables with survival, describe the survival outcomes according to clinical stage and estimate the direct costs associated to GC care in a Panamanian population with GC. DESIGN AND SETTING A retrospective observational study was conducted at the leading public institution for cancer treatment in Panama. PARTICIPANTS Data were obtained from 611 records of patients diagnosed with gastric adenocarcinoma (codes C16.0-C16.9 of the International Classification of Diseases 10th revision), identified between 1 January 2012 and 31 December 2015. METHODS Cox proportional hazards models were used to calculate HRs with 95% CI to examine associations between the variables and survival. Kaplan-Meier curves were used to assess overall and stage-specific survival. Direct costs (based on 2015 US$) were calculated per patient using standard costs provided by the institution for hospital admission (occupied bed-days), radiotherapy, surgery and chemotherapy, yielding total and overall mean costs (OMC). A comparison of OMC between groups (sex, social security status, clinical stage) was performed applying the bootstrap method with a t-test of unequal variances. RESULTS An increased risk of dying was observed for patients without social security coverage (HR: 2.02; 95% CI 1.16 to 3.53), overlapping tumours (HR: 1.50; 95% CI 1.02 to 2.22), poorly differentiated tumours (HR: 2.27; 95% CI 1.22 to 4.22) and stage IV disease (HR: 5.54; 95% CI 3.38 to 9.08) (adjusted models). Overall 1-year survival rate was 41%. The estimated OMC of GC care per patient was 4259 US$. No statistically significant differences were found in OMC between groups. CONCLUSIONS Socioeconomic disparities influence GC outcomes and healthcare utilisation. Policies addressing healthcare disparities related to GC are needed, as well as in-depth studies evaluating barriers of access to GC-related services.
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Affiliation(s)
- Franz Castro
- Department of Research and Health Technology Assessment, Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - David Shahal
- Department of Research and Health Technology Assessment, Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Musharaf Tarajia
- Department of Research and Health Technology Assessment, Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Ilais Moreno Velásquez
- Department of Research and Health Technology Assessment, Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Maribel Tribaldos Causadias
- Department of Research and Health Technology Assessment, Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Víctor Herrera
- Department of Research and Health Technology Assessment, Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Beatriz Gómez
- Department of Research and Health Technology Assessment, Gorgas Memorial Institute for Health Studies, Panama City, Panama
| | - Moisés Cukier
- Division of Surgical Oncology, National Oncology Institute, Panama City, Panama
| | - Jorge Motta
- Department of Research and Health Technology Assessment, Gorgas Memorial Institute for Health Studies, Panama City, Panama
- National Secretariat for Science and Technology, Panama City, Panama
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Kim NY, Oh JS, Choi Y, Shin J, Park EC. Relationship between socioeconomic status and accessibility for endoscopic resection among gastric cancer patients: using National Health Insurance Cohort in Korea: poverty and endoscopic resection. Gastric Cancer 2017; 20:61-69. [PMID: 26884343 DOI: 10.1007/s10120-016-0597-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/22/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Gastric cancer is one of the most common types of cancer among patients in Korea. We measured the inequity in accessibility to endoscopic mucosal/submucosal resection (EMR) for early and curable gastric cancer treatment among different income classes in patients diagnosed from late 2011 to 2013. METHODS Data were obtained from the National Health Insurance Cooperation Claim Data from patients diagnosed from late 2011 until the end of 2013, to provide a total of 1,671 patients with newly diagnosed carcinoma in situ of gastric and gastric cancer among 1,025,340 enrollees. Multiple logistic regression analysis was conducted to investigate the associations between independent variables and the rate of treatment with EMR. RESULTS Among 1671 gastric cancer patients, 317 (19.0 %) subjects were treated with EMR. The 'lowest' income group was associated with a statistically significant lower rate of EMR treatment [odds ratio (OR) = 0.55, 95 % confidence index (CI) 0.34-0.89] compared to the 'highest' income group. The ORs for the 'low-middle' and 'middle-high' income groups were both higher than for the reference group, although these were not significantly different. According to the subgroup analysis by gender, rate of EMR treatment of 'lowest' income group (OR = 0.37, 95 % CI 0.18-0.74) was significantly lower only among men. CONCLUSION In conclusion, we suggest that although universal health insurance in Korea has covered EMR treatment since August 2011, patients from the lowest income group are less likely to receive this treatment. Thus, we need to detect more eligible early-stage gastric cancer and treatment for individuals of low socioeconomic status.
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Affiliation(s)
- Na Yeon Kim
- Premedical Courses, College of Medicine, Yonsei University, Seoul, Korea
| | - Jun Seok Oh
- Premedical Courses, College of Medicine, Yonsei University, Seoul, Korea
| | - Young Choi
- Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Korea.,Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
| | - Jaeyong Shin
- Department of Preventive Medicine, College of Medicine, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, Korea. .,Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Korea. .,Department of Public Health, Graduate School, Yonsei University, Seoul, Korea.
| | - Eun-Cheol Park
- Department of Preventive Medicine, College of Medicine, Yonsei University, 50, Yonsei-ro, Seodaemun-gu, Seoul, Korea.,Institute of Health Services Research, College of Medicine, Yonsei University, Seoul, Korea.,Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
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11
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Hahm MI, Chen HF, Miller T, O'Neill L, Lee HY. Why Do Some People Choose Opportunistic Rather Than Organized Cancer Screening? The Korean National Health and Nutrition Examination Survey (KNHANES) 2010-2012. Cancer Res Treat 2016; 49:727-738. [PMID: 27809458 PMCID: PMC5512382 DOI: 10.4143/crt.2016.243] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/11/2016] [Indexed: 12/24/2022] Open
Abstract
Purpose Although the Korean government has implemented a universal screening program for common cancers, some individuals choose to participate in opportunistic screening programs. Therefore, this study was conducted to identify factors contributing to the selection of organized versus opportunistic screening by the Korean general population. Materials and Methods Data from 11,189 participants aged ≥ 40 yearswho participated in the fifth Korean National Health and Nutrition Examination Survey (2010-2012) were analyzed in this study. Results A total of 6,843 of the participants (58.6%) underwent cancer screening, of which 6,019 (51.1%) participated in organized and 824 (7.5%) participated in opportunistic screening programs. Being female, older, highly educated, in the upper quartile of income, an ex-smoker, and a light drinker as well as having supplementary private health insurance and more comorbid conditions and engaging in moderate physical activity 1-4 days per week were related to participation in both types of screening programs. Being at least a high school graduate, in the upper quartile for income, and a light drinker, as well as having more comorbid conditions and engaging in moderate physical activities 1-4 days per week had a stronger effect on those undergoing opportunistic than organized screening. Conclusion The results of this study suggest that socioeconomic factors such as education and income, as well as health status factors such as health-related quality of life and number of comorbid conditions and health behaviors such as drinking and engaging in moderate physical activity 1-4 days per week had a stronger influence on participation in an opportunistic than in an organized screening program for cancer.
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Affiliation(s)
- Myung-Il Hahm
- Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Korea
| | - Hsueh-Fen Chen
- Department of Health Management and Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Thaddeus Miller
- Department of Health Management and Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Liam O'Neill
- Department of Health Management and Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Hoo-Yeon Lee
- Department of Social Medicine, Dankook University College of Medicine, Cheonan, Korea
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12
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Wu CC, Chang CM, Hsu TW, Lee CH, Chen JH, Huang CY, Lee CC. The effect of individual and neighborhood socioeconomic status on esophageal cancer survival in working-age patients in Taiwan. Medicine (Baltimore) 2016; 95:e4140. [PMID: 27399129 PMCID: PMC5058858 DOI: 10.1097/md.0000000000004140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Esophageal cancer is the sixth leading cause of cancer mortality. More than 90% of patients with esophageal cancer in Taiwan have squamous cell carcinoma. Survival of such patients is related to socioeconomic status (SES). We studied the association between SES (individual and neighborhood) and the survival of working-age patients with esophageal cancer in Taiwan. A population-based study was conducted of 4097 patients diagnosed with esophageal cancer between 2002 and 2006. Each was traced for 5 years or until death. Individual SES was defined by enrollee job category. Neighborhood SES was based on household income and dichotomized into advantaged or disadvantaged. Multilevel logistic regression was used to compare the survival rates by SES group after adjustment for possible confounding and risk factors. Hospital and neighborhood SES were used as random effects in multilevel logistic regression. In patients younger than 65 years, 5-year overall survival rates were worst for those with low individual SES living in disadvantaged neighborhoods. After adjustment for patient characteristics, esophageal cancer patients with high individual SES had a 39% lower risk of mortality than those with low individual SES (odds ratio 0.61, 95% confidence interval 0.48-0.77). Patients living in disadvantaged areas with high individual SES were more likely to receive surgery than those with low SES (odds ratio 1.45, 95% confidence interval 1.11-1.89). Esophageal cancer patients with low individual SES have the worst 5-year survival, even with a universal healthcare system. Public health, education, and social welfare programs should address the inequality of esophageal cancer survival.
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Affiliation(s)
- Chin-Chia Wu
- Division of Colorectal Surgery
- Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
| | - Chun-Ming Chang
- Division of General Surgery, Department of Surgery
- Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
- School of Medicine, Tzu Chi University, Hualien
| | - Ta-Wen Hsu
- Division of Colorectal Surgery
- Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
- School of Medicine, Tzu Chi University, Hualien
| | - Cheng-Hung Lee
- Division of General Surgery, Department of Surgery
- Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
| | - Jian-Han Chen
- Division of General Surgery, Department of Surgery
- Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi
| | - Chih-Yuan Huang
- Division of Nephrology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi
| | - Ching-Chih Lee
- Department of Otorhinolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung
- Department of Otolaryngology, Head and Neck Surgery, Tri-Service General Hospital
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Correspondence: Ching-Chih Lee, No. 386, Dazong 1st Road, Zouying District, Kaohsiung, Taiwan (e-mail: )
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13
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Goto R, Hamashima C, Mun S, Lee WC. Why screening rates vary between Korea and Japan--differences between two national healthcare systems. Asian Pac J Cancer Prev 2015; 16:395-400. [PMID: 25684461 DOI: 10.7314/apjcp.2015.16.2.395] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Both Japan and Korea provide population-based screening programs. However, screening rates are much higher in Korea than in Japan. To clarify the possible factors explaining the differences between these two countries, we analyzed the current status of the cancer screening and background healthcare systems. Population- based cancer screening in Korea is coordinated well with social health insurance under a unified insurer system. In Japan, there are over 3,000 insurers and coordinating a comprehensive strategy for cancer screening promotion has been very difficult. The public healthcare system also has influence over cancer screening. In Korea, public healthcare does not cover a wide range of services. Almost free cancer screening and subsidization for medical cost for cancers detected in population-screening provides high incentive to participation. In Japan, on the other hand, a larger coverage of medical services, low co-payment, and a lenient medical audit enables people to have cancer screening under public health insurance as well as the broad range of cancer screening. The implementation of evidence-based cancer screening programs may be largely dependent on the background healthcare system. It is important to understand the impacts of each healthcare system as a whole and to match the characteristics of a particular health system when designing an efficient cancer screening system.
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Affiliation(s)
- Rei Goto
- The Hakubi Center of Advanced Research, Graduate School of Economic, Kyoto University, Kyoto, Japan E-mail :
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14
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The Effect of National Cancer Screening on Disparity Reduction in Cancer Stage at Diagnosis by Income Level. PLoS One 2015; 10:e0136036. [PMID: 26284526 PMCID: PMC4540564 DOI: 10.1371/journal.pone.0136036] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 07/29/2015] [Indexed: 11/23/2022] Open
Abstract
Background Early detection of cancer is an effective and efficient cancer management strategy. In South Korea, the National Health Insurance administers the National Cancer Screening Program to its beneficiaries. We examined the impact of the National Cancer Screening Program on socioeconomic disparities in cancer stage at diagnosis. Methods Cancer patients registered in the Korean Central Cancer Registry from January 1, 2010 to December 31, 2010 with a diagnosis of gastric cancer (n = 22,470), colon cancer (n = 16,323), breast cancer (n = 10,076), or uterine cervical cancer (n = 2,447) were included. Income level was divided into three groups according to their monthly contribution of National Health Insurance. We employed absolute (age-standardized prevalence rate, slope index of inequality) and relative (relative index of inequality) measures to separately examine social disparities among participants and non-participants of the National Cancer Screening Program in terms of the early-stage rate. Results Age-standardized prevalence rates of early-stage by income group were always higher in participants than in non-participants. Furthermore, the age-standardized prevalence rate of early-stage in the low income group of the participants was also higher than that of the high income group of the non-participants. The sizes of disparities (both slope index of inequality and relative index of inequality) are smaller in participants compared to non-participants. Conclusion National Cancer Screening Program participation reduced income disparity in cancer stage at diagnosis. Population-based cancer screening programs can be used as an effective measure to reduce income disparity in cancer care.
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15
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Chang Y, Cho B, Son KY, Shin DW, Shin H, Yang HK, Shin A, Yoo KY. Determinants of gastric cancer screening attendance in Korea: a multi-level analysis. BMC Cancer 2015; 15:336. [PMID: 25927821 PMCID: PMC4424570 DOI: 10.1186/s12885-015-1328-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 04/21/2015] [Indexed: 11/17/2022] Open
Abstract
Background We aimed to assess individual and area-level determinants of gastric cancer screening participation. Method Data on gastric cancer screening and individual-level characteristics were obtained from the 2007–2009 Fourth Korea National Health and Nutrition Examination Survey. The area-level variables were collected from the 2005 National Population Census, 2008 Korea Medical Association, and 2010 National Health Insurance Corporation. The data were analyzed using multilevel logistic regression models. Results The estimated participation rate in gastric cancer screening adhered to the Korea National Cancer Screening Program guidelines was 44.0% among 10,658 individuals aged over 40 years who were included in the analysis. Among the individual-level variables, the highest income quartile, a college or higher education level, living with spouse, having a private health insurance, limited general activity, previous history of gastric or duodenal ulcer, and not currently smoking were associated with a higher participation rate in gastric cancer screening. Urbanization showed a significant negative association with gastric cancer screening attendance among the area-level factors (odds ratio (OR) = 0.73; 95% confidence interval (CI) = 0.57-0.93 for the most urbanized quartile vs. least urbanized quartile). Conclusion There are differences in gastric cancer screening attendance according to both individual and regional area characteristics.
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Affiliation(s)
- Yunryong Chang
- Department of Preventive Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 110-779, Korea. .,Department of Family Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 110-779, Korea.
| | - Belong Cho
- Department of Family Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 110-779, Korea.
| | - Ki Young Son
- Department of Family Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 110-779, Korea.
| | - Dong Wook Shin
- Department of Family Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 110-779, Korea.
| | - Hosung Shin
- Department of Social and Humanity in Dentistry, Wonkwang University School of Dentistry, 460 Iksan-dearo, Iksan, 570-749, Korea.
| | - Hyung-Kook Yang
- Cancer Policy Branch, National Cancer Control Institute, National Cancer Center, 323 Ilsanro Ilsandong-gu, Goyang-si, 410-769, Korea.
| | - Aesun Shin
- Department of Preventive Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 110-779, Korea.
| | - Keun-Young Yoo
- Department of Preventive Medicine, Seoul National University College of Medicine, 103 Daehakro, Jongno-gu, Seoul, 110-779, Korea.
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16
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Suh M, Choi KS, Park B, Lee YY, Jun JK, Lee DH, Kim Y. Trends in Cancer Screening Rates among Korean Men and Women: Results of the Korean National Cancer Screening Survey, 2004-2013. Cancer Res Treat 2015; 48:1-10. [PMID: 25943324 PMCID: PMC4720068 DOI: 10.4143/crt.2014.204] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 03/06/2015] [Indexed: 12/15/2022] Open
Abstract
Purpose The Korean National Cancer Screening Survey (KNCSS), a nationwide cross-sectional survey, has been conducted annually since 2004. The current study was conducted to report on the trends in screening rates among Korean men and women, and to evaluate policies regarding cancer screening programs implemented to reduce the burden of cancer. Materials and Methods The current study used KNCSS data. The eligible study population included men aged 40-74 years and women aged 30-74 years with no cancer history. The lifetime screening rate, screening rate with recommendation, and changes in annual rates were calculated for five major cancers (i.e., stomach, liver, colorectal, breast, and cervix uteri). Results The screening rates with recommendation increased by 4.2% (95% confidence interval [CI], 3.7% to 4.8%) annually for stomach cancer, 1.2% (95% CI, 0.1% to 2.4%) for liver cancer, 3.0% (95% CI, 1.8% to 4.1%) for colorectal cancer, 3.7% (95% CI, 2.7% to 4.8%) for breast cancer, and 1.3% (95% CI, 0.8% to 1.8%) for cervical cancer. In 2013, the screening rates with recommendation for stomach, liver, colorectal, breast, and cervical cancers were 73.6%, 33.6%, 55.6%, 59.7%, and 67.0%, respectively. Conclusion Both the lifetime screening rates and screening rates with recommendation for the five above-mentioned cancers increased annually from 2004 to 2013.
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Affiliation(s)
- Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Kui Son Choi
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Boyoung Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Yoon Young Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Duk-Hyoung Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
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17
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Shridhar K, Dey S, Bhan CM, Bumb D, Govil J, Dhillon PK. Cancer detection rates in a population-based, opportunistic screening model, New Delhi, India. Asian Pac J Cancer Prev 2015; 16:1953-8. [PMID: 25773793 DOI: 10.7314/apjcp.2015.16.5.1953] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In India, cancer accounts for 7.3% of DALY's, 14.3% of mortality with an age-standardized incident rate of 92.4/100,000 in men and 97.4/100,000 in women and yet there are no nationwide screening programs. MATERIALS AND METHODS We calculated age-standardized and age-truncated (30-69 years) detection rates for men and women who attended the Indian Cancer Society detection centre, New Delhi from 2011-12. All participants were registered with socio-demographic, medical, family and risk factors history questionnaires, administered clinical examinations to screen for breast, oral, gynecological and other cancers through a comprehensive physical examination and complete blood count. Patients with an abnormal clinical exam or blood result were referred to collaborating institutes for further investigations and follow-up. RESULTS A total of n=3503 were screened during 2011-12 (47.8% men, 51.6% women and 0.6% children <15 years) with a mean age of 47.8 yrs (±15.1 yrs); 80.5% were aged 30-69 years and 77.1% had at least a secondary education. Tobacco use was reported by 15.8%, alcohol consumption by 11.9% and family history of cancer by 9.9% of participants. Follow-up of suspicious cases yielded 45 incident cancers (51.1% in men, 48.9% in women), consisting of 55.5% head and neck (72.0% oral), 28.9% breast, 6.7% gynecological and 8.9% other cancer sites. The age-standardized detection rate for all cancer sites was 340.8/100,000 men and 329.8/100,000 women. CONCLUSIONS Cancer screening centres are an effective means of attracting high-risk persons in low-resource settings. Opportunistic screening is one feasible pathway to address the rising cancer burden in urban India through early detection.
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Affiliation(s)
- Krithiga Shridhar
- Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Gurgaon, India E-mail :
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18
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Lee YY, Jun JK, Suh M, Park BY, Kim Y, Choi KS. Barriers to cancer screening among medical aid program recipients in the Republic of Korea: a qualitative study. Asian Pac J Cancer Prev 2014; 15:589-94. [PMID: 24568462 DOI: 10.7314/apjcp.2014.15.2.589] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Few studies have examined reasons why those with low socioeconomic status do not adequately receive cancer screening. We therefore conducted a qualitative study to assess the barriers to cancer screening in people with low socioeconomic status, and to examine the reasons why Medical Aid Program (MAP) recipients do not participate in the National Cancer Screening Program (NCSP). A focus group methodology was used. Participants included MAP recipients (men aged 45-79 years, women aged 35-79 years) who had been invited to cancer screening at least twice based on the NCSP protocol, but had not been screened for any cancer from 2009-2012. We recruited participants living in the cities of Goyang and Paju. A total of 23 MAP recipients participated in four focus group discussions, including 12 men and 11 women. In this qualitative study, we identified six barriers to screening: lack of trust in the NCSP and cancer screening units; fear of being diagnosed with cancer; discomfort or pain from the screening procedure; lack of time, lack of knowledge about cancer screening or lack of awareness of the existence of the NCSP; physical disability or underlying disease; and logistic barriers. Interventions such as individualized counseling, letters and reminders, or other individually-targeted strategies, especially for those with lower socioeconomic status are required to increase participation and reduce disparities in cancer screening.
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Affiliation(s)
- Yoon Young Lee
- National Cancer Control Institute, National Cancer Centre, Goyang, Republic of Korea E-mail :
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19
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Kang M, Yoo KB, Park EC, Kwon K, Kim G, Kim DR, Kwon JA. Factors Associated with Organized and Opportunistic Cancer Screening: Results of the Korea National Health and Nutrition Examination Survey (KNHANES) 2007-2011. Asian Pac J Cancer Prev 2014; 15:3279-86. [DOI: 10.7314/apjcp.2014.15.7.3279] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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20
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Wu CC, Hsu TW, Chang CM, Yu CH, Wang YF, Lee CC. The effect of individual and neighborhood socioeconomic status on gastric cancer survival. PLoS One 2014; 9:e89655. [PMID: 24586941 PMCID: PMC3934911 DOI: 10.1371/journal.pone.0089655] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 01/26/2014] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Gastric cancer is a leading cause of death, particularly in the developing world. The literature reports individual socioeconomic status (SES) or neighborhood SES as related to survival, but the effect of both has not been studied. This study investigated the effect of individual and neighborhood SES simultaneously on mortality in gastric cancer patients in Taiwan. MATERIALS AND METHODS A study was conducted of 3,396 patients diagnosed with gastric cancer between 2002 and 2006. Each patient was followed for five years or until death. Individual SES was defined by income-related insurance premium (low, moderate, and high). Neighborhood SES was based on household income dichotomized into advantaged and disadvantaged areas. Multilevel logistic regression model was used to compare survival rates by SES group after adjusting for possible confounding factors. RESULTS In patients younger than 65 years, 5-year overall survival rates were lowest for those with low individual SES. After adjusting for patient characteristics (age, gender, Charlson Comorbidity Index Score), gastric cancer patients with high individual SES had 68% risk reduction of mortality (adjusted odds ratio [OR] of mortality, 0.32; 95% confidence interval [CI], 0.17-0.61). Patients aged 65 and above had no statistically significant difference in mortality rates by individual SES group. Different neighborhood SES did not statistically differ in the survival rates. CONCLUSION Gastric cancer patients aged less than 65 years old with low individual SES have higher risk of mortality, even under an universal healthcare system. Public health strategies, education and welfare policies should seek to correct the inequality in gastric cancer survival, especially in those with lower individual SES.
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Affiliation(s)
- Chin-Chia Wu
- Department of Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- Cancer center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Ta-Wen Hsu
- Department of Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Cancer center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Chun-Ming Chang
- Department of Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Cancer center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Chia-Hui Yu
- Department of Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Yuh-Feng Wang
- Department of Nuclear Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- Cancer center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Ching-Chih Lee
- Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- Center for Clinical Epidemiology and Biostatistics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- Department of Education, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
- Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
- Cancer center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
- * E-mail:
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Chiou ST, Wu CY, Hurng BS, Lu TH. Changes in the magnitude of social inequality in the uptake of cervical cancer screening in Taiwan, a country implementing a population-based organized screening program. Int J Equity Health 2014; 13:4. [PMID: 24405587 PMCID: PMC3896803 DOI: 10.1186/1475-9276-13-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 12/17/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION We sought to examine changes in the magnitude of social inequality in the uptake of cervical cancer screening between 2001 and 2009 in Taiwan. METHODS We used data from the 2001 and 2009 Taiwan National Health Interview Surveys to calculate the absolute (slope of index of inequality, SII) and relative (relative index of inequality, RII) summary measures of social inequality in the uptake of Pap smear tests to indicate the magnitude of social inequality. RESULTS The prevalence of having had a Pap smear during the previous 3 years increased in each age and socioeconomic group from 2001 to 2009. The SII and RII by urbanization and education level decreased significantly, while the SII and RII by income level increased significantly between the two study years. The largest increase in inequality of prevalence from 2001 to 2009 was between women living in suburban and rural areas with highest income level and women live in metropolitan areas with lowest income level. CONCLUSIONS The changes in magnitude of social inequality in the uptake of cervical cancer screening differed by indicators of socioeconomic position. Further studies are needed to explore the mechanisms that result in social inequality by different indicators of socioeconomic position.
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Affiliation(s)
| | | | | | - Tsung-Hsueh Lu
- Institute of Public Health, National Cheng Kung University, Tainan, Taiwan.
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Suh M, Choi KS, Lee YY, Jun JK. Trends in Cancer Screening Rates among Korean Men and Women: Results from the Korean National Cancer Screening Survey, 2004-2012. Cancer Res Treat 2013; 45:86-94. [PMID: 23864841 PMCID: PMC3710967 DOI: 10.4143/crt.2013.45.2.86] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 02/22/2013] [Indexed: 11/21/2022] Open
Abstract
Purpose The Korean National Cancer Screening Survey (KNCSS), a nationwide, annual cross-sectional survey, has been conducted since 2004. The current study was conducted in order to report on trends in cancer screening rates for five types of cancer (stomach, liver, colorectal, breast, and cervix uteri). Materials and Methods KNCSS data were collected between 2004 and 2012. The eligible study population included cancer-free men who were 40 years of age and older and women who were 30 years of age and older. The lifetime screening rate, screening rate with recommendation, and changes in annual rates were calculated. Results Lifetime screening rates and screening rates with recommendation for the five types of cancer rose steadily until 2010, showed a slight drop or were stable in 2011, and increased again in 2012. On average, screening rates with recommendation have shown annual increases of 4.3% (95% confidence interval [CI], 3.6 to 5.0%) for stomach cancer, 0.8% (95% CI, -0.5 to 2.1%) for liver cancer, 2.4% (95% CI, 1.3 to 3.5%) for colorectal cancer, 4.5% (95% CI, 3.9 to 5.1%) for breast cancer, and 1.3% (95% CI, 0.6 to 2.0%) for cervical cancer. Disparities in age groups and household incomes have been decreasing since 2004. Conclusion Cancer screening rates in Korea showed a significant increase from 2004 to 2012, and screening rates for gastric and breast cancer are now approaching 70%. The 10-Year Plan for Cancer Control target for screening rates was met or nearly met for all cancer types examined, with the exception of liver and colorectal cancer.
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Affiliation(s)
- Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
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Park B, Choi KS, Suh M, Shin JY, Jun JK. Factors associated with compliance with recommendations for liver cancer screening in Korea: a nationwide survey in Korea. PLoS One 2013; 8:e68315. [PMID: 23840846 PMCID: PMC3695955 DOI: 10.1371/journal.pone.0068315] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 05/28/2013] [Indexed: 11/28/2022] Open
Abstract
To investigate the factors associated with compliance with recommendations regarding liver cancer screening intervals and methods among individuals at high-risk for liver cancer in the Republic of Korea. We used data from the fourth Korean National Health and Nutrition Examination Survey (KNHANES IV), a representative cross-sectional nationwide survey conducted between 2007 and 2009. The liver cancer screening rate and factors associated with compliance with recommended screening intervals (6 months) and methods (both abdominal ultrasonography and serum alpha-fetoprotein testing) among individuals at high risk for liver cancer such as hepatitis B virus (HBV) carriers were investigated. Out of 24,871 KNHANES IV participants, 604 HBV carriers aged ≥20 years were included in our analysis. 39.6% of our study sample reported attending liver cancer screening at least once in their lifetime, 12.3% had attended within the previous 6 months, and 14.6% were screened using both recommended methods. Older age was associated with increased compliance with screening intervals (P-trend 0.011) and methods (40–49 year: OR = 3.25, 95% CI: 1.62–6.51; 50–59 years: OR = 3.09, 95% CI: 1.44–6.66; 60–69 years: OR = 3.17, 95% CI: 1.28–7.82). Unawareness of HBV infection status was negatively related to compliance with screening intervals and methods (OR = 0.30, 95% CI: 0.17–0.53; OR = 0.45, 95% CI: 0.26–0.79). Female sex (OR = 0.45, 95% CI: 0.25–0.78), lower household income (P-trend 0.011), and routine and manual occupations (OR = 0.46, 95% CI: 0.22–0.97) were associated with decreased compliance with screening methods. The liver cancer screening rate among high-risk individuals is much less suboptimal. Considering that those unaware of their HBV infection status got regular and complete liver cancer screening much less often, efforts should be made not only to decrease sociodemographic disparities, but also to better identify the high-risk population.
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Affiliation(s)
- Boyoung Park
- National Cancer Control Institute, National Cancer Center, Goyang-si, Korea
| | - Kui Son Choi
- National Cancer Control Institute, National Cancer Center, Goyang-si, Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang-si, Korea
| | - Ji-Yeon Shin
- National Cancer Control Institute, National Cancer Center, Goyang-si, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang-si, Korea
- * E-mail:
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Rohani-Rasaf M, Moradi-Lakeh M, Ramezani R, Asadi-Lari M. Measuring socioeconomic disparities in cancer incidence in Tehran, 2008. Asian Pac J Cancer Prev 2013; 13:2955-60. [PMID: 22938489 DOI: 10.7314/apjcp.2012.13.6.2955] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health disparities exist among and within countries, while developing and low income countries suffer more. The aim of this study was to quantify cancer disparities with regard to socioeconomic position (SEP) in 22 districts of Tehran, Iran. METHOD According to the national cancer registry, 7599 new cancer cases were recorded within 22 districts of Tehran in 2008. Based on combined data from census and a population-based health equity study (Urban HEART), socioeconomic position (SEP) was calculated for each district. Index of disparity, absolute and relative concentration indices (ACI and RCI) were used for measuring disparities in cancer incidence. RESULTS The overall cancer age standardised rate (ASR) was 117.2 per 100,000 individuals (120.4 for men and 113.5 for women). Maximum ASR in both genders was seen in districts 6, 3, 1 and 2. Breast, colorectal, stomach, skin and prostate were the most common cancers. Districts with higher SEP had higher ASR (r=0.9, p<0.001). Positive ACI and RCI indicated that cancer cases accumulated in districts with high SEP. Female disparity was greater than for men in all measures. Breast, colorectal, prostate and bladder ASR ascended across SEP groups. Negative ACI and RCI in cervical and skin cancers in women indicate their aggregation in lower SEP groups. Breast cancer had the highest absolute disparities measure. CONCLUSION This report provides an appropriate guide and new evidence on disparities across geographical, demographic and particular SEP groups. Higher ASR in specific districts warrants further research to investigate the background predisposing factors.
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Affiliation(s)
- Marzieh Rohani-Rasaf
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Kim BJ, Heo C, Kim BK, Kim JY, Kim JG. Effectiveness of gastric cancer screening programs in South Korea: Organized vs opportunistic models. World J Gastroenterol 2013; 19:736-741. [PMID: 23430471 PMCID: PMC3574600 DOI: 10.3748/wjg.v19.i5.736] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 11/19/2012] [Accepted: 12/25/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the outcome and effectiveness of two screening programs, National Cancer Screening Program (NCSP) and opportunistic screening (OS), for the detection of gastric cancer.
METHODS: A total of 45 654 subjects underwent upper endoscopy as part of the NCSP or OS at the Chung-Ang University Healthcare System in Korea between January 2007 and December 2010. The study population was comprised of subjects over the age of 40 years. More specifically, subjects who took part in the NCSP were Medicaid recipients and beneficiaries of the National Health Insurance Corporation. Still photographs from the endoscopies diagnosed as gastric cancer were reviewed by two experienced endoscopists.
RESULTS: The mean age of the screened subjects was 55 years for men and 54 years for women. A total of 126 cases (0.28%) of gastric cancer were detected from both screening programs; 100 cases (0.3%) from NCSP and in 26 cases (0.2%) from OS. The proportion of early gastric cancer (EGC) detected in NCSP was higher than that in OS (74.0% vs 53.8%, P = 0.046). Among the 34 416 screenees in NCSP, 6585 (19.1%) underwent upper endoscopy every other year as scheduled. Among the 11 238 screenees in OS, 3050 (27.1%) underwent upper endoscopy at least once every two years during the study period. The detection rate of gastric cancer was found to be significantly higher during irregular follow-up than during regular follow-up in both screening programs (0.3% vs 0.2%, P = 0.036). A higher incidence of EGC than advanced gastric cancer was observed during regular follow-up compared with irregular follow-up.
CONCLUSION: Compliance to the screening program is more important than the type of screening system used.
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Lee HY, Choi KS, Jun JK, Hahm MI, Park EC. Time to follow up after an abnormal finding in organized gastric cancer screening in Korea. BMC Cancer 2012; 12:400. [PMID: 22963347 PMCID: PMC3517455 DOI: 10.1186/1471-2407-12-400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 09/03/2012] [Indexed: 01/07/2023] Open
Abstract
Background The prognosis for an abnormal medical finding is affected by both early detection and adherence to the presecribed schedule for follow-up examinations. In this study, we examined the time to follow up after an abnormal finding and determined the risk factors related to delays in follow up in a population-based screening program. Methods The study population consisted of patients who were newly diagnosed with gastric cancer through a gastric cancer screening program sponsored by the National Cancer Screening Program (NCSP) in 2005. Due to the skewed nature of the distribution of time to follow up, medians and interquartile ranges (IQR) are presented, and we analyzed the number of days preceding the follow-up time as a binary variable (≤90 days or >90 days). We used logistic regression analyses to evaluate the risk factors for a long delay. Results The median number of days to follow-up initiation after an abnormal finding was 11 (IQR 7–27); 13.9% of the patients with gastric cancer obtained their follow-up evaluation more than 90 days. Age, type of health insurance, screening method, and screening results were risk factors for delays in follow up. Conclusions This study examined delays from the time of the discovery of an abnormal finding to time of the follow-up evaluation. Because inadequate follow up of abnormal exam results undermines the potential benefits of cancer screening, it is important to organize services that minimize delays between cancer screening and treatment.
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Affiliation(s)
- Hoo-Yeon Lee
- Department of Preventive Medicine & Institute of Health Services Research, College of Medicine, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-749, Korea
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Wee LE, Koh GCH, Chin RT, Yeo WX, Seow B, Chua D. Socioeconomic factors affecting colorectal, breast and cervical cancer screening in an Asian urban low-income setting at baseline and post-intervention. Prev Med 2012; 55:61-7. [PMID: 22561028 DOI: 10.1016/j.ypmed.2012.04.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 04/06/2012] [Accepted: 04/18/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Inequalities in cancer screening are little studied in Asian societies. We determined whether area and individual measures of socio-economic status (SES) affected cancer screening participation in Singapore and prospectively evaluated an access-enhancing community-based intervention. METHODS The study population involved all residents aged >40 years in two housing estates comprising of owner-occupied (high-SES area) and rental (low-SES area) flats. From 2009 to 2011, non-adherents to regular screening for colorectal/breast/cervical cancer were offered free convenient screening over six months. Pre- and post-intervention screening rates were compared with McNemar's test. Multi-level logistic regression identified factors of regular screening at baseline; Cox regression analysis identified predictors of screening post-intervention. RESULTS Participation was 78.2% (1081/1383). In the low-SES area, 7.7% (33/427), 20.4% (44/216), and 14.3% (46/321) had regular colorectal, cervical and breast cancer screening respectively. Post-intervention, screening rates in the low-SES area rose significantly to 19.0% (81/427), 25.4% (55/216), and 34.3% (74/216) respectively (p<0.001). Area SES was more consistently associated with screening than individual SES at baseline. Post-intervention, for colorectal cancer screening, those with higher education were more likely to attend (p=0.004); for female cancer screening, the higher-income were less likely to attend (p=0.032). CONCLUSIONS Access-enhancing community-based interventions improve participation among disadvantaged strata of Asian societies.
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Affiliation(s)
- Liang En Wee
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore
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Han MA, Choi KS, Lee HY, Jun JK, Jung KW, Kang S, Park EC. Performance of papanicolaou testing and detection of cervical carcinoma in situ in participants of organized cervical cancer screening in South Korea. PLoS One 2012; 7:e35469. [PMID: 22530028 PMCID: PMC3328331 DOI: 10.1371/journal.pone.0035469] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 03/19/2012] [Indexed: 11/29/2022] Open
Abstract
Background The present study measured the performance of the Papanicolaou (Pap) test and detection of cervical carcinoma in situ (CIS) and cancer in participants of organized cervical cancer screening in South Korea, and examined differences in the proportion of CIS according to socio-demographic factors. Methods Data were obtained from the National Cancer Screening Program and National Health Insurance Cancer Screening Program databases. We analyzed data from 4,072,997 screenings of women aged 30 years or older who underwent cervical cancer screening by Pap test between January 1, 2005 and December 31, 2006. We calculated the performances of the Pap test and compared that according to socio-demographic factors. Results The positivity rate for all screenings was 6.6%. The cancer detection rate (CDR) and interval cancer rate (ICR) were 0.32 per 1,000 screenings, and 0.13 per 1,000 negative screenings, respectively. About 63.4% of screen-detected CIS+ cases (CIS or invasive cervical cancer) were CIS. The CDR and ICR, and percentage of CIS among all CIS+ were significantly different by age group and health insurance status. The odds ratios of CDR and ICR were higher for Medical Aid Program (MAP) recipients compared with National Health Insurance (NHI) beneficiaries. The likelihood of a detected CIS+ case to be CIS was significantly lower among MAP recipients than among NHI beneficiaries. Conclusions The difference in performance of cervical cancer screening among different socio-demographic groups may indicate an important influence of socio-demographic factors on preventive behavior. The findings of the study support the critical need for increasing efforts to raise awareness and provide more screening in at-risk populations, specifically low-income groups.
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Affiliation(s)
- Mi Ah Han
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Korea
| | - Kui Son Choi
- National Cancer Control Research Institute, National Cancer Center, Goyang, Korea
- * E-mail:
| | - Hoo-Yeon Lee
- Department of Social Medicine, Dankook University, College of Medicine, Cheonan, Korea
| | - Jae Kwan Jun
- National Cancer Control Research Institute, National Cancer Center, Goyang, Korea
| | - Kyu Won Jung
- National Cancer Control Research Institute, National Cancer Center, Goyang, Korea
| | - Sokbom Kang
- Branch of Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Eun-Cheol Park
- Department of Preventive Medicine and Institute of Health Services Research, Yonsei University, College of Medicine, Seoul, Korea
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Yoon YS, Kim HK, Choi YS, Kim K, Kim J, Shim YM. Primary gastric cancer in an oesophageal gastric graft after oesophagectomy. Eur J Cardiothorac Surg 2011; 40:1181-4. [PMID: 21868245 DOI: 10.1016/j.ejcts.2011.02.061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 02/10/2011] [Accepted: 02/28/2011] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Recent advances in surgical treatment of oesophageal cancer have improved the prognosis of early, locally advanced oesophageal cancer. Primary cancer from oesophageal graft is rare, but has been detected in long-term survivor. We analyzed data from patients who developed primary gastric cancer in an oesophageal graft to evaluate strategies of treatment and their outcomes. METHODS We retrospectively reviewed data from patients who developed primary gastric cancer in oesophageal graft at Samsung Medical Center between September 1994 and December 2009. The clinico-pathologic features and prognoses were investigated. Long-term survival rate was determined by Kaplan-Meier analysis. RESULTS Ten primary gastric graft cancers (five early gastric cancer (EGC), five advanced gastric cancer (AGC)) were diagnosed. The mean age was 69.0 (range 59.6-74.6). Initial operation was Ivor-Lewis transthoracic oesophagectomy in eight cases and three-field lymphadenectomy in two. The median period to detection of the primary gastric graft cancer after oesophagectomy was 50 (9-102) months. Seven gastric graft cancers were diagnosed by regular endoscopic examination. EGCs were treated with ESD in two cases, partial resection of stomach in one, and oesophagocolojejunostomy in three, including one patient who underwent the operation after ESD. AGCs were treated with chemotherapy in one case, supportive care in one, and oesophagocolojejunostomy in three. There was no adjuvant chemotherapy used in any case. The median follow-up period after second operation was 14 months (range 1-97). Six patients survived during this period. Three of the five AGC patients died. The estimated 5-year survival rate of our cases was 70%. CONCLUSIONS In areas of high prevalence of stomach cancer, regular endoscopic examinations of oesophageal gastric grafts may help in the early detection of primary gastric graft cancer. Reoperation with a colon graft is a potential treatment option for primary gastric graft cancer.
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Affiliation(s)
- Yoo Sang Yoon
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Park MJ, Park EC, Choi KS, Jun JK, Lee HY. Sociodemographic gradients in breast and cervical cancer screening in Korea: the Korean National Cancer Screening Survey (KNCSS) 2005-2009. BMC Cancer 2011; 11:257. [PMID: 21682886 PMCID: PMC3144456 DOI: 10.1186/1471-2407-11-257] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 06/17/2011] [Indexed: 11/25/2022] Open
Abstract
Background Cancer screening rates in Korea for five cancer types have increased steadily since 2002. With regard to the life-time cancer screening rates in 2009 according to cancer sites, the second highest was breast cancer (78.1%) and the third highest was cervical cancer (76.1%). Despite overall increases in the screening rate, disparities in breast and cervical cancer screening, based on sociodemographic characteristics, still exist. Methods Data from 4,139 women aged 40 to74 years from the 2005 to 2009 Korea National Cancer Screening Survey were used to analyze the relationship between sociodemographic characteristics and receiving mammograms and Pap smears. The main outcome measures were ever having had a mammogram and ever having had a Pap smear. Using these items of information, we classified women into those who had had both types of screening, only one screening type, and neither screening type. We used logistic regression to investigate relationships between screening history and sociodemographic characteristics of the women. Results Being married, having a higher education, a rural residence, and private health insurance were significantly associated with higher rates of breast and cervical cancer screening after adjusting for age and sociodemographic factors. Household income was not significantly associated with mammograms or Pap smears after adjusting for age and sociodemographic factors. Conclusions Disparities in breast and cervical cancer screening associated with low sociodemographic status persist in Korea.
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Affiliation(s)
- Mi Jin Park
- National Cancer Control Institute, National Cancer Center, 111 Jungbalsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410-769, Korea.
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Kim BJ, Cheon WS, Oh HC, Kim JW, Park JD, Kim JG. Prevalence and risk factor of erosive esophagitis observed in Korean National Cancer Screening Program. J Korean Med Sci 2011; 26:642-6. [PMID: 21532855 PMCID: PMC3082116 DOI: 10.3346/jkms.2011.26.5.642] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 02/28/2011] [Indexed: 12/19/2022] Open
Abstract
Prevalence of erosive esophagitis (EE) has been increasing in Korea. The purpose of this study was to estimate prevalence of EE among low socioeconomic population in Korea and to investigate risk factors for EE. We reviewed the medical records of 7,278 subjects who were examined by upper endoscopy in the Korean National Cancer Screening Program at Chung-Ang University Yong-san Hospital from March 2003 to March 2008. The study population included subjects ≥ 40 yr of age who were Medicaid recipients and beneficiaries in the National Health Insurance Corporation. Multivariate analysis was used to determine risk factors for EE. Prevalence of EE was 6.7% (486/7,278). According to the LA classification system, LA-A in 344 subjects, LA-B in 135 subjects, and LA-C and D in 7 subjects. In multivariate analysis, age ≥ 60 yr, male sex, BMI ≥ 25, current smoking, alcohol consumption, fasting glucose level ≥ 126 mg/dL, and endoscopic hiatal hernia were significant risk factors for EE. The prevalence of EE in low socioeconomic Korean population is similar to that in personal annual medical check-ups. Risk factors for EE among them include old age, male sex, BMI ≥ 25, current smoking, alcohol consumption, fasting glucose level ≥ 126 mg/dL, and hiatal hernia.
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Affiliation(s)
- Beom Jin Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Won Seok Cheon
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hyoung-Chul Oh
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeong Wook Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jung Duck Park
- Department of Preventive Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jae G. Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
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Hahm MI, Park EC, Choi KS, Lee HY, Park JH, Park S. Inequalities in adoption of cancer screening from a diffusion of innovation perspective: identification of late adopters. Cancer Epidemiol 2010; 35:90-6. [PMID: 20947463 DOI: 10.1016/j.canep.2010.08.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 08/30/2010] [Accepted: 08/31/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although national-level organized cancer screening programs have reduced barriers to screening for people of low socioeconomic status, barriers to early screening remain. Our aim was to determine the diffusion pattern and identify the factors associated with early participation in stomach and breast cancer screening programs. METHODS The study population was derived from the Korean National Cancer Screening Survey, conducted in 2007. A stratified random sample of people aged 40 years and older from a nationwide population-based database was gathered in Korea (n=1,517) in 2007. Time of participation in early screening was defined as the number of years that had elapsed between the participant's 30th birthday and the age at first screening. RESULTS Significant differences were observed in the probability of adopting stomach and breast cancer screening in relation to education, household income, and job level. Results from Cox's proportional hazard model indicated that higher household income was significantly associated with an increased probability of adopting stomach cancer screening earlier (p<0.05), and people with high household incomes were more likely to adopt breast cancer screening earlier than were those with incomes under US$1,500 per month (p<0.01). When considered at a significance level of 0.1, we found that the most highly educated women were more likely than the least educated to be screened early. CONCLUSIONS Despite organized governmental screening programs, there are still inequalities in the early adoption of cancer screening. The results of this study also suggest that inequalities in early adoption may affect participation in regular screening.
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Affiliation(s)
- Myung-Il Hahm
- Department of Healthcare Management, College of Medical Science, Soonchunhyang University, Shinchang-myun, Asan-si, Choongchungnam-do 336-745, Republic of Korea
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