The Effect of National Cancer Screening on Disparity Reduction in Cancer Stage at Diagnosis by Income Level

Delays in treatment initiation and conclusion in women with stage IA to IIIB cervical cancer: A survival study in a hospital-based cohort from a developing country

AIM

To evaluate the effect of delays in stage IA to IIIB cervical cancer treatment initiation and conclusion on hospital-based survival among Brazilian women.

METHODS

A retrospective follow-up study was conducted in a stage IA to IIIB cervical cancer cohort treated from 2012 and 2014 and followed until December 31, 2017 in Rio de Janeiro. Delay in treatment initiation definition was defined based on the Brazilian law of 60 days for treatment initiation after diagnosis. Delay in treatment conclusion was defined based on the literature and sample distributions: < 120/121-200/> 200 days. The endpoint was death(from all causes or cervical cancer). Death causes and dates were obtained by a record linkage procedure between the hospital cancer registry and the Mortality Information System. Global 36-month survival and HRs were estimated by the KaplanMeier method and proportional Cox regression models, respectively.

RESULTS

From 865 patients, 269(31.1%) died over the median follow-up time of 27 months. Delay on treatment initiation(>60-days) was 92.8%, while the delay in treatment conclusion(>120 days) was 87.5%. Overall survival was 61.3% (<60-days:62.6%; 61-90 days:63.5%). Among stage IIB-IIIB, women treated < 60-days presented 40.1% survival, while 61-90-days had 52.5%, and > 90-days had 53.3%. Delays in treatment conclusion significantly reduced survival[72.2%(<120-days) to 60.7%(>200-days)]. Multivariate analysis showed that delays in treatment initiation did not affect 36-month death risk. Compared to women concluding treatment in < 120-days, those taking 121-200-days or > 200-days showed increases in death risk of 89%(95%CI:1.10-3.24) and 111%(95%CI:1.31-3.39), respectively, regardless of age, stage, treatment protocol, and time to treatment initiation.

CONCLUSION

Delays in cervical cancer treatment conclusion (but not treatment initiation) affected 36-month survival and death risk among Brazilians.

Individual and joint effect of socioeconomic status and lifestyle factors on cancer in Korea

BACKGROUND

There is limited evidence on the individual and joint effect of socioeconomic status (SES) and unhealthy lifestyle on cancer. Therefore, this study aimed to examine the effects of these factors on cancer incidence and mortality.

METHODS

In this population-based cohort study, income was used as the proxy of SES. A combined unhealthy lifestyle score was obtained using data on smoking, alcohol consumption, physical activity, and body mass index. Hazard ratios were estimated using a Cox proportional hazards model.

RESULTS

The study included data on 8,353,169 participants (median follow-up period, 17 years). Although the association between low income and cancer incidence varied depending on cancer type, low income consistently increased the risk of cancer-related death with a social gradient. Unhealthy behaviors increased the risk of cancer incidence and mortality, except for thyroid and breast cancer in women and prostate cancer in men. Compared with the wealthiest and healthiest individuals, the poorest and unhealthiest men and women showed 2.1-fold (2.05-2.14) and 1.36-fold (1.31-1.41) higher risk of cancer-related death, respectively. The joint effect was most robust for lung, liver, head, and neck cancers in men and liver and cervical cancers in women; further, the effect was stronger with cancer-specific mortality than with incidence.

CONCLUSION

In conclusion, income and combined healthy lifestyle behaviors have individual and joint effects on cancer incidence and mortality. The effect varies by cancer type and sex.

Colonoscopy decreases mortality in colorectal cancer patients compared with fecal immunochemical test

BACKGROUND AND AIM

Colonoscopy and fecal immunochemical test (FIT) are commonly used screening methods for the detection of colorectal cancer (CRC), but their effects on survival have not been compared. We compared survival outcomes in patients with CRC according to the exposure history to colonoscopy or FIT before diagnosis of CRC.

METHODS

We performed a nationwide population-based retrospective cohort study using Korean national-insurance claims data. In total, 24 875 patients with CRC diagnosed in 2012 were included. The patients were divided into three groups in terms of examinations performed during the 10 years prior to CRC diagnosis: the colonoscopy group, the FIT group, and the never-screened group. Survival outcomes were compared among the three groups. The colonoscopy group and FIT group were matched using propensity score-matching method.

RESULTS

The cohort consisted of 9619 patients in the colonoscopy group, 6936 patients in the FIT group, and 8320 patients in the never-screened group. The 5-year overall survival rates were 74.1% in the colonoscopy group, 65.9% in the FIT group, and 59.6% in the never-screened group (P < 0.001). The adjusted hazard ratios for death were 0.56 (95% confidence interval [CI], 0.53-0.59) in the colonoscopy group and 0.78 (95% CI, 0.74-0.82) in the FIT group compared with the never-screened group. In the matched cohort, the adjusted hazard ratios for death was 0.76 (95% CI, 0.72-0.81) in the colonoscopy group compared with the FIT group.

CONCLUSION

Colonoscopy is a more effective method for reducing mortality in patients with CRC compared with FIT.

Introducing the Sanguis-Filum for Detection of Gastric Mucosal Lesions Prior to Endoscopy: A Study Protocol

Early diagnosis of gastric cancer (GC) is compromised by a lack of specific signs to enable identification of affected individuals. We designed the Sanguis-filum (S-filum) as a simple bedside tool that could be used to detect the presence of gastric mucosal lesions prior to endoscopy. We previously published evidence that at a sensitivity of 91%, the presence of free blood in the stomach was associated with mucosal lesions. The S-filum is made of an inert but absorbent string coiled up in a gelatin capsule (Capsuline, FL, USA), which can be swallowed and the string retrieved to test for free blood. Preliminary testing of the S-filum was successfully conducted on healthy volunteers. We now intend to test it on actual patients, comparing the results to oesophagogastroduodenoscopy (OGD) findings. This will enable us to determine the diagnostic accuracy of the S-filum at detecting GC and other mucosal lesions. The S-filum as a bedside tool has the potential to assist healthcare providers to identify individuals likely to have early gastric mucosal lesions and requiring OGD examination. The S-filum could, in the long run, facilitate population-wide screening for early GC prior to endoscopy.

Income Disparities in Cancer Screening: A Cross-Sectional Study of the Korean National Health and Nutrition Examination Survey, 2013–2019

Background

Cancer is one of the leading chronic diseases, which causes premature mortality in Korea. Early detection has been reported to be associated with reduced mortality and morbidity. Consistent evidence reports that lower screening rates are associated with socioeconomic-based disparities. This study aimed to examine income-related disparities in cancer screening services and to analyze the association between utilization of cancer screening and individual characteristics, including income levels.

Methods

This study utilized the data from the Korea National Health and Nutrition Examination Survey (KNHANES), a population-based survey from 2013 to 2019. The study population included individuals aged 40 years or over. The variables were socioeconomic characteristics and perceived health status. Household income was categorized into quartiles from Q1 (the lowest income group) to Q4 (the highest income group). Multivariate logistic regression analysis was performed to analyze the association between cancer screening and individual characteristics and household income levels.

Results

There were 20,347 individuals included in this study. Among these, 14,741 (72.4%) had undergone cancer screening. There existed a gap in the utilization of cancer screening between the lowest (Q1) and highest (Q4) income quintiles owing to evident income disparities; Q4 thus had a significantly higher likelihood of undergoing cancer screening than other quintiles. Female sex, university and over education, number of chronic diseases, and private insurance coverage were positively associated with cancer screening (p < 0.001).

Conclusion

Our findings suggest that policymakers should develop and design strategies to increase awareness and efforts to improve the education and promotion of cancer screening among lower-income target groups.

Risk factors for precancerous cervical lesion among women screened for cervical cancer in south Ethiopia: Unmatched case-control study

BACKGROUND

Nearly 90% of deaths from cervical cancer occur in a low resource setting. In Ethiopia, the magnitude of precancerous cervical lesions ranges from 7% to 28%. Precancerous cervical lesions may progress to cervical cancer. Early screening and treatment of precancerous cervical lesions is a cost-effective way to avert the growth of cervical cancer. However, there has been limited research on risk factors for precancerous cervical lesions in Ethiopia. Therefore, this study aimed to identify risk factors for precancerous cervical lesions among women screened for cervical cancer in south Ethiopia.

METHOD

A facility-based unmatched case-control study was carried out in five health facilities in south Ethiopia between 8 May to 28 September 2018. Interviewer administered questionnaires were used to collect data from 98 cases and 197 controls. Multivariate logistic regression was employed to identify determinants of precancerous cervical lesions.

RESULTS

Women aged 30-39 years (AOR = 2.51, 95% CI: 1.03-6.08), monthly income ≤66 (AOR = 3.51, 95% CI: 1.77-6.97), initiation of first sexual intercourse at age less than or equal to 20 (AOR = 2.39, 95% CI: 1.14-5.47), having more than one lifetime sexual partner (AOR = 4.70, 95% CI: 2.02-10.95), having a partner/ husband with more than one lifetime sexual partner (AOR = 2.98, 95% CI: 1.35-6.65) had higher odds of precancerous cervical lesions.

CONCLUSION AND RECOMMENDATION

Strategies to prevent precancerous cervical lesions should focus on modification of lifestyle and sexual behaviour. The findings of this study highlight several implications for policymakers: targeting older women for cervical cancer screening, addressing inequalities and education relating to risky sexual behaviour may reduce precancerous cervical lesions. Furthermore, future longitudinal studies are needed to assess the awareness of women about cervical cancer screening.

Barriers and Challenges to Cervical Cancer Screening, Follow-Up, and Prevention Measures among Korean Immigrant Women in Hawaii

OBJECTIVE

Despite being the fastest-growing population in the United States, Asian American women have one of the lowest cancer screening rates and the least attention given to cancer-related research. Cervical cancer screening disparities among Korean immigrant women (KIWs) in Hawaii have been reported.

METHODS

The qualitative ethnographic study was to explore the health barriers and challenges of cervical cancer prevention among KIWs in Hawaii. The Social Ecological Model was used to guide the study. Data were collected using individual structured interviews with 20 KIWs aged 21-65 years. The data were coded and analyzed to identify themes in exploring health barriers.

RESULTS

The findings revealed that participants (a) lacked knowledge about the U.S. health-care system; (b) lacked access; (c) had limited resources regarding cervical cancer screening communicated in Korean; (d) lacked an understanding of cultural and psychosocial beliefs on preventive care; (e) lacked female and Korean-speaking providers; and (f) experienced language barriers and limited coverage of health insurance.

CONCLUSIONS

A multicomponent intervention combining individual and community-based, Internet-accessible, culturally, and linguistically appropriate approaches may enhance effective cervical cancer screening rates and positive health outcomes among KIWs in Hawaii.

FENDRR: A pivotal, cancer-related, long non-coding RNA

Long non-coding RNAs (lncRNAs) have more than 200 nucleotides and do not encode proteins. Based on numerous studies, lncRNAs have emerged as new and crucial regulators of biological function and have been implicated in the pathogenesis of a variety of diseases, especially cancers. Specific lncRNAs have been identified as novel molecular biomarkers for cancer diagnosis, prognosis, and treatment efficacy. Fetal-lethal non-coding developmental regulatory RNA (FENDRR, also known as FOXF1-AS1) is a novel lncRNA that is located at chr3q13.31 and has four exons and 3099 nucleotides, and its genomic site is located at chr3q13.31. FENDRR is abnormally expressed in a variety of cancers and is significantly associated with different clinical characteristics. In addition, FENDRR has shown potential as a biomarker for cancer diagnosis, prognosis, and treatment. In this review, we summarize the current understanding of FENDRR and its mechanistic role in cancer progression. We also discuss recent insights into the clinical significance of FENDRR for cancer diagnosis, prognosis, and treatment.

Cervical Cancer Treatment Delays and Associated Factors in a Cohort of Women From a Developing Country

PURPOSE

To estimate treatment delays and associated factors among women diagnosed with cervical cancer who were treated at the main cancer center in Rio de Janeiro, Brazil.

MATERIALS AND METHODS

A retrospective cohort study was performed comprising 865 women newly diagnosed with cervical cancer between 2012 and 2014. Times from diagnosis to treatment initiation (less than or equal to 60 days) and from diagnosis to treatment ending (less than or equal to 120 days) were analyzed according to the Brazilian law for the treatment of patients with cancer. Associations between treatment delays and sociodemographic, economic, lifestyle, clinical, and treatment variables were estimated using logistic regression models, with 95% CIs.

RESULTS

The average age was 48 (± 13.7) years, and the median age was 47 years; 36.2% of patients had stage IIIB to IVA disease. The median time from diagnosis to treatment initiation was 114 days, which was statistically higher among women with stage IIB to IVA (105.5 days) compared with those with earlier stages (119 days). The delay in treatment initiation occurred in 92.8% of participants; the median time from diagnosis to treatment ending was 274 days, with a delay (more than 120 days) for 92.6% of patients. The median time interval from diagnosis to the first visit to the cancer center was 28 days, with a delay of more than 30 days for 46.6% of patients. Age (odds ratio [OR], 1.05; 95% CI,1.02 to 1.08), stage IIIB to IVA (OR, 0.38; 95% CI, 0.16 to 0.90), time to first visit to the cancer center (OR, 11.52; 95% CI, 4.32 to 30.66), chemoradiation treatment (OR, 4.56; 95% CI, 1.81 to 11.47), and adequate treatment (OR, 2.57; 95% CI, 1.26 to -5.40) were independently associated with delay of treatment initiation.

CONCLUSION

Significant delays in treatment initiation and ending were observed in this studied population. The treatment initiation delay was positively associated with age, time interval more than 30 days from diagnosis to first specialist assessment at the cancer center, treatment with chemoradiation, and adequate treatment.

Inequality in Life Expectancy in Korea according to Various Categorizations of the National Health Insurance Premiums as a Marker of Income

The purpose of this study was to examine the degree to which the magnitude of income inequality in life expectancy according to different categorization across beneficiary types under the National Health Insurance Service (NHIS) in Korea. We used population and death data in 2017 from the National Health Information Database of the NHIS. Income quintile groups were classified in four ways according to beneficiary type (employee insured, self-employed insured, and Medical Aid beneficiaries). Standard life table procedures were used to calculate life expectancy. The life expectancy gap between the lowest and highest income quintiles was the largest when the entire population was divided into quintiles without distinguishing among types of beneficiaries. In conclusion, we suggest that income quintile indicators in NHIS data, measured without distinguishing among types of beneficiaries, may best represent the magnitude of health inequalities in Korean society. This indicator could be used for future research on health inequalities, as well as for monitoring health inequalities in Korea.

Epigallocatechin gallate reverses gastric cancer by regulating the long noncoding RNA LINC00511/miR-29b/KDM2A axis

Epigallocatechin gallate (EGCG), as one of the main ingredients of green tea, has been reported to have potential prevention on a variety of solid tumors. However, the system-wide molecular mechanisms targeted to EGCG's anti-tumor effect have not been illustrated. Here, AGS and SGC7901 GC cells were used to investigate the EGCG-mediated change of gene expression. Our data showed that EGCG retarded cell growth and promoted cell death of GC in dose-dependent manner. Analyses based on transcription, translation as well as function were performed to explore the elusive anticancer role of EGCG. Of them, cell cycle was probably implicated key pathway of EGCG. Besides, our data revealed numerous LncRNAs activated after EGCG treatment. In this study, LINC00511 was discovered to be suppressed by EGCG and highly expressed in GC cells and tissues. Knockdown of LINC00511 inhibited cell growth and promoted cell death ratio in GC. Additionally, our data suggested LINC00511 could decrease the expression of miR-29b, followed by inducing GC development. Knockdown of miR-29b recovered the effects of LINC00511 silencing. In addition, we found overexpression of KDM2A, a target of miR-29b, would rescue the level of LINC00511. All the data showed that the LINC00511/miR-29b/KDM2A axis can be used as a diagnostic and therapeutic target for GC.

Association between the National Cancer Screening Programme (NSCP) for gastric cancer and oesophageal cancer mortality

Background

The aim was to evaluate whether this gastric cancer-screening programme was effective in reducing oesophageal cancer mortality.

Methods

A population-based retrospective cohort study was conducted using the Korean National Cancer Screening Programme (NCSP) database. The study cohort comprised 16,969 oesophageal cancer patients who had been diagnosed in 2007–2014. We analysed the association between the history of NSCP for gastric cancer and oesophageal cancer mortality.

Results

Compared with never-screened subjects, ever-screened subjects had an overall HR for oesophageal cancer mortality of 0.647 (95% CI, 0.617–0.679). According to the time interval since screening, the HRs of death were 0.731 (95% CI, 0.667–0.801) for 6–11 months, 0.635 (95% CI, 0.594–0.679) for 12–23 months, 0.564 (95% CI, 0.522–0.610) for 24–35 months and 0.742 (95% CI, 0.679–0.810) for ≥36 months. According to the last screening modality, the HRs of death were 0.497 (95% CI, 0.464–0.531) for upper endoscopy, and 0.792 (95% CI, 0.749–0.838) for UGIS. Upper endoscopy reduced the mortality consistently in all age groups over 50 years, whereas UGIS could not.

Conclusion

The NCSP for gastric cancer was effective in reducing the mortality of oesophageal cancer, and upper endoscopy was superior to UGIS.

Disparities in gastric cancer screening among people with disabilities: a national registry-linkage study in South Korea

BACKGROUND AND AIM

Using the national disability registration linked to the cancer screening database in Korea, we examined (1) trends in the gastric cancer screening rate among people with disabilities over time, and (2) whether gastric cancer screening participation and modalities differed according to presence, severity, and type of disability.

METHODS

We examined gastric cancer screening participation rates among individuals with registered disability, from 2006 to 2015.

RESULTS

The age- and sex-adjusted rate for gastric cancer screening in people with disabilities increased from 25.9% in 2006 to 51.9% in 2015 (change: + 26.0%). During the same period, screening rates among people without disability improved from 24.7 to 56.5% (change: + 31.8%). Disability was associated with a screening rate [adjusted odds ratio (aOR) 0.89, 95% confidence interval (CI), 0.88-0.89]. Screening rates were markedly lower among people with severe disabilities (aOR 0.58, 95% CI 0.57-0.58) and people with autism (aOR 0.36, 95% CI 0.25-0.52), renal failure (aOR 0.39, 95% CI 0.38-0.39), brain injury (aOR 0.41, 95% CI 0.40-0.41), ostomy problems (aOR 0.53, 95% CI 0.51-0.55), intellectual disabilities (aOR 0.54, 95% CI 0.53-0.54), or mental disorders (aOR 0.55, 95% CI 0.54-0.56). The use of gastroscopy as the initial screening modality in people with disabilities was lower than in people without a disability.

CONCLUSIONS

In spite of the availability of national gastric cancer screening program, we found significant disparities in gastric cancer screening participation, especially among people with severe disabilities and those with renal failure or brain-related/mental disabilities.

Pattern of Care, Health Care Disparities, and Their Impact on Survival Outcomes in Stage IVB Cervical Cancer: A Nationwide Retrospective Cohort Study

OBJECTIVE

Although locally advanced cervical cancer can be cured, patients with stage IVB disease have poor prognosis with limited treatment options. Our aim was to describe the pattern of care and analyze health disparity variables that may account for differences in treatment modalities and survival in this population.

METHODS

The National Cancer Database was queried for patients diagnosed between 2004 and 2013 with metastatic squamous cell carcinoma or adenocarcinoma of the cervix. Codes representing parenchymal and lymphatic metastasis (beyond the para-aortic radiation fields) were used to identify the cohort. Variables included age, race, insurance status, comorbidity, treatment modality, and outcomes. We used Kaplan-Meier methods to compare survival curves and Cox proportional hazards to estimate the association between variables and overall survival (OS). Log-rank method was used to compare Kaplan-Meier curves.

RESULTS

There were 4576 patients identified. The majority was white (59.7%); 19.5% were Hispanic, and 9.6% were black. Fifty-one percent had Medicare/Medicaid; 33.7% had private, and 12.5% had no insurance. The majority (56.3%) received chemotherapy (CMT) alone or in combination with radiation therapy (RT) and/or surgery. Median follow-up was 7.3 months (0-124.8 months). Median OS was 11.5 months (10.5-12.5 months). Higher probability of receiving CMT and RT was associated with having private insurance (P < 0.001). Significant prognostic values positively affecting survival on multivariate analysis included black and Asian race, private insurance, comorbidity index of 0, metastatic site at initial presentation (lung), and treatment modality. Patients treated with CMT + RT with or without surgery had significantly better median OS (12 months) compared with those treated with CMT alone (8.3 months), RT alone (4.8 months), or those untreated (2.3 months) (P < 0.001).

CONCLUSIONS

Insurance status influences treatment options in patients with distant metastatic cervical cancer. Race, comorbidity index, metastatic site, and suboptimal treatment appear to affect survival outcomes. Regardless of treatment, survival was extremely limited.

Potential factors associated with clinical stage of nasopharyngeal carcinoma at diagnosis: a case-control study

Background

In China, most patients with nasopharyngeal carcinoma (NPC) are diagnosed at a late stage and consequently have a poor prognosis. This study aimed to investigate potential factors associated with the clinical stage of NPC at diagnosis.

Methods

Data were obtained from 118 patients with early-stage NPC and 274 with late-stage NPC who were treated at Sun Yat-sen University Cancer Center between August 2014 and July 2015. Patients were individually matched by age, sex, and residence, and a conditional logistic regression model was applied to assess the associations of clinical stage at diagnosis with socioeconomic status indicators, knowledge of NPC, physical examinations, patient interval, and risk factors for NPC.

Results

Although knowledge of early NPC symptoms, smoking cessation, and patient interval were important factors, the number of cigarettes smoked per day, motorbike ownership, and physical examination exhibited the strongest associations with the clinical stage of NPC at diagnosis. Compared with smoking fewer than ten cigarettes a day, smoking 10–30 cigarettes [odds ratio (OR) 4.03; 95% confidence interval (CI) 1.11–14.68] or more than 30 cigarettes (OR 11.46; 95% CI 1.26–103.91) was associated with an increased risk of late diagnosis. Compared with not owning a motorbike, owning a motorbike (OR 0.38; 95% CI 0.23–0.64) was associated with early diagnosis. Subjects who underwent physical examinations were less likely to receive a late diagnosis than those who did not undergo examinations (OR 0.50; 95% CI 0.28–0.89). However, indicators of wealth were not significant factors.

Conclusions

Initiatives to improve NPC patient prognosis should aim to promote knowledge about early symptoms and detection, health awareness, and accessibility to health facilities among all patients, regardless of socioeconomic status.

Influence of Socioeconomic Status, Comorbidity, and Disability on Late-stage Cancer Diagnosis

Objectives

Understanding factors affecting advanced stage at diagnosis is vital to improve cancer outcomes and overall survival. We investigated the factors affecting later-stage cancer diagnosis.

Methods

Patients completed self-reported questionnaires. We collected cancer stage data from medical records review. Logistic regression analyses were performed to identify factors associated with later stage cancer at diagnosis by gender.

Results

In total, 1,870 cancer patients were included in the study; 55.8% were men, 31.1% had more than one comorbid condition, and 63.5% had disabilities. About half of the patients were smokers, and drank alcohol, and 58.0% were diagnosed at an advanced stage. By cancer type, lung and liver cancers (both genders), prostate (men), colorectal, cervical, and thyroid cancer (women) were more likely to be diagnosed at a later stage. After controlling for socioeconomic factors, comorbidity (odds ratio [OR], 1.48 in men) and disability (OR, 1.64 in men and 1.52 in women) remained significantly associated with late-stage diagnosis.

Conclusion

In this nationwide study, using combined information from patients and medical records, we found that male patients with comorbidities or disabilities, and female patients with disabilities were more likely to have advanced stage cancer at diagnosis. Targeted approaches by cancer type and health conditions are recommended.

Association between education and the risk of incident coronary heart disease among middle-aged and older Chinese: the Dongfeng-Tongji Cohort

Educational achievement was related to cardiovascular disease in some western populations, but prospective evidence on the relationship between education and the risk of incident coronary heart disease (CHD) in Asians is scarce. We aimed to explore this association and the potential modifying effect of major CHD risk factors related to education in middle-aged and older Chinese adults. We included 18,551 participants with mean age 62.8 years at baseline between September 2008 and June 2010, and followed the population until October 2013. Cox proportional hazard models and log-binomial regression models were used for multivariate analyses. Compared with participants with low education, the adjusted hazard ratio (HR) and 95% confidence interval (95% CI) for incident CHD in those with high education was 0.89 (95% CI: 0.80, 0.98). In addition, such inverse association between education and the risk of incident CHD was more evident among individuals who were more than 60 years, physically active, overweight, and hypertension. Besides, decreases in the relative index of inequality with high education versus low education were from 0.83 to 0.76 for hypertension, from 0.85 to 0.82 for diabetes. In conclusion, education was inversely associated with the risk of incident CHD among middle-aged and older Chinese adults.

Factors associated with participation in cervical cancer screening among young Koreans: a nationwide cross-sectional study

OBJECTIVES

Despite the possibility of early detection of cervical cancer, participation in screening programmes among young Koreans is low. We sought to identify associations between risk factors and participation in screening for cervical cancer among young Koreans.

DESIGN

Nationwide cross-sectional study.

SETTING

Republic of Korea.

PARTICIPANTS

3734.

MAIN OUTCOME MEASURES

The Korea National Health and Nutrition Examination Survey (KNHANES V: 2010-2012) was used to evaluate factors associated with attendance for cervical cancer screening among women aged 15-39. After excluding those who were previously diagnosed with cervical cancer and those with incomplete responses to questionnaires, a total of 3734 subjects were eligible. Multi-dimensional covariates as potential predictors of cervical cancer screening were adjusted in multiple logistic regression analysis.

RESULTS

The participation rate for cervical cancer screening was 46% among women aged 40 or younger. The logistic analyses showed that age, education, total household income, smoking and job status among women aged 15-39 were associated with participation in cervical cancer screening (p<0.05). After age stratification, the associated factors differed by age groups. Moreover, a dose-response between participation in cervical cancer screening and high total household income in the 30-39 age group was seen.

CONCLUSIONS

Predictive factors differed among young women (aged 15-29 vs 30-39). Thus, age-specific tailored interventions and policies are needed to increase the participation rate in screening for cervical cancer.

Increased breast cancer mortality only in the lower education group: age-period-cohort effect in breast cancer mortality by educational level in South Korea, 1983-2012

BACKGROUND

A steadily increasing pattern of breast cancer mortality has been reported in South Korea since the late 1980s. This paper explored the trends of educational inequalities of female breast cancer mortality between 1983 and 2012 in Korea, and conducted age-period-cohort (APC) analysis by educational level.

METHODS

Age-standardized mortality rates of breast cancer per 100,000 person-years were calculated. Relative index of inequality (RII) for breast cancer mortality was used as an inequality measure. APC analyses were conducted using the Web tool for APC analysis provided by the Division of Cancer Epidemiology and Genetics at the U.S. National Cancer Institute.

RESULTS

An increasing trend in breast cancer mortality among Korean women between 1983 and 2012 was due to the increased mortality of the lower education groups (i.e., no formal education or primary education and secondary education groups), not the highest education group. The breast cancer mortality was higher in women with a tertiary education than in women with no education or a primary education during 1983-1992, and the reverse was true in 1993-2012. Consequently, RII was changed from positive to negative associations in the early 2000s. The lower education groups had the increased breast cancer mortality and significant cohort and period effects between 1983 and 2012, whereas the highest group did not.

CONCLUSIONS

APC analysis by socioeconomic position used in this study could provide an important clue for the causes on breast cancer mortality. The long-term monitoring of socioeconomic patterning in breast cancer risk factors is urgently needed.

Income Disparities in the Use of Health Screening Services Among University Students in Korea: A Cross-Sectional Study of 2479 Participants in a University

Public health insurance coverage for preventive care in young adults is incomplete in Korea. Few studies have focused on young adults' socioeconomic disparities in preventive care utilization. We aimed to explore household income disparities in the use of different types of health screening services among university students in Korea.This cross-sectional study used a web-based self-administered survey of students at a university in Korea from January to February 2013. To examine the associations between household income levels and health screening service use within the past 2 years, odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression with adjustment for various covariables.Of 2479 participants, 45.5% reported using health screening services within 2 years (university-provided screening 32.9%, private sector screening 16.7%, and both 4.1%). Household income levels were not significantly associated with overall rates of health screening service use with a multivariable-adjusted OR (95% CI) in the lowest versus highest income group of 1.12 (0.87-1.45, Ptrend = 0.35). However, we found significantly different associations in specific types of utilized screening services by household income levels. The multivariable-adjusted OR (95% CI) of university-provided health screening service use in the lowest versus highest income level was 1.74 (1.30-2.34; Ptrend < 0.001), whereas the multivariable-adjusted OR (95% CI) of private sector service use in the lowest versus highest income level was 0.45 (0.31-0.66; Ptrend < 0.001).This study demonstrated significant disparities in the types of utilized health screening services by income groups among university students in Korea, although overall rates of health screening service use were similar across income levels. Low-income students were more likely to use university-provided health screening services, and less likely to use private sector screening services. To ensure appropriate preventive care delivery for young adults and to address disparities in disadvantaged groups, the expansion of medical insurance coverage for preventive health care, establishment of a usual source of care, focusing on vulnerable groups, and the development of evidence-based standardized health screening guidelines for young adults are needed.