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Tran TXM, Kim S, Cha C, Park B. Temporal Trend in Uptake of the National General Health Checkups and Cancer Screening Program among Korean Women with Breast Cancer. Cancer Res Treat 2024; 56:522-530. [PMID: 37905311 PMCID: PMC11016641 DOI: 10.4143/crt.2023.729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/28/2023] [Indexed: 11/02/2023] Open
Abstract
PURPOSE This study assessed the temporal trends of uptake of national general health and cancer screening among women with breast cancer in Korea between 2009 and 2016. MATERIALS AND METHODS We retrospectively analyzed the claims data from the Korean National Health Insurance Service database. Participants included 101,403 breast cancer patients diagnosed between 2009 and 2016. Information on participation in national screening programs, including breast cancer screening, general health, and gastric, colorectal, and cervical cancers, up to 2020 was collected. Screening participation rates within the first 2 and 5 years postdiagnosis were calculated by diagnosis year and fitted with joinpoint regression models to assess temporal trends. RESULTS Overall, the participation rate in breast cancer screening within 2 years postdiagnosis increased from 10.9% to 14.0% from 2009-2016, with an annual percentage change (APC) of 3.7% (p < 0.05). The participation rate in breast cancer screening was lower than that in general health checkup and screening for other cancers within 2 and 5 years postdiagnosis. A steady increase in screening trends was also observed for general health, gastric, colorectal, and cervical cancers, with APC of 5.3%, 5.7%, 6.9%, and 7.6% in the 2-year postdiagnosis rate, and APC of 3.6%, 3.7%, 3.7%, and 4.4% in 5-year postdiagnosis rate, respectively. The screening rate was highest among age groups 50-59 and 60-69 in 2009 and significant upward trends were observed in all age groups for general health checkup and gastric, colorectal, and cervical cancer screening. CONCLUSION Among female breast cancer survivors in Korea, the uptake rate of screenings for general health and various cancers, including breast, gastric, colorectal, and cervical cancers, has shown a gradual increase in recent years.
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Affiliation(s)
- Thi Xuan Mai Tran
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
- Institute for Health and Society, Hanyang University, Seoul, Korea
| | - Soyeoun Kim
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
- Institute for Health and Society, Hanyang University, Seoul, Korea
| | - Chihwan Cha
- Department of Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Boyoung Park
- Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, Korea
- Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, Korea
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Zhang B, Wang S, Yang X, Chen M, Ren W, Bao Y, Qiao Y. Knowledge, willingness, uptake and barriers of cervical cancer screening services among Chinese adult females: a national cross-sectional survey based on a large e-commerce platform. BMC Womens Health 2023; 23:435. [PMID: 37592252 PMCID: PMC10436426 DOI: 10.1186/s12905-023-02554-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/18/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Improving the coverage rate of cervical cancer screening is a challenge mission for cervical cancer elimination. This study attempted to assess the knowledge, willingness, and uptake of cervical cancer screening services among Chinese females and determined associated factors. METHODS This is a cross-sectional online survey conducted in China from March to April 2022. Information on demographic characteristics, knowledge, willingness, and uptake of cervical cancer screening was collected through a large e-commerce platform. Women aged 18-65 were included in the analysis. Logistic regression analysis was employed to detect the possible factors associated with knowledge, willingness, and screening participation. RESULTS A total of 4518 women (37.83 ± 9.14 years) were included in the final analysis, of whom 87.16% (n = 3938) lived in urban areas. About 93.40% (n = 4220) of the respondents reported hearing of cervical cancer screening. The median score of knowledge about cervical cancer was 16 out of 26. Over 84% (n = 3799) of the respondents were willing to receive regular cervical cancer screening. Nearly 40% (n = 1785) had never received cervical cancer screening. Among the screened women, 21.26% (n = 581), 35.24% (n = 1151), and 42.37% (n = 1158) were screened through a national cervical cancer screening program, employee physical examination, and self-paid physical examination, respectively. Knowledge was positively associated with willingness and screening participation. Age, marital status, occupation, monthly household income, and HPV vaccination history could influence screening participation (all p < 0.05). CONCLUSIONS Though women had high-level awareness and strong participation willingness in cervical cancer screening, the overall screening coverage among Chinese women was still low. Besides, the knowledge about cervical cancer was still limited. Comprehensive health education should be enhanced by utilizing social media platforms and medical workers. It is also important to promote national free cervical cancer screening with high-performance screening methods.
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Affiliation(s)
- Bo Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Sumeng Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiyu Yang
- The High School Affiliated to Renmin University of China, Beijing, China
| | - Mingyang Chen
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wenhui Ren
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yanping Bao
- National Institute On Drug Dependence and Beijing Key Laboratory of Drug Dependence, Peking University, Beijing, China
| | - Youlin Qiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
- Present Address: School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100005, China.
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Nari F, Park J, Kim N, Kim DJ, Jun JK, Choi KS, Suh M. Impact of health disparities on national breast cancer screening participation rates in South Korea. Sci Rep 2023; 13:13172. [PMID: 37580427 PMCID: PMC10425442 DOI: 10.1038/s41598-023-40164-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/05/2023] [Indexed: 08/16/2023] Open
Abstract
Socioeconomic barriers to cancer screening exist at a regional level. The deprivation index is used to estimate socioeconomic gradients and health disparities across different geographical regions. We aimed to examine the impact of deprivation on breast cancer screening participation rates among South Korean women. Municipal breast cancer screening participation rates in women were extracted from the National Cancer Screening Information System and linked to the Korean version of the deprivation index constructed by the Korea Institute for Health and Social Affairs. A generalised linear mixed model was employed to investigate the association between the deprivation index and age-standardised breast cancer screening participation rates in 2005, 2012, and 2018. Participation rates increased gradually across all age groups from 2005 to 2018. Participants in their 60 s consistently had one of the highest participation rates (2005: 30.37%, 2012: 61.57%, 2018: 65.88%). In 2005, the most deprived quintile had a higher estimate of breast cancer screening participation than the least deprived quintile (2nd quintile; estimate: 1.044, p = 0.242, 3rd quintile; estimate: 1.153, p = 0.192, 4th quintile; estimate: 3.517, p = 0.001, 5th quintile; estimate: 6.913, p = < 0.0001). In 2012, the participation rate also increased as the level of deprivation increased. There were no statistically meaningful results in 2018. Regions with high deprivation have a higher participation rate in breast cancer screening. The role of health disparities in determining cancer outcomes among women in Korea requires further examination.
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Affiliation(s)
- Fatima Nari
- National Cancer Control Institute, National Cancer Center, 323-Ilsan-Ro, Goyang, 10408, Republic of Korea
| | - Juwon Park
- National Cancer Control Institute, National Cancer Center, 323-Ilsan-Ro, Goyang, 10408, Republic of Korea
| | - Nayeon Kim
- National Cancer Control Institute, National Cancer Center, 323-Ilsan-Ro, Goyang, 10408, Republic of Korea
| | - Dong Jin Kim
- Center for Health Policy Research, Korea Institute for Health and Social Affairs, Sejong City, 30147, Republic of Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, 323-Ilsan-Ro, Goyang, 10408, Republic of Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, 10408, Republic of Korea
| | - Kui Son Choi
- National Cancer Control Institute, National Cancer Center, 323-Ilsan-Ro, Goyang, 10408, Republic of Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, 10408, Republic of Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, 323-Ilsan-Ro, Goyang, 10408, Republic of Korea.
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, 10408, Republic of Korea.
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4
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Song SY, Lee YY, Shin HY, Park B, Suh M, Choi KS, Jun JK. Trends in breast cancer screening rates among Korean women: results from the Korean National Cancer Screening Survey, 2005-2020. Epidemiol Health 2022; 44:e2022111. [PMID: 36470263 PMCID: PMC10396513 DOI: 10.4178/epih.e2022111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 11/24/2022] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVES Since 2002, the Korean government has provided breast cancer screening as part of the National Cancer Screening Program. This study reported trends in the screening rate among Korean women from 2005 to 2020, including organized and opportunistic screening for breast cancer. METHODS Data from the Korean National Cancer Screening Survey, an annual cross-sectional nationwide survey, were collected using a structured questionnaire between 2005 and 2020. The study population included 23,702 women aged 40-74 years with no history of cancer. We estimated the screening rate based on the current recommendation of biennial mammographic screening for breast cancer. In addition, a joinpoint trend analysis was performed for breast cancer screening rates among various subgroups. RESULTS In 2020, the breast cancer screening rate was 63.5%, reflecting an annual increase of 7.72% (95% confidence interval 5.53 to 9.95) between 2005 and 2012, followed by non-significant trends thereafter. In particular, a significant decrease in the breast cancer screening rate was observed in the subgroups aged 50-59 years old, with 12-15 years of education, and living in rural areas. CONCLUSIONS Although there has been substantial improvement in breast cancer screening rates in Korean women, the trend has flattened in recent years. Therefore, continual efforts are required to identify subgroups with unmet needs and solve barriers to the uptake of breast cancer screening.
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Affiliation(s)
- Soo Yeon Song
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Yun Yeong Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | | | - Bomi Park
- Department of Preventive Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Kui Son Choi
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
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5
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Organized Breast and Cervical Cancer Screening: Attendance and Determinants in Rural China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148237. [PMID: 35886089 PMCID: PMC9318997 DOI: 10.3390/ijerph19148237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 01/27/2023]
Abstract
To evaluate the attendance and determinants of organized cervical and breast cancer (two-cancer) screening, especially higher-level factors, we conducted a cross-sectional survey in central China from June 2018 to November 2019 among 1949 women (age ≥ 35 years). We examined organizer-level factors, provider-level factors, receiver-lever factors and attendance and participation willingness of screening. The results indicate that the attendance and participation willingness of organized two-cancer screening was 61.19% and 77.15%, respectively. After adjustment for potential confounders, women who received screening notification were more likely to have greater participation willingness and higher attendance than those who received no notification (adjusted odds ratio [aOR] = 1.59, 95% confidence interval [CI]: 1.27-1.99; aOR = 98.03, 95% CI: 51.44-186.82, respectively). Compared with being notified about screening by GPs, being notified by community women's leaders and other community leaders were more likely to lead to greater willingness to participate again (aOR = 2.86, 95% CI: 1.13-7.24; aOR = 3.27, 95% CI: 1.26-8.48, respectively) and recommending screening to others (aOR = 2.18, 95% CI: 1.02-4.65; aOR = 4.14, 95% CI: 1.84-9.30, respectively). The results suggest that notification of women about screening by community leaders is an important organizer-level factor. As a part of public health services, the design and implementation of optimal cancer screening strategies may require public-sector involvement at the organizer level instead of a one-man show by the health sector.
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Luu XQ, Lee K, Jun JK, Suh M, Jung KW, Choi KS. Effect of gastric cancer screening on long-term survival of gastric cancer patients: results of Korean national cancer screening program. J Gastroenterol 2022; 57:464-475. [PMID: 35568752 DOI: 10.1007/s00535-022-01878-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/26/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gastric cancer (GC) is the most common cancer type in Korea. Korean National Cancer Screening Program (KNCSP) offer either upper gastrointestinal series (UGIS) or upper endoscopy biennially for adults aged ≥ 40. This study aimed to investigate the effect of cancer screening program on the long-term survival among GC patients. METHODS A nationwide population-based cohort was constructed based on three national databases. Overall, 46,701 GC patients diagnosed in 2008 and 2009 were included in our final analysis, and they were followed-up until the end of 2019. Survival curves were estimated using the Kaplan-Meier analysis with the log-rank test. Cox proportional-hazards regression analysis was used to report the hazard ratios (HRs) with 95% confidence intervals. RESULTS A total of 18,614/46,701 (39.9%) patients died during the median follow-up time of 10.5 years. The survival rate was higher among screened patients (65.8%) than never-screened patients (49.1%). Screened patients had 53% (HR, 0.47; 95% CI 0.45-0.48) lower risk of death from GC. The HRs of GC-specific mortality was lower in upper endoscopy group (HR = 0.36; 95% CI = 0.34-0.37) compared with UGIS (HR = 0.69; 95% CI = 0.67-0.73). Screened patients within 2 years prior to cancer diagnosis had a 35% reduction in risk of GC death. The figure decline to approximately 19% among patients with interval time since last screening of > 3 years. CONCLUSIONS Our findings emphasized the positive effects of GC screening on long-term GC patient survival. Also, patients screened by upper endoscopy or within 2 years before diagnosis had the best survival outcomes.
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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, 10408, Korea
| | - Kyeongmin Lee
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, 10408, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, 10408, Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, 10408, Korea
| | - Kyu-Won Jung
- National Cancer Control Institute, National Cancer Center, Goyang, 10408, Korea
| | - Kui Son Choi
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, 10408, Korea.
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Seo JY, Shin DW, Yu SJ, Jung JH, Han K, Cho IY, Kim SY, Choi KS, Park JH, Park JH, Kawachi I. Disparities in Liver Cancer Surveillance Among People With Disabilities: A National Database Study in Korea. J Clin Gastroenterol 2021; 55:439-448. [PMID: 32889960 DOI: 10.1097/mcg.0000000000001405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/05/2020] [Indexed: 02/08/2023]
Abstract
GOAL The goal of this study was to determine disparities in liver cancer surveillance among people with disabilities is the goal of this study. BACKGROUND Using the linked administrative database in Korea, we sought to investigate (1) whether there are disparities in liver cancer surveillance according to degree and type of disability and (2) temporal trends in liver cancer surveillance among people with disabilities. MATERIALS AND METHODS We linked national disability registration data with national cancer surveillance data. We analyzed age-standardized participation rates for each year during the 2006-2015 period according to presence, type, and severity of the disability. We also examined factors associated with liver cancer surveillance by multivariate logistic regression using the most current data (2014-2015). RESULTS The age-adjusted and sex-adjusted surveillance rate for liver cancer in people with disabilities increased from 25.7% in 2006 to 49.6% in 2015; however, during the same period, surveillance rate among people without disabilities increased from 24.9% to 54.5%. As a result, disparities in surveillance for liver cancer increased over time. The surveillance participation rate among people with disabilities was 12% lower than among people without disabilities. Surveillance rates were markedly lower among people with severe disabilities [adjusted odds ratio (aOR)=0.71] and people with renal disease (aOR=0.43), brain injuries (aOR=0.60), ostomy problems (aOR=0.60), and intellectual disabilities (aOR=0.69). CONCLUSIONS Despite the availability of a national liver cancer surveillance program, a marked disparity was found in liver cancer surveillance participation, especially among people with severe disabilities, renal disease, or brain-related or mental disabilities.
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Affiliation(s)
- Jae Youn Seo
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center
| | - Dong Wook Shin
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center
- Department of Digital Health, SAIHST, Sungkyunkwan University
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine
| | - Jin Hyung Jung
- Department of Medical Statistics, The Catholic University of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul
| | - In Young Cho
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
| | - So Young Kim
- College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju
| | - Kui Son Choi
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang
| | - Jong Heon Park
- Big Data Steering Department, National Health Insurance Service, Wonju, Republic of Korea
| | - Jong Hyock Park
- College of Medicine/Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju
| | - Ichiro Kawachi
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
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Bui CN, Hong S, Suh M, Jun JK, Jung KW, Lim MC, Choi KS. Effect of Pap smear screening on cervical cancer stage at diagnosis: results from the Korean National Cancer Screening Program. J Gynecol Oncol 2021; 32:e81. [PMID: 34378364 PMCID: PMC8362811 DOI: 10.3802/jgo.2021.32.e81] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/01/2021] [Accepted: 06/26/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We aimed to determine the differences in stage at diagnosis of cervical cancer among Korean women according to screening history. METHODS Using linkage data from the Korean Central Cancer Registry and Korean National Cancer Screening Program (KNCSP), we included 18,388 women older than 30 years who were newly diagnosed with cervical cancer between 2013 and 2014 and examined their screening history. Between individuals, age group and socioeconomic status were matched to control for potential confounders. RESULTS Significantly more cases of carcinoma in situ (CIS) were diagnosed in the ever-screened (71.77%) group than in the never-screened group (54.78%), while localized, regional, distant, and unknown stage were more frequent in the never-screened group. Women in the ever-screened group were most likely to be diagnosed with CIS than with invasive cervical cancer (adjusted odds ratio [aOR]=2.40; 95% confidence interval [CI]=2.18-2.65). The aOR for being diagnosed with CIS was highest among women who were screened 3 times or more (aOR=5.10; 95% CI=4.03-6.45). The ORs were highest for women screened within 24 months of diagnosis and tended to decrease with an increasing time since last screening (p-trend <0.01). CONCLUSION The KNCSP for cervical cancer was found to be positively associated with diagnosis of cervical cancers at earlier stages among women aged 30 years or older. The benefit of screening according to time was highest for women screened within 24 months of diagnosis.
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Affiliation(s)
- Cam Nhung Bui
- National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea
| | - Seri Hong
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Mina Suh
- National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea.,National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea.,National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Kyu Won Jung
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Myong Cheol Lim
- National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea.,Division of Tumor Immunology, Center for Gynecologic Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kui Son Choi
- National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Korea.,National Cancer Control Institute, National Cancer Center, Goyang, Korea.
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Bui CN, Choi E, Suh M, Jun JK, Jung KW, Lim MC, Choi KS. Trend analysis of process quality indicators for the Korean National Cervical Cancer Screening Program from 2005 to 2013. J Gynecol Oncol 2020; 32:e14. [PMID: 33327046 PMCID: PMC7767658 DOI: 10.3802/jgo.2021.32.e14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/12/2020] [Accepted: 11/08/2020] [Indexed: 11/30/2022] Open
Abstract
Objective This study sought to examine changes in trends for quality indicators of the population-based Korean National Cancer Screening Program (KNCSP) for cervical cancer from years 2005 to 2013. Methods Our study data were derived from the KNCSP database. Cervical cancer diagnosis information was ascertained through linkage with the Korean National Cancer Registry and the KNCSP database. Performance measures for cervical cancer screening were estimated, including participation rate, positive rate, crude detection rate (CDR), interval cancer rate (ICR), positive predictive value (PPV), sensitivity, and specificity. Joinpoint analysis was applied to calculate annual percentage changes (APCs) in all indicators according to socio-demographic factors. Results A significant increasing trend was noted in participation rates (APC=13.4%; 95% confidence interval [CI]=10.5, 16.4). PPV and specificity increased from years 2005 to 2009 and remained stable till 2013. An increasing trend was discovered in CDRs for cervical cancer in situ (APC=3.9%; 95% CI=1.0, 6.9), whereas a decreasing trend was observed in ICRs for invasive cervical cancer (APC=−2.5%; 95% CI=−4.5, −0.5). Medical Aid recipients and women older than 70 years showed the lowest participation rates, but higher CDRs and ICRs, compared to other groups. In general, most of the quality indicators for cervical cancer screening improved from 2005 to 2009 and remained stable to 2013. Conclusion The KNCSP for cervical cancer in Korea has improved in terms of participation rate and accuracy of the screening test. These results may be attributed to the National Quality Improvement Program for KNCSP.
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Affiliation(s)
- Cam Nhung Bui
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Eunji Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.,National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Kyu Won Jung
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Myong Cheol Lim
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.,Division of Tumor Immunology, Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.,National Cancer Control Institute, National Cancer Center, Goyang, Korea.
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Park J, Han K, Shin DW, Park SH, Shin HB. Conditional Relative Survival and Competing Mortality of Patients with Prostate Cancer in Korea: A Nationwide Cohort Study. Cancer Epidemiol Biomarkers Prev 2020; 30:326-334. [PMID: 33187966 DOI: 10.1158/1055-9965.epi-20-1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/16/2020] [Accepted: 11/09/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Conditional relative survival (CRS) and competing mortality are important survivorship issues after cancer treatment. We aimed to investigate them among patients with prostate cancer treated by various modalities. METHODS Using a nationwide population-based database, we calculated 5-year CRS conditioned on 1 through 5 years survival after diagnosis. These rates were stratified by age, sex, socioeconomic status, comorbidities, and treatment received. Cause of death and estimated cause-specific mortality were also described and considered with competing risks. RESULTS A total of 81,773 patients newly diagnosed with primary prostate cancer from 2007 to 2013 were identified. The 5-year CRS was 81.1% at baseline, but increased gradually up to 95.4% at 4 years and exceeded 100% at 5 years after diagnosis, suggesting no excess mortality compared with the general population. However, this pattern differed by treatment received. Patients who underwent androgen deprivation therapy showed 5-year CRS of only 88.4% at 5 years after diagnosis, implying persistent excess mortality. Prostate cancer constituted around one-third of deaths, while other cancers were the main cause of death within <2 years after diagnosis. Noncancer-related deaths, including cardiovascular disease and respiratory disease, increased with time since diagnosis. CONCLUSIONS CRS rates for patients with prostate cancer improved over time and exceeded that of the general population at 5 years. Other cancers were the main cause of death in the earlier survivorship phase, and deaths from noncancer causes gradually increased over time. IMPACT Our findings will help patients and clinicians make evidence-based decisions on the basis of a patient's dynamic risk profile.
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Affiliation(s)
- Jinsung Park
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Republic of Korea (South)
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea (South)
| | - Dong Wook Shin
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (South). .,Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea (South).,Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea (South)
| | - Sang Hyun Park
- Department of Medical Statistics, The Catholic University of Korea, Seoul, Republic of Korea (South)
| | - Hyun Bin Shin
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Republic of Korea (South)
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Patterns of percutaneous transthoracic needle biopsy (PTNB) of the lung and risk of PTNB-related severe pneumothorax: A nationwide population-based study. PLoS One 2020; 15:e0235599. [PMID: 32649662 PMCID: PMC7351186 DOI: 10.1371/journal.pone.0235599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 06/19/2020] [Indexed: 12/12/2022] Open
Abstract
Background As percutaneous transthoracic needle biopsy (PTNB) of the lung is a well-established diagnostic method for the evaluating pulmonary lesions, evidence of safety based on representative data is limited. This study investigated the practice patterns of PTNB of the lung and assessed the incidence and risk factors of PTNB-related severe pneumothorax in Korea. Methods We used a national-level health insurance database between January 1, 2007 and December 31, 2015. Patients who underwent PTNB of the lung were identified using procedure codes for organ biopsy, fluoroscopy, computed tomography, chest radiography, and lung-related diagnosis codes. The annual age-/sex-standardized rate of PTNB and the incidence of PTNB-related severe pneumothorax were calculated. We defined severe pneumothorax as the pneumothorax requiring intervention. The odds ratios of risk factors were assessed by a generalized estimating equation model with exchangeable working correlation matrix to address clustering effect within institution. Results A total of 66,754 patients were identified between 2007 and 2015. The annual age-/sex-standardized rate of PTNB per 100,000 population was 19.6 in 2007 and 22.4 in 2015, and it showed an increasing trend. The incidence of severe pneumothorax was 2.4% overall: 2.5% in men and 1.2% in women, and 2.6%, 2.7%, 2.1%, 2.1%, 1.9%, 2.4%, and 2.4% from 2009 to 2015. Older age (≥60), male sex, presence of chronic obstructive pulmonary disease, receiving treatment in an urban or rural area versus a metropolitan area, and receiving treatment at a general hospital were significantly associated with the risk of severe pneumothorax. Conclusions Considering the increasing trend of PTNB, more attention needs to be paid to patients with risk factors for severe pneumothorax.
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Shin DW, Han K, Park HS, Lee SP, Park SH, Park J. Risk of Ischemic Heart Disease and Stroke in Prostate Cancer Survivors: A Nationwide Study in South Korea. Sci Rep 2020; 10:10313. [PMID: 32587285 PMCID: PMC7316755 DOI: 10.1038/s41598-020-67029-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 05/28/2020] [Indexed: 11/26/2022] Open
Abstract
In this study using national health insurance data, we investigated the risk of ischemic heart disease (IHD) and stroke among prostate cancer (PC) survivors compared with the general population, as well as the risk of cardiovascular disease (CVD) according to primary treatment. A total of 48,298 PC patients diagnosed from 2007 to 2013 were included and matched to non-cancer controls. Compared to the general population, PC survivors had a slightly lower risk of IHD (adjusted hazard ratio [aHR] = 0.89, 95% confidence interval [CI] 0.83–0.96) or stroke (aHR 0.90, 95% CI 0.87–0.95). Especially, survivors who underwent surgery had lower risks of IHD (aHR 0.70, 95% CI 0.61–0.80) or stroke (aHR 0.73, 95% CI 0.67–0.81). Compared to survivors in the active surveillance/watchful waiting group, the androgen deprivation therapy (ADT) group had a significantly greater risk of stroke (aHR 1.16, 95% CI 1.02–1.32), but the IHD risk was not significantly elevated (aHR 1.06, 95% CI 0.88–1.29). In conclusion, PC survivors had a slightly lower risk of CVD compared to the general population, which was attributable to self-selection for PSA screening, specifically in the surgery-only group. CVD risk was dependent on treatment received, and attention should be given to patients who receive ADT.
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Affiliation(s)
- Dong Wook Shin
- Supportive Care Center/Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Hyun Sik Park
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
| | - Seung-Pyo Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Hyun Park
- Department of Medical Statistics, Catholic University of Korea, Seoul, Korea
| | - Jinsung Park
- Department of Urology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea.
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13
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Breast cancer screening disparities between women with and without disabilities: A national database study in South Korea. Cancer 2020; 126:1522-1529. [DOI: 10.1002/cncr.32693] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/02/2019] [Accepted: 12/08/2019] [Indexed: 11/07/2022]
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Shin DW, Chang D, Jung JH, Han K, Kim SY, Choi KS, Lee WC, Park JH, Park JH. Disparities in the Participation Rate of Colorectal Cancer Screening by Fecal Occult Blood Test among People with Disabilities: A National Database Study in South Korea. Cancer Res Treat 2019; 52:60-73. [PMID: 31096735 PMCID: PMC6962481 DOI: 10.4143/crt.2018.660] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 05/06/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Implementation of screening program may lead to increased health disparity within the population if participation differs by socioeconomic status. In Korea, colorectal cancer screening is provided at no or minimal cost to all people over 50 by National Cancer Screening Program. We investigated colorectal cancer screening participation rate and its trend over the last 10 years in relation to disabilities. Materials and Methods We linked national disability registration data with National Cancer Screening Program data. Age, sex-standardized participation rates were analyzed by type and severity of disability for each year, and factors associated with colorectal cancer screening participation were examined by multivariate logistic regression. RESULTS Age, sex-standardized participation rate in people without disability increased from 16.2 to 33.9% (change, +17.7), but it increased from 12.7% to 27.2% (change, +14.5) among people with severe disability. People with severe disabilities showed a markedly lower colorectal cancer screening participation rate than people without disability (adjusted odds ratio [aOR], 0.714; 95% confidence interval, 0.713 to 0.720). People with autism (aOR, 0.468), renal failure (aOR, 0.498), brain injury (aOR, 0.581), ostomy (aOR, 0.602), and intellectual disability (aOR, 0.610) showed the lowest participation rates. CONCLUSION Despite the availability of a National Cancer Screening Program and overall increase of its usage in the Korean population, a significant disparity was found in colorectal cancer screening participation, especially in people with severe disabilities and or several specific types of disabilities. Greater effort is needed to identify the barriers faced by these particularly vulnerable groups and develop targeted interventions to reduce inequality.
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Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea
| | - Dongkyung Chang
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, Korea.,Division of Gastroenterology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Hyung Jung
- Department of Medical Statistics, The Catholic University of Korea, Seoul, Korea
| | - Kyungdo Han
- Department of Medical Statistics, The Catholic University of Korea, Seoul, Korea
| | - So Young Kim
- College of Medicine, Chungbuk National University/Chungbuk National University Hospital, Cheongju, Korea
| | - Kui Son Choi
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Won Chul Lee
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Heon Park
- Big Data Steering Department, National Health Insurance Service, Wonju, Korea
| | - Jong Hyock Park
- College of Medicine, Chungbuk National University/Chungbuk National University Hospital, Cheongju, Korea
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15
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Shin DW, Lee JW, Jung JH, Han K, Kim SY, Choi KS, Park JH, Park JH. Disparities in Cervical Cancer Screening Among Women With Disabilities: A National Database Study in South Korea. J Clin Oncol 2018; 36:2778-2786. [DOI: 10.1200/jco.2018.77.7912] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Using the linked administrative database in Korea, we investigated (1) whether cervical cancer screening participation differed by the presence of varying degrees and types of disability; (2) trends in the cervical cancer screening rate relative to disabilities over time; and (3) factors associated with cervical cancer screening. Methods We linked national disability registration data with national cancer screening program data. Age-standardized participation rates were analyzed for each year during the period 2006 to 2015, according to the presence, type, and severity of disabilities. Factors associated with undergoing cervical cancer screening were examined by multivariate logistic regression with the most current data (ie, 2014 to 2015). Results The age-adjusted screening rate for cervical cancer screening in women with disabilities increased from 20.8% in 2006% to 42.1% in 2015 (change, +21.3%); however, among women without disabilities, it increased from 21.6% to 53.5% (change: +31.9%) during that time. Disability was associated with a lower screening rate (adjusted odds ratio [aOR], 0.71; 95% CI, 0.71 to 0.72). Screening rates were markedly lower in women with severe disabilities (aOR, 0.42; 95% CI, 0.42 to 0.42) and women with autism (aOR, 0.06; 95% CI 0.03 to 0.11), intellectual disability (aOR, 0.25; 95% CI, 0.25 to 0.26), brain injury (aOR, 0.311; 95% CI, 0.31 to 0.32), ostomy (aOR, 0.36; 95% CI, 0.33 to 0.38), or mental disorder (aOR, 0.43; 95% CI, 0.42 to 0.44). Conclusion Despite the availability of free screening, a significant disparity was found in cervical cancer screening participation, especially in women with severe disabilities and those with mental disabilities. The identification of barriers associated with decreased screening rates in women with disabilities has important implications for the design of tailored interventions and health care policies to improve cervical cancer screening and outcomes in this vulnerable population.
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Affiliation(s)
- Dong Wook Shin
- Dong Wook Shin and Jeong-Won Lee, Samsung Medical Center; Jin Hyung Jung and Kyungdo Han, The Catholic University of Korea; Kui Son Choi, National Cancer Center, Seoul; So Young Kim, Chungbuk National University Hospital; Jong Hyock Park, Chungbuk National University, Cheongju; and Jong Heon Park, National Health Insurance Service, Wonju, Korea
| | - Jeong-Won Lee
- Dong Wook Shin and Jeong-Won Lee, Samsung Medical Center; Jin Hyung Jung and Kyungdo Han, The Catholic University of Korea; Kui Son Choi, National Cancer Center, Seoul; So Young Kim, Chungbuk National University Hospital; Jong Hyock Park, Chungbuk National University, Cheongju; and Jong Heon Park, National Health Insurance Service, Wonju, Korea
| | - Jin Hyung Jung
- Dong Wook Shin and Jeong-Won Lee, Samsung Medical Center; Jin Hyung Jung and Kyungdo Han, The Catholic University of Korea; Kui Son Choi, National Cancer Center, Seoul; So Young Kim, Chungbuk National University Hospital; Jong Hyock Park, Chungbuk National University, Cheongju; and Jong Heon Park, National Health Insurance Service, Wonju, Korea
| | - Kyungdo Han
- Dong Wook Shin and Jeong-Won Lee, Samsung Medical Center; Jin Hyung Jung and Kyungdo Han, The Catholic University of Korea; Kui Son Choi, National Cancer Center, Seoul; So Young Kim, Chungbuk National University Hospital; Jong Hyock Park, Chungbuk National University, Cheongju; and Jong Heon Park, National Health Insurance Service, Wonju, Korea
| | - So Young Kim
- Dong Wook Shin and Jeong-Won Lee, Samsung Medical Center; Jin Hyung Jung and Kyungdo Han, The Catholic University of Korea; Kui Son Choi, National Cancer Center, Seoul; So Young Kim, Chungbuk National University Hospital; Jong Hyock Park, Chungbuk National University, Cheongju; and Jong Heon Park, National Health Insurance Service, Wonju, Korea
| | - Kui Son Choi
- Dong Wook Shin and Jeong-Won Lee, Samsung Medical Center; Jin Hyung Jung and Kyungdo Han, The Catholic University of Korea; Kui Son Choi, National Cancer Center, Seoul; So Young Kim, Chungbuk National University Hospital; Jong Hyock Park, Chungbuk National University, Cheongju; and Jong Heon Park, National Health Insurance Service, Wonju, Korea
| | - Jong Heon Park
- Dong Wook Shin and Jeong-Won Lee, Samsung Medical Center; Jin Hyung Jung and Kyungdo Han, The Catholic University of Korea; Kui Son Choi, National Cancer Center, Seoul; So Young Kim, Chungbuk National University Hospital; Jong Hyock Park, Chungbuk National University, Cheongju; and Jong Heon Park, National Health Insurance Service, Wonju, Korea
| | - Jong Hyock Park
- Dong Wook Shin and Jeong-Won Lee, Samsung Medical Center; Jin Hyung Jung and Kyungdo Han, The Catholic University of Korea; Kui Son Choi, National Cancer Center, Seoul; So Young Kim, Chungbuk National University Hospital; Jong Hyock Park, Chungbuk National University, Cheongju; and Jong Heon Park, National Health Insurance Service, Wonju, Korea
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Shin JY, Choi KS, Suh M, Park B, Jun JK. Comparison of cervical cancer screening among women with and without hysterectomies: a nationwide population-based study in Korea. BMC Cancer 2018; 18:810. [PMID: 30098592 PMCID: PMC6087535 DOI: 10.1186/s12885-018-4723-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical cancer screening is not recommended for women who underwent hysterectomy with no history of cervical intraepithelial neoplasia (CIN) of grade 2 or higher. We aimed to determine the cervical cancer screening rate in Korean women who underwent hysterectomies and compare it to that in women with intact uteri. METHODS We used data from the 2014-2016 Korean National Cancer Screening Survey; 6807 women aged 30-74 years were included in the study. Participants were asked about their experiences with cervical cancer screening, hysterectomy status, and other variables associated with cancer screening. RESULTS The screening rates among women who have undergone a hysterectomy vs. those who have not during the past 2 years were 61.8% (95% confidence interval [CI], 58.8-64.9) and 64.7% (95% CI, 64.1-65.3), respectively. Among younger women (30-44 years) and women with a family history of cancer, those with hysterectomies showed a higher cervical cancer screening rate than those without (77.8% vs. 57.1% and 75.0% vs. 67.1%, respectively). CONCLUSIONS Despite available evidence and clinical recommendations, a considerable number of Korean women who no longer have a cervix continue to undergo unnecessary cervical cancer screening. It is necessary to identify the exact underlying causes for this phenomenon, and systematic efforts are required to prevent unnecessary screening for women who have undergone a hysterectomy.
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Affiliation(s)
- Ji-Yeon Shin
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, 41944 Republic of Korea
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408 Republic of Korea
- National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408 Republic of Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408 Republic of Korea
| | - Boyoung Park
- National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408 Republic of Korea
- Department of Medicine, College of Medicine, Hanyang University, Seoul, 04763 Republic of Korea
| | - Jae Kwan Jun
- Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408 Republic of Korea
- National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408 Republic of Korea
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Suh B, Song YS, Shin DW, Lim J, Kim H, Min SH, Lee SP, Park EA, Lee W, Lee H, Park JH, Cho B. Incidentally detected atherosclerosis in the abdominal aorta or its major branches on computed tomography is highly associated with coronary heart disease in asymptomatic adults. J Cardiovasc Comput Tomogr 2018; 12:305-311. [DOI: 10.1016/j.jcct.2018.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 03/01/2018] [Accepted: 03/13/2018] [Indexed: 12/21/2022]
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Lee J. Health Inequality in Health Checkups. Korean J Fam Med 2018; 39:65-66. [PMID: 29629036 PMCID: PMC5876050 DOI: 10.4082/kjfm.2018.39.2.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Jungun Lee
- Department of Family Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea
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