Epidemiology and Health

Brief Communication

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

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Abstract

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Summary

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

Citations

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Methods

Overdiagnosis: epidemiologic concepts and estimation: Jong-Myon Bae; Epidemiol Health. 2015;37:e2015004. Published online February 10, 2015; DOI: https://doi.org/10.4178/epih/e2015004

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Abstract

Overdiagnosis of thyroid cancer was propounded regarding the rapidly increasing incidence in South Korea. Overdiagnosis is defined as ‘the detection of cancers that would never have been found were it not for the screening test’, and may be an extreme form of lead bias due to indolent cancers, as is inevitable when conducting a cancer screening programme. Because it is solely an epidemiological concept, it can be estimated indirectly by phenomena such as a lack of compensatory drop in post-screening periods, or discrepancies between incidence and mortality. The erstwhile trials for quantifying the overdiagnosis in screening mammography were reviewed in order to secure the data needed to establish its prevalence in South Korea.

Summary

Korean summary
최근 갑상선암의 발생 증가는 과진단에 기인한 것이란 주장이 제기되었다. 과진단은 ‘평생동안 몰랐을 암을 검진으로 알아낸 경우’로 정의하는 바, 예상보다 늦은 진행으로 예후가 더 좋고 치료를 안해도 사망률 변동을 만들지 못하는 암에 대하여 반복되는 암검진에 더 잘 진단되는 기간차이 바이어스가 개입되는 것을 제대로 통제하지 못해서 생긴 것이다. 검진을 더 이상 하지 않았을 경우 발생률이 본래대로 되돌아오지 않는 현상을 보이거나, 사망률과 발생률 간의 변동에서 큰 차이를 보일 때 과진단이 있다고 판단한다. 국내에서 발생하는 과진단의 크기를 측정하기 위한 방법들을 알아보기 위하여, 기존의 유방암 조기검진용 유방촬영술에 대한 과진단 크기를 알아낸 연구방법들을 살펴보았다.

Citations

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Epidemiological evidences on overdiagnosis of prostate and kidney cancers in Korean
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Epidemiology and Health.2015; 37: e2015015. CrossRef
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Hypothesis

Two hypotheses of dense breasts and viral infection for explaining incidence of breast cancer by age group in Korean women: Jong-Myon Bae; Epidemiol Health. 2014;36:e2014020. Published online September 26, 2014; DOI: https://doi.org/10.4178/epih/e2014020

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Abstract

Breast cancer, the second leading type of cancer in Korean women, has shown increasing incidence over the past 10 years. However, the curves of incidence by age group cast doubt on the birth cohort effect hypothesis. To explain the curves, here I suggest two alternative hypotheses of breast density and viral infection based on pre-existing evidences. Evaluating these hypotheses would require important clues to find unknown risk factors of breast cancer and to plan more effective strategies for breast cancer control in Korean women.

Summary

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Methods

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

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Abstract

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

Summary

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

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Original Articles

An Analysis on the Factors Associated with Cancer Screening in a City.: Woon Nyung Roh, Won Chul Lee, Young Bok Kim, Yong Mun Park, Hong Jae Lee, Kwang Ho Meng; Korean J Epidemiol. 1999;21(1):81-92.

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Abstract PDF: Abstract
This study is aimed at preparing basic data required for establishment of a cancer screening program by examining the status of cancer screenings performed by residents in a community and the factors that have an effect on determination for a cancer screening by residents. Cervix, breast and stomach cancers were chosen as target cancers of the study due to the fact that merits of screening for these cancers have been proved by studies done in different countries. In order to find out the status of cancer screening and the factors having an effect on the determination for a cancer screening, 10 Dongs and a total of 1988 people were selected as study area and subjects by a random cluster sampling method, and the subjects were questioned on different aspects by questionnaires. Additionally, in order to find out how cancer screening is performed at medical facilities and how cancer screening is recommended by doctors, medical facilities doing cancer screening were also questioned. The results of the study are as follows: 1. In the case of the screening of the stomach cancer, 16.1% of male subjects and 25.6% of female subjects turned out to have had one or more screening for the cancer. In the cases of the breast and the cervical cancers, 21.6% and 62.6% of the subjects turned out to have had one or more screenings respectively. 2. As to the screening for the stomach cancer, there was a tendency that more of the subjects with lower level education, excepting those without education, had themselves screened for the cancer. Higher screening rates were shown by the subjects in higher ages, those who visited doctors regularly. 3. As to the screening rate by education levels, a high rate of screening was shown by the subjects with above-university education level and there was not a big difference between the screenings done for high school graduates and for those with lower education levels. Regarding the rates of screening by age groups the screening rate turned out to be higher with the higher ages. Screening rates, checked on the basis of the income levels, did not show a big differences between income levels. 4. The highest rate of screening for the breast cancer was shown by the subjects with postgraduate level of education and regarding the rate by income level, a slightly higher level was shown by the subjects with the monthly income of the 2,010,000 won, but the difference between the rates of screening by subjects at different income levels was overall not significant. 5. The rates for selecting the health screening facilities were higher in orders of the reasons that 1) they were close: 2) service was excellent and 3) equipment and facilities were good. Based on the above-mentioned results obtained by the study, it is anticipated that this study will play a vital role as basic data for the development and execution of cancer screening program for a community, and the analysis, done on the basis of the status of the cancer screening, of the factors related to the determination for the cancer screening showed that for the development of a cancer screening program, factors like income levels, education levels, whether people consult doctors regularly and the local government' care for health in a community should be considered, and in addition to which active participation of doctors in the program is also requested.; Summary

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

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

Review

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

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

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