Epidemiology and Health

Original Articles

Changes in metabolic syndrome and the risk of breast and endometrial cancer according to menopause in Korean women: Thi Xuan Mai Tran, Soyeoun Kim, Boyoung Park; Epidemiol Health. 2023;45:e2023049. Published online May 1, 2023; DOI: https://doi.org/10.4178/epih.e2023049

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study investigated how changes in metabolic syndrome (MetS) are associated with the subsequent risk of breast and endometrial cancer according to menopausal status.
METHODS
This cohort study, using data from the National Health Insurance Service database, included women aged ≥40 years who underwent 2 biennial cancer screenings (2009-2010 and 2011-2012) and were followed up until 2020. Participants were grouped into MetS-free, MetS-recovery, MetS-development, and MetS-persistent groups. Menopausal status (premenopausal, perimenopausal, and postmenopausal) was assessed at 2 screenings. Cox proportional hazard regression was used to assess the association between MetS changes and cancer risk.
RESULTS
In 3,031,980 women, breast and endometrial cancers were detected in 39,184 and 4,298, respectively. Compared with the MetS-free group, those who recovered, developed, or had persistent MetS showed an increased risk of breast cancer, with adjusted hazard ratios (aHRs) of 1.05, 1.05, and 1.11, respectively (p<0.005). MetS persistence was associated with an increased risk of breast cancer in postmenopausal women (aHR, 1.12, 95% confidence interval [CI], 1.08 to 1.16) but not in premenopausal or perimenopausal women. MetS persistence was associated with an increased risk of endometrial cancer in premenopausal, perimenopausal, and postmenopausal women, with aHRs of 1.41 (95% CI, 1.17 to 1.70), 1.59 (95% CI, 1.19 to 2.12), and 1.47 (95% CI, 1.32 to 1.63), respectively.
CONCLUSIONS
Increased breast cancer risk was associated with recovered, developed, and persistent MetS in postmenopausal women. Meanwhile, increased endometrial cancer risk was found in obese women who recovered from MetS or persistently had MetS, regardless of menopausal status, when compared to MetS-free women.; Summary

Korean summary
- 폐경후 여성에서 대사증후군이 회복되었거나, 지속적으로 대사증후군을 앓고 있거나, 대사증후군이 발병한 여성은 유방암 위험과 관련이 있었습니다. - 한편, 폐경 상태와 관계없이 대사증후군에서 회복되었거나 지속적으로 대사증후군를 앓고 있는 비만 여성은 대사증후군이 없는 여성에 비해 자궁내막암 위험이 증가하는 것으로 나타났습니다.

Key Message
- Increased breast cancer risk was associated with recovered, developed, and persistent MetS in postmenopausal women. - Increased endometrial cancer risk was found in obese women who recovered from MetS or persistently had MetS, regardless of menopausal status, when compared to MetS-free women.

Changes in the treatment rate of patients newly diagnosed with stage IV cancer near the end of life from 2012 to 2017 in Korea: Kyuwoong Kim, Hyun Jung Jho, So Jung Park, Bohyun Park, Jin Young Choi; Epidemiol Health. 2023;45:e2023021. Published online February 14, 2023; DOI: https://doi.org/10.4178/epih.e2023021

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
This study aimed to evaluate changes in the cancer treatment rate among patients newly diagnosed with stage IV cancer using socio-demographic and clinical subgroups in a nationwide cohort of Korean patients.
METHODS
This retrospective, national-level study used the Korea Central Cancer Registry (KCCR), which is linked to the National Health Insurance Service (NHIS) database, from January 1, 2012 to December 31, 2017. The records of patients newly diagnosed with stage IV of the 5 cancers with the highest cancer-related mortality rate were identified to analyze changes in the treatment rate. The main outcome examined in this study was the change in the cancer treatment rate between 2012 and 2017, as measured using the annual percent change (APC).
RESULTS
A total of 106,082 patients with newly diagnosed gastric, colorectal, liver, pancreatic, and lung cancers at the end of life (EoL) were identified from the KCCR-NHIS database. Of these patients, 76,533 (72.1%) received cancer treatment. Over the study period (2012-2017), the proportion of patients who received cancer treatment at EoL decreased by 8.3%, with an APC of -2.1% (95% confidence interval, -2.6 to -1.6). This declining trend of cancer treatment among patients with advanced cancer stage at EoL was consistent among socio-demographic and clinical subgroups.
CONCLUSIONS
The proportion of untreated patients with stage IV cancer is increasing in the Korea. For patients who are not undergoing standard cancer treatment near EoL, an alternative care plan, such as early palliative care, should be considered.; Summary

Korean summary
국민건강보험공단과 중앙암등록본부 자료를 활용하여 4기 암환자의 암 치료 비율 추이를 분석한 결과 2012년부터 2017년까지 위암, 대장암, 간암, 췌장암, 폐암으로 진단받은 4기 암환자들의 암 치료 비율의 연간비율변화는 8.3% 감소하는 것으로 나타났다. 이러한 결과는 인구사회학적 및 임상적 특성에 관계없이 일관되었다. 본 연구결과는 말기에 가까운 4기 암 환자들이 표준 치료를 받지 못하는 경우, 조기 완화의료와 같은 대안적인 계획을 고려할 필요가 있음을 시사한다.

Key Message
● Between 2012 and 2017, there was a significant decrease in the treatment rate among these patients, though most still received cancer treatment. ● Alternative clinical choices, such as the early utilization of hospice and palliative care, may improve quality of life and reduce the need for aggressive care for such patients.

Trends in breast cancer screening rates among Korean women: results from the Korean National Cancer Screening Survey, 2005-2020: Soo Yeon Song, Yun Yeong Lee, Hye Young Shin, Bomi Park, Mina Suh, Kui Son Choi, Jae Kwan Jun; Epidemiol Health. 2022;44:e2022111. Published online November 24, 2022; DOI: https://doi.org/10.4178/epih.e2022111

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Since 2002, the Korean government has provided breast cancer screening as part of the National Cancer Screening Program. This study reported trends in the screening rate among Korean women from 2005 to 2020, including organized and opportunistic screening for breast cancer.
METHODS
Data from the Korean National Cancer Screening Survey, an annual cross-sectional nationwide survey, were collected using a structured questionnaire between 2005 and 2020. The study population included 23,702 women aged 40-74 years with no history of cancer. We estimated the screening rate based on the current recommendation of biennial mammographic screening for breast cancer. In addition, a joinpoint trend analysis was performed for breast cancer screening rates among various subgroups.
RESULTS
In 2020, the breast cancer screening rate was 63.5%, reflecting an annual increase of 7.72% (95% confidence interval 5.53 to 9.95) between 2005 and 2012, followed by non-significant trends thereafter. In particular, a significant decrease in the breast cancer screening rate was observed in the subgroups aged 50-59 years old, with 12-15 years of education, and living in rural areas.
CONCLUSIONS
Although there has been substantial improvement in breast cancer screening rates in Korean women, the trend has flattened in recent years. Therefore, continual efforts are required to identify subgroups with unmet needs and solve barriers to the uptake of breast cancer screening.; Summary

Korean summary
본 연구는 2005년에서 2020년까지 암검진수검행태조사 자료를 이용하여 40세 이상의 우리나라 여성의 유방암 검진 수검률이 추이에 대해 분석하였다. 우리나라 유방암 검진 수검률은 2020년 현재 63.5%이다. 하지만 지속적으로 증가하던 유방암 검진 수검률의 추이는 2012년 이후 정체되어 있으며 일부 사회경제적 계층에서는 감소하는 경향을 보였다.

Key Message
In Korea, despite of the high level of breast cancer screening rate, decreasing trends in some socioeconomic classes after 2012. Continual efforts are required to identify subgroup with unmet needs and barriers to the uptake of breast cancer screening.

Effect of mammography screening on the long-term survival of breast cancer patients: results from the National Cancer Screening Program in Korea: Xuan Quy Luu, Kyeongmin Lee, Jae Kwan Jun, Mina Suh, Kyu-Won Jung, Kui Son Choi; Epidemiol Health. 2022;44:e2022094. Published online October 26, 2022; DOI: https://doi.org/10.4178/epih.e2022094

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Abstract PDF Supplementary Material: Abstract
OBJECTIVES
This study investigated the effect of mammography screening on the long-term survival of breast cancer (BC) patients aged 40 years or older according to their screening history and duration since screening.
METHODS
The study cohort was organized from 3 nationwide databases of the Korean National Cancer Screening Program, the Korean Central Cancer Registry, and death certificates. We included 24,387 women diagnosed with invasive BC or ductal carcinoma in situ in 2008 and 2009 and followed up until December 31, 2019. Cox proportional-hazards regression was used to investigate the effect of BC screening on the risk of death.
RESULTS
Overall, 20,916 of 24,387 patients (85.8%) were alive at the end of the follow-up period (median: 10.5 years). The long-term survival rate was significantly lower in the never-screened group (80.3%) than in the screened group (88.9%) (p<0.001). A 35% reduction in the risk of BC death (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.60 to 0.70) from screening was observed. A subgroup analysis according to the cancer stage showed 62%, 36%, and 24% lower risks of BC death for the localized stage, regional stage, and distant stage, respectively. Women aged 40-49 years received the least benefit from BC screening (HR, 0.71; 95% CI, 0.62 to 0.81).
CONCLUSIONS
Mammography screening was effective in reducing the risk of BC-specific death in Asian women across all cancer stages. However, this effect was relatively small among women in their 40s, suggesting that more detailed and specialized screening strategies are needed for that age group.; Summary

Data Profile

The National Hospice and Palliative Care registry in Korea: Kyuwoong Kim, Bohyun Park, Bonju Gu, Eun Jeong Nam, Sue Hyun Kye, Jin Young Choi; Epidemiol Health. 2022;44:e2022079. Published online September 21, 2022; DOI: https://doi.org/10.4178/epih.e2022079

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Abstract Summary PDF

Abstract

The National Hospice and Palliative Care (NHPC) registry is a nationwide database in Korea that systematically collects information on terminally ill cancer patients receiving inpatient hospice care. From 2018 to 2020, a total of 47,911 patients were enrolled in the NHPC registry from hospitals providing inpatient hospice care. The NHPC database mainly contains the socio-demographic and clinical information of the registered patients. Among these patients, approximately 75% were 60 years or older, and the ratio of males to females was 1:1.41. Lung, liver, colorectal, pancreatic, and gastric cancer made up nearly 90% of the cancer sites among the registered patients. Upon their initial admission to the hospice ward, around 80% of the patients were aware of their terminal illness. About half of the patients had mild pain at the time of the initial admission to the hospice ward, and the duration of hospice care was 14 days (interquartile range, 6-30) in 2019 and 2020. The NHPC registry aims to provide national statistics on inpatient hospice care to assist health policy-making.

Summary

Korean summary
본 논문에서 소개된 국가 호스피스·완화의료 등록시스템은 국내 입원형 호스피스 환자의 인구사회학적 특성과 임상정보에 관한 정보를 포함하고 있습니다. 등록시스템은 국내 호스피스·완화의료 현황에 대한 국가통계 생산, 근거기반 호스피스·완화의료 정책 개발 및 연구 등에 활용될 수 있습니다.

Key Message
The National Hospice and Palliative Care registry contains information on demographics and clinical information of patients receiving inpatient hospice care in Korea. Along with its primary purpose to provide national statistics on the current status of hospice care in the country, the registry could also be used for evidence-based health policy or research pertaining to hospice in Korea.

Citations

Citations to this article as recorded by

Advance Care Planning in South Korea
Yu Jung Kim, Sun-Hyun Kim
Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen.2023; 180: 68. CrossRef

Systematic Review

Systematic review and meta-analysis of cancer risks in relation to environmental waste incinerator emissions: a meta-analysis of case-control and cohort studies: Kiook Baek, Jong-Tae Park, Kyeongmin Kwak; Epidemiol Health. 2022;44:e2022070. Published online September 1, 2022; DOI: https://doi.org/10.4178/epih.e2022070

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
Various toxic substances can be generated from incinerators, exposing nearby residents, and epidemiological studies have shown wide variations in risk estimates for cancer risk in populations living close to incinerators.
METHODS
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search and systematic review were conducted to identify studies conducted on general populations exposed to environmental incinerator emissions and cancer outcomes. Meta-analysis was performed according to the cancer types for which 2 or more studies were reported. Subgroup analysis was done for sex, the exposure estimation method, the study period, and the type of outcome.
RESULTS
Eleven studies were found for the qualitative review and meta-analysis. Seven studies had a case-control design, and 4 had a cohort design. The pooled effect size was not significant for breast, colorectal, liver, lung, lymphohematopoietic, stomach, bladder, central nervous system, and laryngeal cancers, non-Hodgkin lymphoma, sarcoma, leukemia, and all cancers. In the subgroup analysis, the pooled effect size of laryngeal cancer in females was 1.82 (95% confidence interval, 1.10 to 3.01), although only 2 studies were identified.
CONCLUSIONS
The meta-analysis did not provide evidence of an increased risk for any cancer among populations living near waste incinerators, except for laryngeal cancer in females. However, since relatively few studies were reviewed and some cancer types showed significant increases in individual studies, this evidence needs to be updated regularly.; Summary

Korean summary
본 연구에서는 현재까지 소각장 인근 주민들의 암 위험도에 대해 보고된 환자-대조군 연구 및 코호트 연구를 체계적 문헌고찰과 메타분석법을 활용하여 분석하였다. 총 11개의 문헌에서 보고한 암 위험도를 암종별로 분석한 결과 소각장 인근 거주로 인한 암 위험도 상승이 유의하게 상승한 암종은 없었다. 세부 그룹 분석에서 여성의 후두암이 비록 단 2개 문헌에서만 보고하고 있었지만 유의한 상승을 보였다. 본 연구는 현재까지 논란이 많은 소각장 인근 거주와 암 발생 위험도의 증가에 대해 관찰연구로서 생태학적 연구를 배제하고 비교적 역학적 증거로서 가치가 높은 연구방법인 환자-대조군 연구와 코호트 연구를 고찰한 의의가 있으며, 본 연구의 방법론을 활용하면 추후 같은 주제의 증거를 지속적으로 갱신하여 종합할 수 있으리라 기대한다.

Key Message
This meta-analysis showed a lack of evidence of elevated risk of specific cancers after pooling the effect sizes by cancer type, except for laryngeal cancer in women. However, due to the small number of included studies, the evidence needs to be monitored and updated on a regular basis in the future.

COVID-19: Original Article

The impact of COVID-19 on screening for colorectal, gastric, breast, and cervical cancer in Korea: Hyeree Park, Seung Hee Seo, Jong Heon Park, Shin Hye Yoo, Bhumsuk Keam, Aesun Shin; Epidemiol Health. 2022;44:e2022053. Published online June 21, 2022; DOI: https://doi.org/10.4178/epih.e2022053

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The coronavirus disease 2019 (COVID-19) pandemic has affected the utilization of healthcare services, including participation in cancer screening programs. We compared cancer screening participation rates for colorectal, gastric, breast, and cervical cancers among participants in the National Cancer Screening Program (NCSP) in 2019 and 2020 to address the potential distraction effect of COVID-19 on cancer screening.

METHODS

Data from the NCSP for 4 cancer types (stomach, colorectal, breast, and cervical) in 2019 and 2020 were used to calculate cancer screening participation rates by calendar month, gender, age group, and geographical region. Monthly participation rates were analyzed per 1,000 eligible individuals.

RESULTS

The screening participation rate decreased in 2020 compared to 2019 for all 4 cancers: colorectal (40.5 vs. 35.3%), gastric (61.9 vs. 54.6%), breast (63.8 vs. 55.8%), and cervical (57.8 vs. 52.2%) cancers. Following 2 major COVID-19 waves in March and December 2020, the participation rates in the 4 types of cancer screening dropped compared with those in 2019. The highest decline was observed in the elderly population aged 80 years and older (percentage change: -21% for colorectal cancer; -20% for gastric cancer; -26% for breast cancer; -20% for cervical cancer).

CONCLUSIONS

After the 2 major COVID-19 waves, the screening participation rate for 4 types of cancer declined compared with 2019. Further studies are needed to identify the indirect effects of the COVID-19 pandemic on cancer patients, such as delayed diagnoses of cancer or excess cancer deaths.

Summary

Korean summary
본 연구는 코로나 대유행 기간 전과 후 대장암, 위암, 유방암, 자궁경부암 검진 수검률 차이를 비교하고자 하였다. 첫 코로나 확진자가 발생한 2020년을 코로나 대유행 기간, 전년도 기간인 2019년을 코로나 대유행 전 기간으로 설정하며 국민건강보험공단에서 집계된 전수자료를 이용하여 암 검진 대상자 수와 수검자 수를 비교 분석하였다. 4개 암종 모두에서 2019년도와 비교하여 2020년도에 전국적으로 수검률이 감소하는 경향이 있었으며, 1차 대유행이 있었던 3월과 3차 대유행 시기인 12월에 2019년도 동기간과 비교하여 수검률이 크게 감소하였고, 80대 이상 노인 인구에서 감소폭이 다른 연령대와 비교하여 크게 나타났다.

Key Message
We found decline of the colorectal, gastric, breast and cervical cancer screening participation rates in 2020 following the two major COVID-19 waves, compared with those of 2019, and the highest decline was observed in the elderly population aged 80 years and older.

Citations

Citations to this article as recorded by

Analysis of the current situation and related influencing factors of cervical precancer screening under the COVID-19
Xiaohong Song, Yongbin Yang
Biotechnology and Genetic Engineering Reviews.2023; : 1. CrossRef
Willingness to Undergo Gastroscopy for Early Gastric Cancer Screening and Its Associated Factors During the COVID-19 Pandemic – A Nationwide Cross-Sectional Study in China
Kejia Ma, Xuejie Chen, Xin Xiang, Xueyi Mao, Ningxin Zhu, Tianyu Wang, Shuyu Ye, Xiaoyan Wang, Minzi Deng
Patient Preference and Adherence.2023; Volume 17: 505. CrossRef
Impact of coronavirus disease 2019 pandemic on breast cancer surgery using the National Database of Japan
Misuzu Fujita, Hideyuki Hashimoto, Kengo Nagashima, Kiminori Suzuki, Tokuzo Kasai, Kazuya Yamaguchi, Yoshihiro Onouchi, Daisuke Sato, Takehiko Fujisawa, Akira Hata
Scientific Reports.2023;[Epub] CrossRef
The impact of COVID-19 pandemic on diagnosis and management of gastrointestinal cancers
Byung Soo Yoo, Ankit Patel, Kevin V. Houston, Alejandra Vargas, Ana Rosa Vilela Sangay, Steve M. D’Souza, David A. Johnson
Exploration of Medicine.2023; : 356. CrossRef
Changes in the Utilization of Health Care Services by Cancer Patients during the COVID-19 Pandemic
Seung Hee Seo, Sooyoung Cho, Shin Hye Yoo, Bhumsuk Keam, Aesun Shin
Yonsei Medical Journal.2023; 64(7): 463. CrossRef
The Challenges of Gastric Cancer Surgery during the COVID-19 Pandemic
Catalin Vladut Ionut Feier, Alaviana Monique Faur, Calin Muntean, Andiana Blidari, Oana Elena Contes, Diana Raluca Streinu, Sorin Olariu
Healthcare.2023; 11(13): 1903. CrossRef
Impact of the COVID-19 Pandemic on Gastric Cancer Screening in South Korea: Results From the Korean National Cancer Screening Survey (2017–2021)
Kyeongmin Lee, Mina Suh, Jae Kwan Jun, Kui Son Choi
Journal of Gastric Cancer.2022; 22(4): 297. CrossRef
Impact of frailty on survival and readmission in patients with gastric cancer undergoing gastrectomy: A meta-analysis
Xiaoyan Wang, Yimeng Sun, Pei Wang, Yu Jie, Guodong Liu, Dandan Gong, Yu Fan
Frontiers in Oncology.2022;[Epub] CrossRef
Trends in breast cancer screening rates among Korean women: results from the Korean National Cancer Screening Survey, 2005-2020
Soo Yeon Song, Yun Yeong Lee, Hye Young Shin, Bomi Park, Mina Suh, Kui Son Choi, Jae Kwan Jun
Epidemiology and Health.2022; 44: e2022111. CrossRef

COVID-19: Original Article

Changes in cancer screening before and during COVID‐19: findings from the Korean National Cancer Screening Survey 2019 and 2020: Thao Thi Kim Trinh, Yun Yeong Lee, Mina Suh, Jae Kwan Jun, Kui Son Choi; Epidemiol Health. 2022;44:e2022051. Published online May 30, 2022; DOI: https://doi.org/10.4178/epih.e2022051

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Abstract Summary PDF Supplementary Material: Abstract
OBJECTIVES
The coronavirus disease 2019 (COVID-19) pandemic has negatively affected every aspect of medical care. However, information regarding the impact of the pandemic on cancer screening is lacking. This study aimed to explore cancer screening changes by geographic region before and during the pandemic in Korea.
METHODS
Korean National Cancer Screening Survey data for 2019 and 2020 were used. Changes in the screening rate before and during the COVID-19 pandemic were calculated by subtracting the rate in 2020 from the rate in 2019. Multivariate logistic regression analyses examined the differences in screening rates at the national and 16 provincial levels before and after the COVID-19 outbreak.
RESULTS
The 1-year screening rates for the four types of cancer decreased during the pandemic (stomach cancer: -5.1, colorectal cancer: -3.8, breast cancer: -2.5, cervical cancer: -1.5%p). In metropolitan areas, the odds of undergoing screening tests during the pandemic were significantly lower than before the pandemic for stomach (adjusted odds ratio [aOR], 0.66; 95% confidence interval [CI], 0.56 to 0.76), colorectal (aOR, 0.63; 95% CI, 0.50 to 0.79), and breast cancers (aOR, 0.75; 95% CI, 0.60 to 0.94). Furthermore, the likelihood of undergoing stomach cancer screening during the pandemic was significantly lower than before the pandemic in non-metropolitan urban areas (aOR, 0.81; 95% CI, 0.70 to 0.94), while it was higher in rural areas (aOR, 1.54; 95% CI, 1.10 to 2.16).
CONCLUSIONS
Since the COVID-19 pandemic, the cancer screening rate has decreased significantly, especially in large cities. Public health efforts are required to improve cancer screening rates.; Summary

Korean summary
• 코로나 대유행 이전과 이후의 최근 1년간 암검진 수검률을 비교한 결과, 위암 (5% 포인트), 대장암 (3.8% 포인트), 유방암 (2.5% 포인트), 자궁경부암 (1.5% 포인트) 수검률이 통계적으로 유의하게 감소하였음 • 특히 위암, 대장암, 유방암의 경우 대도시 지역에서의 수검률이 현저하게 감소하였음

Key Message
The 1-year screening rates for stomach, colorectal, breast, and cervical cancer decreased significantly during the pandemic in Korea, especially in large cities.

Systematic Review

Quantifying the duration of the preclinical detectable phase in cancer screening: a systematic review: Sandra M. E. Geurts, Anne M. W. M. Aarts, André L. M. Verbeek, Tony H. H. Chen, Mireille J. M. Broeders, Stephen W. Duffy; Epidemiol Health. 2022;44:e2022008. Published online January 3, 2022; DOI: https://doi.org/10.4178/epih.e2022008

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Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
The aim of this study was to provide an overview of published mathematical estimation approaches to quantify the duration of the preclinical detectable phase (PCDP) using data from cancer screening programs.

METHODS

A systematic search of PubMed and Embase was conducted for original studies presenting mathematical approaches using screening data. The studies were categorized by mathematical approach, data source, and assumptions made. Furthermore, estimates of the duration of the PCDP of breast and colorectal cancer were reported per study population.

RESULTS

From 689 publications, 34 estimation methods were included. Five distinct types of mathematical estimation approaches were identified: prevalence-to-incidence ratio (n=8), maximum likelihood estimation (n=16), expectation-maximization algorithm (n=1), regression of observed on expected (n=6) and Bayesian Markov-chain Monte Carlo estimation (n=5). Fourteen studies used data from both screened and unscreened populations, whereas 19 studies included only information from a screened population. Estimates of the duration of the PCDP varied between 2 years and 7 years for breast cancer in the Health Insurance Plan study (annual mammography and clinical breast examinations in women aged 40-64 years) and 2 years and 5 years for colorectal cancer in the Calvados study (a guaiac fecal occult blood test in men and women aged 45-74 years).

CONCLUSIONS

Different types of mathematical approaches lead to different estimates of the PCDP duration. We advise researchers to use the method that matches the data available, and to use multiple methods for estimation when possible, since no method is perfect.

Summary

Key Message
Quantifying the duration of the preclinical detectable phase is important for the design and evaluation of cancer screening programs. Different types of mathematical estimation approaches lead to different estimates of the preclinical detectable phase duration. We advise researchers to use the method that matches the data available, and to use multiple methods for estimation when possible, since no method is perfect.

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Original Articles

Effect of chemotherapy and radiotherapy on cognitive impairment in colorectal cancer: evidence from Korean National Health Insurance Database Cohort: Kwanghyun Kim, Chang Woo Kim, Aesun Shin, Hyunseok Kang, Sun Jae Jung; Epidemiol Health. 2021;43:e2021093. Published online November 2, 2021; DOI: https://doi.org/10.4178/epih.e2021093

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4 Citations

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Abstract

OBJECTIVES
We investigated the risk of chemotherapy-related and radiotherapy-related cognitive impairment in colorectal cancer patients.

METHODS

Medical use data of colorectal cancer patients were obtained from the Korean National Health Insurance Database from 2004 to 2018. We randomly selected 40% of all colorectal cancer patients (n=148,848). Cognitive impairment was defined as having 1 or more International Classification of Diseases, 10th revision diagnostic codes for dementia or mild cognitive impairment. Patients aged 18 years or younger, patients diagnosed with cognitive impairment before colorectal cancer diagnosis (n=8,225), and patients who did not receive primary resection (n=45,320) were excluded. The effects of individual chemotherapy regimens on cognitive impairment were estimated. We additionally estimated the effect of radiotherapy in rectal cancer patients. Time-dependent competing risk Cox regression was conducted to estimate the overall and age-specific hazard ratios (HR) separately for colon and rectal cancer. Landmark analyses with different lag times were conducted as sensitivity analyses.

RESULTS

Chemotherapy did not increase the risk of cognitive impairment in colorectal cancer patients (colon cancer: HR, 0.92; 95% confidence interval [CI], 0.83 to 1.03; rectal cancer: HR, 0.88; 95% CI, 0.75 to 1.04), while radiotherapy was negatively associated with cognitive impairment in rectal cancer patients (HR, 0.01; 95% CI, 0.84 to 0.99). Varying directions of the associations between regimens and cognitive impairment were detected. The adverse effect of certain chemotherapy regimens on cognition was more prominent in older adults.

CONCLUSIONS

Chemotherapy and radiotherapy did not increase the risk of cognitive impairment. Older patients with low cognitive reserve could be affected by the adverse cognitive effects of chemotherapy.

Summary

Korean summary
- 대장암 환자를 대상으로 한 항암화학요법 및 방사선요법은 인지기능저하의 위험을 높이지 않았다 - 일부 항암화학요법의 경우 고령의 대장암 환자에서 인지기능저하의 위험을 증가시킬 수 있다

Key Message
Results from nationwide cohort of Korea showed that chemotherapy and radiotherapy did not increase the risk of cognitive impairment in colorectal cancer patients.

Citations

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Predictors of cognitive impairment in patients undergoing ileostomy for colorectal cancer: a retrospective analysis
Jing Xu, Yuelan Yang, Die Hu
PeerJ.2023; 11: e15405. CrossRef
Soluble HSPG and HS relaying neuroinflammation contribute to behavioral comorbidities associated with cancer located outside the central nervous system
Yue-peng Liu, Yan-jun Yang
Medical Hypotheses.2023; 177: 111113. CrossRef
Chemotherapy-induced functional brain abnormality in colorectal cancer patients: a resting‐state functional magnetic resonance imaging study
Siwen Liu, Yesong Guo, Jie Ni, Na Yin, Chenchen Li, Xuan Pan, Rong Ma, Jianzhong Wu, Shengwei Li, Xiaoyou Li
Frontiers in Oncology.2022;[Epub] CrossRef
Association between multimorbidity status and incident dementia: a prospective cohort study of 245,483 participants
He-Ying Hu, Ya-Ru Zhang, Qiaolifan Aerqin, Ya-Nan Ou, Zuo-Teng Wang, Wei Cheng, Jian-Feng Feng, Lan Tan, Jin-Tai Yu
Translational Psychiatry.2022;[Epub] CrossRef

The classification capability of the Asia Pacific Colorectal Screening score in Korea: an analysis of the Cancer Screenee Cohort: Xuan Quy Luu, Kyeongmin Lee, Jeongseon Kim, Dae Kyung Sohn, Aesun Shin, Kui Son Choi; Epidemiol Health. 2021;43:e2021069. Published online September 16, 2021; DOI: https://doi.org/10.4178/epih.e2021069

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3 Citations

Abstract Summary PDF Supplementary Material

Abstract

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Summary

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

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

Citations

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A Comparison of Single and Combined Schemes of Asia-Pacific Colorectal Screening, Faecal Immunochemical and Stool Deoxyribonucleic Acid Testing for Community Colorectal Cancer Screening
Yuan Ze, Huiming Tu, Lin Zhang, Yu Bai, Yilin Ren, Xin Chen, Yuzheng Xue, Renjuan Sun, Yuling Yang, Jie Yang, Xuan Zhou, Li Liu
Journal of Multidisciplinary Healthcare.2023; Volume 16: 571. CrossRef
Advances in Screening Methods for Colorectal Cancer
碗宜张
Advances in Clinical Medicine.2023; 13(03): 2995. CrossRef
A scoping review of risk-stratified bowel screening: current evidence, future directions
J. M. Cairns, S. Greenley, O. Bamidele, D. Weller
Cancer Causes & Control.2022; 33(5): 653. CrossRef

Health Statistics

A comparison of breast cancer survival across different age groups: a multicentric database study in Penang, Malaysia: King Fang Tan, Farzaana Adam, Hasmah Hussin, Noor Mastura Mohd Mujar; Epidemiol Health. 2021;43:e2021038. Published online May 25, 2021; DOI: https://doi.org/10.4178/epih.e2021038

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6 Citations

Abstract Summary PDF

Abstract

This study compared breast cancer survival and the prognostic factors across different age groups of women in Penang, Malaysia. Data on 2,166 women with breast cancer who had been diagnosed between 2010 and 2014 were extracted from the Penang Breast Cancer Registry and stratified into 3 age groups: young (< 40 years old), middle-aged (40-59 years old), and elderly (≥ 60 years). The overall and relative survival rates were calculated using the life table method, median survival time was calculated using the Kaplan-Meier method, and comparisons between groups were conducted using the log-rank test. Prognostic factors were analyzed using a Cox proportional hazards model. The 5-year overall and breast cancer-specific survival rates for women with breast cancer in Penang were 72.9% and 75.2%, with a mean survival time of 92.5 months and 95.1 months, respectively. The 5-year breast cancer-specific survival rates for young, middle-aged, and elderly women were 74.9%, 77.8%, and 71.4%, respectively, with a mean survival time of 95.7 months, 97.5 months, and 91.2 months. There was a significant difference in breast cancer survival between age groups, with elderly women showing the lowest survival rate, followed by young and middle-aged women. Disease stage was the most prominent prognostic factor for all age groups. Survival rates and prognostic factors differed according to age group. Treatment planning for breast cancer patients should be age-specific to promote better cancer care and survival.

Summary

Key Message
The relationship between breast cancer survival and age at diagnosis has been explored, but information between survival at different age groups remains unclear, in addition to conflicting study results. This multicentre study was conducted to compare breast cancer survival across different age groups in an Asian setting.

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Cancer–related symptoms among young and middle–aged women undergoing chemotherapy for breast cancer: Application of latent class analysis and network analysis
Tingting Cai, Tingting Zhou, Qingmei Huang, Fulei Wu, Feixia Ni, Changrong Yuan
European Journal of Oncology Nursing.2023; 63: 102287. CrossRef
myBeST—A Web-Based Survival Prognostic Tool for Women with Breast Cancer in Malaysia: Development Process and Preliminary Validation Study
Mohd Nasrullah Nik Ab Kadir, Suhaily Mohd Hairon, Najib Majdi Yaacob, Siti Norbayah Yusof, Kamarul Imran Musa, Maya Mazuwin Yahya, Seoparjoo Azmel Mohd Isa, Muhammad Hafizuddin Mamat Azlan, Imi Sairi Ab Hadi
International Journal of Environmental Research and Public Health.2023; 20(4): 2985. CrossRef
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Bryan Valcarcel, J. Smith Torres-Roman, Daniel Enriquez-Vera, Gabriel De-la-Cruz-Ku
Journal of Adolescent and Young Adult Oncology.2023;[Epub] CrossRef
Metastasis pattern and prognosis of large cell neuroendocrine carcinoma: a population-based study
Tongchao Jiang, Haishuang Sun, Na Li, Tongcui Jiang
Journal of Cancer Research and Clinical Oncology.2023;[Epub] CrossRef
A Metabolic Gene Signature to Predict Breast Cancer Prognosis
Jun Lu, Pinbo Liu, Ran Zhang
Frontiers in Molecular Biosciences.2022;[Epub] CrossRef
Development of Predictive Models for Survival among Women with Breast Cancer in Malaysia
Mohd Nasrullah Nik Ab Kadir, Najib Majdi Yaacob, Siti Norbayah Yusof, Imi Sairi Ab Hadi, Kamarul Imran Musa, Seoparjoo Azmel Mohd Isa, Balqis Bahtiar, Farzaana Adam, Maya Mazuwin Yahya, Suhaily Mohd Hairon
International Journal of Environmental Research and Public Health.2022; 19(22): 15335. CrossRef

Original Article

Human papillomavirus: footprints in the population of western India: Ashi Robert Thobias, Kinjal Ankit Patel, Supreet Dhananjay Bhatt, Kruti Ashvinkumar Mehta, Chetana Deepal Parekh, Pariseema Sharad Dave, Prabhudas Shankarbhai Patel; Epidemiol Health. 2021;43:e2021013. Published online February 3, 2021; DOI: https://doi.org/10.4178/epih.e2021013

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Abstract Summary PDF: Abstract
OBJECTIVES
Cancer is a multi-factorial disease, with various intrinsic and environmental factors contributing to its occurrence. Human papillomavirus (HPV) has been associated with the occurrence of many cancers. India severely suffers from 3 HPV-associated cancers (cervical cancer, oral cancer, and oropharyngeal cancer). Hence, the present study aimed to evaluate the HPV burden in these 3 cancers among patients from the western region of India.
METHODS
DNA was isolated from samples from 400 cervical cancer, 127 oral cancer, and 75 oropharyngeal cancer patients. Polymerase chain reaction was performed using degenerate primers for HPV infection.
RESULTS
Overall, HPV infection was observed in 87% of cervical cancer cases, 12.5% of oral cancer cases, and 26.7% of oropharyngeal cancer cases when analyzed with a cumulative detection method using the MY 09/11, GP 5+/6+, and CP I/II primer sets.
CONCLUSIONS
A significant prevalence of HPV infection was detected in all 3 cancers using the degenerate primer sets. This finding implies that testing for HPV infection using multiple primer sets is crucial for determining its actual prevalence in various malignancies.; Summary

Key Message
The study emphasised the need to screen population of India for HPV infection for better prognosis and disease management and showcases a perfect screening module to efficiently screen the HPV strains.

Systematic Reviews

Association between gallstones and the risk of biliary tract cancer: a systematic review and meta-analysis: Dan Huang, Hyundeok Joo, Nan Song, Sooyoung Cho, Woosung Kim, Aesun Shin; Epidemiol Health. 2021;43:e2021011. Published online February 3, 2021; DOI: https://doi.org/10.4178/epih.e2021011

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11 Citations

Abstract Summary PDF Supplementary Material

Abstract

OBJECTIVES
Biliary tract cancers (BTCs) are rare but highly fatal. Although the etiology of BTC is poorly understood, gallstones are proposed to be a major risk factor. We conducted a systematic review and meta-analysis to examine the associations between gallstone characteristics and BTC risk.

METHODS

We searched the MEDLINE, Embase, and Cochrane Central databases and systematically reviewed cohort and case-control studies published before April 9, 2018. All the included studies reported appropriate risk estimates and confidence intervals (CIs) for associations between the presence, size, number, or duration of gallstones and the risk of BTC, including gallbladder cancer (GBC), extrahepatic bile duct cancer (EBDC), and ampulla of Vater cancer (AOVC). Summary odds ratios (ORs) and their 95% CIs were calculated using a random-effects model in the meta-analysis. Subgroup analyses were conducted to inspect sources of potential heterogeneity, and the Egger test was performed to assess publication bias.

RESULTS

Seven cohort studies and 23 case-control studies in Asian, European, and American populations were included. The presence of gallstones was associated with an increased risk of BTC (OR, 4.38; 95% CI, 3.23 to 5.93; I²=91.2%), GBC (OR, 7.26; 95% CI, 4.33 to 12.18), EBDC (OR, 3.17; 95% CI, 2.24 to 4.50), and AOVC (OR, 3.28; 95% CI, 1.33 to 8.11). Gallstone size (>1 vs. <1 cm; OR, 1.88; 95% CI, 1.10 to 3.22) was significantly associated with the risk of GBC.

CONCLUSIONS

Gallstone characteristics, such as presence, size, and number, are associated with an increased risk of BTC. However, significantly high heterogeneity in the meta-analyses is a limitation of this study.

Summary

Korean summary
The prevalence of APCT-detected sacroiliitis in CD patients was higher than that in controls, but the condition was asymptomatic. The clinical significance of asymptomatic sacroiliitis in Korean CD patients remains unclear.

Key Message
본 연구에서는 체계적 문헌고찰과 메타분석법을 활용하여 여러 선행연구에서 담도계암 전반과 담석의 다양한 특성사이에 연관성이 있는지 탐구하였다. 총 30개의 문헌을 분석한 결과 담석의 존재 여부가 담도계암과 각 하위 암의 위험을 모두 높이는 것으로 나타났고, 담석의 크기가 클수록 담낭암의 위험이 높은 것으로 드러났다. 본 연구는 담석과 담도계암 전반의 연관성에 대해 체계적으로 정리한 최초의 문헌으로서 담석과 담도계암의 관계에 대한 이해의 폭을 넓히고, 추후 해당 주제로 추가 연구를 수행하는 데에 있어 기준점이 될 수 있으리라 기대한다.

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Jingrui Dou, Wubulitalifu Dawuti, Jintian Li, Hui Zhao, Run Zhou, Jing Zhou, Renyong Lin, Guodong Lü
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Piera Zaccari, Livia Archibugi, Giulio Belfiori, Enrico Nista, Giuseppe dell'Anna, Stefano Crippa, Tommaso Schepis, Matteo Tacelli, Francesca Aleotti, Maria Chiara Petrone, Alberto Mariani, Guido Costamagna, Antonio Gasbarrini, Alberto Larghi, Massimo Fal
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Risk factors for stomach cancer: a systematic review and meta-analysis: Jalal Poorolajal, Leila Moradi, Younes Mohammadi, Zahra Cheraghi, Fatemeh Gohari-Ensaf; Epidemiol Health. 2020;42:e2020004. Published online February 2, 2020; DOI: https://doi.org/10.4178/epih.e2020004

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101 Citations

Abstract PDF Supplementary Material

Abstract

OBJECTIVES
This report provides information on 14 behavioral and nutritional factors that can be addressed in stomach cancer prevention programs.

METHODS

PubMed, Web of Science, and Scopus were searched through December 2018. Reference lists were also screened. Observational studies addressing the associations between stomach cancer and behavioral factors were analyzed. Between-study heterogeneity was investigated using the χ², τ², and I² statistics. The likelihood of publication bias was explored using the Begg and Egger tests and trim-and-fill analysis. Effect sizes were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) using a random-effects model.

RESULTS

Of 52,916 identified studies, 232 (including 33,831,063 participants) were eligible. The OR (95% CI) of factors associated with stomach cancer were as follows: Helicobacter pylori infection, 2.56 (95% CI, 2.18 to 3.00); current smoking, 1.61 (95% CI, 1.49 to 1.75); former smoking 1.43 (95% CI, 1.29 to 1.59); current drinking, 1.19 (95% CI, 1.10 to 1.29); former drinking, 1.73 (95% CI, 1.17 to 2.56); overweight/obesity, 0.89 (95% CI, 0.74 to 1.08); sufficient physical activity, 0.83 (95% CI, 0.68 to 1.02); consumption of fruits ≥3 times/wk, 0.48 (95% CI, 0.37 to 0.63); consumption of vegetables ≥3 times/wk, 0.62 (95% CI, 0.49 to 0.79); eating pickled vegetables, 1.28 (95% CI, 1.09 to 1.51); drinking black tea, 1.00 (95% CI, 0.84 to 1.20); drinking green tea, 0.88 (95% CI, 0.80 to 0.97); drinking coffee, 0.99 (95% CI, 0.88 to 1.11); eating fish ≥1 time/wk 0.79 (95% CI, 0.61 to 1.03); eating red meat ≥4 times/wk 1.31 (95% CI, 0.87 to 1.96), and high salt intake 3.78 (95% CI, 1.74 to 5.44) and 1.34 (95% CI, 0.88 to 2.03), based on two different studies.

CONCLUSIONS

This meta-analysis provided a clear picture of the behavioral and nutritional factors associated with the development of stomach cancer. These results may be utilized for ranking and prioritizing preventable risk factors to implement effective prevention programs.

Summary

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