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Data Profile
Data profile: cancer sample cohorts (stomach, breast, colorectal, and liver) in Korea
Daewoo Pak, Suk Yong Jang, Jin-Ha Yoon, Dong Wook Kim, Jin-Won Noh, Dong-Woo Choi, Minyeong Guk, Hyeri Kim, Ju-Won Oh, Heejung Chae, Hyun-Joo Kong, Gi Hyun Kim, Ji Woong Nam, Ga Ram Lee, Dayun Park, Jehoo Jeon, Byungyoon Yun, Ki-Bong Yoo, Kui Son Choi
Epidemiol Health. 2025;47:e2025058.   Published online October 14, 2025
DOI: https://doi.org/10.4178/epih.e2025058
  • 3,071 View
  • 106 Download
AbstractAbstract AbstractSummary PDF
Abstract
Cancer Public Library Database (CPLD) links data from four major population-based public sources: the Korea National Cancer Incidence Database in the Korea Central Cancer Registry, cause-of-death data in Statistics Korea, the National Health Information Database in the National Health Insurance Service, and the National Health Insurance Research Database in the Health Insurance Review & Assessment Service. The National Cancer Data Center has developed a new nationally representative sample cohort dataset from Korean Clinical Data Utilization for Research Excellence project (K-CURE) CPLD: Stomach Cancer Sample Cohort, Breast Cancer Sample Cohort, Colorectal Cancer Sample Cohort, and Liver Cancer Sample Cohort. The sample populations consisted of approximately 21% of all cancer patients from 2012 to 2019. The populations of the Stomach Cancer Sample Cohort, Breast Cancer Sample Cohort, Colorectal Cancer Sample Cohort, and Liver Cancer Sample Cohort were 51,951, 39,586, 53,485, and 27,375 patients, respectively. The dataset included cancer incidence information, demographics, socioeconomic variables, health utilization data (procedures, diagnoses, and medications), general health checkup data, cancer screening data before and after the cancer incidence, as well as death information. These cohorts could help researchers analyze time-to-event data on mortality, treatment outcomes, comorbid conditions following a cancer diagnosis, and cancer incidence risk factors. The data can be accessed through the K-CURE portal (https://k-cure.mohw.go.kr/).
Summary
Korean summary
국립암센터의 국가암데이터센터는 K-CURE 사업의 일환으로 암·공공라이브러리를 구축하고 위암, 유방암, 대장암, 간암 표본을 공개하였다. 암·공공라이브러리는 국립암센터의 암등록자료를 기준으로 건강보험심사평가원 명세서, 국민건강보험공단 자격 및 검진자료, 통계청 사망자료를 결합하여 구축한 것으로 사용하기 쉽게 암종별 표본을 공개하고 있다. 암등록자료는 발생일자, 요약병기, ICD-O-3 코드를 포함해 기존 청구자료보다 정확한 암 예후 등의 연구가 원격으로 가능하다. 이용자는 희망시 맞춤형 자료로도 신청 가능하다. 사용 신청은 https://k-cure.mohw.go.kr/ 에서 가능하다.
Key Message
The National Cancer Data Center (NCDC) of the National Cancer Center(NCC) developed the Cancer Public Library Database (CPLD) under the Korean Clinical Data Utilization for Research Excellence project (K-CURE). CPLD is constructed by linking the NCC’s cancer registry data with claims data from the Health Insurance Review and Assessment Service, eligibility and health screening data from the National Health Insurance Service, and Cause-of-death data from Statistics Korea. The NCDC has opened sample cohorts for stomach, breast, colorectal, and liver cancers to promote cancer research with a remotely accessible environment. The data can be accessed through the K-CURE portal (https://k-cure.mohw.go.kr/).
Original Articles
The delayed cancer treatment and economic inequality in Korea: results of common cancers by the time-to-surgery
Noorhee Son, Woo-Ri Lee, Dong-Woo Choi, Kyu-Tae Han
Epidemiol Health. 2025;47:e2025056.   Published online September 27, 2025
DOI: https://doi.org/10.4178/epih.e2025056
  • 3,583 View
  • 104 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Growing concerns regarding the concentration of cancer treatment in the capital city in Korea have raised questions about equitable access to timely and optimal patient care. In this study, we evaluated the impact of time-to-surgery (TTS) on healthcare utilization and outcomes, with the goal of providing policy recommendations for effective quality assessment of cancer care.
METHODS
This retrospective cohort study analyzed data from 2011 to 2021 obtained from National Health Insurance Service claims. A generalized estimating equation and a Cox proportional hazards model were applied to assess the effects of TTS on length of stay (LOS), medical costs, and 5-year mortality among patients diagnosed with lung, liver, and colorectal cancers. Subgroup analyses were conducted based on patients’ baseline economic status.
RESULTS
Among patients who underwent surgical treatment for lung, liver, or colorectal cancer, 20.4%, 11.4%, and 11.4% experienced treatment delays, respectively. Regardless of cancer type, longer TTS was associated with prolonged LOS and higher medical costs. Moreover, patients with extended TTS demonstrated an increased risk of 5-year mortality. Disparities by income level were evident, with greater differences observed in the lower-income group.
CONCLUSIONS
This study highlights the importance of timely surgical treatment for patients with cancer, particularly in relation to income-based disparities. These findings emphasize the need to improve Korea’s concentrated cancer care delivery system to enhance healthcare efficiency and address health literacy gaps affecting treatment by income level.
Summary
Korean summary
- 수술 환자의 약 10%~20%에서 치료 지연이 발생했다. - 수술까지 대기시간이 길수록 재원일수가 늘고, 의료비용이 증가하며, 5년 사망위험이 높았다. - 소득수준에 따른 격차가 확인되었고, 저소득층에서 불리한 영향이 더 크게 나타났다.
Key Message
- Among surgical patients, approximately 10–20% experienced treatment delays. - Longer time-to-surgery (TTS) was linked to prolonged length of stay (LOS), higher medical costs, and an increased 5-year mortality risk. - Income-level disparities were evident, with more pronounced adverse differences in lower-income groups.
Association between humidifier disinfectant use duration and lung cancer development in Korea
Sungchan Kang, Jeong-In Hwang, Su Hwan Kim, Hyungryul Lim, Dong-wook Lee, Woojoo Lee, Jong Hun Kim, Sol Yu, Jungyun Lim, Younghee Kim, Kyoung-Nam Kim
Epidemiol Health. 2025;47:e2025023.   Published online May 2, 2025
DOI: https://doi.org/10.4178/epih.e2025023
  • 11,328 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study was conducted to assess the association between the duration of humidifier disinfectant use and lung cancer development.
METHODS
We analyzed data from 3,605 applicants registered for compensation from the Korean government due to health conditions related to humidifier disinfectant exposure. Among these individuals, 121 were diagnosed with lung cancer at least 4 years after their initial exposure (through December 2021). Hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer incidence were estimated according to the duration of disinfectant use using Cox proportional hazards models.
RESULTS
Compared with <5 months of use, the HRs for lung cancer were 1.81 (95% CI, 0.41 to 7.97) for 5-14 months, 2.45 (95% CI, 0.58 to 10.41) for 15-29 months, and 4.61 (95% CI, 1.12 to 18.91) for ≥30 months. Using never smokers with <15 months of use as the reference category, the HRs were 2.97 (95% CI, 1.34 to 6.56) for never smokers with ≥15 months of use, 2.73 (95% CI, 0.94 to 7.95) for current or former smokers with <15 months of use, and 4.74 (95% CI, 1.94 to 11.61) for current or former smokers with ≥15 months of use.
CONCLUSIONS
Our study provides some of the first robust epidemiological evidence that prolonged humidifier disinfectant use contributes to lung cancer development. Future studies—particularly those including unexposed populations—are needed to confirm these findings.
Summary
Korean summary
* 장기간의 가습기 살균제 사용과 폐암 발생의 위험 간에는 정량적 연관성을 발견할 수 있었습니다. * 가습기살균제를 30개월 이상 사용했다고 응답한 사람들은, 가습기살균제를 5개월 미만 사용했다고 응답한 사람들과 비교하여 폐암 발생 위험이 4배 높았습니다.
Key Message
* There is a quantitative association between prolonged humidifier disinfectants use and the risk of lung cancer incidence. * Individuals reported they used humidifier disinfectants for more than 30 months had more than four times higher risk of lung cancer than those of individuals who reported they used humidifier disinfectants for less than five months.
Preventable cancer cases and deaths attributable to alcohol consumption in Korea from 2015 to 2030
Soseul Sung, Jihye An, Jeehi Jung, Hyeon Sook Lee, Sungji Moon, Inah Kim, Jung Eun Lee, Aesun Shin, Sun Ha Jee, Sun-Seog Kweon, Min-Ho Shin, Sangmin Park, Seungho Ryu, Sun Young Yang, Seung Ho Choi, Jeongseon Kim, Sang-Wook Yi, Yoon-Jung Choi, Youjin Hong, Sangjun Lee, Woojin Lim, Kyungsik Kim, Sohee Park, Jeong-Soo Im, Hong Gwan Seo, Kwang-Pil Ko, Sue K. Park
Epidemiol Health. 2025;47:e2025009.   Published online February 27, 2025
DOI: https://doi.org/10.4178/epih.e2025009
  • 6,241 View
  • 167 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Alcohol consumption is causally linked to several cancers, and major health organizations classify it as a carcinogen. This study assessed the impact of alcohol consumption on cancer incidence and mortality in Korea in 2015 and 2020, projected trends up to 2030, and compared results based on different criteria.
METHODS
The relative risk of cancer associated with alcohol consumption in Korea was determined through a meta-analysis of alcohol-related relative risks for specific cancers, using primary data from the Korean Cohort Study within the Korean Cohort Consortium. The population-attributable fraction (PAF) was calculated using Levin’s formula, incorporating drinking prevalence and the number of cancer cases and deaths, with a 15-year latency period assumed.
RESULTS
In Korea, the PAF for alcohol consumption, based on ever/never drinking criteria, was higher than that calculated using other criteria, except for the PAF based on past and current/never drinking criteria. Alcohol consumption contributed to 3.58% of all cancer cases and 3.28% of cancer deaths in 2015. It accounted for 4.58% of new cancer cases in male and 2.08% in female, with a higher contribution to incidence than mortality (4.00 and 2.25% of cancer deaths in male and female, respectively). Projections indicate that alcohol-related cancer PAF will decrease by 17.2% in male but increase by 70.2% in female by 2030.
CONCLUSIONS
This study highlights the impact of alcohol consumption on cancer in Korea, emphasizing the need for sex-specific regulations to address sex differences.
Summary
Korean summary
2015년 알콜 섭취는 한국에서 전체 암 발생의 3.58%, 암 사망의 3.28%를 차지했으며, 남성(4.58%)이 여성(2.08%)보다 더 큰 영향을 받았음. 2030년까지 남성의 알콜 관련 암 발생률은 감소할 것으로 예상되지만, 여성에서는 급증할 것으로 보임. 이러한 결과는 특히 여성에서 증가하는 추세를 반영하여 성별 맞춤형 공공 보건 정책의 필요성을 시사함.
Key Message
In 2015, alcohol consumption was responsible for 3.58% of all cancer cases and 3.28% of cancer deaths in Korea, with a more significant impact on males (4.58% of new cases) than females (2.08%). Projections indicate a decrease in alcohol-related cancer cases among males but a sharp increase in females by 2030. These findings highlight the need for sex-specific public health measures to address the growing impact of alcohol on cancer, particularly the increasing trend in female cases.
Preventable cancer cases and deaths attributable to tobacco smoking in Korea from 2015 to 2030
Soseul Sung, Jihye An, Jeehi Jung, Hyeon Sook Lee, Sungji Moon, Inah Kim, Jung Eun Lee, Aesun Shin, Sun Ha Jee, Sun-Seog Kweon, Min-Ho Shin, Sangmin Park, Seungho Ryu, Sun Young Yang, Seung Ho Choi, Jeongseon Kim, Sang-Wook Yi, Yoon-Jung Choi, Youjin Hong, Sangjun Lee, Woojin Lim, Kyungsik Kim, Daehee Kang, Keun-Young Yoo, Sohee Park, Jeong-Soo Im, Hong Gwan Seo, Hai-Rim Shin, Kwang-Pil Ko, Sue K. Park
Epidemiol Health. 2025;47:e2025008.   Published online February 27, 2025
DOI: https://doi.org/10.4178/epih.e2025008
  • 7,977 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Tobacco smoking is a major public health concern worldwide. This study aimed to assess its impact on cancer incidence and mortality by estimating the population attributable fraction (PAF) in the Korean population for 2015 and 2020 and by projecting future trends until 2030.
METHODS
The Korean relative risk (RR) was calculated via a meta–analysis of RRs for individual cancers attributed to tobacco smoking, based on primary data analysis from the Korean Cohort Consortium. The PAF was estimated using the Levin formula with past and current prevalence rates and the number of cancer cases and deaths, assuming a 15-year latency period.
RESULTS
The proportions of cancer cases and deaths in Korea attributable to tobacco smoking were similar to those calculated using Asian and global RRs for both male and female. In 2015 and 2020, tobacco smoking contributed to 14.32% and 13.17% of cancer cases and 21.70% and 20.69% of cancer deaths in adults, respectively. Among Koreans, smoking was responsible for 25.83% of new cancer cases in male in 2015, 23.49% in male in 2020, 1.46% in female in 2015, and 1.68% in female in 2020. In both years, smoking impacted mortality more strongly than incidence in Korean male and female (incidence in male: 25.83% and 23.49%; mortality in male: 32.09% and 30.41%; incidence in female: 1.46% and 1.68%; and mortality in female: 4.70% and 4.96%, respectively).
CONCLUSIONS
Tobacco smoking causes cancers and deaths in Korea, however, it is preventable. Effective control policies that consider trends and vulnerabilities among female are required.
Summary
Korean summary
한국에서 흡연으로 인한 암 부담은 2015년 발생 14.32%, 사망 21.70%였고 2020년에는 발생 13.17%, 사망 20.69%로 나타남. 두 해 모두 남성에서 부담이 훨씬 컸음(남성: 발생 2015년 25.83%, 2020년 23.49%; 사망 2015년 32.09%, 2020년 30.41% / 여성: 발생 2015년 1.46%, 2020년 1.68%; 사망 2015년 4.70%, 2020년 4.96%). 흡연은 예방 가능한 주요 원인이므로, 여성의 취약성과 추세를 고려한 보다 강력한 금연·규제 정책 강화가 필요함.
Key Message
In Korea, tobacco smoking accounted for 14.32% of incident cancers and 21.70% of cancer deaths in 2015, and 13.17% of incidence and 20.69% of mortality in 2020. The burden was much greater in men than in women in both years (men: incidence 25.83% in 2015 and 23.49% in 2020; mortality 32.09% in 2015 and 30.41% in 2020; women: incidence 1.46% in 2015 and 1.68% in 2020; mortality 4.70% in 2015 and 4.96% in 2020). Smoking remains a preventable driver of substantial cancer incidence and mortality, calling for stronger control policies that also address emerging vulnerabilities among women.
Systematic Review
A meta-analysis of the association between adolescent pregnancy and the risk of gynecological cancers
Bita Azmi-Naei, Fatemeh Shahbazi, Nazanin Azmi-Naei, Jalal Poorolajal
Epidemiol Health. 2024;46:e2024094.   Published online November 26, 2024
DOI: https://doi.org/10.4178/epih.e2024094
  • 9,356 View
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AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
Despite several investigations, the association between adolescent pregnancy and gynecological cancers has yet to be conclusively established. To further explore this association, we conducted a meta-analysis of observational studies.
METHODS
We conducted a comprehensive search of databases such as PubMed, Web of Science, and Scopus to identify studies investigating the link between adolescent pregnancy and gynecologic cancers. This search continued until February 20, 2023. To assess the heterogeneity among the studies, we used the I2-statistics. We also explored the potential presence of publication bias using the Begg and Egger tests. The overall effect sizes were reported as either risk ratio or odds ratio, accompanied by a 95% confidence interval (CI), using a random-effects model.
RESULTS
From an initial pool of 25,436 studies, a total of 76 studies involving 13,991,683 participants met the predefined eligibility criteria. The analysis indicated that the overall effect size for individuals having their first pregnancy at age 20 or older, compared to those having it before age 20, was 0.54 (95% CI, 0.50 to 0.59) for cervical cancer, 0.82 (95% CI, 0.77 to 0.88) for ovarian cancer, and 0.96 (95% CI, 0.89 to 1.04) for uterine cancer.
CONCLUSIONS
Our findings suggest that experiencing one’s initial pregnancy at the age of 20 or above is associated with a significantly reduced risk of cervical and ovarian cancer. However, no significant association was found between first pregnancy at this age and uterine cancer.
Summary
Original Articles
Dietary mercury intake, the IL23R rs10889677 polymorphism, and the risk of gastric cancer in a Korean population: a hospital-based case-control study
Ji Hyun Kim, Madhawa Gunathilake, Jeonghee Lee, Il Ju Choi, Young-Il Kim, Jeongseon Kim
Epidemiol Health. 2024;46:e2024051.   Published online May 21, 2024
DOI: https://doi.org/10.4178/epih.e2024051
  • 12,320 View
  • 94 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Mercury can stimulate immune responses through T helper 17 (Th17). The gene <i>IL23R</i> is a key factor in Th17 function, which may also contribute to digestive tract diseases. The aim of this study was to identify the associations between dietary mercury and gastric cancer (GC) and to investigate whether the <i>IL23R</i> rs10889677 polymorphism modifies those associations.
METHODS
This case-control study included 377 patients with GC and 756 healthy controls. Dietary mercury intake (total mercury and methylmercury) was assessed using a dietary heavy metal database incorporated into the food frequency questionnaire. <i>IL23R</i> genetic polymorphism rs10889677 (A>C) was genotyped. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using unconditional logistic regression models with adjustments for potential confounders.
RESULTS
A higher dietary methylmercury intake was associated with an elevated risk of GC (OR for the highest vs. lowest tertile [T<sub>3</sub> vs. T<sub>1</sub>], 2.02; 95% CI, 1.41 to 2.91; p for trend <0.001). The <i>IL23R</i> rs10889677 reduced the risk of GC in individuals who carried at least 1 minor allele (OR, 0.62; 95% CI, 0.46 to 0.83; p=0.001; AC/CC vs. AA). Individuals with a C allele exhibited a lower susceptibility to GC through methylmercury intake than those with the AA genotype (OR for the T<sub>3</sub> of methylmercury and AA carriers, 2.93; 95% CI, 1.77 to 4.87; and OR for the T<sub>3</sub> of methylmercury and AC/CC genotype, 1.30; 95% CI, 0.76 to 2.21; p-interaction=0.013).
CONCLUSIONS
Our findings suggest that a genetic polymorphism, rs10889677 in <i>IL23R</i>, plays a role in modifying the association between dietary methylmercury intake and the risk of GC.
Summary
Korean summary
본 연구는 식이 수은과 위암 간의 연관성을 탐색하고, microRNA-lethal-7의 예측된 결합 부위 내에 위치한 IL23R rs10889677 다형성이 이러한 연관성에 영향을 미칠 수 있는지 규명하고자 합니다. 식이 메틸수은 섭취량에 비례하여 위암 발생 위험이 증가하는 경향이 확인되었고, IL23R rs10889677 다형성은 식이 메틸수은으로 의한 위암 발생 위험을 조절하는 인자로 작용할 수 있음을 시사합니다.
Key Message
This study aimed to investigate the associations between dietary mercury and gastric cancer (GC) and to determine whether the IL23R rs10889677 polymorphism, located within a predicted binding site for microRNA-lethal-7, may modify these associations. A higher dietary methylmercury intake was associated with an increased risk of GC, while the IL23R rs10889677 polymorphism may modify the detrimental effect of dietary methylmercury on gastric carcinogenesis.

Citations

Citations to this article as recorded by  
  • Genetic Modulation of Mercury Exposure on Perinatal and Birth Outcomes: A Systematic Review and Meta-Analysis of Gene-Environment Interactions
    Aqsa Aufa Syauqi Sadana, Saekhol Bakri, Shinji Tokonami, Eka Djatnika Nugraha, Hasnawati Amqam, Muflihatul Muniroh
    Journal of Xenobiotics.2026; 16(1): 28.     CrossRef
  • Replication Study and Meta‐Analysis of the Contribution of Seven Genetic Polymorphisms in Immune‐Related Genes to the Risk of Gastric and Colorectal Cancers
    Weiguang Zhou, Siqi Yuan, Wenqiang Kang, Xiangyuan Deng, Hang Zhou, Jiangyi Ruan, Xianhong Feng, Meifang Qi, Bifeng Chen
    International Journal of Immunogenetics.2025; 52(1): 39.     CrossRef
Association of decreased estimated glomerular filtration rate with lung cancer risk in the Korean population
Soonsu Shin, Min-Ho Kim, Chang-Mo Oh, Hyejin Chun, Eunhee Ha, Hyo Choon Lee, Seong Ho Moon, Dong-Young Lee, Dosang Cho, Sangho Lee, Min Hyung Jung, Jae-Hong Ryoo
Epidemiol Health. 2024;46:e2024041.   Published online March 20, 2024
DOI: https://doi.org/10.4178/epih.e2024041
  • 15,878 View
  • 178 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Inconsistent results are available regarding the association between low estimated glomerular filtration rate (eGFR) and lung cancer risk. We aimed to explore the risk of lung cancer according to eGFR category in the Korean population.
METHODS
We included 358,293 adults who underwent health checkups between 2009 and 2010, utilizing data from the National Health Insurance Service-National Sample Cohort. Participants were categorized into 3 groups based on their baseline eGFR, as determined using the Chronic Kidney Disease Epidemiology Collaboration equation: group 1 (eGFR ≥90 mL/min/1.73 m<sup>2</sup>), group 2 (eGFR ≥60 to <90 mL/min/1.73 m<sup>2</sup>), and group 3 (eGFR <60 mL/min/1.73 m<sup>2</sup>). Incidences of lung cancer were identified using the corresponding codes from the International Classification of Diseases, 10th revision. Multivariate Cox proportional hazard models were employed to calculate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer incidence up to 2019.
RESULTS
In multivariate analysis, group 2 exhibited a 26% higher risk of developing lung cancer than group 1 (HR, 1.26; 95% CI, 1.19 to 1.35). Furthermore, group 3 demonstrated a 72% elevated risk of lung cancer relative to group 1 (HR, 1.72; 95% CI, 1.58 to 1.89). Among participants with dipstick proteinuria of 2+ or greater, group 3 faced a significantly higher risk of lung cancer than group 1 (HR, 2.93; 95% CI, 1.37 to 6.24).
CONCLUSIONS
Low eGFR was significantly associated with increased lung cancer risk within the Korean population. A particularly robust association was observed in individuals with severe proteinuria, emphasizing the need for further investigation.
Summary
Korean summary
이번 연구에서는 한국인 인구집단에서 단백뇨와 동반된 낮은 사구체 여과율이 페암의 발생 위험을 증가시켰다. 이는 신장기능의 저하가 폐암의 위험을 증가시킬 수 있음을 시사한다. 신장기능이 저하된 환자들의 면밀한 추적관찰이 필요할 수 있다.
Key Message
Our research found that lower estimated glomerular filtration rate with proteinuria increased the risk of lung cancer in a Korean population. These findings suggest that decreased kidney function may increase the risk of lung cancer, indicating the need for careful observation of patients with impaired kidney function.

Citations

Citations to this article as recorded by  
  • Mendelian randomization study of the relationship between blood and urine biomarkers and lung cancer
    Haihua Huang, Haijun Zheng
    Frontiers in Oncology.2024;[Epub]     CrossRef
Regional disparities in the availability of cancer clinical trials in Korea
Jieun Jang, Wonyoung Choi, Sung Hoon Sim, Sokbom Kang
Epidemiol Health. 2024;46:e2024006.   Published online December 11, 2023
DOI: https://doi.org/10.4178/epih.e2024006
  • 14,438 View
  • 103 Download
  • 3 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Unequal access to cancer clinical trials is an important issue, given the potential benefits of participation for cancer patients. We evaluated regional disparities in access to cancer clinical trials in Korea.
METHODS
From the Ministry of Food and Drug Safety database, we extracted 2,465 records of all cancer clinical trials approved between January 2012 and April 2023. To measure disparities in cancer clinical trial access, we calculated the ratio of clinical trials open to non-capital areas relative to those open to capital areas. We then analyzed temporal trends in this ratio, which we termed the trial geographical equity index (TGEI).
RESULTS
Disparities in access to cancer clinical trials, as indicated by the TGEI, did not significantly improve during the study period (regression coefficient, 0.002; p=0.59). However, for phase II/III trials sponsored by global pharmaceutical companies, the TGEI improved significantly (regression coefficient, 0.021; p<0.01). In contrast, the TGEI deteriorated for trials initiated by investigators or those testing domestically developed therapeutics (regression coefficient, -0.015; p=0.05). Furthermore, the increasing trend of TGEI for phase II/III trials sponsored by global companies began to reverse after 2019, coinciding with the outbreak of coronavirus disease 2019 (COVID-19).
CONCLUSIONS
Over the past decade, access to cancer clinical trials has improved in Korea, particularly for phase II/III trials evaluating therapeutics from global companies. However, this increase in accessibility has not extended to trials initiated by investigators or those assessing domestically developed therapeutics. Additionally, the impact of COVID-19 on disparities in clinical trial access should be closely monitored.
Summary
Korean summary
본 연구는 개시된 암 임상시험 수가 국내 수도권에 비해 비수도권에서 절대적으로 부족하고, 이러한 부족이 지난 10년간 개선되지 않았음을 보여줍니다. 다만, 글로벌 제약회사의 치료제를 검증하는 2상/3상 암 임상시험의 경우 임상시험 접근성에 대한 이러한 지역적 격차가 의미 있게 감소했으나 이러한 개선 또한 2019년 이후로는 정체되었을 수 있습니다. 상기 결과들은 임상시험 가용성의 형평성을 향상시키기 위해서는 국내 임상시험 개시 규모가 지역적 불균형을 이루고 있음에 대한 인식이 높아져야 하고, 비수도권 지역에서 임상시험 개시를 방해하는 장벽을 식별하는 데 추가적인 노력이 필요함을 강조합니다.
Key Message
The findings in this study indicate scarcity of cancer clinical trials in non-capital areas compared to that in capital areas of Korea, which has not improved over the past decade. However, this regional disparity in the access to clinical trials meaningfully decreased for phase II/III trials testing therapeutics from global pharmaceutical companies, though this progress may have stalled after 2019. This study highlights that increasing awareness of the regional imbalance in clinical trial access is vital and further efforts are needed to identify the barriers impeding the initiation of clinical trials in non-capital areas to improve the equity of availability.

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Systematic Review
Dietary intake and cancer incidence in Korean adults: a systematic review and meta-analysis of observational studies
Ji Hyun Kim, Shinyoung Jun, Jeongseon Kim
Epidemiol Health. 2023;45:e2023102.   Published online November 30, 2023
DOI: https://doi.org/10.4178/epih.e2023102
  • 24,474 View
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  • 6 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
Cancer is a major health burden in Korea, and dietary factors have been suggested as putative risk factors for cancer development at various sites. This study systematically reviewed the published literature investigating the associations between dietary factors and cancer incidence among Korean adults, following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses guidelines. We focused on the 5 most studied cancer sites (stomach, colorectum, breast, thyroid, and cervix) as outcomes and dietary exposures with evidence levels greater than limited-suggestive according to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) panel’s judgment for any of the cancer sites. This resulted in the inclusion of 72 studies. Pooled estimates of the impact of dietary factors on cancer risk suggested protective associations of fruits and vegetables with risks for gastric cancer (GC), colorectal cancer (CRC), and breast cancer (BC) and dietary vitamin C with the risk of GC, as well as a harmful association between fermented soy products and the risk of GC. Despite the limited number of studies, we observed consistent protective associations of dietary fiber with GC and dietary fiber, coffee, and calcium with CRC. These findings are largely consistent with the WCRF/AICR expert report. However, pooled estimates for the associations of other salt-preserved foods with GC, meat with CRC, and dietary carotenoids and dairy products with BC did not reach statistical significance. Further studies with prospective designs, larger sample sizes, and diverse types of dietary factors and cancer sites are necessary.
Summary
Korean summary
한국 성인을 대상으로 주요 암종 발생과 관련된 식이 요인을 탐색한 72개 역학연구들을 체계적으로 리뷰하고 메타 분석한 결과, 과일 및 채소는 위암, 대장암, 유방암에 대한 보호 효과가 있으며, 식이 비타민 C는 위암 예방에 도움이 된다는 결과가 확인되었다. 반면, 염장 식품 중 발효 대두 제품은 위암 발생 위험을 증가시킬 수 있다. 향후 식이 섭취와 밀접하게 관련되었으나 기존 국내 연구가 부족한 암종과 다양한 식이 요인의 영향을 탐색하는 대규모 전향적 코호트 연구가 요구된다.
Key Message
We conducted a systematic review and meta-analysis on the associations between dietary factors and cancer incidence among Korean adults. Pooled estimates suggested protective associations of fruits and vegetables with risks for gastric cancer (GC), colorectal cancer (CRC), and breast cancer (BC) and dietary vitamin C with the risk of GC, as well as a harmful association between fermented soy products and GC risk. Further research is warranted, emphasizing longitudinal designs, larger sample sizes, and a comprehensive exploration of dietary factors, with a specific focus on anatomical sites with a substantial burden of disease but understudied in the context of diet.

Citations

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Special Article
Cancer risk based on alcohol consumption levels: a comprehensive systematic review and meta-analysis
Seunghee Jun, Hyunjin Park, Ui-Jeong Kim, Eun Jeong Choi, Hye Ah Lee, Bomi Park, Soon Young Lee, Sun Ha Jee, Hyesook Park
Epidemiol Health. 2023;45:e2023092.   Published online October 16, 2023
DOI: https://doi.org/10.4178/epih.e2023092
  • 65,535 View
  • 1,158 Download
  • 44 Web of Science
  • 57 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Alcohol consumption is a well-established risk factor for cancer. Despite extensive research into the relationship between alcohol consumption and cancer risk, the effect of light alcohol consumption on cancer risk remains a topic of debate. To contribute to this discourse, we conducted a comprehensive systematic review and meta-analysis.
METHODS
Our systematic review aimed to investigate the associations between different levels of alcohol consumption and the risk of several cancer types. We focused on analyzing prospective associations using data from 139 cohort studies. Among them, 106 studies were included in the meta-analysis after a quantitative synthesis.
RESULTS
Our analysis did not find a significant association between light alcohol consumption and all-cause cancer risk (relative risk, 1.02; 95% confidence interval, 0.99 to 1.04), but we observed a dose-response relationship. Light alcohol consumption was significantly associated with higher risks of esophageal, colorectal, and breast cancers. Light to moderate drinking was associated with elevated risks of esophageal, colorectal, laryngeal, and breast cancers. Heavy drinking was also found to contribute to the risk of stomach, liver, pancreas, and prostate cancers, thereby increasing the risk of almost all types of cancer. Additionally, females generally had lower cancer risks compared to males.
CONCLUSIONS
Our findings highlight that cancer risks extend beyond heavy alcohol consumption to include light alcohol consumption as well. These findings suggest that there is no safe level of alcohol consumption associated with cancer risk. Our results underscore the importance of public health interventions addressing alcohol consumption to mitigate cancer risks.
Summary
Korean summary
본 연구는 코호트 연구를 기반으로 하여 음주의 수준에 따른 암 위험 연관성에 대해 체계적 문헌고찰(139편)과 메타분석(106편)을 수행하였다. 연구 결과, 음주와 암 위험 사이에 용량-반응 관계가 나타났으며, 소량의 음주는 암 유형에 따라 차이가 있었으나, 식도암, 대장암, 전립선암(남성), 유방암(여성)에서 암 위험과의 연관성이 있음을 발견했다. 따라서, 암 위험 측면에서 음주에 안전한 수준이 없음을 시사하며, 음주와 관련된 잠재적 피해를 완화하기 위해서는 음주 지침 강화와 같은 공중보건개입이 필요하다.
Key Message
The aim of this study was to assess the relationship between different levels of alcohol consumption and the risk of various cancer types through a systematic review and meta-analysis, providing insights into the ongoing debate about alcohol consumption and cancer causality. The findings support a dose-response relationship between alcohol consumption levels and cancer risk and the light alcohol consumption was associated with risks of esophageal, colorectal, prostate (male), and breast (female) cancer. These results emphasize the absence of a safe threshold for alcohol consumption in terms of cancer risk.

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    Frontiers in Immunology.2024;[Epub]     CrossRef
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    Waku Hatta, Tomoyuki Koike, Naoki Asano, Yutaka Hatayama, Yohei Ogata, Masahiro Saito, Xiaoyi Jin, Kaname Uno, Akira Imatani, Atsushi Masamune
    International Journal of Molecular Sciences.2024; 25(14): 7854.     CrossRef
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    Jiawei Wan, Kyohsuke Wakaba, Takeshi Onoue, Kazuyo Tsushita, Yoshio Nakata
    Preventive Medicine Reports.2024; 48: 102915.     CrossRef
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    Therapeutic Advances in Neurological Disorders.2024;[Epub]     CrossRef
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    FMC - Formación Médica Continuada en Atención Primaria.2024; 31(8): 403.     CrossRef
  • Alcohol consumption and its association with cancer, cardiovascular, liver and brain diseases: a systematic review of Mendelian randomization studies
    Naouras Bouajila, Cloé Domenighetti, Henri-Jean Aubin, Mickael Naassila
    Frontiers in Epidemiology.2024;[Epub]     CrossRef
  • Global, regional, and national trends in gastric cancer burden: 1990-2021 and projections to 2040
    Tao Zhang, Yiqun Zhang, Xiaofei Leng
    Frontiers in Oncology.2024;[Epub]     CrossRef
  • Alcohol Consumption and Breast and Ovarian Cancer Development: Molecular Pathways and Mechanisms
    Francesca Fanfarillo, Brunella Caronti, Marco Lucarelli, Silvia Francati, Luigi Tarani, Mauro Ceccanti, Maria Grazia Piccioni, Loredana Verdone, Micaela Caserta, Sabrina Venditti, Giampiero Ferraguti, Marco Fiore
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Original Articles
Regional disparities in major cancer incidence in Korea, 1999-2018
Eun Hye Park, Mee Joo Kang, Kyu-Won Jung, Eun Hye Park, E Hwa Yun, Hye-Jin Kim, Hyun-Joo Kong, Chang Kyun Choi, Jeong-Soo Im, Hong Gwan Seo, The Community of Population-Based Regional Cancer Registries
Epidemiol Health. 2023;45:e2023089.   Published online October 12, 2023
DOI: https://doi.org/10.4178/epih.e2023089
  • 17,928 View
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  • 5 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study investigated regional disparities in the incidence of 8 major cancers at the municipal level in Korea during 1999-2018 and evaluated the presence or absence of hot spots of cancer clusters during 2014-2018.
METHODS
The Korea National Cancer Incidence Database was used. Age-standardized incidence rates were calculated by gender and region at the municipal level for 4 periods of 5 years and 8 cancer types. Regional disparities were calculated as both absolute and relative measures. The possibility of clusters was examined using global Moran’s I with a spatial weight matrix based on adjacency or distance.
RESULTS
Regional disparities varied depending on cancer type and gender during the 20-year study period. For men, the regional disparities of stomach, colon and rectum, lung, and liver cancer declined, and those of thyroid and prostate cancer recently decreased, despite an overall increasing incidence. For women, regional disparities in stomach, colon and rectum, lung, liver, and cervical cancer declined, that of thyroid cancer recently decreased, despite an overall increasing incidence, and that of breast cancer steadily increased. In 2014-2018, breast cancer (I, 0.61; 95% confidence interval [CI], 0.53 to 0.70) showed a high probability of cancer clusters in women, and liver cancer (I, 0.48; 95% CI, 0.40 to 0.56) showed a high probability of cancer clusters in men.
CONCLUSIONS
Disparities in cancer incidence that were not seen at the national level were discovered at the municipal level. These results could provide important directions for planning and implementing local cancer policies.
Summary
Korean summary
이 연구는 한국 시군구 단위에서 지난 20년(1999-2018)간 주요 8개 암 발생률의 지역 간 격차를 조사하고, 최근 5년(2014-2018)의 암 발생 군집 가능성을 평가했습니다. 지역 간 격차는 여성에서 갑상선암, 남성에서는 폐암이 가장 큰 격차를 보였습니다. 군집 가능성은 여성의 경우 유방암, 남성의 경우 간암에서 가장 높았습니다. 전국 단위에서는 볼 수 없었던 지역 간 격차 및 군집 발생 가능성이 시군구 단위에서 발견되었고, 이러한 결과는 지역에 맞는 암 정책을 기획하고 실행하는 데 중요한 방향을 제시할 수 있을 것입니다.
Key Message
This study investigated regional disparities in the incidence of eight major cancers in Korea at the municipal level during 1999-2018 and assessed the possibility of cancer clusters during 2014-2018. Thyroid cancer in women and lung cancer in men showed the most significant regional disparities. Breast cancer in women and liver cancer in men displayed the highest possibility of clustering. Regional disparities and cancer clusters were identified locally, which were not detected nationally. These findings could provide valuable guidance for developing and implementing cancer policies that are tailored to local needs.

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Increased risk of cancer and cancer-related mortality in middle-aged Korean women with prediabetes and diabetes: a population-based study
Thi Xuan Mai Tran, Soyeoun Kim, Huiyeon Song, Boyoung Park
Epidemiol Health. 2023;45:e2023080.   Published online August 28, 2023
DOI: https://doi.org/10.4178/epih.e2023080
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  • 4 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study investigated the risk of developing and dying from all types of cancer, as well as cancer-specific mortality, in women diagnosed with prediabetes and diabetes.
METHODS
We included women aged ≥40 years who underwent cancer screening from 2009 to 2014 with follow-up until 2020. Diabetes status was determined based on fasting plasma glucose levels, self-reported history of diabetes, and the use of antidiabetic medication. We quantified the risk of cancer and mortality in the prediabetes and diabetes groups, relative to the normoglycemia group, by calculating adjusted hazard ratios (aHRs).
RESULTS
The study included 8,309,393 participants with a mean age of 52.7±9.7 years. Among these participants, 522,894 cases of cancer and 193,283 deaths were detected. An increased risk of cancer was observed in both the prediabetes group (aHR, 1.03; 95% confidence interval [CI], 1.02 to 1.04) and the diabetes group (aHR, 1.13; 95% CI, 1.12 to 1.14). The highest risk was identified in those with diabetes who developed liver (aHR, 1.72; 95% CI, 1.66 to 1.79), pancreatic (aHR, 1.68; 95% CI, 1.60 to 1.76), and gallbladder cancer (aHR, 1.43; 95% CI, 1.36 to 1.51). Women with prediabetes and diabetes exhibited a 1.07-fold (95% CI, 1.05 to 1.08) and 1.38-fold (95% CI, 1.36 to 1.41) increased risk of death from cancer, respectively.
CONCLUSIONS
Both prediabetes and diabetes were associated with an elevated risk of cancer, as well as an increased risk of death from cancer, in middle-aged Korean women. However, the degree of risk varied depending on the specific site of the cancer.
Summary
Korean summary
40세 이상의 중년 여성에서 당뇨 또는 당뇨 전 단계는 암 발생 위험과 암으로 인한 사망위험을 증가시킴. 암 종별로는 위암, 대장암, 직장암, 간암, 담낭암, 췌장암, 유방암, 자궁경부암, 자궁암, 신장암, 방광암의 발생 위험이 증가한 반면, 갑상선암의 발생 위험은 감소하였음. 거의 대부분의 암종에서 당뇨는 암으로 인한 사망위험을 증가시킴
Key Message
Both prediabetes and diabetes were independently associated with an overall increased risk of cancer, with a stronger association with malignancies in the liver and pancreas in women. Additionally, both prediabetes and diabetes status are associated with an elevated risk of death from cancer. These findings support the need for prevention and management to reduce cancer-related burden and premature deaths due to cancer, not only in individuals with diabetes but also in those with prediabetes.

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    Problems of Endocrinology.2025; 71(2): 75.     CrossRef
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Special Article
Genetically determined alcohol consumption and cancer risk in Korea
Keum Ji Jung, Ji Woo Baek, Sang Yop Shin, Sun Ha Jee
Epidemiol Health. 2023;45:e2023077.   Published online August 23, 2023
DOI: https://doi.org/10.4178/epih.e2023077
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  • 190 Download
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AbstractAbstract AbstractSummary PDF
Abstract
OBJECTIVES
The purpose of this study was to determine the causal relationship between the genetically determined amount of alcohol consumption and the occurrence of major cancers.
METHODS
The data used in this study were from 129,324 people selected from the Korean Cancer Prevention Study-II, the participants of which visited 18 health examination centers between 2004 and 2013. Cancer incidence was confirmed as of 2020 using data from the National Cancer Center. A genome-wide association study (GWAS) on alcohol consumption was performed using PLINK 2.0, and sex, age, chip type, and principal components were adjusted.
RESULTS
From the GWAS, a genetic risk score for alcohol consumption was calculated and genetically determined alcohol consumption (GDAC) was estimated. GDAC was divided into quintile groups and showed significant causal relationships with rectal cancer and liver cancer, but not with other cancers. For liver cancer, an association was shown in the hepatitis B surface antigen (HBsAg)-negative group, and a particularly strong association was found in the over-60-year-old HBsAg-negative group, in which, compared to the GDAC Q1 group, the Q4 group had a 2.35 times higher risk (95% confidence interval [CI], 1.05 to 5.23), and the Q5 group had a 2.40 times higher risk (95% CI, 1.09 to 5.30).
CONCLUSIONS
The results of this study provided evidence that the amount of alcohol consumed is causally related to the occurrence of rectal cancer and liver cancer in HBsAg-negative individuals. Additional studies should be continued for other cancer types through long-term follow-up.
Summary
Korean summary
본 연구는 유전적으로 결정되는 음주량과 주요 암 발생 사이의 인과 관계를 밝히고자 하였다. 그 결과 유전적으로 결정되는 음주량이 증가할수록 직장암 발생 위험이 높아졌고, 특히 HBsAg 음성인 사람에서 간암 발생 위험이 높아지는 것으로 밝혀졌다.
Key Message
The purpose of this study was to reveal the causal relationship between genetically determined alcohol consumption and the incidence of major cancers. As a result, it was found that as the genetically determined amount of alcohol consumed increases, the risk of rectal cancer increases, and especially in people who are HBsAg negative, the risk of liver cancer increases.

Citations

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  • Cohort profile update: the Korean Cancer Prevention Study-II (KCPS-II) biobank
    Heejin Kimm, Keum Ji Jung, Wes Spiller, Yeun Soo Yang, So Young Kim, Min Young Park, Sun Mi Lee, Sun Ha Jee
    Epidemiology and Health.2025; 47: e2025040.     CrossRef
  • A pan-cancer analysis of the prognostic implication and oncogenic role of tubulin epsilon and delta complex 2 (TEDC2) in human tumors
    Yang Liu, Jie Zhu, Jing Shen, Yuting Lu, Ke Pan, Chuan Tong, Yao Wang
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    Seunghee Jun, Hyunjin Park, Ui-Jeong Kim, Eun Jeong Choi, Hye Ah Lee, Bomi Park, Soon Young Lee, Sun Ha Jee, Hyesook Park
    Epidemiology and Health.2023; 45: e2023092.     CrossRef
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
  • 18,957 View
  • 189 Download
  • 8 Web of Science
  • 8 Crossref
AbstractAbstract AbstractSummary PDFSupplementary 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.

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  • Metabolic obesity phenotypes and breast cancer risk before and after menopause: A nationwide cohort study in South Korea
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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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AbstractAbstract AbstractSummary PDFSupplementary 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
  • 19,673 View
  • 184 Download
  • 14 Web of Science
  • 15 Crossref
AbstractAbstract AbstractSummary PDFSupplementary 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.

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    Soo-Yeon Kim, Sung Eun Song, Min Sun Bae, Kyu Ran Cho, Bo Kyoung Seo, Ok Hee Woo
    Ultrasonography.2026; 45(1): 18.     CrossRef
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    Takahiro Aoyama, Yutaro Koide, Hidetoshi Shimizu, Atsushi Urikura, Tomoki Kitagawa, Shingo Hashimoto, Hiroyuki Tachibana, Takeshi Kodaira
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    International Journal of Cancer.2025; 156(9): 1692.     CrossRef
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    Joanne Kim, Andrew Harper, Valerie McCormack, Hyuna Sung, Nehmat Houssami, Eileen Morgan, Miriam Mutebi, Gail Garvey, Isabelle Soerjomataram, Miranda M. Fidler-Benaoudia
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    Jiwoo Kim, Hyun Jeong Cho, Zisun Kim, Hyun Jo Youn, Jihyoung Cho, Jun Won Min, Yoo Seok Kim, Jung Eun Lee
    Scientific Reports.2025;[Epub]     CrossRef
  • Cost-Effectiveness Analysis of Mammography-Based Breast Cancer Screening in Indonesia
    Ajeng V. Icanervilia, Keris Poelhekken, Jarir At Thobari, Lina Choridah, Susanna H. Hutajulu, Geertruida H. de Bock, Maarten J. Postma, Marcel J.W. Greuter, Antoinette D.I. van Asselt
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    Yejin Ha, Xuan Quy Luu, Woorim Kim, Jae Kwan Jun, Mina Suh, Kui Son Choi
    Epidemiology and Health.2025; 47: e2025031.     CrossRef
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    Cancer Epidemiology.2024; 91: 102594.     CrossRef
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    Jinwook Bahk, Hee-Yeon Kang, Young-Ho Khang, Kyunghee Jung-Choi
    Epidemiology and Health.2024; 46: e2024074.     CrossRef
  • Why is the screening rate in lung cancer still low? A seven-country analysis of the factors affecting adoption
    Charlotte Poon, Tim Wilsdon, Iqra Sarwar, Alexander Roediger, Megan Yuan
    Frontiers in Public Health.2023;[Epub]     CrossRef
  • Mammographic Breast Density and Risk of Ovarian Cancer in Korean Women
    Thi Xuan Mai Tran, Soyeoun Kim, Boyoung Park
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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
  • 18,758 View
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AbstractAbstract PDFSupplementary 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

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  • Supplemental automated breast ultrasound in negative screening mammography: early-stage cancer detection in dense breasts with limited yield in non-dense breasts
    Soo-Yeon Kim, Sung Eun Song, Min Sun Bae, Kyu Ran Cho, Bo Kyoung Seo, Ok Hee Woo
    Ultrasonography.2026; 45(1): 18.     CrossRef
  • Determining risk‐adapted starting age and interval for breast cancer screening based on reproductive and hormonal factors
    Tung Hoang, Jeonghee Lee, So‐Youn Jung, Jeongseon Kim
    International Journal of Cancer.2025; 156(9): 1692.     CrossRef
  • Current Status of the National Cancer Screening Program in Korea: History, Achievements, and Future Directions
    Kyeongmin Lee, Mina Suh, Kui Son Choi
    Journal of Preventive Medicine and Public Health.2025; 58(4): 337.     CrossRef
  • PROTOCOLO DE AVALIAÇÃO PARA ESCOLHA DE CONDUTAS PARA O RASTREIO DE CÂNCER DE MAMA
    Vitória Martins Granja De Moura, Janaína Alvarenga Aragão, Luciano Silva Figueiredo, Ana Paula Rodrigues de Sousa Araújo De Moura, Marcos Rocha Luz
    ARACÊ .2025; 7(10): e9239.     CrossRef
  • A Retrospective Analysis of Breast Cancer Mortality among Jewish and Muslim Arab Women in Israel: The Role of Sociodemographic Factors
    Ronit Pinchas-Mizrachi, Dan Bouhnik
    Cancers.2024; 16(15): 2763.     CrossRef
  • Random forest algorithm identifies miRNA signatures for breast cancer detection and classification from patient urine samples
    Jochen Maurer, Matthias Rübner, Chao-Chung Kuo, Birgit Klein, Julia Franzen, Julia Wittenborn, Tomas Kupec, Laila Najjari, Peter Fasching, Elmar Stickeler
    Therapeutic Advances in Medical Oncology.2024;[Epub]     CrossRef
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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  • 13 Web of Science
  • 18 Crossref
AbstractAbstract AbstractSummary 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.

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  • Patient Acceptance of Death and Symptom Control/Quality of Care Among Terminal Cancer Patients Under Inpatient Hospice Care: A Multicenter Cross-Sectional Study
    Jae Hyuck Lee, Yoo Jeong Lee, So Jung Park, Young Min Park, Chung Woo Lee, Sun Wook Hwang, Min Seok Seo, Sun Hyun Kim, Hong Yup Ahn, In Cheol Hwang
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    Journal of Neuro-Oncology.2026;[Epub]     CrossRef
  • The Impact of Advanced Care Planning on Hospice Utilization in Patients with Cancer: A Nationwide Analysis in Korea
    Woorim Kim, Boram Kim, Minju Kim, Jin Young Choi
    Cancers.2025; 17(9): 1471.     CrossRef
  • Feasibility study protocol: implementing consultation-based high-quality palliative care services in intensive care units
    Ye Sul Jeung, Yejin Kim, Seyeon Kim, Yoon Sun Jung, Tae Jung Kim, Shin Hye Yoo
    BMJ Open.2025; 15(5): e093558.     CrossRef
  • Associated factors of home hospice care utilization by the terminally ill older adults: a mixed-methods study
    Jie Peng, Xiaoling Feng, Xiaoying Cao, Lichong Lai, Pengxin Dong, Haichen Wu, Yidan Chai, Ping Huang, Dongmei Hai, Caili Li, Yanfei Pan, Dejing Fan, Qini Pan, Shuyu Lu, Xiao Pan, Liyan Zhang, Pinyue Tao, HuiQiao Huang
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    Boyoung Shin, Jee Young Lee, Sung Eun Hong, Sang Hyung Lee, Myung Han Hyun, Bo-Hyoung Jang
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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
  • 20,040 View
  • 279 Download
  • 9 Web of Science
  • 8 Crossref
AbstractAbstract AbstractSummary PDFSupplementary 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.

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  • Incineration systems for circular solid waste valorisation in low-income settings: A pathway to close material loops and mitigate health risks?
    Willis Gwenzi, Wilgince Apollon, Flávio Lopes Francisco Bittencourt, Marcio Ferreira Martins
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    Delphine Praud, Amina Amadou, Thomas Coudon, Margaux Duboeuf, Benoît Mercoeur, Elodie Faure, Lény Grassot, Aurélie MN. Danjou, Pietro Salizzoni, Florian Couvidat, Laure Dossus, Gianluca Severi, Francesca Romana Mancini, Béatrice Fervers
    International Journal of Hygiene and Environmental Health.2025; 263: 114489.     CrossRef
  • Residential exposure to municipal solid waste incinerators and health effects: a systematic review with meta-analysis
    Isabella Bottini, Simona Vecchi, Manuela De Sario, Lisa Bauleo, Alessandro Trentalange, Paola Michelozzi, Carla Ancona
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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
  • 27,197 View
  • 472 Download
  • 24 Web of Science
  • 26 Crossref
AbstractAbstract AbstractSummary PDFSupplementary 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.

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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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AbstractAbstract AbstractSummary PDFSupplementary 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.

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  • Geographical Disparities in Faecal Immunochemical Test‐Based Colorectal Cancer Screening Participation and Positivity Rates: A Systematic Review and Meta‐Analysis
    Melkalem Mamuye Azanaw, Erin L. Symonds, Geraldine Laven‐Law, Wudneh Simegn Belay, Syme Aftab, Muktar B. Ahmed, Molla M. Wassie
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    Jin Young Park, Il Ju Choi
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    Boyoung Park, Yoonyoung Jang, Taehwa Kim, Yunsu Choi, Kyoung Hwan Ahn, Jung Ho Kim, Hye Seong, Youn Jeong Kim, Jun Yong Choi, Joon Young Song, Shin-Woo Kim, Sang Il Kim
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    Cristiana Tudor, Robert Aurelian Sova
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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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  • 6 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary 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
  • 24,432 View
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  • 10 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
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.

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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
  • 21,734 View
  • 239 Download
  • 10 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary 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.

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    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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AbstractAbstract AbstractSummary 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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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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AbstractAbstract AbstractSummary 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.

Citations

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    Ashi Robert Thobias, Mrugdha Patel, Chirag Vaghela, Prabhudas Shankarbhai Patel
    Clinical and Translational Oncology.2025; 27(11): 4131.     CrossRef
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    De Partha, Rambhad Gautam S , Wu Ying Hui, Sukarom Isaya
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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
  • 33,964 View
  • 451 Download
  • 38 Web of Science
  • 46 Crossref
AbstractAbstract AbstractSummary PDFSupplementary 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; I<sup>2</sup>=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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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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AbstractAbstract PDFSupplementary 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 χ<sup>2</sup>, τ<sup>2</sup>, and I<sup>2</sup> 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: <i>Helicobacter pylori</i> 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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Perspective
Health effects of exposure to radon: implications of the radon bed mattress incident in Korea
Songwon Seo, Wi-Ho Ha, Jin-Kyu Kang, Dalnim Lee, Soojin Park, Tae-Eun Kwon, Young Woo Jin
Epidemiol Health. 2019;41:e2019004.   Published online February 12, 2019
DOI: https://doi.org/10.4178/epih.e2019004
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AbstractAbstract AbstractSummary PDF
Abstract
Radon is a naturally occurring radioactive material formed by the slow decay of uranium and thorium found in the earth’s crust or construction materials. Internal exposure to radon accounts for about half of the natural background radiation dose to which humans are exposed annually. Radon is a carcinogen and is the second leading cause of lung cancer following smoking. An association between radon and lung cancer has been consistently reported in epidemiological studies on mine workers and the general population with indoor radon exposure. However, associations have not been clearly established between radon and other diseases, such as leukemia and thyroid cancer. Radiation doses are assessed by applying specific dose conversion coefficients according to the source (e.g., radon or thoron) and form of exposure (e.g., internal or external). However, regardless of the source or form of exposure, the effects of a given estimated dose on human health are identical, assuming that individuals have the same sensitivity to radiation. Recently, radiation exceeding the annual dose limit of the general population (1 mSv/yr) was detected in bed mattresses produced by D company due to the use of a monazite-based anion powder containing uranium and thorium. This has sparked concerns about the health hazards for mattress users caused by radiation exposure. In light of this event, this study presents scientific information about the assessment of radon and thoron exposure and its human implications for human health, which have emerged as a recent topic of interest and debate in society.
Summary
Korean summary
라돈은 세계보건기구에서 지정한 발암물질로, 흡연 다음으로 폐암을 유발한다. 지난 2018년 5월에 D사 침대 매트리스에서 라돈 및 토론에 의한 일반인의 선량한도 기준치(1 mSv/yr) 이상의 방사선이 검출되었다. 이로 인해 침대 사용자의 방사선 피폭으로 인한 건강영향 우려가 대두되고 있다. 이번 연구에서는 라돈 침대 노출 사고와 관련하여 그 동안 잘 알려지지 않은 라돈 및 토론의 노출평가 및 역학 연구 결과들을 살펴보고, 그 시사점을 고찰한다.

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Data Profile
National Epidemiologic Survey of Thyroid cancer (NEST) in Korea
Chang-Mo Oh, Hyun-Joo Kong, Eunyang Kim, Hyejin Kim, Kyu-Won Jung, Sohee Park, Young-Joo Won
Epidemiol Health. 2018;40:e2018052.   Published online October 26, 2018
DOI: https://doi.org/10.4178/epih.e2018052
  • 27,489 View
  • 283 Download
  • 32 Web of Science
  • 32 Crossref
AbstractAbstract PDF
Abstract
The Korea Central Cancer Registry conducted the National Epidemiologic Survey of Thyroid cancer (NEST) to investigate changes in the epidemiological and clinical characteristics of thyroid cancer patients between 1999 and 2008. The NEST was designed to collect representative samples of patients with thyroid cancer diagnosed in the years 1999, 2005, and 2008 using a proportionally stratified and systematic random sampling method. Among 42,891 participants diagnosed with thyroid cancer, 5,796 participants were included in the final study population. This survey collected information on diagnostic methods and date, route of diagnosis, prior medical history and history of thyroid-related disease, tumor, lymph node, metastasis and collaborative stage, and treatment. The NEST dataset was also linked to the cause-of-death database from Statistics Korea. The mean age of the study participants was 46.9 years. The ratio of men to women was 1:5.5. In the analysis of the histologic type of cancer, the proportion of papillary thyroid carcinoma showed an increasing trend (p<0.01). In contrast, the proportion of distant metastasis and the mean tumor size of thyroid cancers showed decreasing trends over time (p<0.01, respectively).
Summary

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Original Articles
Androgen deprivation therapy is associated with decreased second primary lung cancer risk in the United States veterans with prostate cancer
Kyungsuk Jung, Jong Chul Park, Hyunseok Kang, Johann Christoph Brandes
Epidemiol Health. 2018;40:e2018040.   Published online August 11, 2018
DOI: https://doi.org/10.4178/epih.e2018040
  • 24,224 View
  • 209 Download
  • 8 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
We investigated whether androgen deprivation therapy (ADT) in prostate cancer patients was associated with a decreased risk for second primary lung cancer in US veterans.
METHODS
Prostate cancer diagnoses in the US Veterans Affairs Cancer Registry between 1999 and 2008 were identified. Use of hormonal therapy and diagnoses of second primary lung cancer were determined from the registry. Synchronous prostate and lung cancers, defined as 2 diagnoses made within 1 year, were excluded from the analysis. Cancer-free survival was estimated using the Kaplan-Meier method and hazard ratios were estimated using Cox proportional hazard models.
RESULTS
Among the 63,141 identified patients with prostate cancer, 18,707 subjects were eligible for the study. Hormonal therapy was used in 38% of patients and the median follow-up period was 28 months. ADT use was associated with longer lung cancer-free survival in prostate cancer patients (log-rank p=0.01). After adjusting for age, race, smoking and prostate cancer stage, ADT use was associated with decreased lung cancer risk by 15, 21, and 24% after 1, 2, and 3 years, respectively.
CONCLUSIONS
ADT in prostate cancer patients may be associated with decreased second primary lung cancer risk among US veterans.
Summary
Korean summary
비소세포성 폐암이 호르몬 수용체에 의해 영향을 받을 수 있다는 기존의 연구 결과를 바탕으로, 이 연구는 미국 재향 군인 병원 암등록 자료를 분석하여 전립선암 환자 중, 안드로겐 박탈 요법으로 치료를 받은 경우와 그렇지 않은 경우의 비소세포성 폐암 발생율을 비교분석하였다. 분석 결과, 전립선암을 진단받은 미국 재향군인들 중 안드로겐 박탈 요법으로 치료를 받은 환자들이 그렇지 않은 환자들에 비해 비소세포성 폐암 발생율이 통계적으로 유의미하게 감소하는 것이 관찰되었다.

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Physician’s awareness of lung cancer screening and its related medical radiation exposure in Korea
Seri Hong, Suyeon Kim, Mina Suh, Boyoung Park, Kui Son Choi, Jae Kwan Jun
Epidemiol Health. 2018;40:e2018002.   Published online January 20, 2018
DOI: https://doi.org/10.4178/epih.e2018002
  • 26,443 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Through a survey on perception of lung cancer screening and accompanying medical radiation exposure in Korea, the present study was to investigate its current situations and evaluate various perception of physicians regarding it in order to propose measures for improvements.
METHODS
Medical specialists in national cancer screening institutions selected through stratified random sampling were subjected to face-to-face interview using a structured questionnaire. We investigated physicians’ perception on effectiveness of lung cancer screening depending on screening modality, selection criteria for subjects of screening, types of equipment used to screen, and perception for seriousness of adverse effects following the test. In addition, odds ratios to underestimate risk of radiation exposure from screening were calculated through logistic regression analysis.
RESULTS
Each response that chest X-ray is effective for lung cancer screening and that smoking history is not considered prior to screening recommendation accounted for more than 60% of respondents, suggesting the chance of unnecessary screening tests. Regarding adverse effects of lung cancer screening, about 85% of respondents replied that false positive, radiation exposure, and overdiagnosis could be ignored. About 70% of respondents underestimated radiation dose from lung cancer screening, and a low proportion of physicians informed patients of radiation exposure risk.
CONCLUSIONS
It was found that most physicians underestimated harms of lung cancer screening including radiation exposure and were lack of awareness regarding lung cancer screening. It should be noted that physicians need to have proper perceptions about screening recommendation and accompanying possible harms, for successful implementation of the screening program.
Summary
Korean summary
전국 100여개 국가암검진 기관을 대상으로 폐암검진 관련 설문을 수행한 결과, 효과적인 폐암검진의 수단이나 방법에 대한 이해 및 검사에 수반되는 각종 부작용에 대한 의사들의 인식이 확연히 부족한 것으로 조사되었다. 그 중에서도 특히 의료방사선 노출에 대한 낮은 인지도는, 촬영 시 피폭량에 대한 전반적인 과소평가 및 방사선 노출 위험과 관련한 환자 교육의 부재를 통해 확인할 수 있었다. 인구집단 대상 선별검사의 도입에 따른 잠재적인 위해 가능성과 그 결과에 대한 고민은 반드시 필요하며, 이와 관련된 의료제공자들의 인식 개선을 촉구하는 본 연구는 정책 도입에 앞서 선결되어야 할 과제로서 공중보건학적 측면에서 중요한 의의를 지닌다.

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    J. Yuan, D. Liu, J. Ni
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Exploring neighborhood inequality in female breast cancer incidence in Tehran using Bayesian spatial models and a spatial scan statistic
Erfan Ayubi, Mohammad Ali Mansournia, Ali Ghanbari Motlagh, Alireza Mosavi-Jarrahi, Ali Hosseini, Kamran Yazdani
Epidemiol Health. 2017;39:e2017021.   Published online May 17, 2017
DOI: https://doi.org/10.4178/epih.e2017021
  • 26,370 View
  • 239 Download
  • 15 Web of Science
  • 14 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
The aim of this study was to explore the spatial pattern of female breast cancer (BC) incidence at the neighborhood level in Tehran, Iran.
METHODS
The present study included all registered incident cases of female BC from March 2008 to March 2011. The raw standardized incidence ratio (SIR) of BC for each neighborhood was estimated by comparing observed cases relative to expected cases. The estimated raw SIRs were smoothed by a Besag, York, and Mollie spatial model and the spatial empirical Bayesian method. The purely spatial scan statistic was used to identify spatial clusters.
RESULTS
There were 4,175 incident BC cases in the study area from 2008 to 2011, of which 3,080 were successfully geocoded to the neighborhood level. Higher than expected rates of BC were found in neighborhoods located in northern and central Tehran, whereas lower rates appeared in southern areas. The most likely cluster of higher than expected BC incidence involved neighborhoods in districts 3 and 6, with an observed-to-expected ratio of 3.92 (p<0.001), whereas the most likely cluster of lower than expected rates involved neighborhoods in districts 17, 18, and 19, with an observed-to-expected ratio of 0.05 (p<0.001).
CONCLUSIONS
Neighborhood-level inequality in the incidence of BC exists in Tehran. These findings can serve as a basis for resource allocation and preventive strategies in at-risk areas.
Summary

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Geographic distribution of the incidence of colorectal cancer in Iran: a population-based study
Fatemeh Khosravi Shadmani, Erfan Ayubi, Salman Khazaei, Mohadeseh Sani, Shiva Mansouri Hanis, Somayeh Khazaei, Mokhtar Soheylizad, Kamyar Mansori
Epidemiol Health. 2017;39:e2017020.   Published online May 17, 2017
DOI: https://doi.org/10.4178/epih.e2017020
  • 30,493 View
  • 303 Download
  • 35 Web of Science
  • 28 Crossref
AbstractAbstract PDF
Abstract
OBJECTIVES
Colorectal cancer (CRC) is the third most common cancer and the fourth most common cause of cancer death in the world. The aim of this study was to investigate the provincial distribution of the incidence of CRC across Iran.
METHODS
This epidemiologic study used data from the National Cancer Registry of Iran and the Center for Disease Control and Prevention of the Ministry of Health and Medical Education of Iran. The average annual age-standardized rate (ASR) for the incidence of CRC was calculated for each province.
RESULTS
We found that adenocarcinoma (not otherwise specified) was the most common histological subtype of CRC in males and females, accounting for 81.91 and 81.95% of CRC cases, respectively. Signet ring cell carcinoma was the least prevalent subtype of CRC in males and females and accounted for 1.5 and 0.94% of CRC cases, respectively. In patients aged 45 years or older, there was a steady upward trend in the incidence of CRC, and the highest ASR of CRC incidence among both males and females was in the age group of 80-84 years, with an ASR of 144.69 per 100,000 person-years for males and 119.18 per 100,000 person-years for females. The highest incidence rates of CRC in Iran were found in the central, northern, and western provinces. Provinces in the southeast of Iran had the lowest incidence rates of CRC.
CONCLUSIONS
Wide geographical variation was found in the incidence of CRC across the 31 provinces of Iran. These variations must be considered for prevention and control programs for CRC, as well as for resource allocation purposes.
Summary

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Cancer mortality-to-incidence ratio as an indicator of cancer management outcomes in Organization for Economic Cooperation and Development countries
Eunji Choi, Sangeun Lee, Bui Cam Nhung, Mina Suh, Boyoung Park, Jae Kwan Jun, Kui Son Choi
Epidemiol Health. 2017;39:e2017006.   Published online February 5, 2017
DOI: https://doi.org/10.4178/epih.e2017006
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AbstractAbstract PDF
Abstract
OBJECTIVES
Assessing long-term success and efficiency is an essential part of evaluating cancer control programs. The mortality-to-incidence ratio (MIR) can serve as an insightful indicator of cancer management outcomes for individual nations. By calculating MIRs for the top five cancers in Organization for Economic Cooperation and Development (OECD) countries, the current study attempted to characterize the outcomes of national cancer management policies according to the health system ranking of each country.
METHODS
The MIRs for the five most burdensome cancers globally (lung, colorectal, prostate, stomach, and breast) were calculated for all 34 OECD countries using 2012 GLOBOCAN incidence and mortality statistics. Health system rankings reported by the World Health Organization in 2000 were updated with relevant information when possible. A linear regression model was created, using MIRs as the dependent variable and health system rankings as the independent variable.
RESULTS
The linear relationships between MIRs and health system rankings for the five cancers were significant, with coefficients of determination ranging from 49 to 75% when outliers were excluded. A clear outlier, Korea reported lower-than-predicted MIRs for stomach and colorectal cancer, reflecting its strong national cancer control policies, especially cancer screening.
CONCLUSIONS
The MIR was found to be a practical measure for evaluating the long-term success of cancer surveillance and the efficacy of cancer control programs, especially cancer screening. Extending the use of MIRs to evaluate other cancers may also prove useful.
Summary

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Perspective
The effect of smoking on lung cancer: ethnic differences and the smoking paradox
Keum Ji Jung, Christina Jeon, Sun Ha Jee
Epidemiol Health. 2016;38:e2016060.   Published online December 20, 2016
DOI: https://doi.org/10.4178/epih.e2016060
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AbstractAbstract AbstractSummary PDF
Abstract
The objectives of this review were to determine whether the smoking paradox still exists and to summarize possible explanations for the smoking paradox. Based on published data, we compared the risk of cigarette smoking for lung cancer in Western and Asian countries. We extracted data from the relevant studies about annual tobacco consumption, lung cancer mortality rates according to smoking status from each country, and possible explanations for the smoking paradox. A significantly greater risk of lung cancer death was found among current smokers in Asian countries than among nonsmokers, with relative risks (RRs) of 4.0 to 4.6 for Koreans, 3.7 to 5.1 for Japanese, and 2.4 to 6.5 for Chinese. Although a significantly greater risk of lung cancer was present among current smokers in Asian countries, the RRs in Asian countries were much lower than those reported in Western countries (range, 9.4 to 23.2). Possible explanations for the smoking paradox included epidemiologic characteristics, such as the smoking amount, age at smoking initiation, and the use of filtered or mild tobacco. The smoking paradox definitely exists, but may be explained by major epidemiologic characteristics. Therefore, the smoking paradox should not be interpreted as indicating that tobacco is safer or less harmful for Asians.
Summary
Korean summary
흡연이 폐암에 미치는 관련성의 인종 차이 흡연은 폐암의 가장 큰 원인으로 알려져 있다. 그러나 흡연이 폐암에 미치는 관련성의 크기는 영국, 미국 등 서양에서 발표된 연구결과에서 10-20배 정도로 보고되고 있으나 한국, 일본, 중국 등 동양에서 발표된 연구에서 3-5배 정도로 낮게 보고되고 있다. 이러한 차이는 흡연유행, 담배성분, 흡연자 특성, 그리고 유전적인 차이로 일부 설명되고 있으나 아직 완전히 이해되어진 상태는 아니다. 이는 공중보건학적으로 매우 중요한 의미를 가지므로 동서양의 직접적인 비교연구가 필요할 것으로 생각된다.

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Original Article
Trends in gastrointestinal cancer incidence in Iran, 2001-2010: a joinpoint analysis
Mehdi Darabi, Mohsen Asadi Lari, Seyed Abbas Motevalian, Ali Motlagh, Shahram Arsang-Jang, Maryam Karimi Jaberi
Epidemiol Health. 2016;38:e2016056.   Published online December 5, 2016
DOI: https://doi.org/10.4178/epih.e2016056
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AbstractAbstract PDF
Abstract
OBJECTIVES
The main purpose of this study was to evaluate changes in the time trends of stomach, colorectal, and esophageal cancer during the past decade in Iran.
METHODS
Cancer incidence data for the years 2001 to 2010 were obtained from the cancer registration of the Ministry of Health. All incidence rates were directly age-standardized to the world standard population. In order to identified significant changes in time trends, we performed a joinpoint analysis. The annual percent change (APC) for each segment of the trends was then calculated.
RESULTS
The incidence of stomach cancer increased from 4.18 and 2.41 per 100,000 population in men and women, respectively, in 2001 to 17.06 (APC, 16.7%) and 8.85 (APC, 16.2%) per 100,000 population in 2010 for men and women, respectively. The corresponding values for colorectal cancer were 2.12 and 2.00 per 100,000 population for men and women, respectively, in 2001 and 11.28 (APC, 20.0%) and 10.33 (APC, 20.0%) per 100,000 in 2010. For esophageal cancer, the corresponding increase was from 3.25 and 2.10 per 100,000 population in 2001 to 5.57 (APC, 12.0%) and 5.62 (APC, 11.2%) per 100,000 population among men and women, respectively. The incidence increased most rapidly for stomach cancer in men and women aged 80 years and older (APC, 23.7% for men; APC, 18.6% for women), for colorectal cancer in men aged 60 to 69 years (APC, 24.2%) and in women aged 50 to 59 years (APC, 25.1%), and for esophageal cancer in men and women aged 80 years and older (APC, 17.5% for men; APC,15.3% for women) over the period of the study.
CONCLUSIONS
The incidence of gastrointestinal cancer significantly increased during the past decade. Therefore, monitoring the trends of cancer incidence can assist efforts for cancer prevention and control.
Summary

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Review
Dietary intakes of citrus fruit and risk of gastric cancer incidence: an adaptive meta-analysis of cohort studies
Jong-Myon Bae, Eun Hee Kim
Epidemiol Health. 2016;38:e2016034.   Published online July 25, 2016
DOI: https://doi.org/10.4178/epih.e2016034
  • 38,636 View
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  • 31 Web of Science
  • 36 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
In the context of supplementary antioxidants having no anticancer effect, it is important to update the meta-analysis to evaluate whether there is an association between intake of citrus fruit and gastric cancer risk.
METHODS
The list of articles to be searched was established using citation discovery tools provided by PubMed and Scopus. The effect size of each article to be used in meta-analysis was calculated using the interval-collapse method. Summary effect size (sES) and 95% confidence intervals (CI) were obtained by conducting this meta-analysis. Random effect dose–response meta-regression (DRMR) was performed to investigate the dose–response relationship.
RESULTS
A total of five cohort studies were selected. The result was 13% reduction of gastric cancer according to the intake of citrus fruit (sES, 0.87; 95% CI, 0.76 to 0.99; I-squared=69.6%). In subgroup analysis, it was found that the intake of citrus fruit inhibited cardia gastric cancer (CGC) (sES, 0.67; 95% CI, 0.55 to 0.81; I-squared=46.1%) and as a result of DRMR, 100 g of citrus fruit intake per day inhibits CGC by 40% (relative risk, 0.60; 95% CI, 0.44 to 0.83).
CONCLUSIONS
It is suggested that the intake of citrus fruit inhibits the development of CGC. This conclusion can be used as a primary prevention measure in the future when the incidence of CGC may be on the rise.
Summary
Korean summary
항산화제 첨가제가 항암효과가 없다는 결론이 난 상황에서, 감귤섭취가 위암발생을 억제한다는 기존의 체계적 고찰연구에 대한 갱신 메타연구를 수행하였다. PubMed와 Scopus에서 제공하는 citation discovery tools를 활용하여 총 5편의 코호트 연구 논문을 선정하였다. 감귤섭취에 따라 위암발생을 13% 억제하며 (sES=0.87, 95% CI: 0.76-0.99, I-squared: 69.6%), 특히 위문부 위암을 억제한다고 나왔다 (sES= 0.67, 95% CI: 0.55-0.81, I-squared=46.1%), 또한, 하루 100 gram 감귤섭취를 하면 CGC 를 40% 억제하는 것으로 나왔다 (RR=0.60, 95% CI: 0.44-0.83).

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Brief Communications
Reinterpretation of the results of a pooled analysis of dietary carotenoid intake and breast cancer risk by using the interval collapsing method
Jong-Myon Bae
Epidemiol Health. 2016;38:e2016024.   Published online June 2, 2016
DOI: https://doi.org/10.4178/epih.e2016024
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
A pooled analysis of 18 prospective cohort studies reported in 2012 for evaluating carotenoid intakes and breast cancer risk defined by estrogen receptor (ER) and progesterone receptor (PR) statuses by using the “highest versus lowest intake” method (HLM). By applying the interval collapsing method (ICM) to maximize the use of the estimated information, we reevaluated the results of the previous analysis in order to reinterpret the inferences made.
METHODS
In order to estimate the summary effect size (sES) and its 95% confidence interval (CI), meta-analyses with the random-effects model were conducted for adjusted relative risks and their 95% CI from the second to the fifth interval according to five kinds of carotenoids and ER/PR status.
RESULTS
The following new findings were identified: α-Carotene and β-cryptoxanthin have protective effects on overall breast cancer. All five kinds of carotenoids showed protective effects on ER− breast cancer. β-Carotene level increased the risk of ER+ or ER+/PR+ breast cancer. α-Carotene, β-carotene, lutein/zeaxanthin, and lycopene showed a protective effect on ER−/PR+ or ER−/PR− breast cancer.
CONCLUSIONS
The new facts support the hypothesis that carotenoids that show anticancer effects with anti-oxygen function might reduce the risk of ER− breast cancer. Based on the new facts, the modification of the effects of α-carotene, β-carotene, and β-cryptoxanthin should be evaluated according to PR and ER statuses.
Summary
Korean summary
Carotenoids 가 항암기전이 있다면 steroid hormone에 무관한 estrogen receptor negative (ER-) 혹은 progesterone receptor negative (PR-) 유방암의 발생을 억제할 것이란 가설에 따라, 18개의 코호트에 대한 pooled analysis 결과가 2012년도에 발표되었다. 이를 재분석한 결과, 5 종류의 carotenoids 모두 ER- 유방암 억제하는 것을 확인하였다.

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Incidence and mortality rates of colorectal cancer in Malaysia
Muhammad Radzi Abu Hassan, Ibtisam Ismail, Mohd Azri Mohd Suan, Faizah Ahmad, Wan Khamizar Wan Khazim, Zabedah Othman, Rosaida Mat Said, Wei Leong Tan, Siti Rahmah @ Noor Syahireen Mohammed, Shahrul Aiman Soelar, Nik Raihan Nik Mustapha
Epidemiol Health. 2016;38:e2016007.   Published online March 9, 2016
DOI: https://doi.org/10.4178/epih.e2016007
  • 43,158 View
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  • 38 Web of Science
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AbstractAbstract PDF
Abstract
OBJECTIVES
This is the first study that estimates the incidence and mortality rate for colorectal cancer (CRC) patients in Malaysia by sex and ethnicity.
METHODS
The 4,501 patients were selected from National Cancer Patient Registry-Colorectal Cancer data. Patient survival status was cross-checked with the National Registration Department. The age-standardised rate (ASR) was calculated as the proportion of CRC cases (incidence) and deaths (mortality) from 2008 to 2013, weighted by the age structure of the population, as determined by the Department of Statistics Malaysia and the World Health Organization world standard population distribution.
RESULTS
The overall incidence rate for CRC was 21.32 cases per 100,000. Those of Chinese ethnicity had the highest CRC incidence (27.35), followed by the Malay (18.95), and Indian (17.55) ethnicities. The ASR incidence rate of CRC was 1.33 times higher among males than females (24.16 and 18.14 per 100,000, respectively). The 2011 (44.7%) CRC deaths were recorded. The overall ASR of mortality was 9.79 cases, with 11.85 among the Chinese, followed by 9.56 among the Malays and 7.08 among the Indians. The ASR of mortality was 1.42 times higher among males (11.46) than females (8.05).
CONCLUSIONS
CRC incidence and mortality is higher in males than females. Individuals of Chinese ethnicity have the highest incidence of CRC, followed by the Malay and Indian ethnicities. The same trends were observed for the age-standardised mortality rate.
Summary

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Review
Human papillomavirus infection and risk of lung cancer in never-smokers and women: an ‘adaptive’ meta-analysis
Jong-Myon Bae, Eun Hee Kim
Epidemiol Health. 2015;37:e2015052.   Published online November 17, 2015
DOI: https://doi.org/10.4178/epih/e2015052
  • 30,770 View
  • 200 Download
  • 10 Web of Science
  • 16 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
The incidence of lung cancer in Koreans is increasing in women and in both men and women with a never-smoking history. Human papillomavirus (HPV) infection has been suggested as a modifiable risk factor of lung cancer in never-smokers and women (LCNSW). This systematic review (SR) aimed to evaluate an association between HPV infection and lung cancer risk in LCNSW.
METHODS
Based on a prior SR and some expert reviews, we identified refereed, cited, or related articles using the PubMed and Scopus databases. All case-control studies that reported the odds ratio of HPV infection in LCNSW were selected. An estimate of the summary odds ratio (SOR) with 95% confidence intervals (CI) was calculated.
RESULTS
A total of four case-control studies were included. The fixed-effect model was applied because of homogeneity (I-squared=0.0%). The SORs in women and in never-smokers were 5.32 (95% CI, 1.75 to 16.17) and 4.78 (2.25 to 10.15) respectively.
CONCLUSIONS
These results showed a significant effect of HPV infection in LCNSW. It is evident that developing a preventive plan against LCNSW may be necessary.
Summary

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Hypothesis
Modifiable risk factors of lung cancer in “never-smoker” women
Jong-Myon Bae
Epidemiol Health. 2015;37:e2015047.   Published online October 29, 2015
DOI: https://doi.org/10.4178/epih/e2015047
  • 30,342 View
  • 229 Download
  • 2 Web of Science
  • 11 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
Korean women with a history of never smoking and with adenocarcinoma showed an increasing trend in lung cancer occurrence during 2002 to 2012. The two modifiable factors of never-smoker lung cancer in women are hormone and oncogenic virus infection. Based on previous studies, hormone replacement therapy (HRT) and human papillomavirus (HPV) infection might afford protection or be a risk factor, respectively. It is necessary to perform a pooled analysis of cohort studies to evaluate HRT and never-smoker lung cancer in women and a systematic review of case-control studies to determine the association between HPV infection and never-smoker lung cancer.
Summary
Korean summary
2002년에서 2012년간 폐암 통계를 살펴보면 비흡연 여성에서 선암종의 발생이 크게 증가하는 것으로 확인된다. 이렇게 여성에서 비흡연 폐암발생과 관련한 요인들로는 호르몬 대체요법 (HRT)과 인유두종바이러스 (HPV) 감염이 알려져 있다. 환자-대조군연구를 이용한 메타분석에 따르면 호르몬대체요법은 폐암발생을 억제하는 것으로 나왔다. HPV에 대한 메타분석은 아직 없는 가운데 위험요인으로 의심하고 있다. 따라서 HRT에 대하여는 코호트 연구 결과를 이용한 연합분석 (pooled analysis)이 필요하며, HPV에 대하여는 환자-대조군연구 결과를 이용한 메타분석이 수행될 필요가 있다.

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    Jong-Myon Bae
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Health Statistics
Changing trends in colorectal cancer in the Republic of Korea: contrast with Japan
Minjoo Yoon, Nicholas Kim, Byungho Nam, Jungnam Joo, Moran Ki
Epidemiol Health. 2015;37:e2015038.   Published online August 17, 2015
DOI: https://doi.org/10.4178/epih/e2015038
  • 35,576 View
  • 330 Download
  • 23 Web of Science
  • 19 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
Colorectal cancer has a high worldwide incidence. Japan, a country that is geographically and culturally similar to the Republic of Korea (here after Korea), has recently reported a decreasing trend in the incidence of colorectal cancer. However, Korea had the highest incidence of colorectal cancer among Asian countries in 2012. Our aim was to observe the changing trends in incidence and mortality of colorectal cancer in Korea and to compare them to those in Japan. Incidence data were collected from the Korean Central Cancer Registry and mortality data were collected from Korean Statistical Information Service. Incidence and mortality data on colorectal cancer in Japan were acquired from the National Cancer Center in Japan. Age-standardized incidence and mortality rates were determined based on Segi’s world population. Screening data from both countries were collected from the national cancer center in each country. In Korea, the age-standardized incidence rate of colorectal cancer in both sexes was 20.9 to 38.0 per 100,000 from 1999 to 2012 and the rate in males increased more dramatically than in females. In addition, the increase between 2002 and 2012 was first observed in the age group over 40. In Japan, the incidence of colorectal cancer has been more constant over recent years than in Korea. The age-standardized mortality rate of colorectal cancer in both sexes in Korea was 8.5 to 9.3 per 100,000 from 2000 to 2013, and the trend in mortality was constant during this period. In Japan, the mortality rate decreased slightly during the same period. Crude screening rates were increased overall in both Korea and Japan during the period studied. Since the incidence of colorectal cancer has increased in Korea, the control of this cancer is an important public health issue. As Japan has achieved a reduction in colorectal cancer, adjustment of Korea’s current systems for screening and treatment of colorectal cancer according to those of Japan may contribute to improved colorectal cancer control in Korea.
Summary
Korean summary
우리나라와 지리적, 문화적으로 가까운 일본은 대장암 발생 및 사망이 감소하고 있는 반면, 한국의 대장암 발생은 증가하는 추세이다. 본 연구는 한국의 대장암 발생 및 사망의 경향을 관찰하고, 이를 일본의 경우와 비교하고자 한다

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Hypothesis
The necessity of an observational study on the interactions between allergic history and citrus fruit intake for the prevention of pancreatic cancer
Jong-Myon Bae
Epidemiol Health. 2015;37:e2015028.   Published online June 16, 2015
DOI: https://doi.org/10.4178/epih/e2015028
  • 28,736 View
  • 169 Download
  • 1 Web of Science
  • 4 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
While the main product of Jeju Island is citrus fruit and the prevalence of atopic dermatitis among the students who live there is relatively high, the incidence of pancreatic cancer is lowest in Korea. Systematic reviews reporting allergic history and intake of citrus fruit as protective factors against pancreatic cancer (PCC) were published in 2005 and 2008, respectively. Although there were discrepancies in the results of the subgroup analyses between case-control and cohort studies, it is necessary to evaluate an interaction effect between allergic history and intake of citrus fruits on PCC risk.
Summary
Korean summary
췌장암 발생과 관련한 요인들의 규명이 절실한 상황에서, 알레르기 질환과 감귤섭취 각각이 발생억제 효과가 있다는 체계적 고찰연구가 있다. 그러나 코호트 연구들만으로 메타분석을 하였을 때는 두 억제 요인 모두 통계적 유의성이 없는 것으로 나왔다. 한편 지역별 췌장암 발생률에서 낮은 수준을 보이는 제주도는 주요 감귤생산지이면서, 초중고등학생의 아토피 유병률이 상대적으로 높은 것으로 알려져 있다. 이런 사실들에 근거할 때 췌장암 발생에 있어 알레르기질환과 감귤섭취의 상호작용을 규명하는 코호트 연구를 제안한다.

Citations

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    Jong-Myon Bae, Eun Hee Kim
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    Jong-Myon Bae, Eun Hee Kim
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Editorial
Epidemiological evidence in law: a comment on Supreme Court Decision 2011Da22092, South Korea
Alex Broadbent
Epidemiol Health. 2015;37:e2015025.   Published online May 31, 2015
DOI: https://doi.org/10.4178/epih/e2015025
  • 25,706 View
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AbstractAbstract PDF
Abstract
This paper offers a commentary on three aspects of the Supreme Court’s recent decision (2011Da22092). First, contrary to the Court’s finding, this paper argues that epidemiological evidence can be used to estimate the probability that a given risk factor caused a disease in an individual plaintiff. Second, the distinction between specific and non-specific diseases, upon which the Court relies, is shown to be without scientific basis. Third, this commentary points out that the Court’s finding concerning defect of expression effectively enables tobacco companies to profit from the efforts of epidemiologists and others involved in public health to raise awareness of the dangers of smoking.
Summary

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Health Statistics
Changing trends in the incidence (1999-2011) and mortality (1983-2013) of cervical cancer in the Republic of Korea
Yoon Park, Champadeng Vongdala, Jeongseon Kim, Moran Ki
Epidemiol Health. 2015;37:e2015024.   Published online May 29, 2015
DOI: https://doi.org/10.4178/epih/e2015024
  • 36,974 View
  • 250 Download
  • 20 Web of Science
  • 14 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
Cervical cancer is a well-known preventable cancer worldwide. Many countries including Korea have pursued the positive endpoint of a reduction in mortality from cervical cancer. Our aim is to examine changing trends in cervical cancer incidence and mortality after the implementation of a national preventive effort in Korea. Cervical cancer incidence data from 1999 to 2011 and mortality data from 1983 to 2013 were collected from the Korean Statistical Information Service. Yearly age-standardized rates (ASR) per 100,000 were compared using two standards: the 2005 Korean population and the world standard population, based on Segi’s world standard for incidence and the World Health Organization for mortality. In Korea, the age-standardized incidence of cervical cancer per 100,000 persons declined from 17.2 in 2000 to 11.8 in 2011. However, the group aged 25 to 29 showed a higher rate in 2011 (ASR, 6.5) than in 2000 (ASR, 3.6). The age-standardized mortality rate per 100,000 persons dropped from 2.81 in 2000 to 1.95 in 2013. In the worldwide comparison, the incidence rates remained close to the average incidence estimate of more developed regions (ASR, 9.9). The decreasing mortality trend in Korea approached the lower rate observed in Australia (ASR, 1.4) in 2010. Although the incidence rate of cervical cancer is continuously declining in Korea, it is still high relative to other countries. Moreover, incidence and mortality rates in females aged 30 years or under have recently increased. It is necessary to develop effective policy to reduce both incidence and mortality, particularly in younger age groups.
Summary
Korean summary
한국의 자궁경부암 발생률과 사망률은 꾸준히 감소하고 있는 추세이다. 그러나 한국의 발생률은 여러 선진국에 비해 여전히 높은 수준에 머무르고 있다. 또한, 지난 10년 동안 자궁경부암 사망률은 상대적으로 큰 감소를 보이지 않았다. 특히 35세 미만에서는 자궁경부암 발생률이 감소하지 않았고, 사망률은 오히려 높아진 것으로 나타났다. 젊은 연령층의 자궁경부암 예방과 관리가 필요하다.

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    Diagnostic Cytopathology.2016; 44(12): 959.     CrossRef
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    Jinyao Wang, Zhiqiang Bai, Zhenkun Wang, Chuanhua Yu
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Methods
Development and application of patient decision aids
Jong-Myon Bae
Epidemiol Health. 2015;37:e2015018.   Published online April 8, 2015
DOI: https://doi.org/10.4178/epih/e2015018
  • 29,369 View
  • 162 Download
  • 4 Web of Science
  • 8 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
With the current overdiagnosis of thyroid cancer resulting from routine screening in Korea, it is necessary to educate the public that not all cancers are malignant. The exposure to patient decision aids (PtDAs) compared to usual care reduced the number of people choosing to undergo prostate-specific antigen screening. This article introduces the definition, usefulness, and developmental processes of PtDAs and suggests the urgent need for a Korean PtDA related to thyroid cancer screening.
Summary

Citations

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  • Design and development of a digital shared decision-making tool for stroke prevention in atrial fibrillation
    Julio C Nunes, Tina Baykaner, Krishna Pundi, Katie DeSutter, Mellanie True Hills, Kenneth W Mahaffey, Samuel F Sears, Daniel P Morin, Bryant Lin, Paul J Wang, Randall S Stafford
    JAMIA Open.2023;[Epub]     CrossRef
  • Usability and understandability of a web-based medical communication aid for patients with ankylosing spondylitis in South Korea: A mixed-methods study
    Sang-Hoon Lee, YoungJu Park, Chan-Bum Choi, Yong-Gil Kim, Jung-Ae Kim, Hoon-Suk Cha
    Medicine.2023; 102(14): e33430.     CrossRef
  • Cultural adaptation of a patient decision-aid for insulin therapy
    Ngiap Chuan Tan, Agnes Koong Ying Leng, Ian Phoon Kwong Yun, Sinead Wang Zhen, Muthulakshmi Paulpandi, Yew Kong Lee, John Furler, Josip Car, Chirk Jenn Ng
    BMJ Open.2020; 10(3): e033791.     CrossRef
  • Ethical, pedagogical, socio-political and anthropological implications of quaternary prevention
    Marc Jamoulle, Michel Roland, Jong-Myon Bae, Bruno Heleno, Giorgio Visentin, Gustavo Diniz Ferreira Gusso, Maciek Godycki-Ćwirko, Miguel Pizzanell, Patrick Ouvrard, Ricardo La Valle, Luis Filipe Gomes, Daniel Widmer, Jorge Bernstein, Mariana Mariño, Hamil
    Revista Brasileira de Medicina de Família e Comunidade.2018; 13(40): 1.     CrossRef
  • Strategies for Appropriate Patient-centered Care to Decrease the Nationwide Cost of Cancers in Korea
    Jong-Myon Bae
    Journal of Preventive Medicine and Public Health.2017; 50(4): 217.     CrossRef
  • Shared decision making: relevant concepts and facilitating strategies
    Jong-Myon Bae
    Epidemiology and Health.2017; 39: e2017048.     CrossRef
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    Kevin Jenniskens, Joris A H de Groot, Johannes B Reitsma, Karel G M Moons, Lotty Hooft, Christiana A Naaktgeboren
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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
  • 29,360 View
  • 165 Download
  • 7 Web of Science
  • 10 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
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.

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Health Statistics
Stomach cancer incidence rates among Americans, Asian Americans and Native Asians from 1988 to 2011
Yeerae Kim, Jinju Park, Byung-Ho Nam, Moran Ki
Epidemiol Health. 2015;37:e2015006.   Published online February 16, 2015
DOI: https://doi.org/10.4178/epih/e2015006
  • 43,093 View
  • 232 Download
  • 41 Web of Science
  • 33 Crossref
AbstractAbstract PDF
Abstract
Stomach cancer is the second most common cancer in Eastern Asia, accounting for approximately 50% of all new cases of stomach cancer worldwide. Our objective was to compare the stomach cancer incidence rates of Asian Americans in Los Angeles with those of native Asians to assess the etiology of stomach cancer from 1988 to 2011. To examine these differences, Asian Americans (Korean, Japanese, Chinese, and Filipino Americans living in Los Angeles, California, USA) and native Asians (from Korea, Japan, China, and the Philippines) were selected for this study. Using the Cancer Incidence in Five Continents database, stomach cancer incidence rates were examined. Data from the National Cancer Registry of Korea were used for native Koreans. Between native countries, the incidence rates in Japan, China, the Philippines, and the US declined over time, but the incidence in Korea has remained constant. The incidences among Asian immigrants were lower than those among native Asians. The incidence rates of males were approximately 2 times higher than those among females in Asian countries were. The effect of immigration on stomach cancer incidence suggests that lifestyle factors are a significant determinant of stomach cancer risk. However, the incidence in Korea remains the highest of these countries
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