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Disparities in the Participation Rate of Colorectal Cancer Screening by Fecal Occult Blood Test among People with Disabilities: A National Database Study in South Korea
Dong Wook Shin, Dongkyung Chang, Jin Hyung Jung, Kyungdo Han, So Young Kim, Kui Son Choi, Won Chul Lee, Jong Heon Park, Jong Hyock Park
Cancer Res Treat. 2020;52(1):60-73.   Published online May 7, 2019
DOI: https://doi.org/10.4143/crt.2018.660
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Implementation of screening program may lead to increased health disparity within the population if participation differs by socioeconomic status. In Korea, colorectal cancer screening is provided at no or minimal cost to all people over 50 by National Cancer Screening Program. We investigated colorectal cancer screening participation rate and its trend over the last 10 years in relation to disabilities.
Materials and Methods
We linked national disability registration data with National Cancer Screening Program data. Age, sex-standardized participation rates were analyzed by type and severity of disability for each year, and factors associated with colorectal cancer screening participation were examined by multivariate logistic regression.
Results
Age, sex-standardized participation rate in people without disability increased from 16.2 to 33.9% (change, +17.7), but it increased from 12.7% to 27.2% (change, +14.5) among people with severe disability. People with severe disabilities showed a markedly lower colorectal cancer screening participation rate than people without disability (adjusted odds ratio [aOR], 0.714; 95% confidence interval, 0.713 to 0.720). People with autism (aOR, 0.468), renal failure (aOR, 0.498), brain injury (aOR, 0.581), ostomy (aOR, 0.602), and intellectual disability (aOR, 0.610) showed the lowest participation rates.
Conclusion
Despite the availability of a National Cancer Screening Program and overall increase of its usage in the Korean population, a significant disparity was found in colorectal cancer screening participation, especially in people with severe disabilities and or several specific types of disabilities. Greater effort is needed to identify the barriers faced by these particularly vulnerable groups and develop targeted interventions to reduce inequality.

Citations

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Single Immunochemical Fecal Occult Blood Test for Detection of Colorectal Neoplasia
Dae Kyung Sohn, Seung-Yong Jeong, Hyo Seong Choi, Seok-Byung Lim, Jin Myeong Huh, Dae-Hyun Kim, Dae Yong Kim, Young Hoon Kim, Hee Jin Chang, Kyung Hae Jung, Joong-Bae Ahn, Hyun Kyung Kim, Jae-Gahb Park
Cancer Res Treat. 2005;37(1):20-23.   Published online February 28, 2005
DOI: https://doi.org/10.4143/crt.2005.37.1.20
AbstractAbstract PDFPubReaderePub
Purpose

This study was designed to investigate the validity of a single immunochemical fecal occult blood test (FOBT) for detection of colorectal neoplasia.

Materials and Methods

A total of 3,794 average-risk screenees and 304 colorectal cancer patients admitted to the National Cancer Center, Korea, between May 2001 and November 2002, were studied prospectively. All screenees and admitted patients underwent FOBT and total colonoscopic examinations. Stools were self-collected, and examined using an immunochemical fecal occult blood test (OC-hemodia®, Eiken Chemical Co. Tokyo, Japan) and an OC-sensor analyzer® (Eiken Chemical Co. Tokyo, Japan).

Results

Of the 3,794 asymptomatic screenees, the colonoscopy identified colorectal adenomas and cancers in 613 (16.2%) and 12 (0.3%) subjects, respectively. The sensitivities of a single immunochemical FOBT for detecting colorectal cancers and adenomas in screenees were 25.0 and 2.4%, respectively. The false positive rate of FOBT for colorectal cancer in screenees was 1.19%. For the total 316 colorectal cancer cases (including 12 cases from screenees), the FOBT sensitivities according to the T-stage were 38.5, 75.0%, 78.9 and 79.2% for T1, 2, 3 and 4 cancers, respectively. The sensitivities according to the Dukes stages A, B and C were 63.4, 79.3 and 78.6%, respectively.

Conclusion

The sensitivities of a single immunochemical FOBT for detecting colorectal cancers and adenomas in screenees were 25.0 and 2.4%, respectively. The sensitivities of FOBT were about 80% for Dukes B or C colorectal cancers and 63.4% for Dukes A.

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