Cancer Research and Treatment

Original Article

Factors Associated with Smoking Cessation of Participants in the National Lung Cancer Screening Program in Korea: Na-Young Yoon, Minji Seo, Nayoung Lee, Yeol Kim; Received July 16, 2024 Accepted January 10, 2025 Published online January 10, 2025; DOI: https://doi.org/10.4143/crt.2024.653 [Accepted]

Abstract PDF: Purpose
Smoking cessation interventions for participants in lung cancer screening are essential for increasing the effectiveness of screening to reduce lung cancer mortality. This study aimed to investigate the factors that lead to smoking cessation after lung cancer screening.
Materials and Methods
The Korean National Lung Cancer Screening (KNLCS) Satisfaction Survey was conducted from 2021 to 2022 with 1,000 samples per year among participants in KNLCS targets 30 or more pack-year smokers. Factors associated with smoking cessation were analyzed based on the survey.
Results
Among 1,525 current smokers in the survey participants, 728 (47.7%) received screening result counseling from physician after screening and showed significantly higher smoking cessation rate than non-counselling participants [OR 2.17, 95% CI 1.27–3.70]. The participants who considered the counseling helpful were more likely to quit smoking [OR 3.53, 95% CI 2.00–6.22] and to reduce smoking amount [OR 2.05, 95% CI 1.54–2.71]. Similarly, those who received physicians’ active recommendations to quit smoking were likely to quit smoking [OR 2.20, 95% CI 1.25–3.87] and to decrease smoking amount [OR 1.30, 95% CI 1.00-1.68]. In contrast, participants who had no abnormal findings from screening tended to have no significant change in smoking status despite the physicians’ active recommendations to quit smoking.
Conclusion
Physicians’ active recommendations and effective counseling to quit smoking could be a key factor in increasing smoking cessation among lung cancer screening participants. Further research should be conducted to develop more effective strategies for smoking cessation to participants without abnormal findings in lung cancer screening.

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Special Article

Trends in Cancer-Screening Rates in Korea: Findings from the National Cancer Screening Survey, 2004-2023: EunKyo Kang, Kui Son Choi, Jae Kwan Jun, Yeol Kim, Hyeon Ji Lee, Chang Kyun Choi, Tae Hee Kim, Sun Hwa Lee, Mina Suh; Cancer Res Treat. 2025;57(1):28-38. Published online August 2, 2024; DOI: https://doi.org/10.4143/crt.2024.325

Abstract PDF Supplementary Material PubReader ePub: Purpose
This study aimed to report the overall national trends in the rates of cancer screening based on recommendations and provide insights into the changing trends of these rates across different demographics.
Materials and Methods
This study used data from the Korean National Cancer Screening Survey (KNCSS), which surveys nationwide cancer-screening rates and includes 4,500 individuals meeting the Korean National Cancer Screening Program (NCSP) protocol age criteria. Cancer-screening rates were assessed using structured questionnaires; yearly trends were analyzed for both lifetime cancer-screening rates and rates of screening based on recommendations, and subgroup analyses were performed based on age and sex.
Results
The rates of cancer screening based on recommendations showed significant increments: the stomach cancer-screening rate increased from 39.2% in 2004 to 77.5% in 2023 (3.50% per year), the liver cancer-screening rate increased from 20.0% to 48.8% (4.30% per year), and the colorectal cancer, increased from 19.9% to 70.7% (5.15% per year). The breast cancer-screening rate increased from 33.2% to 72.7% (2.88% per year), and the cervical cancer, increased from 58.3% to 70.2% (1.08% per year). Despite some differences, particularly in relation to sociodemographic factors, screening rates increased significantly for all cancer types.
Conclusion
Cancer-screening rates in Korea increased consistently from 2004 to 2023, demonstrating the effectiveness of the national cancer-screening program. However, the increments in breast, cervical and lung cancer-screening rates were relatively lower, indicating the need for additional efforts and strategies.

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Original Articles

Lung and Thoracic cancer

Strategies to Improve Smoking Cessation for Participants in Lung Cancer Screening Program: Analysis of Factors Associated with Smoking Cessation in Korean Lung Cancer Screening Project (K-LUCAS): Yeol Kim, Jaeho Lee, Eunju Lee, Juntae Lim, Yonghyun Kim, Choon-Taek Lee, Seung Hun Jang, Yu-Jin Paek, Won-Chul Lee, Chan Wha Lee, Hyae Young Kim, Jin Mo Goo, Kui Son Choi, Boyoung Park, Duk Hyoung Lee, Hong Gwan Seo; Cancer Res Treat. 2024;56(1):92-103. Published online August 7, 2023; DOI: https://doi.org/10.4143/crt.2022.1598

Abstract PDF PubReader ePub

Purpose
Smoking cessation intervention is one of the key components of successful lung cancer screening program. We investigated the effectiveness and related factors of smoking cessation services provided to the participants in a population-based lung cancer screening trial.
Materials and Methods
The Korean Lung Cancer Screening Project (K-LUCAS) is a nationwide, multi-center lung cancer screening trial that evaluates the feasibility of implementing population-based lung cancer screening. All 5,144 current smokers who participated in the K-LUCAS received a mandatory smoking cessation counseling. Changes in smoking status were followed up using a telephone survey in 6 months after lung cancer screening participation. The lung cancer screening’s impact on smoking cessation is analyzed by variations in the smoking cessation interventions provided in screening units.
Results
Among 4,136 survey responders, participant’s motivation to quit smoking increased by 9.4% on average after lung cancer screening. After 6 months from the initial screening, 24.3% of participants stopped smoking, and 10.6% of participants had not smoked continuously for at least 6 months after screening. Over 80% of quitters stated that participation in lung cancer screening motivated them to quit smoking. Low-cost public smoking cessation program combined with lung cancer screening increased the abstinence rates. The smokers were three times more likely to quit smoking when the smoking cessation counseling was provided simultaneously with low-dose computed tomography screening results than when provided separately.
Conclusion
A mandatory smoking cessation intervention integrated with screening result counselling by a physician after participation in lung cancer screening could be effective for increasing smoking cessation attempts.

Citations

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Dixan A. Benitez, Guadalupe Cumplido-Laso, Marcos Olivera-Gómez, Nuria Del Valle-Del Pino, Alba Díaz-Pizarro, Sonia Mulero-Navarro, Angel Román-García, Jose Maria Carvajal-Gonzalez
Biomedicines.2024; 12(7): 1453. CrossRef
Problems and Alternatives for Korea National Lung Cancer Screening Program for Smoking Cessation: Analysis of a Survey Involving Experts
Cheol Min Lee, Sil Vi Han Park, Jinri Kim, Bumjo Oh, Kiheon Lee, Yeol Kim, Yu-Jin Paek
Journal of the Korean Society for Research on Nicotine and Tobacco.2024; 15(2): 49. CrossRef
The pros and cons of lung cancer screening
Roberta Eufrasia Ledda, Georg-Christian Funk, Nicola Sverzellati
European Radiology.2024; 35(1): 267. CrossRef
Effective Smoking Cessation Counseling for Participants in a Lung Cancer Screening
Choon-Young Kim, Yeol Kim, Cheol Min Lee
Journal of the Korean Society for Research on Nicotine and Tobacco.2024; 15(3): 88. CrossRef

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4 Crossref

Gastrointestinal cancer

Trends in the Performance of the Korean National Cancer Screening Program for Gastric Cancer from 2007 to 2016: Ji Eun Ryu, Eunji Choi, Kyeongmin Lee, Jae Kwan Jun, Mina Suh, Kyu Won Jung, Kui Son Choi; Cancer Res Treat. 2022;54(3):842-849. Published online September 30, 2021; DOI: https://doi.org/10.4143/crt.2021.482

Abstract PDF Supplementary Material PubReader ePub

Purpose
The Korean National Cancer Screening Program (KNCSP) has implemented two screening methods for gastric cancer—upper gastrointestinal series (UGIS) and endoscopy—for Koreans aged ≥40 years. We aimed to assess performance trends for both screening methods.
Materials and Methods
The KNCSP database was used to evaluate individuals who underwent screening from 2007 to 2016. The final gastric cancer diagnosis was ascertained by linking with the Korean Central Cancer Registry. We conducted a prospective, cross-sectional analysis to estimate performance indicators of gastric cancer screening by UGIS and endoscopy, stratified by sociodemographic factors.
Results
We found that screening rates for gastric cancer increased from 28% to 51.7% between 2007 and 2016, and that the rate of endoscopy use for gastric cancer screening increased sharply. Cancer detection rates (CDR) of UGIS and endoscopy were 0.41 and 2.25 per 1,000 screens in 2007–2008 and 0.26 and 1.99 in 2015–2016, respectively. Interval cancer rates (ICR) per 1,000 negative screenings were 1.33 (2007–2008) and 1.21 (2015–2016) for UGIS and 1.14 (2007–2008) and 0.88 (2015–2016) for endoscopy. The sensitivity of UGIS decreased from 23.6% (2007–2008) to 17.6% (2015–2016), whereas that of endoscopy increased from 66.4% (2007–2008) to 69.3% (2015–2016). Specificity was maintained at >99% for both methods over the study period.
Conclusion
The use of endoscopy for gastric cancer screening within the KNCSP has increased. Endoscopy has higher CDR, sensitivity, and specificity, and lower ICR estimates than does UGIS.

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Seowoo Bae, Hyewon Lee, Eun Young Her, Kyeongmin Lee, Joon Sung Kim, Jeonghoon Ahn, Il Ju Choi, Jae Kwan Jun, Kui Son Choi, Mina Suh
Journal of Korean Medical Science.2025;[Epub] CrossRef
Korean Practice Guidelines for Gastric Cancer 2024: An Evidence-based, Multidisciplinary Approach (Update of 2022 Guideline)
In-Ho Kim, Seung Joo Kang, Wonyoung Choi, An Na Seo, Bang Wool Eom, Beodeul Kang, Bum Jun Kim, Byung-Hoon Min, Chung Hyun Tae, Chang In Choi, Choong-kun Lee, Ho Jung An, Hwa Kyung Byun, Hyeon-Su Im, Hyung-Don Kim, Jang Ho Cho, Kyoungjune Pak, Jae-Joon Kim
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Yeunji Lee, Eunyoung Lee, Bumhee Park, Gil Ho Lee, Sun Gyo Lim, Sung Jae Shin, Choong-Kyun Noh, Kee Myung Lee
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Lung and Thoracic cancer

Cost Utility Analysis of a Pilot Study for the Korean Lung Cancer Screening Project: Juyoung Kim, Bogeum Cho, Seon-Ha Kim, Chang-Min Choi, Yeol Kim, Min-Woo Jo; Cancer Res Treat. 2022;54(3):728-736. Published online September 24, 2021; DOI: https://doi.org/10.4143/crt.2021.480

Abstract PDF Supplementary Material PubReader ePub

Purpose
The aim of this study was to evaluate the cost utility of a pilot study of Korean Lung Cancer Screening Project.
Materials and Methods
We constructed a Markov model consisting of 26 states based on the natural history of lung cancer according to the Surveillance, Epidemiology, and End Results summary stage (localized, regional, distant). In the base case, people aged 55-74 years were under consideration for annual screening. Costs and quality-adjusted life years were simulated to calculate the incremental cost utility ratio. Sensitivity analyses were performed on the uncertainty associated with screening target ages, stage distribution, cost, utility, mortality, screening duration, and discount rate.
Results
The base case (US$25,383 per quality-adjusted life year gained) was cost-effective compared to the scenario of no screening and acceptable considering a willingness-to-pay threshold of US$27,000 per quality-adjusted life years gained. In terms of the target age of screening, the age between 60 and 74 years was the most cost-effective. Lung cancer screening was still cost-effective in the sensitivity analyses on the cost for treatment, utility, mortality, screening duration, and less than 5% discount rates, although the result was sensitive to a rise in positive rates or variation of stage distribution.
Conclusion
Our results showed the cost-effectiveness of annual low-dose computed tomography screening for lung cancer in high-risk populations.

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Development of Protocol for Korean Lung Cancer Screening Project (K-LUCAS) to Evaluate Effectiveness and Feasibility to Implement National Cancer Screening Program: Jaeho Lee, Juntae Lim, Yeol Kim, Hyae Young Kim, Jin Mo Goo, Choon-Taek Lee, Seung Hun Jang, Won-Chul Lee, Chan Wha Lee, Jin Young An, Ki Dong Ko, Min Ki Lee, Kui Son Choi, Boyoung Park, Duk Hyoung Lee; Cancer Res Treat. 2019;51(4):1285-1294. Published online February 19, 2019; DOI: https://doi.org/10.4143/crt.2018.464

Abstract PDF PubReader ePub

Purpose
To reduce lung cancer mortality, lung cancer screening was recommended using low-dose computed tomography (LDCT) to high-risk population. A protocol for multicenter lung cancer screening pilot project was developed to evaluate the effectiveness and feasibility of lung cancer screening to implement National Cancer Screening Program in Korea.
Materials and Methods
Multidisciplinary expert committee was comprised to develop a standardized protocol for Korean Lung Cancer Screening Project (K-LUCAS). K-LUCAS is a population-based single arm trial that targets high-risk population aged 55-74 years with at least 30 pack-year smoking history. LDCT results are reported by Lung-RADS suggested by American Radiology Society. Network-based system using computer-aided detection program is prepared to assist reducing diagnostic errors. Smoking cessation counselling is provided to all currently smoking participants. A small pilot test was conducted to check the feasibility and compliance of the protocols for K-LUCAS.
Results
In pilot test, 256 were participated. The average age of participants was 63.2 years and only three participants (1.2%) were female. The participants had a smoking history of 40.5 pack-year on average and 53.9% were current smokers. Among them, 86.3% had willing to participate in lung cancer screening again. The average willingness to quit smoking among current smokers was 12.7% higher than before screening. In Lung-RADS reports, 10 (3.9%) were grade 3 and nine (3.5%) were grade 4. One participant was diagnosed as lung cancer.
Conclusion
The protocol developed by this study is assessed to be feasible to perform K-LUCAS in multicenter nationwide scale.

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Stages of Adoption for Fecal Occult Blood Test and Colonoscopy Tests for Colorectal Cancer Screening in Korea: Nhung Cam Bui, Ha Na Cho, Yoon Young Lee, Mina Suh, Boyoung Park, Jae Kwan Jun, Yeol Kim, Kui Son Choi; Cancer Res Treat. 2018;50(2):416-427. Published online May 10, 2017; DOI: https://doi.org/10.4143/crt.2017.075

Abstract PDF PubReader ePub

Purpose
While colorectal cancer (CRC) is common in Asian countries, screening for CRC is not. Moreover, CRC screening behaviors in Asian populations remain largely unknown. The present study aimed to investigate the stages of adopting CRC screening in Korea according to screening modality.
Materials and Methods
Data were obtained from the 2014 Korean National Cancer Screening Survey, a cross-sectional survey that utilized nationally representative random sampling to investigate cancer screening rates. A total of 2,066 participants aged 50-74 years were included in this study. Chi-square test and multinomial logistic regressionwere applied to determine stages of adoption for fecal occult blood test (FOBT) and colonoscopy and factors associated with each stage.
Results
Of 1,593 participants included in an analysis of stage of adoption for FOBT, 36% were in action/maintenance stages, while 18%, 40%, and 6% were in precontemplation, contemplation, and relapse/relapse risk stages, respectively. Of 1,371 subjects included in an analysis of stage of adoption for colonoscopy, 48% were in action/maintenance stages, with 21% in precontemplation, 21% in contemplation, and 11% in relapse/relapse risk stages. Multinomial logistic regression highlighted sex, household income, place of residency, family history of cancer, having private cancer insurance, smoking status, alcohol use, and regular exercise as being associated with stages of adoption for FOBT and colonoscopy.
Conclusion
This study outlines the distributions of stages of adoption for CRC screening by screening modality. Interventions to improve screening rates should be tailored to individuals in particular stages of adoption for CRC screening by modality.

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Factors Affecting Adherence to National Colorectal Cancer Screening: A 12-Year Longitudinal Study Using Multi-Institutional Pooled Data in Korea
Dae Sung Kim, Jeeyoung Hong, Kihyun Ryu, Sang Hyuk Lee, Hwanhyi Cho, Jehyeong Yu, Jieun Lee, Jong-Yeup Kim
Journal of Korean Medical Science.2024;[Epub] CrossRef
A new TGF‐β risk score predicts clinical and immune landscape in colorectal cancer patients
Bing Tang, Binggang Liu, Zhiyao Zeng
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Utilization of colorectal cancer screening tests: a systematic review and time trend analysis of nationally representative data
Idris Ola, Rafael Cardoso, Michael Hoffmeister, Hermann Brenner
eClinicalMedicine.2024; 75: 102783. CrossRef
Role of breast cancer screening in the overdiagnosis of thyroid cancer: results from a cross-sectional nationwide survey
Eunhye Lee, Sung Hoon Jeong, Chung Mo Nam, Jae Kwan Jun, Eun-Cheol Park
BMC Women's Health.2023;[Epub] CrossRef
Socioeconomic inequality in organized and opportunistic screening for colorectal cancer: results from the Korean National Cancer Screening Survey, 2009-2021
Xuan Quy Luu, Kyeongmin Lee, Jae Kwan Jun, Mina Suh, Kui Son Choi
Epidemiology and Health.2023; 45: e2023086. CrossRef
The risk of developing colorectal cancer in individuals aged 50-70 years and behavioral changes in high-risk individuals regarding a fecal occult blood test
Renginar ÖZTÜRK DÖNMEZ, Süheyla ÖZSOY, Melek ARDAHAN
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Dongmei Ai, Hongfei Pan, Rongbao Han, Xiaoxin Li, Gang Liu, Li C. Xia
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Rafael Cardoso, Tobias Niedermaier, Chen Chen, Michael Hoffmeister, Hermann Brenner
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Perceptions of colorectal cancer screening and recommendation behaviors among physicians in Korea
Hye Young Shin, Mina Suh, Boyoung Park, Jae Kwan Jun, Kui Son Choi
BMC Cancer.2017;[Epub] CrossRef

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Trends in Participation Rates for the National Cancer Screening Program in Korea, 2002-2012: Mina Suh, Seolhee Song, Ha Na Cho, Boyoung Park, Jae Kwan Jun, Eunji Choi, Yeol Kim, Kui Son Choi; Cancer Res Treat. 2017;49(3):798-806. Published online November 11, 2016; DOI: https://doi.org/10.4143/crt.2016.186

Abstract PDF Supplementary Material PubReader ePub

Purpose
The National Cancer Screening Program (NCSP) in Korea supports cancer screening for stomach, liver, colorectal, breast, and cervical cancer. This study was conducted to assess trends in participation rates among Korean men and women invited to undergo screening via the NCSP as part of an effort to guide future implementation of the program in Korea.
Materials and Methods
Data from the NCSP for 2002 to 2012 were used to calculate annual participation rates with 95% confidence intervals (CI) by sex, insurance status, and age group for stomach, liver, colorectal, breast, and cervical cancer screening.
Results
In 2012, participation rates for stomach, liver, colorectal, breast, and cervical cancer screening were 47.3%, 25.0%, 39.5%, 51.9%, and 40.9%, respectively. The participation rates increased annually by 4.3% (95% CI, 4.0 to 4.6) for stomach cancer, 3.3% (95% CI, 2.5 to 4.1) for liver cancer, 4.1% (95% CI, 3.2 to 5.0) for colorectal cancer, 4.6% (95% CI, 4.1 to 5.0) for breast cancer, and 0.9% (95% CI, –0.7 to 2.5) for cervical cancer from 2002 to 2012.
Conclusion
Participant rates for the NCSP for the five above-mentioned cancers increased annually from 2002 to 2012.

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Optimal Interval for Repeated Gastric Cancer Screening in Normal-Risk Healthy Korean Adults: A Retrospective Cohort Study: Jong-Myon Bae, Sang Yop Shin, Eun Hee Kim; Cancer Res Treat. 2015;47(4):564-568. Published online January 30, 2015; DOI: https://doi.org/10.4143/crt.2014.098

Abstract PDF PubReader ePub

Purpose
This retrospective cohort study was conducted to estimate the optimal interval for gastric cancer screening in Korean adults with initial negative screening results.
Materials and Methods
This study consisted of voluntary Korean screenees aged 40 to 69 years who underwent subsequent screening gastroscopies after testing negative in the baseline screening performed between January 2007 and December 2011. A new case was defined as the presence of gastric cancer cells in biopsy specimens obtained upon gastroscopy. The follow-up periods were calculated during the months between the date of baseline screening gastroscopy and positive findings upon subsequent screenings, stratified by sex and age group. The mean sojourn time (MST) for determining the screening interval was estimated using the prevalence/incidence ratio.
Results
Of the 293,520 voluntary screenees for the gastric cancer screening program, 91,850 (31.29%) underwent subsequent screening gastroscopies between January 2007 and December 2011. The MSTs in men and women were 21.67 months (95% confidence intervals [CI], 17.64 to 26.88 months) and 15.14 months (95% CI, 9.44 to 25.85 months), respectively.
Conclusion
These findings suggest that the optimal interval for subsequent gastric screening in both men and women is 24 months, supporting the 2-year interval recommended by the nationwide gastric cancer screening program.

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Gastric Cancer Screening in Korea: Report on the National Cancer Screening Program in 2008: Kyung Sook Lee, Dong Kwan Oh, Mi Ah Han, Hoo-Yeon Lee, Jae Kwan Jun, Kui Son Choi, Eun-Cheol Park; Cancer Res Treat. 2011;43(2):83-88. Published online June 30, 2011; DOI: https://doi.org/10.4143/crt.2011.43.2.83

Abstract PDF PubReader ePub

PURPOSE
The National Cancer Screening Program (NCSP) began in 1999. The objective of this report is to evaluate the results of the NCSP in 2008 and provide essential evidence associated with the gastric cancer screening program in Korea.
MATERIALS AND METHODS
Data was obtained from the National Cancer Screening Information System; participation rates in gastric cancer screening were calculated. According to screening modalities, recall rates were estimated with 95% confidence intervals (CIs).
RESULTS
The target population of the gastric cancer screening program in 2008 was 7,132,820 Korean men and women aged 40 and over, 2,076,544 of whom underwent upper endoscopy or upper gastrointestinal (UGI) series as screening tools (participation rate, 29.1%). Disparities in participation rates were observed relating to gender and health insurance type. Overall, recall rates of upper endoscopy and UGI series were 3.1% (95% CI, 3.0 to 3.1) and 33.3% (95% CI, 33.3 to 33.4), respectively.
CONCLUSION
According to our research, efforts to facilitate participation and to reduce disparities in gastric cancer screening among Korean men and women are needed. These results will provide essential data for evidence-based strategies in gastric cancer control in Korea.

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Results of Colorectal Cancer Screening of the National Cancer Screening Program in Korea, 2008: Jung Im Shim, Yeonju Kim, Mi Ah Han, Hoo-Yeon Lee, Kui Sun Choi, Jae Kwan Jun, Eun-Cheol Park; Cancer Res Treat. 2010;42(4):191-198. Published online December 31, 2010; DOI: https://doi.org/10.4143/crt.2010.42.4.191

Abstract PDF PubReader ePub

Purpose

This study aims to investigate the current situation of national colorectal cancer screening by analyzing participation rates, positive rates of screening methods and screening rate of secondary screening tests in colorectal screening of the national cancer screening program in 2008.

Materials and Methods

With database about target population and screened individuals of the national cancer screening program, the results of target population and participants of colorectal cancer screening in 2008 were analyzed. Among adults aged over 50 years of medical aid and beneficiaries of national health insurance paying lower 50% premiums in the total subscribers, 4,640,365 were target population of colorectal cancer screening and the data of 984,915 undergoing fecal occult blood test (FOBT) as a primary screening were analyzed.

Results

The colorectal cancer screening rate was 21.2% and the rates of national health insurance subscribers, females and the elderly aged 60-64 years were higher than those of others. The recipients with a positive result in FOBT recorded approximately 7.5%. Medical aid beneficiaries (7.9%), males (8.8%) and seniors aged over 75 years (9.1%) showed higher positive rates than the average one. Out of the FOBT positive recipients, 43.0% took a secondary screening and the rate undergoing colonoscopy (31.4%) was higher than that of doing double-contrast barium enema test (11.6%).

Conclusion

Colorectal cancer screening rate of medical aid beneficiaries and people paying lower 50% premiums among national health insurance subscribers, was different according to demographic characters (gender, age and types of health insurance). This finding meant that screening for the vulnerable needed to be encouraged by considering socio-demographic characters. Additionally, more efforts were necessary to increase the secondary screening rate of people with a positive result in primary one.

Citations

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