Trends in Cancer Screening Rates among Korean Men and Women: Results from the Korean National Cancer Screening Survey (KNCSS), 2004-2011

Boyoung Park; Kui Son Choi; Yoon Young Lee; Jae Kwan Jun; Hong Gwan Seo

doi:10.4143/crt.2012.44.2.113

Articles

Page Path: HOME > Cancer Res Treat > Volume 44(2); 2012 > Article

Original Article Trends in Cancer Screening Rates among Korean Men and Women: Results from the Korean National Cancer Screening Survey (KNCSS), 2004-2011: Boyoung Park, MD, PhD, Kui Son Choi, PhD, Yoon Young Lee, MPH, Jae Kwan Jun, MD, PhD, Hong Gwan Seo, MD, PhD; Cancer Research and Treatment : Official Journal of Korean Cancer Association 2012;44(2):113-120.
DOI: https://doi.org/10.4143/crt.2012.44.2.113
Published online: June 30, 2012

National Cancer Control Institute, National Cancer Center, Goyang, Korea.

Correspondence: Jae Kwan Jun, MD, PhD. National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 410-769, Korea.
Tel: 82-31-920-2184, Fax: 82-31-920-2189, jkjun@ncc.re.kr

• Received: February 6, 2012 • Accepted: April 19, 2012

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

14,127 Views
60 Download
33 Crossref
33 Scopus

prev next

Full Article

Download PDF

Abstract

Purpose
The Korean National Cancer Screening Survey (KNCSS) is a nationwide survey conducted annually, since 2004. This study was conducted in order to report on trends in rates of cancer screening for five major cancers-stomach, liver, colorectal, breast, and cervix uteri in Korea.
Materials and Methods
Data collected by the KNCSS between 2004 and 2011 were used in this study. The eligible study population included cancer-free men who were 40 years old and over, and women who were 30 years old and over. Lifetime screening rate, screening rate with recommendation, and changes in annual rates were calculated.
Results
Both lifetime screening rates and screening rates with recommendation have increased since 2004. On average, screening rates with recommendation have shown an annual increase of 4.2% (95% CI, 3.3 to 5.2%) for stomach cancer, 1.1% (95% CI, -0.5 to 2.7%) for liver cancer, 2.2% (95% CI, 0.8 to 3.6%) for colorectal cancer, 4.0% (95% CI, 3.0 to 4.9%) for breast cancer, and 0.2% (95% CI, -0.9 to 1.3%) for cervical cancer. Increases in rates of cancer screening, with the exception of liver and cervical cancers, were significant, and screening rates for stomach and breast cancer in particular showed a marked increase.
Conclusion
Cancer screening rates among Koreans showed a consistent increase from 2004 to 2011 and rates of screening for gastric, breast, and cervical cancer are approaching 70%.
Key words: Early detection of cancer, Trends, Health-care surveys

Introduction

Incidences of cancer in Korea showed a rapid increased from 1999 to 2009, as indicated by a 3.4% annual increase for both genders: 1.6% in men and 5.5% in women. A high rate of cancer incidence was reported in Korea, and for the year 2009, more than 178,000 people were diagnosed with cancer; nearly 70,000 deaths resulting from cancer were reported. This accounts for 28% of all deaths, despite the fact that age-standardized mortality rates have decreased since 2002 [1].

In 1996, the Korean government implemented the 10-Year Plan for Cancer Control. The first-term was conducted from 1996 to 2005 and the second-term started in 2006. The plan includes primary, secondary, and tertiary cancer prevention and a cancer registry. One objective of the program is establishment of early cancer screening for all Koreans through enhanced medical service coverage. To achieve this objective, the National Cancer Screening Program (NCSP) was established by the Korean government in 1999. Since then, both the target population and types of cancer covered have expanded. Between 1999 and 2001, the NCSP provided Medical Aid recipients with free screening for cancer of the stomach, breast, and cervix. National Health Insurance (NHI) beneficiaries in the lower 20% income bracket were included in the NCSP in 2002, and, in 2003, the NCSP was expanded to NHI beneficiaries in the lower 30% income bracket and a screening program for liver cancer was added to the NCSP. Screening for colorectal cancer was included in 2004, and, since 2006, the NSCP has provided Medical Aid recipients and NHI beneficiaries in the lower half of the income bracket with free-of-charge screenings for stomach, liver, colorectal, breast, and cervical cancer. Individuals in the upper 50% of NHI beneficiaries can also receive screening services for these five cancers from the NHI Corporation, and 90% of the costs are subsidized [2-6].

In Korea, both the organized cancer screening program and opportunistic cancer screening are widely available. Organized screening programs have nationally implemented guidelines defining a target population, screening interval, and follow-up strategies. In terms of screening items, screening method, and intervals between screenings, a variety of options are available through oopportunistic screening programs, which are based on individual decisions or recommendations from health-care providers. All fees are paid entirely by users without governmental subsidy [7]. This study was conducted in order to report on trends in rates of cancer screening, including both organized and opportunistic screening within the Korean population.

Materials and Methods

Data from the Korean National Cancer Screening Survey (KNCSS), collected from 2004 to 2011, were used in this study. The KNCSS is a nationwide, population-based, cross-sectional survey conducted annually by the National Cancer Center in Korea. Stratified multistage random sampling, based on resident registration population data, was conducted according to geographic area, age, and gender. This study was approved by the Institutional Review Board of the National Cancer Center, Korea (approval number: NCCNCS-08-129).

In 2004, computer-assisted telephone interviews were conducted for collection of data. Since 2005, face-to-face interviews have been conducted by a professional research agency. The number of enumeration districts was designated in proportion to population size and the final study clusters were randomly selected. Five to eight households in an urban area and 10-12 households in one rural area were chosen randomly.

Subjects were recruited by door-to-door contact, and at least three attempts at each household were made. According to the guidelines for organized cancer screening, the eligible population consists of cancer-free men who are 40 years old and over, and women who are 30 years old and over (see Appendix 1). Men and women who were 40 years old and over were eligible to undergo gastric cancer screening, men and women who were 50 years old and over were included for colorectal cancer screening, women who were 40 years old and older were eligible to undergo breast cancer screening, and women who were 30 years old and over were included for cervical cancer screening. Screening for liver cancer was restricted to people who were 40 years old and over, including those in high-risk groups, such as those with hepatitis B virus surface antigen or hepatitis C virus antibody positive, or liver cirrhosis. One person was selected from each household; if there were more than one eligible person in the household, the person whose date of birth was closest to the study date was selected.

Between 2005 and 2011, rates of response ranged between 34.5% and 58.5%. Following an explanation of the aim and confidentiality of the survey, informed consent was obtained from all participants. Using a structured questionnaire, participants were asked about sociodemographic characteristics, as well as their experience with cancer screening for five common cancers (stomach, liver, colorectal, breast, and cervix uteri). Questions included: "Have you ever undergone (cancer type) screening?" and "Which screening method have you experienced?" For the interval between screenings, the question was: "When did you last undergo (cancer type) screening with this method?", and, regarding reasons for undergoing screening or not undergoing screening, the question was: "What are your primary reasons for undergoing screening or not undergoing screening?" General sociodemographic characteristics of survey respondents for each year are shown in Appendix 2.

Calculation of cancer screening rates was based on two definitions. "Lifetime screening" was defined as having experienced each type of screening test. Rates were calculated as the proportion of subjects within the target age range for each type of cancer screening examined. The "screening with recommendation" category was assigned to participants who had undergone screening tests according to organized cancer screening guidelines (Appendix 1). However, in colorectal screening, respondents who underwent colonoscopy, double-contrast barium enema (DCBE), or fecal occult blood test (FOBT) within five, five, or one years, respectively, before 2009, and within ten, five, and one years, respectively, in 2009 and afterward were regarded as having undergone screening with recommendation. Rates were calculated as the proportion of subjects within the target age range for each type of cancer screening examined in accordance with recommendation. Changes in annual lifetime screening rates and screening rates with recommendation were calculated as the annual percentage change, within 95% confidence intervals (CIs) [8].

Calculation of screening rates according to gender, age, and income was also performed. Monthly household income was regarded as income level and was subgrouped into three tertiles for each year. Due to an inadequate number of individuals within the high-risk group, as well as unstable results showing wide 95% CIs, liver cancer was excluded from subgroup analysis.

Results

Lifetime screening rates and screenings with recommendation showed a continuous increase from 2004 until 2011. On average, between 2004 and 2011, the rate of screening with recommendation showed an annual increase of 4.2% for gastric cancer, 1.1% for liver cancer, 2.2% for colorectal cancer, 4.0% for breast cancer, and 0.2% for cervical cancer (Table 1). Significant increasing trends were observed in the rates of gastric, colorectal, and breast cancer screening, but not liver or cervical cancer screening. Despite observance of an increasing trend between 2004 and 2010, screening rates did not show an increase in 2011, and a stable pattern was observed instead compared to 2010 (Table 1). Trends differed according to screening methods. The average rate of increase of screenings using upper endoscopy was nearly twice as fast as that for screenings using upper gastrointestinal series (4.3% per year vs. 1.9% per year, respectively). Regarding colorectal cancer, on average, the rate of screening using FOBT showed a more rapid increase, compared with the rate of screening using colonoscopy or DCBE (3.1% per year vs. 1.6% per year, 0.4% per year, respectively).

Screening with recommendation of stomach cancer showed a significant increase, while that of colorectal cancer among men showed a plateau after 2009. In women, despite an increase in the rate of screening with recommendation for stomach and breast cancer, the trend of cervical cancer uptake according to guidelines plateaued in 2009, and a decreasing tendency was observed for colorectal cancer after 2008 (Fig. 1). According to age group, overall rates of screening with recommendation showed an increase in all age groups and all four types of cancer, except for cervical cancer screening among women in their thirties. The most noticeable increases for gastric cancer screenings were among subjects over the age of 70, and for rates of breast cancer screening among subjects over the age of 70, both of which showed steep increases when compared to other groups (Fig. 2). Rates of screening for stomach and breast cancer have shown a steady increase at all income levels, and differences in screening rates among income groups have shown a decrease. Screening rates for colorectal cancer peaked in 2008, followed by a pattern of decrease in all income groups, while gaps between groups showed a decrease. The rate of cervical cancer screening showed a plateau in 2009; however, differences in screening rates among income levels showed a decrease (Fig. 3).

Discussion

Rates of lifetime screening and screening with recommendation for five major cancers, particularly stomach and breast cancer, have shown a continuous increase since 2004. Rates of screening with recommendation for stomach, breast, and cervical cancer, for which organized screening services began in 1999, exceeded 60% after 2010. Under the second-term 10-Year Plan for Cancer Control, one of the goals was to achieve an increase in rates of cancer screening with recommendation to 70% by 2015 [9]. Screening rates for these three cancers have come close to reaching that goal. However, the start of services for screening of liver and colorectal cancer was relatively recent, and lower screening rates were observed. Overall rates of cancer screening across age and income groups, particularly for breast cancer, showed an increase.

In the US, where opportunistic screening is dominant [10], the screening rate for biannual breast cancer mammography among women who were 40 years old and over was 67% in 2005, and the rate for annual screening was 51% and 53% for 2005 and 2008, respectively [10,11]. These rates are similar to those reported in Korea. The rate of screening for breast cancer in the US showed an increase until 2000, reached a plateau, where it remained until 2003, and then showed a decrease. These trends were observed in all races and education groups. However, absolute percent differences in the use of breast cancer screening services, according to race and level of education, remained similar between 1987 and 2005 [11]. In the US, the rate of females who were 18 years old and over and had undergone screening for cervical cancer within a period of three years showed a slight increase until 2000, and then fell. In 2008, the rate was 78%, which was higher than the rate reported in Korea. As with breast cancer screening, no change in absolute differences in rates of cervical cancer screening according to education was observed [12]. Rates of screening for colorectal cancer were significantly higher in the US than in Korea. Regarding the screening method, in contrast with Korea, where FOBT and colonoscopy showed a similar share of total colorectal cancer screening, in the US, the rate of screenings using colonoscopy was much higher than for those using FOBT [13]. In Korea, the rate of colorectal cancer screening using FOBT showed a more rapid increase when compared with other methods, which may be due to guidelines of the organized cancer screening program, which designated that only cases showing abnormal results on FOBT could be subsidized for the cost of colonoscopy or DCBE. Considering that we regarded those who underwent colonoscopy within a period of five years as having undergone screening with recommendation, which was more strict than the organized screening guidelines before 2009, due to changes in the questionnaire, the average rate of increase of colonoscopy screening could be lower than we calculated.

In the UK, where screening for breast and cervical cancer are included in an organized program, 73.3% of women underwent mammography in 2009 and 2010 [14]. Relatively stable trends in breast cancer screening were observed for women under 65 years of age; however, an increase was observed in the 65 and over age group [15]. Five-year coverage of cervical cancer screening was 79% in 2010 and 2011 for women 25-49 years of age; this trend tended toward stability. However, among women 50-64 years of age, while 78% underwent screening, the rate showed a declining tendency [16]. In contrast to the lower rates of colorectal cancer screening in Korea, where screening started later, nationwide coverage for colorectal cancer screening was achieved in the UK [17].

In a study conducted in Japan, the rate of screening for gastric cancer was 11.8%, with a declining trend since the early 1990s. The screening rate for colorectal cancer showed a gradual increase, reaching 18.8% in 2007, and the screening rate for breast cancer was 14.2%, trending toward a gradual increase. The screening rate for cervical cancer began a decline during the early 1990s, and then began to increase again in the mid 2000s. In contrast with Korea, screening for lung cancer is included in Japan's organized screening program, and the screening rate showed a continuous increase until the mid 2000s, and then showed a slight decrease, reaching 21.6% in 2007 [18].

This study has several limitations. First, our results were reliant on self-reported data. Although survey data from self-reported interviews may have introduced a bias, findings from many studies have demonstrated the reliability of self-reported histories of cancer screening, which have shown good agreement with medical records [19-21]. Second, the rate of response in our study ranged from 34.5% to 58.5%; however, compared with other nationwide studies conducted in Korea, in which rates of response were less than 50% [22,23], in the Korean context, our rate of response can be considered acceptable.

Several improvements in secondary prevention of cancer have been achieved through implementation of the National Cancer Control Plan. The lifetime screening rate and screening rate with recommendation have shown an increase; in addition, socioeconomic disparities, such as income, which affect use of cancer screening services, have begun to show a decrease. In comparison, in the US, rates of screening have shown an increase, however, differences among socioeconomic levels have not decreased [11-13]; both the increasing rates of screening and decreasing disparities shown in our results from Korea might reflect the success of the National Cancer Control Plan. Although we did not exclude the effect of opportunistic screening, results suggest that the NCSP has played an important role in the rapid increase of cancer screening services in Korea. Based on our results, we found that use of an organized screening program has shown a rapid increase and covers more than 70% of cancer screening usage (data not shown).

In order to increase the rate of cancer screening, efforts have been launched from both the national and private sector. Invitation letters were sent to the eligible members of the population for the NCSP and efforts were made at public health centers to encourage increased participation in the organized cancer screening program by eligible members of the population. In addition, opportunistic cancer screening programs featuring various options and equipped with diagnostic tools have been developed in private general hospitals.

The rate of screening for colorectal, breast, and cervical cancer is lower in Korea than in Western countries, such as the US [10-13] and UK [14-17], and lower than the average of member countries in the Organization for Economic Co-operation and Development (OECD) for breast cancer screening [24]; however, for cervical cancer screening, the rate is slightly higher than the average of OECD members [25]. In order to detect cancer at an early stage and to reduce mortality through timely treatment, it is important to follow recommendations for screening. Target cancers included in the organized program are relatively common, and, if diagnosed and treated early, are completely curable. Therefore, greater effort should be dedicated to increasing rates of screening and to decreasing the cancer-related health-care burden in Korea.

Conclusion

The National Cancer Control Plan was implemented for the purpose of reducing the economic burden of cancer. One its objective is to increase the rate of cancer screening to 70% by 2015. The KNCSS is an ongoing survey conducted for systematic collection, analysis, and interpretation of data essential to planning, implementation, and evaluation of nationwide cancer screening policies in Korea. As a result of these efforts, the rates of screening for gastric, breast, and cervical cancer are now approaching this goal. Greater effort will be needed in order to increase participation in cancer screening and to bring about improvements in cancer prevention and control in Korea.

Acknowledgements

Acknowledgments

This study was supported by a Grant-in-Aid for Cancer Research and Control from the National Cancer Center of Korea (#1010201-2).

NOTES

Conflicts of interest relevant to this article was not reported.

REFERENCES

1. National Cancer Information Center, 2009. Cancer Statistics [Internet]. 2009. cited 2012 Jan 31Goyang: National Cancer Information Center; Available from: http://www.cancer.go.kr/ncic/index.html
2. Lee KS, Oh DK, Han MA, Lee HY, Jun JK, Choi KS, et al. Gastric cancer screening in Korea: report on the national cancer screening program in 2008. Cancer Res Treat. 2011;43:83–88. PMID: 21811423Article PubMed PMC PDF
3. Oh DK, Shim JI, Han M, Kim Y, Lee HY, Jun JK, et al. Breast cancer screening in Korean women: report of the National Cancer Screening Program in 2008. J Breast Cancer. 2010;13:299–304. Article
4. Lee EH, Han MA, Lee HY, Jun JK, Choi KS, Park EC. Liver cancer screening in Korea: a report on the 2008 National Cancer Screening Programme. Asian Pac J Cancer Prev. 2010;11:1305–1310. PMID: 21198282PubMed
5. Shim JI, Kim Y, Han MA, Lee HY, Choi KS, Jun JK, et al. Results of colorectal cancer screening of the national cancer screening program in Korea, 2008. Cancer Res Treat. 2010;42:191–198. PMID: 21253320Article PubMed PMC PDF
6. Jun JK, Choi KS, Jung KW, Lee HY, Gapstur SM, Park EC, et al. Effectiveness of an organized cervical cancer screening program in Korea: results from a cohort study. Int J Cancer. 2009;124:188–193. PMID: 18785204Article PubMed
7. Miles A, Cockburn J, Smith RA, Wardle J. A perspective from countries using organized screening programs. Cancer. 2004;101(5 Suppl):1201–1213. PMID: 15316915Article PubMed
8. Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000;19:335–351. PMID: 10649300Article PubMed
9. Han MA, Choi KS, Park JH, Moore MA, Park EC. Midcourse evaluation of the second-term 10-year plan for cancer control in Korea. Asian Pac J Cancer Prev. 2011;12:327–333. PMID: 21517281PubMed
10. Smith RA, Cokkinides V, Brooks D, Saslow D, Brawley OW. Cancer screening in the United States, 2010: a review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin. 2010;60:99–119. PMID: 20228384Article PubMed
11. National Cancer InstituteCancer trends progress report: 2009/2010 update. Breast cancer screening [Internet]. 2010. cited 2012 Jan 5Bethesda, MD: National Cancer Institute; Available from: http://progressreport.cancer.gov/doc_detail.asp?pid=1&did=2009&chid=92&coid=916&mid=#trends
12. National Cancer InstituteCancer trends progress report: 2009/2010 update. Cervical cancer screening [Internet]. 2010. cited 2012 Jan 5Bethesda, MD: National Cancer Institute; Available from: http://progressreport.cancer.gov/doc_detail.asp?pid=1&did=2009&chid=92&coid=917&mid=#trends
13. National Cancer InstituteCancer trends progress report: 2009/2010 update. Colorectal cancer screening [Internet]. 2010. cited 2012 Jan 5Bethesda, MD: National Cancer Institute; Available from: http://progressreport.cancer.gov/doc_detail.asp?pid=1&did=2009&chid=92&coid=918&mid=
14. NHS Cancer Screening ProgrammesNHS breast screening programme 2011 annual review [Internet]. 2011. cited 2012 Jan 5Sheffield: NHS Cancer Screening Programmes; Available from: http://www.cancerscreening.nhs.uk/cervical/publications/cervical-annual-review-2011.pdf
15. NHS Cancer Screening ProgrammesBreast cancer screening programme, England 2008-09 [Internet]. 2011. cited 2012 Jan 5Sheffield: NHS Cancer Screening Programmes; Available from: http://www.cancerscreening.nhs.uk/breastscreen/breast-statistics-bulletin-2008-09.pdf
16. NHS Cancer Screening ProgrammesNHS Cervical Screening Programme: annual review 2011 [Internet]. 2010. cited 2012 Jan 5Sheffield: NHS Cancer Screening Programmes; Available from: http://www.cancerscreening.nhs.uk/cervical/publications/cervical-annualreview-2011.pdf
17. NHS Cancer Screening ProgrammesNHS Bowel cancer screening programme [Internet]. 2010. cited 2012 Jan 5Sheffield: NHS Cancer Screening Programmes; Available from: http://www.cancerscreening.nhs.uk/bowel/index.html
18. Yoshida M, Kondo K, Tada T. The relation between the cancer screening rate and the cancer mortality rate in Japan. J Med Invest. 2010;57:251–259. PMID: 20847525Article PubMed
19. Caplan LS, McQueen DV, Qualters JR, Leff M, Garrett C, Calonge N. Validity of women's self-reports of cancer screening test utilization in a managed care population. Cancer Epidemiol Biomarkers Prev. 2003;12(11 Pt 1):1182–1187. PMID: 14652278PubMed
20. Hoffmeister M, Chang-Claude J, Brenner H. Validity of self-reported endoscopies of the large bowel and implications for estimates of colorectal cancer risk. Am J Epidemiol. 2007;166:130–136. PMID: 17456475Article PubMed
21. Jones RM, Mongin SJ, Lazovich D, Church TR, Yeazel MW. Validity of four self-reported colorectal cancer screening modalities in a general population: differences over time and by intervention assignment. Cancer Epidemiol Biomarkers Prev. 2008;17:777–784. PMID: 18381476Article PubMed
22. Park B, Lee YK, Cho LY, Go UY, Yang JJ, Ma SH, et al. Estimation of nationwide vaccination coverage and comparison of interview and telephone survey methodology for estimating vaccination status. J Korean Med Sci. 2011;26:711–719. PMID: 21655054Article PubMed PMC
23. Ock SM, Choi JY, Cha YS, Lee J, Chun MS, Huh CH, et al. The use of complementary and alternative medicine in a general population in South Korea: results from a national survey in 2006. J Korean Med Sci. 2009;24:1–6. PMID: 19270805Article PubMed PMC
24. OECD indicators, 2009. Screening, survival and mortality for breast cancer: OECD iLibrary, health at a glance 2011 [Internet]. 2011. cited 2012 Jan 5OECD iLibrary; Available at: http://www.oecd-ilibrary.org/
25. OECD indicators, 2009. Screening, survival and mortality for cervical cancer: OECD iLibrary, health at a glance 2011 [Internet]. 2011. cited 2012 Jan 5OECD iLibrary; Available at: http://www.oecd-ilibrary.org/

Appendix

Appendix 1

Cancer screening guidelines issued by the National Cancer Screening Program (NCSP) in Korea

Cancer	Target population	Interval	Test
Stomach	Age 40 and over	2 yr	Upper endoscopy or UGI^a)
Liver	High-risk group^b) aged 40 and over	6 mo	Ultrasonography and AFP
Colorectal	Age 50 and over	1 yr	FOBT^c)
Breast	Age 40 and over, women	2 yr	Mammography
Cervix	Age 30 and over, women	2 yr	Pap smear

UGI, upper gastrointestinal series; AFP, alpha-fetoprotein; FOBT, fecal occult blood test. ^a)In the case of an abnormality on the UGI, endoscopy is recommended, and a biopsy is performed when an abnormality is found during endoscopy, ^b)Patients at high risk for liver cancer include those with chronic hepatitis determined from serological evidence of infection with hepatitis B or C virus in liver cirrhosis, ^c)In the case of an abnormality on FOBT, colonoscopy or a double-contrast barium enema is recommended, and a biopsy is performed when an abnormality is found during colonoscopy.

Appendix 2

Distribution (%) of sociodemographic characteristics of the study population in the Korean National Cancer Screening Survey (KNCSS) 2004-2011

	Survey year

	2004	2005	2006	2007	2008	2009	2010	2011
Total (n)	3,592	2,028	2,030	2,021	2,038	2,000	4,056	4,100
Gender
Male	42.4	41.0	40.2	39.4	40.6	41.0	41.4	41.9
Female	57.6	59.0	59.8	60.6	59.4	59.1	58.6	58.1
Age (yr)
30-39^a)	14.1	12.0	17.6	17.8	17.7	17.0	15.9	15.5
40-49	35.9	41.1	34.6	34.8	35.5	35.6	34.9	33.7
50-59	22.7	28.6	21.8	21.6	24.7	25.2	27.3	28.5
60-69	17.3	15.6	19.1	21.9	16.4	16.4	16.8	16.1
≥70	10.2	2.7	6.9	3.9	5.8	5.9	5.2	6.2
Education (yr)
≤8	25.8	16.4	20.9	18.2	13.6	15.1	8.1	8.2
9-11	15.6	16.1	15.1	14.3	16.6	11.3	10.9	10.6
12-15	34.3	47.6	44.7	46.3	46.6	46.8	52.1	52.5
≥16	22.6	18.5	17.6	19.1	20.7	24.9	28.8	28.7
Monthly household income^b) ($)^c)
≤999	25.3	11.4	14.1	10	9.3	9.4	4.6	4.5
1,000-2,999	39	57.1	53.1	50.5	48.8	45	37.6	37.8
≥3,000	18.8	29.7	29.9	38.7	40.3	44.5	57.7	57.7
Marital status
Married	88.2	92.8	89.6	89.8	90.3	90.2	91.5	91.5
Not married	1.6	2.1	2.2	2.8	2.5	3.6	3	3.1
Others^d)	9.5	5.1	8.3	7.4	7.2	6.3	5.5	5.5
Residence area
Metropolitan	46.8	47.4	47.4	47.5	46.5	46.6	44.3	45.2
Urban	53.2^e)	39.8	40.5	40.3	44.2	44	42.2	41.6
Rural	53.2^e)	12.7	12.1	12.2	9.3	9.4	13.5	13.1
Health insurance type
National Health Insurance	90.8	95.8	94.5	96.7	95.9	95.3	96.5	96.7
Medical Aid Program	6	4.2	4.2	3.2	3.8	4.3	3.5	3.3

^a)Restricted to women aged 30-39, ^b)Due to missing data, some row sums are not 100% every year, ^c)1 USD=1,000 KWN, ^d)Others: divorced or separated, ^e)The question related to residential area did not distinguish between urban and rural areas in 2004.

Fig. 1

Cancer screening rates with recommendation by gender, 2004-2011.

Fig. 2

Cancer screening rates with recommendation by age, 2004-2011.

Fig. 3

Cancer screening rates with recommendation by family income level, 2004-2011. Monthly family income status was classified by tertile.

Table 1

Cancer screening rates of five major cancers in Korea, 2004-2011

	Survey year								APC (95% CI)

	2004	2005	2006	2007	2008	2009	2010	2011
Lifetime screening rate (%)^a)
Stomach	52.0	48.5	53.5	55.3	65.0	65.1	76.7	76.2	4.2 (2.8 to 5.6)
Liver	31.8	47.7	58.3	57.6	64.8	81.3	54.2	54.3	3.2 (-1.6 to 8.0)
Colon and rectum	25.3	27.9	34.0	40.7	50.4	48.1	57.1	56.1	4.9 (3.7 to 6.1)
Breast	55.9	57.4	60.2	66.4	72.7	78.1	79.5	79.0	4.0 (3.0 to 4.9)
Cervix uteri	76.8	74.0	68.0	73.6	74.4	76.1	75.0	74.8	0.2 (-0.9 to 1.3)
Screening rate with recommendation (%)^b)
Stomach^c)	39.2	39.4	43.3	45.6	53.5	56.9	65.1	64.6	4.2 (3.3 to 5.2)
Upper endoscopy^d)	32.4	32.9	33.5	37.8	44.8	49.3	58.9	58.1	4.3 (3.1 to 5.6)
UGI series^d)	13.0	13.1	15.2	20.4	21.1	19.5	24.9	25.3	1.9 (1.3 to 2.5)
Liver^e)	20.0	16.3	16.5	22.7	19.7	31.3	22.9	22.9	1.1 (-0.5 to 2.7)
Colon and rectum^f)	19.9	25.4	29.4	34.1	37.9	36.7	35.5	35.3	2.2 (0.8 to 3.6)
Colonoscopy^d)^,^f)	14.4	12.4	16.8	19.5	19.1	23.4	23.3	23.6	1.6 (1.1 to 2.2)
DCBE^d)	2.8	4.1	5.3	8.7	7.0	6.1	6.1	6.0	0.4 (-0.2 to 1.0)
FOBT^d)	3.8	7.2	13.6	20.2	20.9	19.0	25.9	25.0	3.1 (1.9 to 4.2)
Breast^g)	33.2	38.4	40.6	45.8	49.3	55.2	61.6	60.4	4.0 (3.0 to 4.9)
Cervix uteri^h)	58.3	57.0	54.9	57.0	59.9	63.9	62.9	62.4	0.2 (-0.9 to 1.3)

APC, annual percent change; CI, confidence interval; UGI, upper gastrointestinal; DCBE, double-contrast barium enema; FOBT, fecal occult blood test. ^a)Lifetime screening rate is defined as the proportion of respondents who ever underwent the screening test(s), ^b)Recommended screening rate is defined as the proportion of respondents who fulfilled the screening recommendation criteria among respondents within the targeted age group for the relevant cancer, ^c)Respondents were restricted to men and women who were 40 years old and over whose last upper endoscopy or UGI series screening was performed within a period of two years, ^d)Screening rates shown in parentheses are modality-specific rates, ^e)Respondents were restricted to men and women who were 40 years old and over who were at high risk for liver cancer [hepatitis B virus surface antigen (+), hepatitis C virus antibody (+), or liver cirrhosis] whose last screening with abdominal ultrasonography and serum α-fetoprotein was performed within a period of six months, ^f)Respondents were restricted to men and women who were 50 years old and over whose last screening with colonoscopy, DCBE, or FOBT was undertaken within a period of 10, five, or one years, respectively. However, before 2009, patients who underwent colonoscopy within a period of five years were regarded as having undergone screening with recommendation, ^g)Respondents were restricted to women who were 40 years old and over whose last screening with mammography was performed within a period of two years, ^h)Respondents were restricted to women who were 30 years old and over whose last screening with conventional cytology was undertaken within a period of two years.

Figure & Data

REFERENCES

Citations

Citations to this article as recorded by

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
Better survival of patients with hepatitis B virus-related hepatocellular carcinoma in South Korea: Changes in 16-years cohorts
Sang Il Choi, Yuri Cho, Moran Ki, Bo Hyun Kim, In Joon Lee, Tae Hyun Kim, Seong Hoon Kim, Young Hwan Koh, Hyun Beom Kim, Eun Kyung Hong, Chang-Min Kim, Joong-Won Park, Hamidreza Karimi-Sari
PLOS ONE.2022; 17(3): e0265668. CrossRef
Clinical subtypes and prognosis in breast cancer according to parity: a nationwide study in Korean Breast Cancer Society
Sungmin Park, Byung In Moon, Se Jeong Oh, Han-Byoel Lee, Min-Ki Seong, Seokwon Lee, Kyung Do Byun, Seung Pil Jung, Soo Youn Bae
Breast Cancer Research and Treatment.2019; 173(3): 679. CrossRef
Women’s knowledge, awareness and attitudes toward newly implemented national HPV-based screening in Turkey
Hasan Aykut Tuncer, Serap Firtina Tuncer
Journal of Cancer Policy.2019; 22: 100205. CrossRef
Temporal improvement in survival of patients with hepatocellular carcinoma in a hepatitis B virus‐endemic population
Bo Hyun Kim, Young‐Suk Lim, Eun‐Yang Kim, Hyun‐Joo Kong, Young‐Joo Won, Seungbong Han, Sohee Park, Jae Seok Hwang
Journal of Gastroenterology and Hepatology.2018; 33(2): 475. CrossRef
Clinicopathologic score predicting lymph node metastasis in T1 gastric cancer
Thuy B. Tran, David J. Worhunsky, Malcolm H. Squires, Linda X. Jin, Gaya Spolverato, Konstantinos I. Votanopoulos, Sharon M. Weber, Carl Schmidt, Edward A. Levine, Ryan C. Fields, Timothy M. Pawlik, Shishir K. Maithel, Jeffrey A. Norton, George A. Poultsi
Surgery.2018; 163(4): 889. CrossRef
Risk factors for developing liver cancer in people with and without liver disease
Jae Kyung Suh, Jayoun Lee, Jeong-Hoon Lee, Sangjin Shin, Ha jin Tchoe, Jin-Won Kwon, Jason Blackard
PLOS ONE.2018; 13(10): e0206374. CrossRef
Disparities in the utilisation of preventive health services by the employment status: An analysis of 2007-2012 South Korean national survey
SangJune Kim, Jee Hey Song, Yoo Min Oh, Sang Min Park, Geofrey Musinguzi
PLOS ONE.2018; 13(12): e0207737. CrossRef
Oral Medications Enhance Adherence to Surveillance for Hepatocellular Carcinoma and Survival in Chronic Hepatitis B Patients
Joon Yeul Nam, Jeong-Hoon Lee, Hwi Young Kim, Jieun E. Kim, Dong Hyeon Lee, Young Chang, Hyeki Cho, Jeong-Ju Yoo, Minjong Lee, Young Youn Cho, Yuri Cho, EunJu Cho, Su Jong Yu, Yoon Jun Kim, Jung-Hwan Yoon, Chi-Ling Chen
PLOS ONE.2017; 12(1): e0166188. CrossRef
Prognostic value of ABO blood types in young patients with breast cancer; a nationwide study in Korean Breast Cancer Society
Sungmin Park, Ku Sang Kim, Jeong-Soo Kim, Wonshik Han, Byeong-Woo Park, Seokwon Lee, Ye Won Jeon, Se Kyung Lee, Jonghan Yu, Jeong Eon Lee, Seok Won Kim, Seok Jin Nam
Medical Oncology.2017;[Epub] CrossRef
Different prognosis of young breast cancer patients in their 20s and 30s depending on subtype: a nationwide study from the Korean Breast Cancer Society
Jai Min Ryu, Jonghan Yu, Seung Il Kim, Ku Sang Kim, Hyeong-Gon Moon, Jung Eun Choi, Joon Jeong, Kyung Do Byun, Seok Jin Nam, Jeong Eon Lee, Se Kyung Lee, Seok Won Kim
Breast Cancer Research and Treatment.2017; 166(3): 833. CrossRef
Cancer literacy as a mediator for cancer screening behaviour in Korean adults
Hee Yun Lee, Taeho Greg Rhee, Nam Keol Kim
Health & Social Care in the Community.2016; 24(5): e34. CrossRef
Breast cancer-specific mortality in small-sized tumor with node-positive breast cancer: a nation-wide study in Korean breast cancer society
Jai Min Ryu, Hyouk Jin Lee, Tae in Yoon, Eun Sook Lee, Soo Jung Lee, Jin Hyang Jung, Byung Joo Chae, Seok Jin Nam, Jeong Eon Lee, Se Kyung Lee, Soo Youn Bae, Jonghan Yu, Seok Won Kim
Breast Cancer Research and Treatment.2016; 159(3): 489. CrossRef
Predictive Value of Antiviral Effects in the Development of Hepatocellular Carcinoma in the General Korean Population with Chronic Hepatitis B
Jae-Jun Shim, In Hwan Oh, Sang Bae Kim, Jung Wook Kim, Chang Kyun Lee, Jae Young Jang, Ju-Seog Lee, Byung-Ho Kim
Gut and Liver.2016; 10(6): 962. CrossRef
Long-term outcome comparison of endoscopic resection and surgery in early gastric cancer meeting the absolute indication for endoscopic resection
Il Ju Choi, Jun Ho Lee, Young-Il Kim, Chan Gyoo Kim, Soo-Jeong Cho, Jong Yeul Lee, Keun Won Ryu, Byung-Ho Nam, Myeong-Cherl Kook, Young-Woo Kim
Gastrointestinal Endoscopy.2015; 81(2): 333. CrossRef
Robotic distal subtotal gastrectomy with D2 lymphadenectomy for gastric cancer patients with high body mass index: comparison with conventional laparoscopic distal subtotal gastrectomy with D2 lymphadenectomy
Juhan Lee, Yoo-Min Kim, Yanghee Woo, Kazutaka Obama, Sung Hoon Noh, Woo Jin Hyung
Surgical Endoscopy.2015; 29(11): 3251. CrossRef
High liver fibrosis index FIB‐4 is highly predictive of hepatocellular carcinoma in chronic hepatitis B carriers
Beomseok Suh, Sehhoon Park, Dong Wook Shin, Jae Moon Yun, Hyung‐Kook Yang, Su Jong Yu, Cheong‐Il Shin, Jin‐Soo Kim, Eunmi Ahn, Hyejin Lee, Jin Ho Park, BeLong Cho
Hepatology.2015; 61(4): 1261. CrossRef
Endoscopic Resection for Synchronous Esophageal Squamous Cell Carcinoma and Gastric Adenocarcinoma in Early Stage Is a Possible Alternative to Surgery
Se Jeong Park, Ji Yong Ahn, Hwoon-Yong Jung, Shin Na, So-Eun Park, Mi-Young Kim, Kwi-Sook Choi, Jeong Hoon Lee, Do Hoon Kim, Kee Don Choi, Ho June Song, Gin Hyug Lee, Jin-Ho Kim, Seungbong Han
Gut and Liver.2015; 9(1): 59. CrossRef
Prediction of future hepatocellular carcinoma incidence in moderate to heavy alcohol drinkers with the FIB‐4 liver fibrosis index
Beomseok Suh, Jae Moon Yun, Sehhoon Park, Dong Wook Shin, Tae Hoon Lee, Hyung‐Kook Yang, Eunmi Ahn, Hyejin Lee, Jin Ho Park, BeLong Cho
Cancer.2015; 121(21): 3818. CrossRef
Is microsatellite instability a prognostic marker in gastric cancer?: A systematic review with meta-analysis
Yoon Young Choi, Jung Min Bae, Ji Yeong An, In Gyu Kwon, In Cho, Hyun Beak Shin, Tanaka Eiji, Mohammad Aburahmah, Hyung-Il Kim, Jae-Ho Cheong, Woo Jin Hyung, Sung Hoon Noh
Journal of Surgical Oncology.2014; 110(2): 129. CrossRef
Guidelines for the diagnosis and treatment of Helicobacter pylori infection in Korea, 2013 revised edition
Sang Gyun Kim, Hye‐Kyung Jung, Hang Lak Lee, Jae Young Jang, Hyuk Lee, Chan Gyoo Kim, Woon Geon Shin, Ein Soon Shin, Yong Chan Lee
Journal of Gastroenterology and Hepatology.2014; 29(7): 1371. CrossRef
Effects of Screening on Gastric Cancer Management: Comparative Analysis of the Results in 2006 and in 2011
Yun Gyoung Kim, Seong-Ho Kong, Seung-Young Oh, Kyung-Goo Lee, Yun-Suhk Suh, Jun-Young Yang, Jeongmin Choi, Sang Gyun Kim, Joo-Sung Kim, Woo Ho Kim, Hyuk-Joon Lee, Han-Kwang Yang
Journal of Gastric Cancer.2014; 14(2): 129. CrossRef
Breast Cancer Screening Knowledge and Perceived Health Beliefs among Immigrant Women in Korea
Jiyoung Kim, Se Kyung Lee, Jeonghui Lee, Min-Young Choi, Seung Pil Jung, Min Kook Kim, Sangmin Kim, Seok Jin Nam, Jeong Eon Lee, Won Ho Kil
Journal of Breast Cancer.2014; 17(3): 279. CrossRef
Factors Associated with Organized and Opportunistic Cancer Screening: Results of the Korea National Health and Nutrition Examination Survey (KNHANES) 2007-2011
Minsun Kang, Ki-Bong Yoo, Eun-Cheol Park, Kisung Kwon, Gaeun Kim, Doo Ree Kim, Jeoung A Kwon
Asian Pacific Journal of Cancer Prevention.2014; 15(7): 3279. CrossRef
The Korean National Liver Cancer Surveillance Program: Experience of a Single Healthcare Center in 2011
Jae-Jun Shim, Hyun Jin Park, Jung-Wook Kim, Eun Jung Hwang, Chang Kyun Lee, Jae Young Jang, Seong Jin Park, Hyun Rim Choi, Byung-Ho Kim
Korean Journal of Medicine.2013; 84(5): 672. CrossRef
Relationship between Social Network and Stage of Adoption of Gastric Cancer Screening among the Korean Population
Myung Ha Lee, Kui Son Choi, Yoon Young Lee, Mina Suh, Jae Kwan Jun
Asian Pacific Journal of Cancer Prevention.2013; 14(10): 6095. CrossRef
Cancer Screening in Korea, 2012: Results from the Korean National Cancer Screening Survey
Mina Suh, Kui Son Choi, Yoon Young Lee, Boyoung Park, Jae Kwan Jun
Asian Pacific Journal of Cancer Prevention.2013; 14(11): 6459. CrossRef
Incidence of cervical, endometrial, and ovarian cancer in Korea, 1999-2010
Myong Cheol Lim, Eun-Kyeong Moon, Aesun Shin, Kyu-Won Jung, Young-Joo Won, Sang Soo Seo, Sokbom Kang, Jae-Weon Kim, Joo-Young Kim, Sang-Yoon Park
Journal of Gynecologic Oncology.2013; 24(4): 298. CrossRef
Guidelines for the Diagnosis and Treatment ofHelicobacter pyloriInfection in Korea, 2013 Revised Edition
Sang Gyun Kim, Hye-Kyung Jung, Hang Lak Lee, Jae Young Jang, Hyuk Lee, Chan Gyoo Kim, Woon Geon Shin, Ein Soon Shin, Yong Chan Lee
The Korean Journal of Gastroenterology.2013; 62(1): 3. CrossRef
Knowledge of Colorectal Cancer Screening among Young Malaysians
Redhwan Ahmed Al-Naggar, Yuri V. Bobryshev
Asian Pacific Journal of Cancer Prevention.2013; 14(3): 1969. CrossRef
Prevalence of and Risk Factors for Gastrointestinal Diseases in Korean Americans and Native Koreans Undergoing Screening Endoscopy
Hee Sun Kim, Su Jung Baik, Kyung Hee Kim, Cho Rong Oh, Jung Hyun Lee, Wan Jae Jo, Hye Kyoung Kim, Eun Young Kim, Min Jung Kim
Gut and Liver.2013; 7(5): 539. CrossRef
The National Cancer Screening Program for Breast Cancer in the Republic of Korea: Is it Cost-Effective?
Moon Hae Kang, Eun-Cheol Park, Kui Son Choi, MiNa Suh, Jae Kwan Jun, Eun Cho
Asian Pacific Journal of Cancer Prevention.2013; 14(3): 2059. CrossRef
Factors Associated with Compliance with Recommendations for Liver Cancer Screening in Korea: A Nationwide Survey in Korea
Boyoung Park, Kui Son Choi, Mina Suh, Ji-Yeon Shin, Jae Kwan Jun, Hiromu Suzuki
PLoS ONE.2013; 8(6): e68315. CrossRef

PubReader
ePub Link

Cite

CITE: export Copy Download Format; Close

Download Citation

Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

Format:

RIS — For EndNote, ProCite, RefWorks, and most other reference management software
BibTeX — For JabRef, BibDesk, and other BibTeX-specific software

Include:

Citation for the content below
Citation and abstract for the content below

Trends in Cancer Screening Rates among Korean Men and Women: Results from the Korean National Cancer Screening Survey (KNCSS), 2004-2011

Cancer Res Treat. 2012;44(2):113-120. Published online June 30, 2012

DOI: https://doi.org/10.4143/crt.2012.44.2.113

XML Download

Abstract
Introduction
Materials and Methods
Results
Discussion
Conclusion
Acknowledgments
NOTES
REFERENCES
Appendix

Trends in Cancer Screening Rates among Korean Men and Women: Results from the Korean National Cancer Screening Survey (KNCSS), 2004-2011

Fig. 1 Cancer screening rates with recommendation by gender, 2004-2011.

Fig. 2 Cancer screening rates with recommendation by age, 2004-2011.

Fig. 3 Cancer screening rates with recommendation by family income level, 2004-2011. Monthly family income status was classified by tertile.

Fig. 1

Fig. 2

Fig. 3

Trends in Cancer Screening Rates among Korean Men and Women: Results from the Korean National Cancer Screening Survey (KNCSS), 2004-2011

	Survey year								APC (95% CI)

	2004	2005	2006	2007	2008	2009	2010	2011
Lifetime screening rate (%)^a)
Stomach	52.0	48.5	53.5	55.3	65.0	65.1	76.7	76.2	4.2 (2.8 to 5.6)
Liver	31.8	47.7	58.3	57.6	64.8	81.3	54.2	54.3	3.2 (-1.6 to 8.0)
Colon and rectum	25.3	27.9	34.0	40.7	50.4	48.1	57.1	56.1	4.9 (3.7 to 6.1)
Breast	55.9	57.4	60.2	66.4	72.7	78.1	79.5	79.0	4.0 (3.0 to 4.9)
Cervix uteri	76.8	74.0	68.0	73.6	74.4	76.1	75.0	74.8	0.2 (-0.9 to 1.3)
Screening rate with recommendation (%)^b)
Stomach^c)	39.2	39.4	43.3	45.6	53.5	56.9	65.1	64.6	4.2 (3.3 to 5.2)
Upper endoscopy^d)	32.4	32.9	33.5	37.8	44.8	49.3	58.9	58.1	4.3 (3.1 to 5.6)
UGI series^d)	13.0	13.1	15.2	20.4	21.1	19.5	24.9	25.3	1.9 (1.3 to 2.5)
Liver^e)	20.0	16.3	16.5	22.7	19.7	31.3	22.9	22.9	1.1 (-0.5 to 2.7)
Colon and rectum^f)	19.9	25.4	29.4	34.1	37.9	36.7	35.5	35.3	2.2 (0.8 to 3.6)
Colonoscopy^d)^,^f)	14.4	12.4	16.8	19.5	19.1	23.4	23.3	23.6	1.6 (1.1 to 2.2)
DCBE^d)	2.8	4.1	5.3	8.7	7.0	6.1	6.1	6.0	0.4 (-0.2 to 1.0)
FOBT^d)	3.8	7.2	13.6	20.2	20.9	19.0	25.9	25.0	3.1 (1.9 to 4.2)
Breast^g)	33.2	38.4	40.6	45.8	49.3	55.2	61.6	60.4	4.0 (3.0 to 4.9)
Cervix uteri^h)	58.3	57.0	54.9	57.0	59.9	63.9	62.9	62.4	0.2 (-0.9 to 1.3)

Table 1 Cancer screening rates of five major cancers in Korea, 2004-2011