Trend analysis of process quality indicators for the Korean National Cervical Cancer Screening Program from 2005 to 2013

Cam Nhung Bui,최은지,서미나,전재관,정규원,임명철,최귀선 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.1

Objective: This study sought to examine changes in trends for quality indicators of thepopulation-based Korean National Cancer Screening Program (KNCSP) for cervical cancerfrom years 2005 to 2013. Methods: Our study data were derived from the KNCSP database. Cervical cancer diagnosisinformation was ascertained through linkage with the Korean National Cancer Registry andthe KNCSP database. Performance measures for cervical cancer screening were estimated,including participation rate, positive rate, crude detection rate (CDR), interval cancer rate(ICR), positive predictive value (PPV), sensitivity, and specificity. Joinpoint analysis wasapplied to calculate annual percentage changes (APCs) in all indicators according to socio demographic factors. Results: A significant increasing trend was noted in participation rates (APC=13.4%; 95%confidence interval [CI]=10.5, 16.4). PPV and specificity increased from years 2005 to 2009and remained stable till 2013. An increasing trend was discovered in CDRs for cervicalcancer in situ (APC=3.9%; 95% CI=1.0, 6.9), whereas a decreasing trend was observed inICRs for invasive cervical cancer (APC=−2.5%; 95% CI=−4.5, −0.5). Medical Aid recipientsand women older than 70 years showed the lowest participation rates, but higher CDRs andICRs, compared to other groups. In general, most of the quality indicators for cervical cancerscreening improved from 2005 to 2009 and remained stable to 2013. Conclusion: The KNCSP for cervical cancer in Korea has improved in terms of participationrate and accuracy of the screening test. These results may be attributed to the NationalQuality Improvement Program for KNCSP.

Effect of Pap smear screening on cervical cancer stage at diagnosis: results from the Korean National Cancer Screening Program

Cam Nhung Bui,Seri Hong,서미나,전재관,정규원,임명철,최귀선 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.5

Objective: We aimed to determine the differences in stage at diagnosis of cervical cancer among Korean women according to screening history. Methods: Using linkage data from the Korean Central Cancer Registry and Korean National Cancer Screening Program (KNCSP), we included 18,388 women older than 30 years who were newly diagnosed with cervical cancer between 2013 and 2014 and examined their screening history. Between individuals, age group and socioeconomic status were matched to control for potential confounders. Results: Significantly more cases of carcinoma in situ (CIS) were diagnosed in the ever- screened (71.77%) group than in the never-screened group (54.78%), while localized, regional, distant, and unknown stage were more frequent in the never-screened group. Women in the ever-screened group were most likely to be diagnosed with CIS than with invasive cervical cancer (adjusted odds ratio [aOR]=2.40; 95% confidence interval [CI]=2.18– 2.65). The aOR for being diagnosed with CIS was highest among women who were screened 3 times or more (aOR=5.10; 95% CI=4.03–6.45). The ORs were highest for women screened within 24 months of diagnosis and tended to decrease with an increasing time since last screening (p-trend <0.01). Conclusion: The KNCSP for cervical cancer was found to be positively associated with diagnosis of cervical cancers at earlier stages among women aged 30 years or older. The benefit of screening according to time was highest for women screened within 24 months of diagnosis.

Stages of Adoption for Fecal Occult Blood Test and Colonoscopy Tests for Colorectal Cancer Screening in Korea

Nhung Cam Bui,조하나,이윤영,서미나,박보영,전재관,김열,최귀선 대한암학회 2018 Cancer Research and Treatment Vol.50 No.2

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 regression were 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.

Intentions to Undergo Lung Cancer Screening among Korean Men

Cam, Nhung Bui,Lee, Yoon Young,Yoon, HyoJoong,Suh, Mina,Park, Boyoung,Jun, Jae Kwan,Kim, Yeol,Choi, Kui Son Asian Pacific Journal of Cancer Prevention 2015 Asian Pacific journal of cancer prevention Vol.16 No.15

Opportunistic screening for lung cancer is commonly conducted in Korea in accordance with physician recommendations and screenee's preferences. However, studies have yet to thoroughly examine the public's understanding of the risks posed by lung cancer screening. This study was conducted to assess changes in intentions to undergo lung cancer screening in response to being informed about exposure to radiation during low-dose computed tomography (LDCT) tests and to identify factors with the greatest influence thereon among Korean men. We conducted sub-group interviews among men chosen from the 2013 Korea National Cancer Screening Survey (KNCSS), a nationwide, population-based, cross-sectional survey of men aged 40 to 74 years and women aged 30 to 74 years. From 4100 participants in the KNCSS, 414 men who underwent any cancer screening test within the last 2 years were randomly selected for inclusion in this study. Via face-to-face interviews, their intentions to undergo lung cancer screening were assessed before and after being informed about exposure to radiation during LDCT testing. Of the 414 participants, 50% were current smokers. After receiving information on the benefits of the test, 95.1% stated an intention to undergo screening; this decreased to 81.6% after they received information on the harms of the test. The average decrease in intention rate was 35.3%. Smoking status, household income, and education level were not associated with lowered intentions to undergo lung cancer screening. Participants who were older than 60 years old (OR=0.56; 95% CI= 0.33-0.96) and those with less concern for radiation exposure (OR=0.56; 95% CI=0.36-0.89) were less likely to lower their screening intentions. The results of this study suggest that there is a need to educate both non-smokers and former smokers on the harms of lung cancer screening.

Beliefs and Intentions to Undergo Lung Cancer Screening among Korean Males

Nhung Cam Bui,이윤영,서미나,박보영,조현순,김열,최귀선 대한암학회 2018 Cancer Research and Treatment Vol.50 No.4

Purpose Low-dose computed tomography (LDCT) has been reported as an effective screening method for lung cancer in high-risk populations. We aimed to examine willingness to be screened among Korean males using LDCT and to determine factors associated with lung cancer screening intentions (LCS) based on the Health Belief Model (HBM). Materials and Methods Data were obtained from the 2015 Korean National Cancer Screening Survey, a cross-sectional survey that utilized nationally representative random sampling. The survey included 1,730 male participants 40-74-year-old. Respondents were questioned regarding their willingness to undergo LCS and components of HBM. Factors associated with intentions to undergo screening were explored using logistic regression. Results Among participants, 65.2% were current smokers. Among high-risk subjects, 60.6% of men reported intentions to undergo LCS, compared to 49.9% of average-risk males. Men with higher perceived susceptibility in the average- and high-risk groups were, respectively, 1.63 (95% confidence interval [CI], 1.39 to 1.91) and 2.30 (95% CI, 1.14 to 4.63) times more likely to intend to undergo LCS compared to those with lower perceived barriers. Also, men in the average- and high-risk groups with higher perceived barriers to screening were, respectively, 0.79 (95% CI, 0.68 to 0.91) and 0.52 (95% CI, 0.29 to 0.92) times less likely to intend to undergo LCS compared to those with lower perceived barriers. Conclusion Tailored interventions designed to promote accurate perceptions of susceptibility and risk, as well as to reduce perceived barriers to screening, may effectively increase adherence to recommendations for LCS among high-risk Korean men.

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 Su,Boyoung Park,Jae Kwan Jun,Kui Son Choi 한국역학회 2017 Epidemiology and Health Vol.39 No.-

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.