Cost-Effectiveness of Korea’s National Cervical Cancer Screening Program

Background: Cervical cancer, which is common in developing countries, is also a major health issue inKorea. Our aim was to evaluate the cost-effectiveness of Korea’s National Cancer Screening Program (NCSP),implemented in 1999. Materials and Methods: The target population was Korean women 30 years or over whowere invited to take part in the NCSP in 2002–2007. By merging NCSP records with Korean Central CancerRegistry data, patients diagnosed with cervical cancer who had been screened were assigned to a “screened group,”while patients diagnosed elsewhere were assigned to a “non-screened group.” Clinical outcomes were measuredin terms of life-years saved (LYS), derived from 5-year mortality rates supplied by the Korean National HealthInsurance Corporation and National Statistical Office. Direct and travel costs associated with screening wereevaluated from the perspective of the payer, the NCSP. Results: A diagnosis via screening was associated with 2.30LYS, and the incremental cost-effectiveness ratio (ICER) estimate for screening was 7,581,679 KW/LYS (6,727USD/LYS). ICER estimates were lower for older patients (≥ 50 years) than younger patients (4,047,033 KW/LYS vs 5,680,793 KW/LYS). The proportion of early-stage cancers detected was 16.3% higher in the screenedgroup. Conclusions: In light of Korea’s per capita gross domestic product (32,272 USD in 2012), the currentNCSP’s incremental cost per LYS appears acceptable.     

Children’s Exposure to Secondhand Smoke at Home in Seoul,Korea

There is little information about Korean children’s secondhand smoke (SHS) exposure at home. This paperexamines the extent and determinants of their SHS exposure at home. A population-based random digit dialtelephone survey was conducted in 2002 with 500 adults in Seoul. We analyzed data for 207 adults with childrenliving in the household. Thirty-one percent of respondents reported children’s SHS exposure at home. Themean weekly dose was 5 cigarettes among exposed children. Multiple logistic regression results showed thatchildren’s odds of SHS exposure at home increased if the respondent or spouse smoked, if the respondent’sparent smoked, if smoking was allowed in the home, and if fewer groups discouraged smoking. Stronger protectivemeasures are urged, such as widespread increase in home smoking bans and discouragement of smoking.     

Development of a Protein Biomarker Panel to Detect Non–Small-Cell Lung Cancer in Korea

Background

Lung cancer screening using low-dose computed tomography reduces lung cancer mortality. However, the high false-positive rate, cost, and potential harms highlight the need for complementary biomarkers. We compared the diagnostic performance of modified aptamer-based protein biomarkers with Cyfra 21-1.

Liver Cancer Screening in Korea: A Report on the 2008 National Cancer Screening Programme

Background: The Korean National Cancer Screening Programme (NCSP) for liver cancer was initiatedin 2003. The objective of this study was to evaluate participation in the NCSP and provide essential evidenceassociated with the screening of Korean adults at high risk for liver cancer. Methods: Liver cancer screeningwas conducted in two stages. During the first, the fraction of the population at high risk for liver cancer wasidentified through detection of the hepatitis B virus surface antigen (HBsAg) and hepatitis C virus antibodies(anti-HCV Ab). During the second stage, this high-risk population was kept under surveillance to detect livercancers as quickly as possible, and screening participation rates and recall rates were assessed. We estimated the95% confidence intervals (CIs) for all outcome measures. Results: In the first stage, 2.57% (95% CI, 2.47-2.67)of Medical Aid Programme (MAP) recipients tested positive for HBsAg and 3.70% (95% CI, 3.25-4.15) testedpositive for anti-HCV Ab. The total target population for liver cancer screening in 2008 included 433,822 adultsover 40 years of age. Of them, 141,381 (32.6%) participated in the NCSP for liver cancer. Participation rates were34.9% for National Health Insurance (NHI) recipients and 25.2% for MAP recipients. Among participants, 1,139individuals exhibited a positive screening result (recall rate = 0.81%). Conclusions: Our findings demonstratethe current status of liver cancer screening in Korea. They provide evidence for implementing an organised livercancer screening programme among high-risk groups.     

Long-term Survival of Cancer Patients in Korea, 1993-2007: National Cancer Registry Study

Although survival rates are very useful for monitoring the effects of early cancer detection and treatment,at present there are only limited population-based estimates of long-term survival rates in Korea. Furthermore,published data are only available for 5-year survival; 10-year survival rates have hitherto not been reported.We therefore analysed data from the Korean National Cancer Incidence Database between 1993 and 2007 andfollowed through into 2008 to estimate long-term survival rates and trends at 5 and 10 years after diagnosis ofall cancers combined. Further analysis was conducted on the 19 most common cancers in Korea. From 1993 to2007, the 10-year relative survival rates (RSRs) for all cancer types combined were 36.3% and 56.4% in Koreanmen and women, respectively. The 10-year RSRs for all cancers combined improved from 29.5% and 50.5%during 1993-1998 to 39.2% and 58.9% during 1999-2007 in Korean men and women, respectively. From 1993to 2007, the 5-year and 10-year RSRs thus improved in both sexes for the most common cancers. In the 75 yearsand older group, increases of the 5-year and 10-year RSR for all combined, and for most of the major cancerswere lower than all other age groups. This study provides population-based estimates of long-term survivaland confirms improvements of long-term survivals for all cancer sites and for most of the major cancer sites.Improvements of survival for young patients are more significant than for older patients. The results may helpclinicians and patients assess long-term prognosis.     

The National Cancer Screening Program for Breast Cancerin the Republic of Korea: Is it Cost-Effective?

This goal of this research was to evaluate the cost-effectiveness of the National Cancer ScreeningProgram (NCSP) for breast cancer in the Republic of Korea from a government expenditure perspective. In2002-2003 (baseline), a total of 8,724,860 women aged 40 years or over were invited to attend breast cancerscreening by the NCSP. Those who attended were identified using the NCSP database, and women weredivided into two groups, women who attended screening at baseline (screened group) and those who did not(non-screened group). Breast cancer diagnosis in both groups at baseline, and during 5-year follow-up wasidentified using the Korean Central Cancer Registry. The effectiveness of the NCSP for breast cancer wasestimated by comparing 5-year survival and life years saved (LYS) between the screened and the unscreenedgroups, measured using mortality data from the Korean National Health Insurance Corporation and theNational Health Statistical Office. Direct screening costs, indirect screening costs, and productivity costs wereconsidered in different combinations in the model. When all three of these costs were considered together,the incremental cost to save one life year of a breast cancer patient was 42,305,000 Korean Won (KW)(1 USD=1,088 KW) for the screened group compared to the non-screened group. In sensitivity analyses,reducing the false-positive rate of the screening program by half was the most cost-effective (incrementalcost-effectiveness ratio, ICER=30,110,852 KW/LYS) strategy. When the upper age limit for screening wasset at 70 years, it became more cost-effective (ICER=39,641,823 KW/LYS) than when no upper age limitwas set. The NCSP for breast cancer in Korea seems to be accepted as cost-effective as ICER estimates werearound the Gross Domestic Product. However, cost-effectiveness could be further improved by increasingthe sensitivity of breast cancer screening and by setting appropriate age limits.     

Do Long Term Cancer Survivors Have Better Health-Promoting Behavior than Non-Cancer Populations?: Case-Control Study in Korea

Background: We compared the health-promoting behavior of long-term cancer survivors with those ofthe general population to identify necessary behavioral interventions to reduce the health risk among cancerpatients. Materials and Methods: We used data from the 2007 and 2012 Korea National Health and NutritionExamination Surveys (KNHANES IV [2007~2009] and KNHANES V [2010~2012]) on smoking status, alcohol use,physical exercise, and disease screening. We compared long-term cancer survivors with members of the generalpopulation; the controls were matched by propensity score matching. A multiple logistic regression model wasused to investigate the association between cancer status and health-promoting behavior. Results: Long-termcancer survivors had a lower risk of smoking than the general population controls (OR: 0.42, 95%CI: 0.25-0.71).In addition, the long-term cancer survivors had a lower risk of alcohol use than the general population controls(OR: 0.70, 95%CI: 0.50-0.98). However, in terms of physical exercise and disease screening, no statisticallysignificant differences were detected (physical exercise OR: 1.01, 95%CI: 0.75-1.35; disease screening OR: 1.27,95%CI: 0.93-1.74). All covariates were adjusted. Conclusions: The long-term cancer survivors had a much lowerrisk of smoking and alcohol use than the general population controls. However, almost no differences in physicalexercise and screening for cancer recurrence or secondary disease were detected between the long-term cancersurvivors and general population controls. To reduce the health risks and challenges facing long-term cancersurvivors, interventions to encourage physical exercise and screening for cancer recurrence and secondarydisease should be implemented.     

Long-term Trends in Cancer Mortality in Korea (1983-2007): A Joinpoint Regression Analysis

Cancer has been the most common cause of death in Korea since 1983 and is a major public concern. Theaim of this study was to analyze the secular trend of cancer mortality in Korea from 1983 to 2007. Mortality andpopulation data from 1983 to 2007 were obtained from the Korea Statistical Office. The annual cancer deathrates for 18 age groups were estimated, and joinpoint regression was applied to detect significant changes incancer mortality. The age-standardized mortality rate for all sites combined increased until the mid-1990s andhas been decreasing thereafter, this also being the case for cancers of the esophagus, liver, lung and bladder, aswell as leukemia. With stomach and uterine cancers a constant reduction was evident throughout the period.The declines in stomach, liver, and uterine cancer mortality have made major contributions to the recent overallfavorable trend. Mortality for cancers of the colon and rectum and the prostate increased in the early 2000s andthen leveled off, whereas female breast cancer mortality has displayed a constant increasing trend. In conclusion,overall cancer mortality is decreasing in men and women in Korea, and this trend will probably continue andimprove further in line with advances in management as well as the expected impact of the national screeningprogram for major five cancers over the next decades.     

The National “Smoking Cessation Clinics” Program in the Republic of Korea: Socioeconomic Status and Age Matter

Background: Between 1998-2009 South Korea experienced significant progress in reducing the male smokingrate from 66.3% to 46.9%. As part of a significant government effort in the area of smoking cessation intervention,the Korean government implemented the national “Smoking Cessation Clinics (SCC)” program in 2004. Materialsand Methods: Data covered 804,334 adult male smokers participating in SCC program at 253 public healthcenters between 2006-2009. We examined participant cessation rates with the SCC program, their characteristicsand program intervention components using health insurance status as a socioeconomic status (SES) indicator.Multivariate logistic regression analyses were performed correcting for intra-class correlations within publichealth centers. Results: The overall 6-month quit rate was high (46.8%). Higher odds of smoking cessation werepositively associated with higher levels of behavioral counseling sessions, but not nicotine replacement therapy(NRT). Cessation rates were lower for Medicaid participants than for regular health insurance participants.Disadvantaged younger smokers were less likely to participate in the program. Older smokers were more likelyto quit regardless of SES. Stress was cited as major reason for failure. Conclusions: SES inequalities acrossdifferent age groups exist in smoking cessation among Korean adult male smokers. There is a need for interventionprograms specifically targeting sub-populations of SES by different age groups.     

A Comparison of the Cancer Incidence Rates between the National Cancer Registry and Insurance Claims Data in Korea

Although much health services research has been conducted using national health insurance claimsdata in Korea, the validity of this method has not been ascertained. The objective of this study was tovalidate the use of claims data for health services research by comparing incidence rate of cancers foundusing insurance claims data against rates of the national cancer registry of Korea. An algorithm to estimateincidence rates using claims data was developed and applied. The claims data from 2005-2008 were acquiredand the patients admitted to hospitals due to cancer in 2008 without admission to hospital from 2005-2007 by the same diagnosis code were regarded as incident cases. The acquired results were comparedwith the values from the National Cancer Registry of Korea. The incidence rate of all cancers found usingclaims data was 363.1 per 100,000 people, which is very similar to the 361.9 per 100,000 rate of the nationalcancer registry. Also the age-, gender- and disease-specific rates between the two data sources were similar.Therefore, national health insurance claims data may be a worthwhile resource for health services researchif appropriate algorithms are applied, especially considering the cost effectiveness of this method.     

Epstein�CBarr virus antibody level and gastric cancer risk in Korea: a nested case�Ccontrol study

Background:

Few cohort studies have investigated Epstein–Barr virus (EBV) infection before the occurrence of gastric cancer.

Methods:

Among 14 440 cohort participants, 100 incident gastric cancer cases were individually matched to two controls. Epstein–Barr virus antibodies IgG and IgA against viral capsid antigen (VCA), EBV nuclear antigen (EBNA) antibody IgG, and early antigen (EA) antibody IgG were measured using enzyme immunoassays (EIAs).

Results:

The highest titres of VCA IgG (odds ratio (OR): 1.37, 95% confidence interval (CI): 0.62–3.06) or EBNA IgG (OR: 0.87, 95% CI: 0.51–1.46) were not associated with gastric cancer risk.

Conclusion:

Higher levels of VCA IgG or EBNA IgG were not associated with increased risk of gastric adenocarcinoma in Koreans.     

Pre- and post-ESD discrepancies in clinicopathologic criteria in early gastric cancer: the NECA–Korea ESD for Early Gastric Cancer Prospective Study (N-Keep)

Background

Discrepancies in the clinicopathologic parameters pre- and post-endoscopic submucosal dissection (ESD) sometimes necessitate additional surgical resection. The aim of this study was to assess such discrepancies in clinicopathologic parameters before and after ESD in the context of reducing the risk of failure of curative ESD.

Methods

Data on 712 early gastric cancer patients were prospectively collected from 12 university hospitals nationwide. The inclusion criteria were differentiated carcinoma <3 cm in size, no ulceration, submucosal invasion <500 μm, and no metastasis. Clinicopathologic factors were compared retrospectively.

Results

The discrepancy rate was 20.1 % (148/737) and the most common cause of discrepancy was tumor size (64 cases, 8.7 %). Ulceration, undifferentiated histology, and SM2 invasion were found in 34 (4.6 %), 18 (2.4 %), and 51 cases (6.9 %), respectively. Lymphovascular invasion (LVI) was observed in 34 cases (4.6 %). Cases with lesions exceeding 3 cm in size showed more frequent submucosal invasion, an elevated gross morphology, and upper and middle locations (p < 0.05). In the cases with ulceration, depth of invasion (DOI) was deeper than in the cases without ulceration (p = 0.005). Differentiation was correlated with DOI and LVI (p = 0.021 and 0.007). DOI was correlated with tumor size, ulceration, differentiation, LVI, gross type, and location. There were statistically significant differences between mucosal cancer cases and submucosal cancer cases in tumor size, differentiation, ulceration, LVI, and location.

Conclusions

The overall discrepancy rate was 20.1 %. To reduce this rate, it is necessary to evaluate the DOI very cautiously, because it is correlated with other parameters. In particular, careful checking for SM-invasive cancer is required due to the high incidence of LVI irrespective of the depth of submucosal invasion.

     

Who participates in the gastric cancer screening and on‐time rescreening in the National Cancer Screening Program? A population‐based study in Korea

Gastric cancer (GC) screening is a major challenge in countries where the disease is highly prevalent. This study was conducted to identify the factors associated with participation in GC screening and on-time rescreening among the average-risk population in Korea. The study population was derived from the National Cancer Screening Program database. The population for this study was 22 913 618 individuals aged ≥40 years who had been invited to participate in a GC screening program from 2005 to 2006. We determined whether these individuals had attended the GC screening program and which method - an upper gastrointestinal series (UGIS) or endoscopy-they underwent. We followed the participants to determine whether they had a second GC screening after 2 years. The overall participation rate in the GC screening was 20.5%. More people underwent UGIS than endoscopy. Individuals who had been screened by endoscopy rather than UGIS were more likely to be younger, male, or those who were National Health Insurance (NHI) beneficiaries with a higher premium rate. Of those who underwent baseline screening, 59.4% participated in a rescreening program 2 years later. NHI beneficiaries with a higher premium rate were significantly more likely to be rescreened than medical aid recipients. The results from this study showed that the UGIS were more commonly used in organized GC screenings in Korea, and those who underwent UGIS were more likely to return for subsequent screening compared to those who underwent an endoscopy.     

Alcohol consumption and mortality from all-cause and cancers among 1.34 million Koreans: the results from the Korea national health insurance corporation’s health examinee cohort in 2000

Background  

The relationship between alcohol and cancer death has not been well established in Asian population, particularly among women.     

Prevalence,treatment patterns,and prognosis of low estrogen receptor-positive (1% to 10%) breast cancer: a single institution’s experience in Korea

Purpose

To determine prevalence, clinicopathological characteristics, initial treatments, and outcomes associated with low estrogen receptor (ER)-expressing invasive breast cancer.

Methods

This retrospective, non-interventional database study included patients undergoing surgery with curative intent for invasive ductal or lobular breast cancer. Patients were treated between January 2003–December 2012. Demographics, clinicopathological characteristics, initial treatments, and outcomes were abstracted from patient records. Patients were categorized using immunohistochemistry to determine ER, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) levels. ER-positive patients were subclassified as ER-low (1% to 10%) and ER-high (>?10%) according to the Allred Proportion Score. Disease-free survival (DFS) and overall survival (OS) were estimated by the Kaplan–Meier method and compared among groups by log-rank test.

Results

5930 patients were included (median follow-up, 80.9 months). Of all patients included, 117 (2.0%) had ER-low tumors: 63 (53.8%) of whom had HER2? tumors and 54 (46.2%) HER2+ tumors. Five-year DFS and OS were highest in the ER-high/HER2? cohort (94.0% and 98.6%, respectively) and lowest in the triple-negative breast cancer (TNBC; 81.3% and 90.1%) and ER-low/HER2? (85.7% and 92.1%) cohorts. Menopausal status, elevated Ki-67, higher nuclear grade, higher tumor stage, presence of lymphovascular invasion, greater regional lymph node involvement, and larger tumor size were all potential prognostic factors for shorter DFS and OS.

Conclusion

Patients with ER-low/HER2? breast cancer had similar clinicopathological characteristics, treatments, and outcomes as patients with TNBC irrespective of disease setting. Further research is needed to understand predictive and prognostic factors associated with ER-low/HER2? disease.

     

Clinicopathologic features of gastric cancer with synchronous and metachronous colorectal cancer in Korea: are microsatellite instability and p53 overexpression useful markers for predicting colorectal cancer in gastric cancer patients?

Background

A large-scale study was performed to identify the risk factors for developing synchronous and metachronous colorectal cancer (CRC) in gastric cancer (GC) patients, including microsatellite instability (MSI) and p53 overexpression.

Methods

A total of 1041 GC patients who underwent endoscopic resection or surgery and underwent colonoscopy simultaneously or during surveillance for GC were consecutively enrolled. Clinicopathologic characteristics, MSI, and p53 overexpression were compared between the GC patients with and those without synchronous and metachronous CRC.

Results

Of the 1041 patients, CRCs were detected in 67 (6.4 %) patients with GC. Forty-six (4.4 %) had synchronous CRC and 21 (2.0 %) had metachronous CRC. Univariate analysis indicated that age ≥63 years (P < 0.001), male sex (P = 0.005), and p53 overexpression (P = 0.040) were significantly associated with a higher incidence of CRC. However, body mass index, smoking, tumor location, tumor multiplicity, tumor histology, TNM stage, and MSI were not significantly associated with the incidence of CRC. Age ≥63 years (OR: 5.881; 95 % CI: 3.083–11.221; P < 0.001) and male sex (OR: 2.933; 95 % CI: 1.307–6.584; P = 0.009) were risk factors for CRC in GC patients according to multivariate analysis.

Conclusions

GC patients who are male and/or ≥63 years old are recommended to receive colonoscopy to detect CRC. MSI and p53 overexpression were not useful molecular markers for predicting CRC in GC.