Kui Son Choi

Socioeconomic factors affecting breast and cervical cancer screening compliance in Asian National Cancer Centers Alliance countries: a systematic review

Breast and cervical cancers are the most frequently diagnosed cancers in women. The Asian National Cancer Centers Alliance (ANCCA) has strengthened cancer control efforts in the Asia region; however, only a few countries have achieved sufficient participation rates. This systematic review aimed to synthesize the existing evidence on socioeconomic factors influencing women’s compliance with breast and cervical cancer screening in ANCCA countries. This study was conducted as a systematic review, with studies collected from PubMed, Cochrane Library, Scopus, and Embase. All included studies employed cross-sectional designs to identify socioeconomic factors affecting compliance with breast or cervical cancer screening. Study selection, quality assessment, and data extraction were carried out by 2 independent reviewers with cross-checking. In total, 48 studies were reviewed. Education level and family history were associated with participation in breast cancer screening, while education level, household income, marital status, and medical insurance were linked with cervical cancer screening. When stratified by Human Development Index (HDI) level or by the presence of a National Cancer Screening Program, differences were observed in the factors influencing screening compliance. Nevertheless, higher education consistently correlated with higher screening rates for both cancer types, regardless of HDI level. This systematic review identified multiple socioeconomic factors that shape breast and cervical cancer screening compliance in Asian countries. To reduce disparities in participation, tailored multi-strategy approaches adapted to each country’s specific context are required. These findings may provide useful evidence for future research and policy initiatives aimed at addressing health equity issues.

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

We aimed to determine the differences in stage at diagnosis of cervical cancer among Korean women according to screening history. 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. 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). 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.

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

This study sought to examine changes in trends for quality indicators of the population-based Korean National Cancer Screening Program (KNCSP) for cervical cancer from years 2005 to 2013. Our study data were derived from the KNCSP database. Cervical cancer diagnosis information was ascertained through linkage with the Korean National Cancer Registry and the 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 was applied to calculate annual percentage changes (APCs) in all indicators according to socio-demographic factors. 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 2009 and remained stable till 2013. An increasing trend was discovered in CDRs for cervical cancer in situ (APC=3.9%; 95% CI=1.0, 6.9), whereas a decreasing trend was observed in ICRs for invasive cervical cancer (APC=-2.5%; 95% CI=-4.5, -0.5). Medical Aid recipients and women older than 70 years showed the lowest participation rates, but higher CDRs and ICRs, compared to other groups. In general, most of the quality indicators for cervical cancer screening improved from 2005 to 2009 and remained stable to 2013. The KNCSP for cervical cancer in Korea has improved in terms of participation rate and accuracy of the screening test. These results may be attributed to the National Quality Improvement Program for KNCSP.

Knowledge of Cervical Cancer and Human Papillomavirus Vaccines among Child-Bearing Aged Women in Hanoi, Vietnam

The study sought to examine knowledge of cervical cancer and human papillomavirus (HPV) vaccines among child-bearing aged women in Hanoi, Vietnam. In 2016, 807 women aged 18 to 49 years were recruited from one urban area and one rural area in 2016 and were examined through face-to-face paper-based interviews. Pearson's chi-square test and an independent t-test were utilized to compare awareness of cervical cancer and HPV vaccination among women according residential status. Overall, 83.8% and 71.3% women had heard about cervical cancer and HPV vaccination, respectively. Mean knowledge scores for cervical cancer and HPV vaccination were 4.60±1.43 out of 7 and 1.53±1.35 out of 5, respectively. Women living in an urban area were more likely to be aware of cervical cancer and to be more knowledgeable of HPV vaccination than women in a rural area. Despite strong awareness, we found knowledge on cervical cancer and HPV vaccination to be alarmingly insufficient among Vietnamese women..

Effect of Pap smears on the long-term survival of cervical cancer patients: a nationwide population-based cohort study in Korea

OBJECTIVES: This study aimed to investigate the effect of cervical cancer screening by Papanicolaou (Pap) smears on the long-term survival of cervical cancer patients.METHODS: We constructed a retrospective cohort of 14,903 women diagnosed with invasive cancer or carcinoma in situ in 2008 and 2009 and followed up until December 31, 2019, by using individual-level data from 3 national databases of the Korean National Cancer Screening Program, the Korean Central Cancer Registry, and death certificates. Cox proportional-hazards regression was used to investigate the effect of cervical cancer screening on mortality.RESULTS: In total, 12,987 out of 14,867 patients (87.4%) were alive at the end of the follow-up period (median: 10.5 years). Screened patients had a 38% lower risk of cervical cancer death than never-screened patients (hazard ratio [HR], 0.62; 95% confidence interval [CI], 0.54 to 0.70). Screening was associated with 59% and 35% lower risks of death, respectively, in screened patients with localized and regional stages. Furthermore, lower HRs among women who received screening were observed in all age groups, especially women aged 50–59 years (HR, 0.54; 95% CI, 0.42 to 0.69). The lowest HR for cervical cancer death was reported among patients screened within the past 2 years (HR, 0.54; 95% CI, 0.47 to 0.63), and the HRs increased with increasing time intervals.CONCLUSIONS: Pap smear screening significantly reduced the risk of cervical cancer-specific death in Korean women across all cancer stages.

Changes in cancer screening before and during COVID‐19: findings from the Korean National Cancer Screening Survey 2019 and 2020

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has negatively affected every aspect of medical care. However, information regarding the impact of the pandemic on cancer screening is lacking. This study aimed to explore cancer screening changes by geographic region before and during the pandemic in Korea.METHODS: Korean National Cancer Screening Survey data for 2019 and 2020 were used. Changes in the screening rate before and during the COVID-19 pandemic were calculated by subtracting the rate in 2020 from the rate in 2019. Multivariate logistic regression analyses examined the differences in screening rates at the national and 16 provincial levels before and after the COVID-19 outbreak.RESULTS: The 1-year screening rates for the four types of cancer decreased during the pandemic (stomach cancer: -5.1, colorectal cancer: -3.8, breast cancer: -2.5, cervical cancer: -1.5%p). In metropolitan areas, the odds of undergoing screening tests during the pandemic were significantly lower than before the pandemic for stomach (adjusted odds ratio [aOR], 0.66; 95% confidence interval [CI], 0.56 to 0.76), colorectal (aOR, 0.63; 95% CI, 0.50 to 0.79), and breast cancers (aOR, 0.75; 95% CI, 0.60 to 0.94). Furthermore, the likelihood of undergoing stomach cancer screening during the pandemic was significantly lower than before the pandemic in non-metropolitan urban areas (aOR, 0.81; 95% CI, 0.70 to 0.94), while it was higher in rural areas (aOR, 1.54; 95% CI, 1.10 to 2.16).CONCLUSIONS: Since the COVID-19 pandemic, the cancer screening rate has decreased significantly, especially in large cities. Public health efforts are required to improve cancer screening rates.

Trends in cervical cancer screening rates among Korean women: results of the Korean National Cancer Screening Survey, 2005–2020

This study aimed to analyze the trends in cervical cancer screening rates, including organized and opportunistic cancer screening rates, with the Papanicolaou test among Korean women. Data were collected from a nationwide, cross-sectional, Korean National Cancer Screening Survey. To evaluate the cervical cancer screening rates, we used the screening approach of " The cervical cancer screening rate was 56.0% in 2020. From 2005 to 2013, there was a rising trend in cervical cancer screening rates (APC=2.70%, 95% confidence interval [CI]:1.05 to 4.38), followed by a falling trend (APC=-2.67%, 95% CI:-4.3 to -1.01). The falling trend was significantly associated with age (≥40 years), education level (below the 15th grade), household income (below the middle-income level), and residence (all residential areas). The recent falling trend was more common in women with a low socioeconomic status, which suggests that there is a socioeconomic gap in cervical cancer screening. Moreover, young women in their thirties had a low screening rate. Therefore, an active participation strategy for women vulnerable to cervical cancer is required.

Parental intention to vaccinate daughters with the human papillomavirus vaccine in Korea: a nationwide cross-sectional survey

OBJECTIVES: We aimed to identify and compare the characteristics and factors associated with parental intention to vaccinate daughters under 12 years old against human papillomavirus (HPV), examining data from 2016 and 2020.METHODS: Data were obtained from the Korean National Cancer Screening Survey conducted in 2016 and 2020. The present study included 3,510 parents with daughters under 12 years old. Changes in parental intention-to-vaccinate rates were calculated. To identify factors associated with parental intention to vaccinate their daughters, the chi-square test and logistic regression analysis were used.RESULTS: The percentage of respondents intending to vaccinate their daughters increased from 33.4% in 2016 to 58.9% in 2020, constituting a 25.5 percentage point (%p) increase. Since 2016, the proportion of men expressing positive intention towards HPV vaccination increased by 31.5%p, while that of women demonstrated a 20.9%p increase. Logistic regression analysis indicated that parents with a strong intention to vaccinate their daughters tended to be younger, more educated, and aware of the free vaccination program available, as well as to have a history of HPV vaccination and to have undergone cervical cancer screening within 2 years, compared to those who did not intend to vaccinate. Being a mother with a history of HPV vaccination was the strongest predictor of positive intention to vaccinate a daughter.CONCLUSIONS: The intention among parents to vaccinate daughters remains relatively low, although it is rising. To increase the HPV vaccination rate, strong recommendations and education should be provided to parents and the younger generation.