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Objective To investigate whether screening for thyroid cancer led to the current “epidemic” in South Korea.Design Review of the medical records of nationally representative samples of patients with a diagnosis of thyroid cancer in 1999, 2005, and 2008.Setting Sample cases were randomly selected from South Korea’s nationwide cancer registry, using a systematic sampling method after stratification by region.Participants 5796 patients with thyroid cancer were included (891 in 1999, 2355 in 2005, and 2550 in 2008).Main outcome measures The primary outcome was age standardised incidence of thyroid cancer and the changes in incidence between 1999 and 2008 according to the methods used to detect tumours (screen detection versus clinical detection versus unspecified).Results Between 1999 and 2008, the incidence of thyroid cancer increased 6.4-fold (95% confidence interval 4.9-fold to 8.4-fold), from 6.4 (95% confidence interval 6.2 to 6.6) per 100 000 population to 40.7 (40.2 to 41.2) per 100 000 population. Of the increase, 94.4% (34.4 per 100 000 population) were for tumours less than 20 mm, which were detected mainly by screening. 97.1% of the total increase was localised and regional tumours according to the Surveillance, Epidemiology, and End Results (SEER) summary stage. Where cases were clinically detected, 99.9% of the increased incidences (6.4 per 100 000 population) over the same period were tumours less than 20 mm.Conclusion The current “epidemic” of thyroid cancer in South Korea is due to an increase in the detection of small tumours, most likely as a result of overdetection. Concerted efforts are needed at a national level to reduce unnecessary thyroid ultrasound examinations in the asymptomatic general population.

PurposeAims to investigate the structural relationships between out‐patient satisfaction and service quality dimensions under a South Korea health care system where patients have substantial freedom in choosing their medical service providers and to further study the causal relationship between service quality and satisfaction between out‐patient subgroups obtained on the basis of gender, age and types of services received.Design/methodology/approachAfter assessing the construct validity of the service quality dimensions based on confirmatory factor analysis, a path model specifying the relationships between service quality dimensions and patient satisfaction was estimated. The next analysis was a series of multi‐sample analyses. A multigroup LISREL analysis was used to test the invariance of structural paths between service quality dimensions and patient satisfaction.FindingsResults indicated that the general causal relationship between service quality and patient satisfaction was well supported in the South Korean health‐care delivery system. An examination of the estimated path coefficients showed that the pattern of relationships between service quality and patient satisfaction was similar across the gender, age, and service type subgroups. Results also revealed that the level of satisfaction, on the other hand, was not the same for subgroups when divided by age and the types of services received.Originality/valueSince the majority of the past studies have been geographically concentrated in the countries in North America and Western Europe, the findings of this study expand understanding of the relationships between service quality and patient satisfaction.

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