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

Abstract

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. (Cancer Sci 2011; 102: 2241-2247 G astric cancer (GC) is the fourth most common cancer behind lung cancer, breast cancer, and colorectal cancer, and in 2008 was the second most common cause of cancer deaths worldwide. (1) In Korea, GC is the most frequent type of cancer. (2,3) In countries where GC is highly prevalent, GC screening is offered to the average-risk population to reduce the disease burden. (4) Gastric cancer screening has shown improvements in survival rates as a result of early detection and consequently higher cure rates. (5) Therefore, many Asian countries with a high burden of GC have considered implementing GC screening for the general population. (6) Since 1960, Japan has implemented photofluorography (via an indirect upper gastrointestinal series [UGIS]) screening programs to detect GC in its early stages and prevent GC deaths. (6) The cohort studies conducted in Japan showed a significant GC mortality reduction with photofluorography screening. (5,7) In recent years, endoscopy has replaced photofluorography as the initial mass screening method in several cities in Japan. (8,9) This technique is increasingly useful for GC screening because of its high detection rate. In a study conducted in Niigata, Japan, the detection of GC by endoscopy was 2.7-4.6 times higher than that by direct or indirect UGIS. (10)(11)(12) Recently, Hosokawa et al. (13) reported an approximately 65% reduction in the GC death rate for participants screened with endoscopy. Despite this promising result, direct evidence for t...

Effectiveness of Interventions to Increase the Participation Rate of Gastric Cancer Screening in the Republic of Korea: a Pilot study

“…This study showed that ever-screened subjects had a higher participation rate in gastric cancer screening than never-screened subjects. This is in agreement with a previous study showing that, generally, individuals with a previous screening experience were more likely to be rescreened (Hahm et al, 2011).…”

“…According to the Annual Report of the NCSP, the participation rate of gastric cancer screening was only 29.1% in 2008 . Furthermore, among those who did undergo gastric cancer screening, only 59.4% participated in on-time subsequent screening (Hahm et al, 2011). Relatively little is known about the factors associated with participation in gastric cancer screening, and very few published studies have examined how to improve the participation rate of the NCSP for gastric cancer.…”

Cost-effectiveness Outcomes of the National Gastric Cancer Screening Program in South Korea

“…Although endoscopy was a preferred method for gastric cancer screening by the majority of population in Korea from survey in 2008 and 2010, people who had undergone UGI screening were likely to prefer UGI while people with an endoscopy screening within the previous 2 years preferred endoscopy for the following screening method Hahm et al, 2011;. Dissatisfaction in endoscopy screening participants was related to insufficient explanation from the staff and the physical environment .…”

Factors Associated with the Use of Gastric Cancer Screening Services in Korea: The Fourth Korea National Health and Nutrition Examination Survey 2008 (KNHANES IV)

“…To increase the participation rate and improve the survival of gastric cancer patients, identification and removal of potential barriers to cancer screening participation are likely of great importance. Recent reports have highlighted the factors associated with cancer screening participation in Korea, but results were inconsistent (Bae et al, 2008;Kwon et al, 2009;Kye et al, 2010;Hahm et al, 2011).…”