Open Access, Peer-reviewed
pISSN 2005-0380   eISSN 2005-0399
    J Gynecol Oncol. 2024 Mar;35(2):e18. English.
    Published online Oct 16, 2023.
    https://doi.org/10.3802/jgo.2024.35.e18
    © 2024. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology
    Original Article

    Regularity of cervical cancer screening in Korea: analysis using national public data for 12 years

    Jong-Yeup Kim,1,* Jeeyoung Hong,1,* Juhee Yoon,2 Jinsol Park,2 and Tae-Hyun Kim2
      • 1Department of Biomedical Informatics, Konyang University College of Medicine, Daejeon, Korea.
      • 2Department of Obstetrics and Gynecology, Konyang University College of Medicine, Daejeon, Korea.
    • Correspondence to Tae-Hyun Kim. Department of Obstetrics and Gynecology, Konyang University Hospital, Konyang University College of Medicine, 158 Gwanjeodong-ro, Seo-gu, Daejeon 35365, Korea. Email: th2580@konyang.ac.kr

      *Jong-Yeup Kim and Jeeyoung Hong contributed equally to this study.
    Received May 08, 2023; Revised September 04, 2023; Accepted October 03, 2023.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Objective

    To assess the frequency of regular uptake of national cervical cancer screening (CCS) program and identify associated factors among Korean women.

    Methods

    This study is a fundamental investigation that employs openly accessible public data of Korea through secondary data analysis. A cohort of 4,663 women from the 2007–2012 Korean National Health and Nutrition Examination Survey, was followed up for up to 12 years (2007–2018) to obtain the frequency of national CCS. Compliance level with CCS was categorized, and an ordinal logistic regression model was employed to investigate the contributing factors.

    Results

    The regular uptake of CCS in South Korea was low at 18.9%. The trend of regular screening showed significant association with various factors, including age (40–59 years), household income (100%–150% bracket), occupation (service workers), place of residence (small to medium sized cities), education level (middle school graduates), marital status (married), and possession of private insurance. Moreover, individuals with a history of non-cervical cancer or carcinoma in situ of the cervix, a family history of cervical cancer, or a higher frequency of general check-ups demonstrated a stronger adherence to regular CCS uptake.

    Conclusion

    Our findings revealed that regular participation in CCS in Korea was lower than anticipated, with factors such as socioeconomic status, personal history of gynecologic issue, and frequency of general health check-ups playing influential roles. However, further research, including an exploration of unexamined psychological barriers to screening, is necessary to gain a better understanding the reasons behind the reduced rates of regular CCS among Korean women.

    Synopsis

    The screening pattern for cervical cancer in South Korea was predominantly irregular, with only 18.9% of participants exhibiting regular compliance with screening. Our study identified several factors associated with regular screening, including a personal history of non-cervical cancer, a history of carcinoma in situ, a family history of cervical cancer, and a higher frequency of general checkups.

    Graphical Abstract

    Keywords
    Cervical Cancer; Cancer Screening; Secondary Prevention; Follow Up Studies

    INTRODUCTION

    Cervical cancer of the uterus was the fifth most prevalent cancer among Korean women in 2020, with 2,998 new cases accounting for 2.5% of all female incident cancers [1]. The widespread implementation of cervical cancer screening (CCS) has played a significant role in improving incidence, mortality, and survival of cervical cancer over the past few decades in Korea. The incidence and mortality rates of cervical cancer in Korean women decreased from 8.6% to 4.0% and 1.4% to 0.9%, respectively, between 1999 and 2019 [2]. The 5-year survival rate for cervical cancer has shown only minor improvements, with a slight increase from 78% in 1993–1995 to 80.5% in 2015–2019 [2]. However, the 5-year survival rate was 94.6% for early-stage cervical cancer with localized lesions, compared to 27.8% for advanced cervical cancer with distant metastases [2]. Therefore, screening and treating precancerous lesions or early-stage cervical cancer can significantly improve the prognosis and reduce mortality from cervical cancer [3].

    The CCS for women aged ≥30 years in South Korean was introduced in 1999 and was expanded to include women aged ≥20 years in 2016 with a recommended screening frequency of every two years, and no out-of-pocket costs [4]. The uptake rate of CCS has increased from 40.2% in 2010 to 53.3% in 2020 due to the expansion of screening programs in Korea [5]. However, the rate still lags behind developed countries such as the United States (US) (84.5%), Sweden (79.7%), the United Kingdom (UK) (78.1%), and France (73.6%) [6]. To improve the survival rate of patients with cervical cancer, it is necessary to increase the screening rate among Korean women to the level of developed countries. Furthermore, since cervical cancer typically progresses through a precancerous stage (carcinoma in situ [CIS] or dysplasia of the cervix) before it becomes malignant, regular and repeated screening is crucial for early diagnosis and reduction of mortality rate [7].

    Understanding the factors influencing the uptake of CCS is important to increase the screening rates and improve the prognosis of cervical cancer. Previous studies in Korea on CCS and its influencing factors have reported various socioeconomic factors with inclusion of age, income, education, region of residence, occupation, marital status, and family history of cervical cancer, as contributing to inequalities in the screening rate [8, 9, 10, 11, 12]. However, these studies were based on cross-sectional design using the Korean National Health and Nutrition Examination Survey (KNHANES) and the Korea National Cancer Screening Survey, which only captured the uptake of CCS at a single time point, making it difficult to obtain information on the regular uptake of CCS over a long-term period. Obtaining information on the prevalence of precancerous lesions in the cervix, which can be a key factor in determining the need for regular CCS, is challenging using cross-sectional survey data and requires medical care usage data from the Korean Health Insurance Review and Assessment Service (KHIRA) or individual medical records.

    In this study, therefore, we utilized individual-level linked and longitudinal data from the KHNANES, claim data of the KHIRA and CCS data table of the Korean National Health Insurance Service (KNHIS) (2007–2018) to investigate regularity of national CCS program and identify multiple potential factors that contribute to regular uptake of CCS.

    MATERIALS AND METHODS

    1. Data source and study population

    In 2019, the Korean National Evidence-based Healthcare Collaborating Agency (KNECA) established a project that links individual-level data from various sources including the Korean Disease Control Agency (KDCA), the KNHIS, the KHIRA, and the Korean National Cancer Center. Our study utilized 3 of these national healthcare linkage datasets; 1) KNHANES data from the KDCA, 2) information on the uptake of CCS and insurance from the KNHIS, and 3) claims data from the KHIRA. For the 50,404 participants of the 2007–2012 KNHANES [13], we requested various information from the KNHIS and the KHIRA. The KNECA selected patients with malignant cancer (KCD C00-C96) from the KHIRA database between 2007 and 2012 and matched each cancer patient by sex and age to 10 KNHANES participants without malignant cancer. All diseases, symptoms, and signs were coded according to the Korean Standard Classification of Diseases (KCD). Our research team provided with a total of 17,637 participants, consisting of a cancer group (n=1,603) and a non-cancer group (n=16,034). After applying exclusion criteria, such as excluding 1) males (n=9,523), 2) women under the age of 20 on the index date (January 1, 2007) (n=3,115), 3) women who died between 2007 and 2012 (n=140), and 4) women diagnosed with cervical cancer (KCD C53) between 2007 and 2012 (n=196), 4,663 women aged 20 years older were selected from the 17,637 participants in the KNHANES 2007–2012 as the study population for final analysis. The data linkage and study sample selection processes are depicted in Fig. 1.

    Fig. 1
    Data link process and sdtudy design.
    KHIRA, Korean Health Insurance Review Agency; KNHANES, Korean National Health and Nutrition Examination Survey; KNHIS, Korea National Health Insurance Service.

    2. Individual variables

    The KNHANES provided valuable socioeconomic data, such as household income, education, marital status, and private health insurance status, which were unavailable in the KNHIS and the KHIRA. The KNHIS contained critical information on the use of the public CCS service, as well as disability status and cervical cancer family history, and was used as an outcome variable. The KHIRA provided data on precancerous conditions of cervical cancer as a predictor. The detailed process of generating of predictors and outcomes from the linked KNHANES-KNHIS-KHIRA data is described in Table S1.

    The structured questionnaire of KNHANES included demographic information such as age, area of residence, and marital status. Age was categorized as 20–39 years, 40–59 years, and ≥60 years, with the index date being January 1, 2007. The study compared CCS adherence across three regions: metropolitan cities (Seoul, Busan, Daegu, Incheon, Gwangju, Daejeon, and Ulsan), small-to-medium cities, and rural areas. Marital status was classified as unmarried, divorced (including separated individuals), or married. Education levels were divided into primary school or less, middle school, high school, and college or university based on the International Standard Classification of Education [14]. To determine the household income level, the relative poverty line was used, which was defined as 50% of the median household income based on the annual data provided by the Korean Statistical Office [15]. The classification of household income was divided into five categories based on household size: below 50% (below the relative poverty line), 50% to less than 100%, 100% to less than 150%, 150% to less than 200%, and 200% or higher. The occupation types were recorded based on the Korean Standard Classification of Occupations [16] and were divided into manual workers (service workers; sales workers; skilled agricultural, forestry, and fishery workers; craft and related trade workers; equipment, machine operating, and assembly workers; and unskilled laborers), non-manual workers (managers, professionals, and clerks), and others (armed forces, homemakers, and students). Occupational classes were categorized into 6 types based on previous studies [17, 18, 19]: higher-level professionals and managers; lower-level professionals; office, sales, and service workers; manual workers; self-employed, entrepreneurs, and farmers; never worked; and others.

    To collect data on physical or mental disabilities, we referred to the Korean Disabled Persons Welfare Act [20], and obtained information from the KNHIS disability registry data. The National Health Insurance (NHI) system covers around 97% of the total Korean population, including both self-employed and employed individuals, while the remaining 3% is covered by the Korean Medicaid system. We categorized the type of public health insurance as Medicaid, self-employed NHI, and employed NHI based on eligibility and premiums data from the KNHIS. The presence of private health insurance was obtained from the KNHANES. We operationalized the experience of visiting local public health organizations as a visit to one or more of following four types of facilities: public health clinics, centers, units, and maternal and child health organizations [21]. We retrieved information on whether individuals had utilized services from local public health organizations since January 1, 2007, from claim data of the KHIRA. To ascertain the medical history of all types of cancer, except for cervical cancer, we used data from the self-reported cancer prevalence of the KNHANES, cancer screening data of the KNHIS, and the KCD list of the KHIRA. Family histories of cervical cancer were extracted from self-reported data of KNHIS cancer screening data table. We obtained data on medical conditions that may promote uptake of CCS from the KCD list of the KNHIRA data. These conditions included four variables (described in Table S2): CIS or dysplasia of female genital organs, benign neoplasm of female genital organs, infectious diseases of female genital organs, and pregnancy.

    3. Outcome variable

    The study used compliance level of CCS as the outcome variable, which was classified into three ordinal categories: none, irregular, and regular. Women who had undergone CCS were defined as those included in the CCS data table from the KNHIS. The follow-up period for censored cases began on January 1, 2007, and ended on December 31, 2018, while the follow-up period for date of death, and date of diagnosis of new cervical cancer ended on their respective dates. We tracked the CCS data during the follow-up period to determine whether participants born in odd-numbered years had undergone CCS in six odd years (2007, 2009, 2011, 2013, 2015, and 2017), and whether those born in even-numbered years had undergone CCS in six even years (2008, 2010, 2012, 2014, 2016, and 2018). We excluded participants from the KNHANES who died between 2007 and 2012, and therefore, at least three CCS assessments were conducted for each participant. In this study, all women were evaluated using a minimum of 3 to 6 Pap smears. Participants were classified as “none” if they had never had a Pap smear, “regular” if they had a Pap smear in all their screening cycles or missed one, and “irregular” for the remainder of the participants.

    4. Statistical analyses

    Statistical analyses were performed using R 4.0.0 software (R Foundation for Statistical Computing, Vienna, Austria). Statistical significance was set at p<0.05. All variables in this study were categorical. Categorical variables are presented as frequencies and percentages in Table 1. In the univariate analysis, we used the chi-squared test to examine differences in the distributions of the predictors among the three levels of CCS compliance (Table 2). Since the outcome variable of this study was ordinal in nature, we used ordinal logistic regression to estimate the adjusted effect on CCS compliance (Table 3).

    Table 1
    Distribution of independent variables by age group in study population

    Table 2
    Compliance level with cervical cancer screening between 2007–2018

    Table 3
    Likelihood of compliance with cervical cancer screening based on ordinal logistic regression

    5. Ethics statement

    The dada linkage protocol was approved by the Institutional Review Board (IRB) of the KNECA (IRB No. NECAIRB20-016-1), and the study protocol was approved by Konyang University’s IRB (IRB No. 2019-10-022). Informed consent was not obtained from the participants since personal information that could be used to identify individuals was removed, and the requirement for informed consent was waived by both IRBs.

    RESULTS

    Table 1 displays the distribution of independent variables by age group in study population. Specific socioeconomic factors, such as high household income, a higher occupational class, urban residence, advanced education level, and possession of private insurance, were predominant among those in their 20s (p<0.001). Conversely, the following variables were most prevalent among individuals aged over 60: low household income (51.2% of the poorest group), lower occupation class (63.9% of manual workers), rural residence (38.8%), limited education level (62.6% of elementary school graduates or less), separated or divorced marital status (66% without a spouse living together), eligibility for Medicaid (59.2%), lack of private health insurance (55.7%), disability (48.0%), and utilization of services through local public health organization (67.5%). A history of any cancer other than cervical cancer (40.5%), family history of cervical cancer (54.0%), benign tumors (43.4%), precancerous lesions (44.0%), and infectious disease (43.7%) of the female genital tract were most prevalent in the 40-59 age group. The frequency of general mass screening more than seven times was also common in the 40-59 age group (54.7%) and least common in the over 60s group (6.8%).

    Table 2 presents the distribution of CCS compliance level across independent variables, all of which were statistically significant (p<0.05) and included in the final ranked logistic regression analysis. Among the 4,663 participants, 1,828 (39.2%) were aged 20–39, 1,750 (37.5%) were aged 40–59, and 1,085 (23.2%) were aged ≥60. Participants aged ≥60 had the highest rate of no screening (no CCS in the past 10 years) at 38.2%. Regular screening (completion of most screenings) was most common among those aged 40–59 years (30.8%), while the lowest rate was observed in the 20–39 years age group (8.0%). Income level had a positive correlation with regular screening, but a slight decrease was observed among the richest 200% of the population (21.6% to >19.2%, p<0.001). Screening adherence based on occupation exhibited variations among different groups, although it did not consistently rise with higher occupational classes. Regarding education level and place of residence, regular screening was highest among middle school graduates (31.5%) and individuals living in small and medium cities (22.1%). However, there was a tendency for these rates to decline with higher education levels and residence in larger cities (12.2% and 18.6%, respectively). Moreover, regular screening was associated with marital status (married), type of health insurance (NHI-employed), possession private insurance, health status (non-disabled), prevalence of cancer related conditions, benign tumors, and infectious disease of female genital tract, as well as the frequency of regular check-ups.

    Table 3 displays the results of the multivariate ordinal logistic regression analysis of CCS adherence by independent variables. Individuals aged of 40–59 had the highest likelihood of regular screening (odds ratio [OR]=1.303; 95% confidence interval [CI]=1.097–1.547). In addition, several groups had higher odds of adherence to regular CCS, including those with an income between 100%–150% of the median (OR=1.173; 95% CI= 0.966–1.425), service workers (OR=1.041; 95% CI=0.849–1.276), residents of small and medium-sized cities (OR=1.745; 95% CI=1.466–2.076), middle-school graduates (OR=1.401; 95% CI=1.107–1.773), married individuals (OR=3.330; 95% CI=2.646–4.189), those with private insurance (OR=1.359; 95% CI=1.158–1.594), those with a history of cancer other than cervical cancer (OR=1.430; 95% CI=1.118–1.829), individuals with a family history of cervical cancer (OR=1.382; 95% CI=1.118–1.708), those with CIS or dysplasia of the cervix (OR=1.303; 95% CI=1.039–1.635), and those who had a higher frequency of general check-ups (OR=43.733; 95% CI=32.554–58.7501).

    DISCUSSION

    This study assessed the frequency of regular uptake of national CCS in South Korea and identified associated factors utilizing data from the 2007–2012 KNHANES. A cohort of 4,663 women was followed up for up to 12 years using linked individual-level data from KNHIS and KHIRA. This study demonstrates that about 70.8% of the subjects participated in one or more of the CCS (including both irregular and regular uptake of CCS across all age groups) during the follow-up period. However, only 18.9% of the subjects completed most CCS (regular uptake of CCS across all age groups). The results of our study revealed that age, income level, occupation class, place of residence, education level, marital status, and private health insurance status were statistically significant factors associated with regular CCS adherence. These findings are largely consistent with previous studies and suggests that socioeconomic inequalities still exist in national CCS of South Korea. Moreover, the present study newly identified a personal history of non-cervical cancer, CIS of the cervix, family history of cervical cancer, and a higher frequency of general check-ups as factors that significantly increased the likelihood of regular CCS adherence. These results can contribute to the development of more effective strategies to improve regularity of CCS adherence.

    In our study, we observed that participants aged 40–59 had the highest regular CCS pattern, followed by the 20–39 age group, and the lowest among those aged 60+. This is contrast to previous findings where CCS rates were lowest in their 20s [8]. This difference might be attributed to the unique composition of our participant group, where the age range of 20 to 39 years held the highest representation (39.2%), differing from the broader South Korean population [22]. Additionally, our participant selection was based on follow-up to a cohort of cancer patients, employing a 1:10 age matching approach. However, it’s important to consider that the proportion of individuals aged 60+ in the general population is increasing, and cervical cancer incidence in this age group remains significant (34.6% according to the 2020 Korean statistical data) [23]. Therefore, it’s important to explore the reasons behind the decrease in CCS rates among individuals aged 60+ based on the characteristics we observed in this age group of our study. Upon retirement from work, both the individuals and their spouses are released from the obligation of workplace health assessments [24], which could inadvertently lead to overlooking general and cancer screenings. Moreover, a substantial proportion of these women reside in rural areas, where access to medical facilities is limited. For those without personal transportation, accessing distant medical centers becomes even more challenging, thereby contributing to an anticipated decrease in both cervical and general health screenings. Furthermore, during gynecological visits, women are queried about their CCS history and are encouraged to undergo screening if necessary. However, as women over 60 enter menopause, become more likely to live without a spouse, and encounter fewer female genital tract conditions, their visits to gynecologists naturally decline. Consequently, their likelihood of being screened for cervical cancer diminishes. Furthermore, they have limited income and education, leading to a lower understanding of the importance of screenings [25].

    Regarding household income, we found that the regularity of CCS adherence increased within 100%–150% income bracket, but it did not consistently increase with higher income brackets. started to go somewhat lower in the richest group. These findings can be understood within the context of the overall national CCS situation in Korea. The national CCS is classified under general health check-ups, with the screening costs being covered by the government of health insurance. All Korean women aged 20 and above can receive the national CCS every two years for free without any personal expenses. CCS options include both conventional PAP smear (CPS) and liquid-based cytology (LBC) [4], with only CPS being offered in the government-sponsored CCS program. If individuals wish to opt for the LBC method, they need to cover the entire cost themselves. Given this scenario, individuals with higher incomes who are willing to pay for health checkups might be more inclined to choose the LBC method. When it comes to opportunistic comprehensive exams where individuals cover all expenses, LBC is frequently conducted as an initial screening test for cervical cancer. Consequently, the decision to opt for LBC over CPS might lead to situations where individuals are not included in the national CCS statistics due to their choice not to undergo CPS.

    Moreover, our study indicated that rural residents exhibit lower adherence to CCS, which is consistent with previous study [8]. This suggests that the lack of obstetricians-gynecologists (OB/GYNs) in rural areas may be a contributing factor [26, 27]. As mentioned earlier, there is a higher likelihood of receiving CCS recommendations and guidance from gynecologists. However, in rural areas where access to gynecologists is limited, it is presumed that the opportunity for receiving confirmation or advice regarding CCS may have decreased. In addition, private insurance status played a significant role in cancer screening behavior, with individuals with private health insurance having higher odds of adherence to regular CCS, possibly due to increased health consciousness and proactive healthcare utilization [28], and fewer financial concerns regarding potential treatment costs. Conversely, high anticipated treatment costs may cause some individuals to delay or avoid cancer screening altogether [29]. These findings highlight the need for tailored interventions to increase CCS adherence among older individuals and rural residents, and to better understand the factors contributing to lower adherence in these populations.

    In addition to socioeconomic factors, this study aimed to further analyze factors that may influence adherence to CCS. Our findings suggest that women with a personal history of non-cervical cancer, CIS of the cervix, and a family history of cervical cancer had increased adherence to CCS, possibly due to higher risk and benefit perception [30, 31]. However, women with benign neoplasm or infectious gynecological diseases, and those who had experienced pregnancy exhibited relatively decreased adherence to CCS. This may be attributed to the substitution of CCS with general gynecologic exams in obstetrics and gynecology clinics, potentially leading to missed opportunities for collecting public CCS data. Additionally, our study revealed that individuals who underwent frequent general mass screenings had a significantly increased likelihood of regular CCS adherence. This is likely because in Korea, all adults are mandated to undergo a national health check-up every two years, along with additional workplace screenings [24, 32]. These general health examinations include both general and cancer examinations [32], which could be attributed to the concurrent offering of both types of examination in Korea’s national health check-up program. These findings emphasize the need for targeted intervention to increase CCS adherence among certain groups and the importance of collecting comprehensive data on cancer screening.

    To identify potential solutions, we examined the strategies adopted in developed countries. In the UK, local family physicians conduct cervical CCS every 3–5 years, with approximately 85% of women participating in screening [33]. The UK implemented the “cervical cancer screening incentive scheme”, linking parliament members’ income to the number of enrolled women undergoing screening [33]. In the US, health maintenance organization-based private insurers are adopting a preventive medicine approach to CCS [34], utilizing the primary care system to assess an individual’s health status and recommend appropriate testing and CCS. The presence of a healthcare system with a primary care provider plays a critical role in achieving high CCS rates in developed countries. However, in Korea, the National Health Insurance Service sends national CCS notifications to women aged 20 and older every two years, either by paper mail or electronic document (for applicants only), to the address on their residence registration. However, there is no confirmation of screening status and no reminder, and a new screening notice is sent after two years. The method and frequency of CCS notifications are the same for each age group, and there is currently no system for more frequent reminders for those who have not been screened for a long time. Consequently, in cases where individuals receive gynecological care, there is a possibility of receiving CCS recommendations from gynecologists. However, for older adults residing in areas without access to gynecological services or experiencing reduced utilization of such services, the opportunity for such recommendations becomes even more limited. Therefore, considering the circumstances of Korea, it might be beneficial to explore strategies that involve redistributing resources within the community. This could include targeting the older population aged 60+, residents in rural areas with limited healthcare accessibility, and high-risk groups who have never undergone screenings. Implementing more frequent reminders [35], and offering transportation options to healthcare facilities could be potential measures to consider.

    This study examined CCS behaviors among Korean women with over 12 years of follow-up using the linked KNHANES-KNHIS-KHIRA data. Participants were categorized into three levels based on their screening frequency (none, irregular, or regular), and their level of compliance was analyzed accordingly. However, this study is essentially a basic investigation of regular CCS patterns among a subset of Korean women, utilizing openly accessible public data through secondary data analysis. Therefore, this dataset had limitations in comprehensively identifying diverse barriers associated with CCS. Various factors, including education level, income level, occupation class, and place of residence, history of gynecological diseases, family history of cancer, and frequency of routine screenings were found to be linked to regular CCS uptake. However, these factors fell short of providing a complete understanding of the underlying causes behind the observed low screening rates. To uncover reasons for lower rates of regular CCS uptake, subsequent investigations should focus on psychological factors, particularly by surveying groups with low CCS rates.

    In conclusion, this study found that the CCS pattern in South Korea was predominantly irregular, with only 18.9% of participants showing regular compliance to CCS. It confirmed the persistent of socioeconomic inequality, and gained a fresh insight that maintaining regular general health check-ups could also enhance CCS rates. Through comprehensive surveys targeting groups with lower rates of CCS uptake, it is anticipated that clearer policies to boost CCS could be proposed, addressing factors that hinder screening among this populations.

    SUPPLEMENTARY MATERIALS

    Table S1

    Predictors and outcome extracted from linked data of the KNHANES, the KNHIS and the KHIRA

    Click here to view.(45K, xls)

    Table S2

    Conditions of facilitating cervical cancer screening according to the KCD codes

    Click here to view.(40K, xls)

    Notes

    Funding:This research was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health & Welfare, Republic of Korea (HI19C1310).

    Conflict of Interest:No potential conflict of interest relevant to this article was reported.

    Author Contributions:

    • Conceptualization: K.J.Y., H.J., K.T.H.

    • Data curation: H.J., Y.J., P.J.

    • Formal analysis: H.J., K.T.H.

    • Funding acquisition: K.J.Y.

    • Investigation: H.J., Y.J., P.J., K.T.H.

    • Methodology: H.J.

    • Project administration: K.J.Y.

    • Resources: Y.J., P.J.

    • Supervision: K.J.Y., K.T.H.

    • Validation: K.T.H.

    • Visualization: Y.J., P.J.

    • Writing - original draft: H.J., K.T.H.

    • Writing - review & editing: H.J., K.T.H.

    References

      1. Statistics Korea. Statistical database: cancer incident cases and incidence rates by site (24 items) and sex [Internet]. Daejeon: Statistics Korea; 2023 [cited 2023 Jan 8].
        Available from: https://kosis.kr/eng/statisticsList/statisticsListIndex.do?menuId=M_01_01&vwcd=MT_ETITLE&parmTabId=M_01_01&statId=1997018&themaId=#SelectStatsBoxDiv.
      1. Kang MJ, Won YJ, Lee JJ, Jung KW, Kim HJ, Kong HJ, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2019. Cancer Res Treat 2022;54:330–344.
      1. World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. Geneva: World Health Organization; 2020 [cited 2023 Jan 8].
        Available from: https://www.who.int/publications/i/item/9789240014107.
      1. Min KJ, Lee YJ, Suh M, Yoo CW, Lim MC, Choi J, et al. The Korean guideline for cervical cancer screening. J Gynecol Oncol 2015;26:232–239.
      1. Statistics Korea. Statistical database: statistics on cancer screening target recipients and number of screened examinees by district and gender. Daejeon: Statistics Korea; 2023 [cited 2023 Jan 8].
        Available from: https://kosis.kr/statHtml/statHtml.do?orgId=350&tblId=DT_35007_N009&vw_cd=MT_ETITLE&list_id=350_35007_A002&scrId=&seqNo=&language=en&obj_var_id=&itm_id=&conn_path=A6&path=%252Feng%252Fsearch%252FsearchList.do.
      1. OECD Health Statistics. Quality screening, survival and mortality for cervical cancer. Paris: OECD; 2015 [cited 2023 Jan 10].
        http://dx.doi.org/10.1787/888933281196.
      1. Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J, et al. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. Am J Clin Pathol 2012;137:516–542.
      1. Shin HY, Lee YY, Song SY, Park B, Suh M, Choi KS, et al. Trends in cervical cancer screening rates among Korean women: results of the Korean National Cancer Screening Survey, 2005–2020. J Gynecol Oncol 2022;33:e39
      1. Kim JY, Kang HT. Association between socioeconomic status and cancer screening in Koreans over 40 years in age based on the 2010–2012 Korean National Health and Nutrition Examination Survey. Korean J Fam Med 2016;37:287–292.
      1. Choi E, Lee YY, Suh M, Lee EY, Mai TT, Ki M, et al. Socioeconomic Inequalities in cervical and breast cancer screening among women in Korea, 2005–2015. Yonsei Med J 2018;59:1026–1033.
      1. Lee YY, Jun JK, Suh M, Park BY, Kim Y, Choi KS. Barriers to cancer screening among medical aid program recipients in the Republic of Korea: a qualitative study. Asian Pac J Cancer Prev 2014;15:589–594.
      1. Ko KD, Park SM, Lee K. Factors associated with the use of uterine cervical cancer screening services in Korean elderly women. Korean J Fam Med 2012;33:174–181.
      1. Korea Disease Control and Prevention Agency. Raw data usage manual of the 5th Korea National Health and Nutrition Examination Survey. Cheongju: Korea Disease Control and Prevention Agency; 2012 [cited 2023 Jan 3].
        Available from: https://knhanes.kdca.go.kr/knhanes/sub03/sub03_02_05.do.
      1. Organization for Economic Cooperation and Development (OECD). Classifying educational programmes: manual for ISCED-97 implementation in OECD countries. Paris: OECD; 1999 [cited 2023 Jan 4].
        Available from: https://www.oecd.org/education/1841854.pdf.
      1. Statistics Korea. Monthly average household income according to household size. 2007–2012. Daejeon: Statistics Korea; 2021 [cited 2023 Feb 18].
        Available from: https://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_1L9E028.
      1. Statistics Korea. Korean standard classification of occupations. Daejeon: Statistics Korea; 2023 [cited 2023 Feb 18].
        Available from: http://kssc.kostat.go.kr.
      1. Kim M, Chung W, Lim S, Yoon S, Lee J, Kim E, et al. Socioeconomic inequity in self-rated health status and contribution of health behavioral factors in Korea. J Prev Med Public Health 2010;43:50–61.
      1. Yoon TH, Lee SY, Jeong BG, Lee SJ, Kim NS, et al. Difference in health behaviors among the social strata in Korea. Korean J Prev Med 2003;33:469–476.
      1. Aranda E, Franck JE, Ringa V, Sassenou J, Coeuret-Pellicer M, Rigal L, et al. Social inequalities in participation in cancer screening: does the mode of data collection matter? The CONSTANCES cohort. Eur J Public Health 2021;31:602–608.
      1. Ministry of Government Legislation. Act on Welfare of Persons with Disabilities. Sejong: Ministry of Government Legislation; 2023 [cited 2023 Feb 20].
        Available from: https://elaw.klri.re.kr/kor_service/lawView.do?hseq=57347&lang=ENG.
      1. Ministry of Government Legislation. Regional Public Health Act. Sejong: Ministry of Government Legislation; 2023 [cited 2023 Feb 20].
        Available from: https://elaw.klri.re.kr/kor_service/lawView.do?hseq=49575&lang=ENG.
      1. Statistics Korea. Women and men in Korea. Daejeon: Statistics Korea; 2019 [cited 2023 Mar 27].
        Available from: https://kostat.go.kr/board.es?mid=a10301020200&bid=203&act=view&list_no=359281.
      1. Ministry of Health and Welfare. “Cancer Registry Statistics,” 2020, 2023.08.02, number of cancer cases by 24 cancer types/sex/age (5 years), incidence rate. Sejong: Ministry of Health and Welfare; 2023 [cited 2023 Mar 27].
        Available from: https://kosis.kr/statHtml/statHtml.do?orgId=117&tblId=DT_117N_A00023&conn_path=I2.
      1. Ministry of Government Legislation. Occupational Safety And Health Act: Article 129 (General Health Examination). Sejong: Ministry of Government Legislation; 2020 [cited 2023 Mar 27].
        Available from: https://elaw.klri.re.kr/kor_service/lawView.do?hseq=55395&lang=ENG.
      1. Akinlotan M, Bolin JN, Helduser J, Ojinnaka C, Lichorad A, McClellan D. Cervical cancer screening barriers and risk factor knowledge among uninsured women. J Community Health 2017;42:770–778.
      1. Statistics Korea. Displayed by municipality and district councillor status by subject. Daejeon: Statistics Korea; 2023 [cited 2023 Feb 14].
        Available from: https://kosis.kr/statHtml/statHtml.do?orgId=354&tblId=DT_HIRA4G.
      1. Seoul Metropolitan Government. Seoul cervical cancer screening rate statistics (2010–2014). Seoul: Seoul Metropolitan Government; 2017 [cited 2023 Feb 14].
        Available from: https://data.seoul.go.kr/dataList/10681/S/2/datasetView.do.
      1. Jeon B, Kwon S. Effect of private health insurance on health care utilization in a universal public insurance system: a case of South Korea. Health Policy 2013;113:69–76.
      1. Rajaguru V, Kim TH, Shin J, Lee SG. Income disparities in cancer screening: a cross-sectional study of the Korean National Health and Nutrition Examination Survey, 2013–2019. Front Public Health 2022;10:820643
      1. Dsouza JP, Van Den Broucke S, Pattanshetty S, Dhoore W. Exploring the barriers to cervical cancer screening through the lens of implementers and beneficiaries of the national screening program: a multi-contextual study. Asian Pac J Cancer Prev 2020;21:2209–2215.
      1. Abamecha F, Tena A, Kiros G. Psychographic predictors of intention to use cervical cancer screening services among women attending maternal and child health services in Southern Ethiopia: the theory of planned behavior (TPB) perspective. BMC Public Health 2019;19:434.
      1. Kang HT. Current status of the national health screening programs in South Korea. Korean J Fam Med 2022;43:168–173.
      1. Patnick J. Cervical cancer screening in England. Eur J Cancer 2000;36:2205–2208.
      1. Habbema D, De Kok IM, Brown ML. Cervical cancer screening in the United States and the Netherlands: a tale of two countries. Milbank Q 2012;90:5–37.
      1. Molokwu JC, Dwivedi A, Alomari A, Guzman J, Shokar N. Effect of text message reminders on attendance at cervical cancer screening appointments in a predominantly Hispanic population. Hisp Health Care Int 2023;21:121–128.
    MeSH Terms
    Carcinoma in Situ
    Cervix Uteri
    Cohort Studies
    Compliance
    Data Analysis
    Early Detection of Cancer
    Education
    Family Characteristics
    Female
    Follow-Up Studies
    Humans
    Insurance
    Korea*
    Logistic Models
    Marital Status
    Mass Screening*
    Nutrition Surveys
    Occupations
    Program
    Secondary Prevention
    Social Class
    Uterine Cervical Neoplasms*
    Metrics
    Share
    Figures
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    ORCID IDs
    Funding Information
    PERMALINK