Journal of Preventive Medicine and Public Health

Original Articles

Operational Definitions of Colorectal Cancer in the Korean National Health Insurance Database: Hyeree Park, Yu Rim Kim, Yerin Pyun, Hyundeok Joo, Aesun Shin; J Prev Med Public Health. 2023;56(4):312-318. Published online May 31, 2023; DOI: https://doi.org/10.3961/jpmph.23.033

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Objectives
We reviewed the operational definitions of colorectal cancer (CRC) from studies using the Korean National Health Insurance Service (NHIS) and compared CRC incidence derived from the commonly used operational definitions in the literature with the statistics reported by the Korea Central Cancer Registry (KCCR).
Methods
We searched the MEDLINE and KoreaMed databases to identify studies containing operational definitions of CRC, published until January 15, 2021. All pertinent data concerning the study period, the utilized database, and the outcome variable were extracted. Within the NHIS-National Sample Cohort, age-standardized incidence rates (ASRs) of CRC were calculated for each operational definition found in the literature between 2005 and 2019. These rates were then compared with ASRs from the KCCR.
Results
From the 62 eligible studies, 9 operational definitions for CRC were identified. The most commonly used operational definition was “C18-C20” (n=20), followed by “C18-C20 with claim code for treatment” (n=3) and “C18-C20 with V193 (code for registered cancer patients’ payment deduction)” (n=3). The ASRs reported using these operational definitions were lower than the ASRs from KCCR, except for “C18-C20 used as the main diagnosis.” The smallest difference in ASRs was observed for “C18-C20,” followed by “C18- C20 with V193,” and “C18-C20 with claim code for hospitalization or code for treatment.”
Conclusions
In defining CRC patients utilizing the NHIS database, the ASR derived through the operational definition of “C18-C20 as the main diagnosis” was comparable to the ASR from the KCCR. Depending on the study hypothesis, operational definitions using treatment codes may be utilized.

Summary

Korean summary
- 국민건강보험공단 자료 기반 연구에서 사용된 대장암의 조작적 정의를 검토하고 각 조작적 정의에 따른 대장암의 연령표준화발생률을 중앙암등록본부에서 보고한 수치와 비교하였다. - 62개의 출판된 문헌을 검토하여 9개의 조작적 정의를 확인하였고 이 중 "C18-C20"이 가장 일반적으로 사용되었다. - "C18-C20"을 주진단으로 정의한 경우의 연령표준화발생률은 중앙암등록본부에서 보고한 연령표준화발생률과 가장 유사하였다.

Citations

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Worsening of health disparities across COVID-19 pandemic stages in Korea
Hyejin Lee, Hyunwoo Nam, Jae-ryun Lee, Hyemin Jung, Jin Yong Lee
Epidemiology and Health.2024; : e2024038. CrossRef
National Trends in Rotavirus Enteritis among Infants in South Korea, 2010–2021: A Nationwide Cohort
Hyun Jee Lee, Yujin Choi, Jaeyu Park, Yong-Sung Choi, Dong Keon Yon, Do Hyun Kim
Children.2023; 10(9): 1436. CrossRef
Real-world data analysis on effectiveness of integrative therapies: A practical guide to study design and data analysis using healthcare databases
Ye-Seul Lee, Yoon Jae Lee, In-Hyuk Ha
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The Association Between Metabolic Syndrome and Colorectal Cancer Risk by Obesity Status in Korean Women: A Nationwide Cohort Study: Seong-geun Moon, Boyoung Park; J Prev Med Public Health. 2022;55(5):475-484. Published online September 21, 2022; DOI: https://doi.org/10.3961/jpmph.22.286

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Objectives
This study aimed to determine the association between metabolic syndrome (MetS) and the incidence of colorectal cancer (CRC) in Korean women with obesity.
Methods
Cancer-free women (n=6 142 486) aged 40-79 years, who underwent National Health Insurance Service health examinations in 2009 and 2010 were included. The incidence of CRC was followed until 2018. The hazard ratio (HR) of MetS for the incidence of colon and rectal cancer was analyzed according to body mass index (BMI) categories, adjusting for confounders such as women’s reproductive factors. In addition, the heterogeneity of associations across BMI categories was assessed.
Results
Women with MetS were at increased risk of colon and rectal cancer compared to women without MetS (HR, 1.20; 95% confidence interval [CI], 1.16 to 1.23 and HR,1.15; 95% CI, 1.11 to 1.20), respectively. The HR of MetS for colon cancer across BMI categories was 1.12 (95% CI, 1.06 to 1.19), 1.14 (95% CI, 1.08 to 1.20), and 1.16 (95% CI, 1.12 to 1.21) in women with BMIs <23.0 kg/m², 23.0-24.9 kg/m², and ≥25.0 kg/m², respectively. The HR of MetS for rectal cancer across corresponding BMI categories was 1.16 (95% CI, 1.06 to 1.26), 1.14 (95% CI, 1.05 to 1.23), and 1.13 (95% CI, 1.06 to 1.20). The heterogeneity of associations across BMI categories was not significant in either colon or rectal cancer (p=0.587 for colon cancer and p=0.927 for rectal cancer).
Conclusions
Women with MetS were at increased risk of colon and rectal cancer. Clinical and public health strategies should be considered for primary CRC prevention with an emphasis on improving women’s metabolic health across all BMI groups.

Summary

Korean summary
한국 여성에서 대사증후군은 대장암 발생과 직장암 발생에 유의한 위험요인으로 보인다. 이는 체질량지수를 층화하고 여성력과 관련된 요인들을 보정하더라도 유의했다. 한국 여성의 대장암 및 직장암 예방을 위해 비만도에 관계 없이 대사증후군 요소를 관리하는 것이 필요하다.

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Increased risk of cancer and cancer-related mortality in middle-aged Korean women with prediabetes and diabetes: a population-based study
Thi Xuan Mai Tran, Soyeoun Kim, Huiyeon Song, Boyoung Park
Epidemiology and Health.2023; 45: e2023080. CrossRef

The Risk of Colorectal Cancer After Cholecystectomy or Appendectomy: A Population-based Cohort Study in Korea: Joonki Lee, Sunho Choe, Ji Won Park, Seung-Yong Jeong, Aesun Shin; J Prev Med Public Health. 2018;51(6):281-288. Published online October 29, 2018; DOI: https://doi.org/10.3961/jpmph.18.105

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Abstract Summary PDF Supplementary Material

Objectives
We investigated the association between cholecystectomy or appendectomy and the subsequent risk of colorectal cancer (CRC) in the Korean population.
Methods
A retrospective cohort study was conducted with the National Health Insurance Service–National Sample Cohort of Korea; this sample was followed up from January 1, 2002, until the date of CRC incidence, loss to follow-up, or December 31, 2015. The exposure status of cholecystectomy and appendectomy was treated as a time-varying covariate. The calculated risk of CRC was stratified by follow-up period, and the association between these surgical procedures and CRC was investigated by a Cox regression model applying appropriate lag periods.
Results
A total of 707 663 individuals were identified for analysis. The study population was followed up for an average of 13.66 years, and 4324 CRC cases were identified. The hazard ratio (HR) of CRC was elevated in the first year after cholecystectomy (HR, 1.71; 95% confidence interval [CI], 1.01 to 2.89) and in the first year and 2-3 years after appendectomy (HR, 4.22; 95% CI, 2.87 to 6.20; HR, 2.34; 95% CI, 1.36 to 4.03, respectively). The HRs of CRC after applying 1 year of lag after cholecystectomy and 3 years of lag after appendectomy were 0.80 (95% CI, 0.57 to 1.13) and 0.77 (95% CI, 0.51 to 1.16), respectively.
Conclusions
The risk of CRC increased in the first year after cholecystectomy and appendectomy, implying the possibility of bias. When appropriate lag periods after surgery were applied, no association was found between cholecystectomy or appendectomy and CRC.

Summary

Korean summary
본 연구는 담낭절제술, 충수돌기절제술 후 대장암의 발생위험에 관한 연구로 국민건강보험공단 표본코호트자료를 사용한 후향적코호트 연구이다. 총 707 663명을 대상으로 연구를 진행하였으며, 담낭절제술을 시행한 환자들은 수술 후 1년 이내에서 대장암의 위험도가 유의하게 증가하였으나 이후 관련성을 보이지 않았고, 충수돌기절제술을 시행한 환자들은 수술 후 1년, 2~3년에서 유의하게 위험도가 증가하였으나, 이후에는 관련성을 보이지 않았다. 이 결과는 역인과관계의 가능성을 시사하며 이것을 고려하였을 때, 담낭절제술과 충수돌기절제술은 대장암의 발생위험과의 연관성을 보이지 않았다.

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Ji Hye Huh, Kyong Joo Lee, Yun Kyung Cho, Shinje Moon, Yoon Jung Kim, Eun Roh, Kyung-do Han, Dong Hee Koh, Jun Goo Kang, Seong Jin Lee, Sung-Hee Ihm
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No association between cholecystectomy and risk of colorectal cancer: a meta-analysis of cohort studies
Lulin Yu, Wenjing Liu, Yici Yan, Yu Jiang, Xin Gao, Shanming Ruan
International Journal of Colorectal Disease.2023;[Epub] CrossRef
Operational Definitions of Colorectal Cancer in the Korean National Health Insurance Database
Hyeree Park, Yu Rim Kim, Yerin Pyun, Hyundeok Joo, Aesun Shin
Journal of Preventive Medicine and Public Health.2023; 56(4): 312. CrossRef
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Spatial Inequalities in the Incidence of Colorectal Cancer and Associated Factors in the Neighborhoods of Tehran, Iran: Bayesian Spatial Models: Kamyar Mansori, Masoud Solaymani-Dodaran, Alireza Mosavi-Jarrahi, Ali Ganbary Motlagh, Masoud Salehi, Alireza Delavari, Mohsen Asadi-Lari; J Prev Med Public Health. 2018;51(1):33-40. Published online January 2, 2018; DOI: https://doi.org/10.3961/jpmph.17.167

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Abstract PDF

Objectives
The aim of this study was to determine the factors associated with the spatial distribution of the incidence of colorectal cancer (CRC) in the neighborhoods of Tehran, Iran using Bayesian spatial models.
Methods
This ecological study was implemented in Tehran on the neighborhood level. Socioeconomic variables, risk factors, and health costs were extracted from the Equity Assessment Study conducted in Tehran. The data on CRC incidence were extracted from the Iranian population-based cancer registry. The Besag-York-Mollié (BYM) model was used to identify factors associated with the spatial distribution of CRC incidence. The software programs OpenBUGS version 3.2.3, ArcGIS 10.3, and GeoDa were used for the analysis.
Results
The Moran index was statistically significant for all the variables studied (p<0.05). The BYM model showed that having a women head of household (median standardized incidence ratio [SIR], 1.63; 95% confidence interval [CI], 1.06 to 2.53), living in a rental house (median SIR, 0.82; 95% CI, 0.71 to 0.96), not consuming milk daily (median SIR, 0.71; 95% CI, 0.55 to 0.94) and having greater household health expenditures (median SIR, 1.34; 95% CI, 1.06 to 1.68) were associated with a statistically significant elevation in the SIR of CRC. The median (interquartile range) and mean (standard deviation) values of the SIR of CRC, with the inclusion of all the variables studied in the model, were 0.57 (1.01) and 1.05 (1.31), respectively.
Conclusions
Inequality was found in the spatial distribution of CRC incidence in Tehran on the neighborhood level. Paying attention to this inequality and the factors associated with it may be useful for resource allocation and developing preventive strategies in atrisk areas.

Summary

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Adeylson Guimarães Ribeiro, Allini Mafra da Costa, Talita Fernanda Pereira, Denise Peixoto Guimarães, José Humberto Tavares Guerreiro Fregnani
Global Epidemiology.2023; 5: 100097. CrossRef
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Ali Ghorbani Ranjbary, Jalil Mehrzad, Nasrollah Rahbar, Hesam Dehghani
Molecular Biology Reports.2023; 50(10): 8589. CrossRef
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James Hogg, Jessica Cameron, Susanna Cramb, Peter Baade, Kerrie Mengersen
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Sharifah Saffinas Syed Soffian, Azmawati Mohammed Nawi, Rozita Hod, Huan-Keat Chan, Muhammad Radzi Abu Hassan
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Favorable colorectal cancer mortality-to-incidence ratios in countries with high expenditures on health and development index
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Premature mortality of gastrointestinal cancer in Iran: trends and projections 2001–2030
Fatemeh Khosravi Shadmani, Farshad Farzadfar, Moein Yoosefi, Kamyar Mansori, Reza Khosravi Shadman, Aliakbar Haghdoost
BMC Cancer.2020;[Epub] CrossRef

A Survival Analysis of Gastric or Colorectal Cancer Patients Treated With Surgery: Comparison of Capital and a Non-capital City: Nam-Soo Hong, Kyeong Soo Lee, Sin Kam, Gyu Seog Choi, Oh Kyoung Kwon, Dong Hee Ryu, Sang Won Kim; J Prev Med Public Health. 2017;50(5):283-293. Published online July 3, 2017; DOI: https://doi.org/10.3961/jpmph.17.043

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Abstract PDF Supplementary Material

Objectives
The objective of the present study was to compare prognosis of patients with gastric or colorectal cancer according to places where they received surgeries. Methods: The cancer patients underwent surgeries in sampled hospitals located in Daegu were matched 1:1 to the patients who visited sampled hospitals in Seoul using propensity score method. After the occurrences of death were examined, Kaplan-Meier method was used for survival analysis and the log-rank test was performed to compare the survival curves. Results: A total of six out of 291 gastric cancer patients who had surgeries in Daegu died (2.1%) and ten deaths (3.4%) occurred from patients went Seoul hospitals. Out of 84 gastric cancer patients who had chemotherapy after surgeries in Daegu, 13 (15.5%) patients died while 18 (21.4%) deaths occurred among patients underwent surgeries in Seoul. Six deaths (6.9%) out of 87 colorectal cancer patients who had surgeries in Daegu were reported. Five patients (5.7%) died among the patients underwent surgeries in Seoul. Among the colorectal cancer patients with chemotherapy after surgeries, 13 patients (12.4%) who visited hospitals in Daegu and 14 (13.3%) patients who used medical centers in Seoul died. There were no significant differences according to places where patients used medical services. Conclusions: The result of this study is expected to be used as basic data for policy making to resolve centralization problem of cancer patients and to help patients to make rational choices in selection of medical centers.

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Domestic medical travel from non-Seoul regions to Seoul for initial breast cancer treatment: a nationwide cohort study
Jae Ho Jeong, Jinhong Jung, Hee Jeong Kim, Jong Won Lee, Beom-Seok Ko, Byung Ho Son, Kyung Hae Jung, Il Yong Chung
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Diabetes Mellitus and Site-specific Colorectal Cancer Risk in Korea: A Case-control Study: Hyeongtaek Woo, Jeeyoo Lee, Jeonghee Lee, Ji Won Park, Sungchan Park, Jeongseon Kim, Jae Hwan Oh, Aesun Shin; J Prev Med Public Health. 2016;49(1):45-52. Published online December 22, 2015; DOI: https://doi.org/10.3961/jpmph.15.029

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Abstract PDF

Objectives
Previous large-scale cohort studies conducted in Korea have found a positive association between diabetes mellitus (DM) and colorectal cancer (CRC) in men only, in contrast to studies of other populations that have found significant associations in both men and women.
Methods
A total of 1070 CRC cases and 2775 controls were recruited from the National Cancer Center, Korea between August 2010 and June 2013. Self-reported DM history and the duration of DM were compared between cases and controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by binary and polytomous logistic regression models.
Results
DM was associated with an elevated risk of CRC in both men (OR, 1.47; 95% CI, 1.13 to 1.90) and women (OR, 1.92; 95% CI, 1.24 to 2.98). This association remained when we controlled for age, body mass index, alcohol consumption, and physical activity level. In sub-site analyses, DM was associated with distal colon cancer risk in both men (multivariate OR, 2.04; 95% CI, 1.39 to 3.00) and women (multivariate ORs, 1.99; 95% CI, 1.05 to 3.79), while DM was only associated with rectal cancer risk in women (multivariate OR, 2.05; 95% CI, 1.10 to 3.82). No significant association was found between DM and proximal colon cancer risk in either men (multivariate OR, 1.45; 95% CI, 0.88 to 2.41) or women (multivariate OR, 1.79; 95% CI, 0.78 to 4.08).
Conclusions
Overall, DM was associated with an increased risk of CRC in Koreans. However, potential over-estimation of the ORs should be considered due to potential biases from the case-control design.

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Economic Burden of Colorectal Cancer in Korea: Ju-Young Byun, Seok-Jun Yoon, In-Hwan Oh, Young Ae Kim, Hye-Young Seo, Yo-Han Lee; J Prev Med Public Health. 2014;47(2):84-93. Published online March 31, 2014; DOI: https://doi.org/10.3961/jpmph.2014.47.2.84

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Abstract PDF

Objectives

The incidence and survival rate of colorectal cancer in Korea are increasing because of improved screening, treatment technologies, and lifestyle changes. In this aging population, increases in economic cost result. This study was conducted to estimate the economic burden of colorectal cancer utilizing claims data from the Health Insurance Review and Assessment Service.

Methods

Economic burdens of colorectal cancer were estimated using prevalence data and patients were defined as those who received ambulatory treatment from medical institutions or who had been hospitalized due to colorectal cancer under the International Classification of Disease 10th revision codes from C18-C21. The economic burdens of colorectal cancer were calculated as direct costs and indirect costs.

Results

The prevalence rate (per 100 000 people) of those who were treated for colorectal cancer during 2010 was 165.48. The economic burdens of colorectal cancer in 2010 were 3 trillion and 100 billion Korean won (KRW), respectively. Direct costs included 1 trillion and 960 billion KRW (62.85%), respectively and indirect costs were 1 trillion and 160 billion (37.15%), respectively.

Conclusions

Colorectal cancer has a large economic burden. Efforts should be made to reduce the economic burden of the disease through primary and secondary prevention.

Summary

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Improving the Performance of Risk-adjusted Mortality Modeling for Colorectal Cancer Surgery by Combining Claims Data and Clinical Data: Won Mo Jang, Jae-Hyun Park, Jong-Hyock Park, Jae Hwan Oh, Yoon Kim; J Prev Med Public Health. 2013;46(2):74-81. Published online March 28, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.2.74

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Abstract PDF

Objectives

The objective of this study was to evaluate the performance of risk-adjusted mortality models for colorectal cancer surgery.

Methods

We investigated patients (n=652) who had undergone colorectal cancer surgery (colectomy, colectomy of the rectum and sigmoid colon, total colectomy, total proctectomy) at five teaching hospitals during 2008. Mortality was defined as 30-day or in-hospital surgical mortality. Risk-adjusted mortality models were constructed using claims data (basic model) with the addition of TNM staging (TNM model), physiological data (physiological model), surgical data (surgical model), or all clinical data (composite model). Multiple logistic regression analysis was performed to develop the risk-adjustment models. To compare the performance of the models, both c-statistics using Hanley-McNeil pair-wise testing and the ratio of the observed to the expected mortality within quartiles of mortality risk were evaluated to assess the abilities of discrimination and calibration.

Results

The physiological model (c=0.92), surgical model (c=0.92), and composite model (c=0.93) displayed a similar improvement in discrimination, whereas the TNM model (c=0.87) displayed little improvement over the basic model (c=0.86). The discriminatory power of the models did not differ by the Hanley-McNeil test (p>0.05). Within each quartile of mortality, the composite and surgical models displayed an expected mortality ratio close to 1.

Conclusions

The addition of clinical data to claims data efficiently enhances the performance of the risk-adjusted postoperative mortality models in colorectal cancer surgery. We recommended that the performance of models should be evaluated through both discrimination and calibration.

Summary

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Quantitative Analysis of Cancer-associated Gene Methylation Connected to Risk Factors in Korean Colorectal Cancer Patients: Ho-Jin Kang, Eun-Jeong Kim, Byoung-Gwon Kim, Chang-Hun You, Sang-Yong Lee, Dong-Il Kim, Young-Seoub Hong; J Prev Med Public Health. 2012;45(4):251-258. Published online July 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.4.251; Correction in: J Prev Med Public Health 2012;45(5):333

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Abstract PDF

Objectives

The purpose of this paper was to elucidate the potential methylation levels of adjacent normal and cancer tissues by comparing them with normal colorectal tissues, and to describe the correlations between the methylation and clinical parameters in Korean colorectal cancer (CRC) patients.

Methods

Hypermethylation profiles of nine genes (RASSF1, APC, p16^INK4a, Twist1, E-cadherin, TIMP3, Smad4, COX2, and ABCB1) were examined with 100 sets of cancer tissues and 14 normal colorectal tissues. We determined the hypermethylation at a given level by a percent of methylation ratio value of 10 using quantitative methylation real-time polymerase chain reaction.

Results

Nine genes' hypermethylation levels in Korean CRC patient tissues were increased more higher than normal colorectal tissues. However, the amounts of p16^INK4a and E-cadherin gene hypermethylation in normal and CRC tissues were not significantly different nor did TIMP3 gene hypermethylation in adjacent normal and cancer tissues differ significantly. The hypermethylation of TIMP3, E-cadherin, ABCB1, and COX2 genes among other genes were abundantly found in normal colorectal tissues. The hypermethylation of nine genes' methylation in cancer tissues was not significantly associated with any clinical parameters. In Cohen's kappa test, it was moderately observed that RASSF1 was related with E-cadherin, and Smad4 with ABCB1 and COX2.

Conclusions

This study provides evidence for different hypermethylation patterns of cancer-associated genes in normal and CRC tissues, which may serve as useful information on CRC cancer progression.

Summary

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Special Article

Cost Effectiveness of Interventions to Promote Screening for Colorectal Cancer: A Randomized Trial: Swati Misra, David R. Lairson, Wenyaw Chan, Yu-Chia Chang, L. Kay Bartholomew, Anthony Greisinger, Amy McQueen, Sally W. Vernon; J Prev Med Public Health. 2011;44(3):101-110. Published online May 17, 2010; DOI: https://doi.org/10.3961/jpmph.2011.44.3.101

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Abstract PDF

Objectives

Screening for colorectal cancer is considered cost effective, but is underutilized in the U.S. Information on the efficiency of "tailored interventions" to promote colorectal cancer screening in primary care settings is limited. The paper reports the results of a cost effectiveness analysis that compared a survey-only control group to a Centers for Disease Control (CDC) web-based intervention (screen for life) and to a tailored interactive computer-based intervention.

Methods

A randomized controlled trial of people 50 and over, was conducted to test the interventions. The sample was 1224 partcipants 50-70 years of age, recruited from Kelsey-Seybold Clinic, a large multi-specialty clinic in Houston, Texas. Screening status was obtained by medical chart review after a 12-month follow-up period. An "intention to treat" analysis and micro costing from the patient and provider perspectives were used to estimate the costs and effects. Analysis of statistical uncertainty was conducted using nonparametric bootstrapping.

Results

The estimated cost of implementing the web-based intervention was $40 per person and the cost of the tailored intervention was $45 per person. The additional cost per person screened for the web-based intervention compared to no intervention was $2602 and the tailored intervention was no more effective than the web-based strategy.

Conclusions

The tailored intervention was less cost-effective than the web-based intervention for colorectal cancer screening promotion. The web-based intervention was less cost-effective than previous studies of in-reach colorectal cancer screening promotion. Researchers need to continue developing and evaluating the effectiveness and cost-effectiveness of interventions to increase colorectal cancer screening.

Summary

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PLOS ONE.2020; 15(9): e0238354. CrossRef
Economic Evaluation of Tailored Web versus Tailored Telephone-Based Interventions to Increase Colorectal Cancer Screening among Women
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English Abstracts

Ten Year Trend of Cancer Incidence in Seoul, Korea: 1993-2002.: Myung Hee Shin, Hyun Kyung Oh, Yoon Ok Ahn; J Prev Med Public Health. 2008;41(2):92-99.; DOI: https://doi.org/10.3961/jpmph.2008.41.2.92

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Abstract PDF

OBJECTIVES
Effective cancer prevention and control measures can only be done when dependable data on the cancer incidence is available. The Seoul Cancer Registry (SCR) was founded to provide valid, comparable and representative cancer incidence data for Koreans. We aimed to compare the cancer incidence in the first (1993-1997) and second term (1998-2002) of the SCR, and we analyzed the annual incidence trend during that 10 years. METHODS: The SCR detects potential cancer cases through the Korean Central Cancer Registry (KCCR) data, the health insurance claims, the individual hospital's discharge records and the death certificates. About 87% of the SCR data is registered through the KCCR. The rest of the data is registered by SCR registrars who visit about 70~80 mid-sized hospitals in Seoul to review and abstract the medical records of the potential cancer patients. RESULTS: The total number of new cancer cases was higher in 1998~2002 than in 1993~1997 by 20.6% for men and 18.4% for women, respectively. The age-standardized rate (ASR) of total cancer per 100,000 increased 1% (from 295.4 to 298.3) for men and 5.1% (from 181.5 to 190.7) for women, between the two periods. The commonest cancer sites during 1998-2002 for men were stomach, liver, bronchus/lung, colorectum, bladder and prostate, and the commonest cancer sites for women were breast, stomach, colorectum, cervix uteri, thyroid and bronchus/lung. Compared with the ASRs in 1993, the ASRs in 2002 increased for colorectum (58.4% for men, 27.1% for women), prostate (81.5%), breast (58.3% for women), thyroid (141% for women), and bronchus/lung (15.4% for women). The ASRs for stomach (-18.7% for men, -20.7% for women) and uterine cervix cancer (-39.7%) had decreased. CONCLUSIONS: The cancer incidence is increasing in Seoul, Korea, especially for the colorectum and prostate for men, and for the breast, colorectum, bronchus/lung and thyroid for women.

Summary

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Cohort Study on the Association between Alcohol Consumption and the Risk of Colorectal Cancer in the Korean Elderly.: Hoi Jeong Lim, Byung Joo Park; J Prev Med Public Health. 2008;41(1):23-29.; DOI: https://doi.org/10.3961/jpmph.2008.41.1.23

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Abstract PDF

OBJECTIVES
We examined the association between alcohol consumption and incidence of colorectal cancer in elderly Koreans. METHODS: The cohort members (n=14,304) consisted of 4,834 males and 9,470 females derived from the Korea Elderly Pharmacoepidemiologic Cohort (KEPEC), a population-based dynamic cohort. They were aged 65 years old or older and lived in Busan between 1993-1998; they were beneficiaries of the Korean Medical Insurance Corporation (KMIC). Baseline information was surveyed by a self-administered, mailed questionnaire. This study population was restricted to 14,304 participants who reported alcohol drinking habits on the questionnaire and had not been diagnosed with colorectal cancer at baseline. The adjusted hazard ratios (aHR) of status, type, frequency and daily average amount of alcohol consumption were computed with Cox's proportional hazard model, with the never-drinkers as a reference group and controlling for age and gender. RESULTS: After 4.82 person-years of mean follow-up 112 cases of colorectal cancer occurred. The incidence densities of colorectal cancer were 161 (95% CI=123-200) for never-drinkers, 219 (95% CI=125-339) for ex-drinkers, and 137 (95% CI=84-189) for current-drinkers per 100,000 person-year. The status, type, frequency, and daily average amount of alcohol consumption were not significantly related to the incidence of colorectal cancer after controlling for age and gender. CONCLSIONS: There was no significant association between alcohol consumption and colorectal cancer among elderly people after controlling for age and gender.

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Original Articles

A Case-control Study of the Relationships between Reproductive Factors and Degree of Dysplasia of the Colorectal Adenoma and Cancer.: Se Young Lee, Won Chul Lee, Kyu Yong Choi, Mi Kyung Kim, Jin Hee Lee, Kwang Ho Meng; Korean J Prev Med. 2003;36(3):279-288.

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Abstract PDF: OBJECTIVES
Evidence for an effect of reproductive factors on colorectal carcinogenesis is not yet consistent. Little research has been conducted to investigate whether reproductive factors were associated with colorectal adenomas that are the precursors of colorectal cancer. We evaluated the relationships between reproductive factors and the degree of dysplasia of the colorectal adenoma and cancer as colorectal adenoma-carcinoma sequence. METHODS: For this study, 241 adenoma cases with histo-pathologically confirmed incident colorectal adenoma, 76 cancer cases with colorectal cancer and 1677 controls were collected from Our Lady of Mercy Hospital, The Catholic University of Korea, during 1994-1999. Before colonoscopy, information on demographic characteristics, reproductive factors, life style habits and dietary intake were obtained by interviewed questionnaire. Adjusted OR and 95% CI were estimated by using polytomous logistic regression model. Potential confounders that were selected based on the goodness of fit statistics and interaction between risk factors were considered in this adjustment. The Wald statistic was calculated to test the heterogeneity of the odds ratios for each case. RESULTS: Postmenopausal women with natural menopause were found to be positively associated with the risk of mild dysplasia adenoma (multivariate-adjusted OR : 2.59, 95% CI=1.1-6.2). Parity was found to be negatively associated with the risk of colorectal cancer (age-adjusted OR : 0.40, 95% CI=0.2-0.9), but did not significantly decrease the risk of colorectal cancer (multivariate-adjusted OR : 0.95, 95% CI=0.3-2.9). No associations were seen between age at menarche, breast feeding, induced abortion, oral contraceptive use, menopausal types, menopausal age or hormone replacement therapy (HRT) and the degree of dysplasia of the colorectal adenoma and cancer. However, none of these associations differed significantly between the degree of dysplasia of the colorectal adenoma and cancer. CONCLUSIONS: These findings suggest that postmenopausal women with natural menopause may experience increased risk of mild dysplasia adenoma among colorectal adenoma-carcinoma sequence.; Summary

A Case-Control Study on the Relationship between Obesity and Female Colorectal Cancer.: Aesun Shin, Hachung Yoon, Keun Young Yoo; Korean J Prev Med. 2002;35(2):147-152.

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Abstract PDF: OBJECTIVES
A hospital-based case-control study was conducted to evaluate the role of obesity in the development of colorectal cancer. METHODS: Three hundred and twenty four histologically confirmed female colorectal cancer cases and 26,998 non-cancer controls were selected from patients invited to the Aichi Cancer Center, Nagoya, Japan between 1989 and 1995. Information concerning demographic factors, medical history, family medical history, reproductive factors and dietary factors were obtained from self-administered questionnaires and medical records. The effects of weight and body mass index to colorectal cancer were examined using multiple logistic regression to control for other risk factors. RESULTS: There was no significant association between female colorectal cancer and obesity. Heavier weight adjusted for height or body mass index did not increase the risk of colorectal cancer. CONCLUSIONS: These results suggest that there is no associa-tion between colorectal cancer risk and obesity in women.; Summary

Nationwide incidence estimation of colorectal cancer by subsite of origin in Korea.: B J Park, M S Lee, Y O Ahn, D S Heo, D H Kim, H Kim, H S Yew, T S Park; Korean J Prev Med. 1996;29(3):555-564.

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Abstract PDF: Nationwide incidence survey was conducted to estimate the annual incidence rates of colorectal cancer among Koreans between Jan 1, 1988 and Dec 31, 1989. The population of the incidence survey was the beneficiaries of Korea Medical Insurance Corporation(KMIC), Which were about 4,500,000 persons. The medical records of patients with diagnosis of either ICD-9 153(colon cancer), 154(rectal caner), 197(secondary malignat neoplasm of digestive and respiratory system), or 211(benign neoplasm of digestive system) were abstracted for the period with the standard format. The diagnosis was confirmed by one oncologist through the review of these abstracts. The numerator of the rate was finally defined as the incident colorectal cancer cases diagnosed between July 1, 1988 and June 30, 1989. The crude annual incidence of colorectal cancer for men was 13.1 per 100,000 and 10.6 for women, which was still low when compared with those of Japan and China during the same period. Age-adjusted sex ratio was 1.2 for fight-sided colon cancer and 1.9 for left-sided colon cancer. The excess of right colon cancer among postmenopausal women was remarkable, so further analytical approach would be needed to investigate which factors are related with this phenomenon.; Summary

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