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Journal of Preventive Medicine and Public Health 2006;39(4): 346-352.
A Study on Scheduling Periodic Examinations for the Early Detection of Breast Cancer in Korea.
Seong Hwa Jeong, Dae Ryong Kang, Nam Wook Hur, Jinheum Kim, Soon Young Lee, Sang Hyuk Jung, Chung Mo Nam
1Department of Public Health, Graduate School of Yonsei University, Korea. cmnam@yumc.yensei.ac.kr
2Department of Preventive Medicine, Yonsei University College of Medicine, Korea.
3Department of Applied Statistics, The University of Suwon, Korea.
4Department of Preventive Medicine and Public Health, School of Medicine, Ajou University, Korea.
5Department of Preventive Medicine, College of Medicine, Ewha Womans University, Korea.
OBJECTIVES: The purposes of this study were to propose a screening schedule for the early detection of breast cancer among Korean women, as based on the statistical model, and to compare the efficacy of the proposed screening schedule with the current recommendations. METHODS: The development of the screening schedule for breast cancer closely followed the work of Lee and Zelen (1998). We calculated the age-specific breast cancer incidence rate from the Korea Central Cancer Registry (2003), and then we estimated the scheduling of periodic examinations for the early detection of breast cancer, using mammography, and based on the threshold method. The efficacy of the derived screening schedule was evaluated by the schedule sensitivity. RESULTS: For estimating the screening schedule threshold method, we set the threshold value as the probability of being in the preclinical stage at age 35, the sensitivity of mammography as 0.9 and the mean sojourn time in the preclinical stage as 4 years. This method generated 14 examinations within the age interval [40, 69] of 40.0, 41.3, 42.7, 44.1, 45.4, 46.7, 48.0, 49.3, 51.0, 53.2, 55.3, 57.1, 59.0 and 63.6 years, and the schedule sensitivity was 75.4%. The proposed screening schedule detected 85.2% (74.5/87.4) of the cases that could have been detected by annual screening, but it required only about 48.7% (14.0/30.0) of the total number of examinations. We also examined the threshold screening schedules for a range of sensitivities of mammography and the mean sojourn time in the preclinical stage. CONCLUSIONS: The proposed screening schedule for breast cancer with using the threshold method will be helpful to provide guidelines for a public health program for choosing an effective screening schedule for breast cancer among Korean women.
Key words: Breast cancer; Early diagnosis; Screening schedule; Threshold method
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