유방암 조기진단을 위한 검진주기 결정에 대한 연구

A Study on Scheduling Periodic Examinations for the Early Detection of Breast Cancer in Korea

  • 정성화 (연세대학교 대학원 보건학과) ;
  • 강대룡 (연세대학교 의과대학 예방의학교실) ;
  • 허남욱 (연세대학교 의과대학 예방의학교실) ;
  • 김진흠 (수원대학교 통계정보학과) ;
  • 이순영 (아주대학교 의과대학 예방의학교실) ;
  • 정상혁 (이화여자대학교 의과대학 예방의학교실) ;
  • 남정모 (연세대학교 의과대학 예방의학교실)
  • Jeong, Seong-Hwa (Department of Public Health, Graduate School of Yonsei University) ;
  • Kang, Dae-Ryong (Department of Preventive Medicine, Yonsei University College of Medicine) ;
  • Hur, Nam-Wook (Department of Preventive Medicine, Yonsei University College of Medicine) ;
  • Kim, Jin-Heum (Department of Applied Statistics, The University of Suwon) ;
  • Lee, Soon-Young (Department of Preventive Medicine and Public Health, School of Medicine, Ajou University) ;
  • Jung, Sang-Hyuk (Department of Preventive Medicine, College of Medicine, Ewha Womans University) ;
  • Nam, Chung-Mo (Department of Preventive Medicine, Yonsei University College of Medicine)
  • 발행 : 2006.07.31

초록

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.

키워드

참고문헌

  1. Parkin DM, Bray FI, Devesa SS. Cancer burden in the year 2000. The global picture. Eur J Cancer 2001; 37(supp18): S4-S66
  2. Yoo KY, Kang D, Park SK, Kim SU, Shin A, Yoon H, Ahn SH, Noh DY, Choe KJ. Epidemiology of breast cancer in Korea: occurrence, high-risk groups, and prevention. J Korean Med Sci 2002; 17(1): 1-6
  3. World Health Organization. National cancer control programmes: polices and managerial guidelines. 2nd ed. Geneva: WHO; 2003
  4. 보건복지부. 국가 암관리 사업안내 2004. 보건복지부; 2004
  5. DeVita VT, Rosenberg SA, Hellman S. Cancer: Principles & Practice of Oncology. 5th ed. Philadelphia: Lippincott Williams & Willkins Publishers; 1997
  6. Adami H, Hunter DJ, Trichopoulos D. A Textbook of Cancer Epidemiology. New York: Oxford University Press; 2002
  7. Mettlin C, Dodd GD. The American Cancer Society guidelines for the cancer-related checkup: an update. Cancer J Clinicians 1991; 41(5): 279-282 https://doi.org/10.3322/canjclin.41.5.279
  8. 이은숙. 한국인의 호발암 조기진단과 관리지침, 유방암의 조기진단. 한국유방암학회; 2001
  9. Baker SG, Chu KC. Evaluating screening for the early detection and treatment of cancer without using a randomized control group. J Am Statist Assoc 1990; 85(410): 321-327 https://doi.org/10.2307/2289767
  10. Parmigiani G. On optimal screening ages. J Am Statist Assoc 1993; 88(422): 622-628 https://doi.org/10.2307/2290344
  11. Parmigiani G. Timing medical examinations via intensity functions. Biometrika 1997; 84(4): 803-816 https://doi.org/10.1093/biomet/84.4.803
  12. Zelen M. Optimal scheduling of examinations for the early detection of disease. Biometrika 1993; 80(2): 279-293 https://doi.org/10.1093/biomet/80.2.279
  13. Lee SJ, Zelen M. Scheduling periodic examinations for early detection of disease: application to breast cancer. J Am Statist Assoc 1998; 93(444): 1271-1281 https://doi.org/10.2307/2670042
  14. 한국중앙암등록본부. 한국중앙암등록사업 연례 보고서. 보건복지부; 2003
  15. National Cancer Institute. Surveillance, Epidemiology, and End Result Program: AgeSpecific Rates for Breast Cancer. Bethesda: National Cancer Institute; 1994
  16. 통계청. Korea Statistical Information System(KOSIS), 통계DB검색, 연령별 추계인구. [cited 2006 March 28]. Available from: URL:http://kosis.nso.go.kr
  17. Day NE, Walter SD. Simplified models of screening of chronic disease: estimation procedures from mass screening programmes. Biometrics 1984; 40(1): 1-13 https://doi.org/10.2307/2530739
  18. Day NE, Walter SD, Tabar L. The Sensitivity and Lead Time of Breast Cancer Screening: A Comparison of the Results of Different Studies. In: Day NE, Miller AB, Editors. Screening for Breast Cancer. Stuttgart: Hans Huber; 1984
  19. Zelen M, Feinleib M. On the theory of screening for chronic disease. Biometrika 1969: 56(3); 601-614 https://doi.org/10.1093/biomet/56.3.601
  20. Shapiro S, Venet W, Strax PH, Venet L, Rosener R. Ten- to fourteen-years effect of screening on breast cancer mortality. J Natl Cancer Inst 1982; 69(2): 349-355
  21. Althuis MD, Dozier ZM, Anderson WF, Devesa SS, Brinton LA Global trends in breast cancer incidence and mortality 1973-1997. Int J Epidemiol 2005; 34(2): 405-412 https://doi.org/10.1093/ije/dyh414
  22. Shen Y, Zelen M. Screening sensitivity and sojourn time from breast cancer early detection clinical trials: Mommograms and physical examinations. J Clin Oncol 2001; 19(15): 3490-3499 https://doi.org/10.1200/JCO.2001.19.15.3490
  23. Maskarinec G, Meng L, Ursin G. Ethnic differences in mammographic densities. Int J Epidemiol 2001; 30(5): 959-965 https://doi.org/10.1093/ije/30.5.959
  24. National Cancer Institute. Cancer trends progress reports. [cited 2006 March 28]. Available from: URL:http://progressrepoltcancer.gov/index.asp
  25. 한국보건사회연구원. 2001국민건강 . 영양조사_총괄편_. 보건복지부; 2002
  26. Sung NY, Park EC, Shin HR, Choi KS. Participation rate and related sociodemographic factors in the national cancer screening program. J Prev Med Public Health 2005; 38(1): 93-100 (Korean)