It is often difficult to conclude that improvements in survival with time are due to a screening programme alone. Although a reduction in the death rate from a given cancer may reflect the benefits of early detection or improved treatment, the benefits may also result from lead time bias and over-diagnosis, the former resulting in longer survival of screen-identified cancers because the time before the cancer would have been clinically diagnosed is included in calculations. Furthermore, recent reviews on randomised clinical trials of cancer screening have provided strong evidence that misclassifications in causes of death have been a major problem, leading to an over-estimation of the effectiveness (or alternatively an under-estimation of potential harm) of screening.
Cervix Neoplasms/*diagnosis ; Endometrial Neoplasms/diagnosis ; Female ; Genital Neoplasms, Female/*diagnosis/epidemiology/mortality ; Human ; Incidence ; Ovarian Neoplasms/diagnosis ; Risk

The majority of patients with recurrent cervical cancer are incurable and treatment is based on the type of primary therapy delivered. Only a very small percentage of the patients with recurrent cervical cancer following primary radiotherapy will have central pelvic recurrences that are amenable to surgical resection and curable by pelvic exenteration. These procedures should be undertaken only after the completion of exhaustive attempts to exclude extrapelvic disease.
Cervix Neoplasms/drug therapy/mortality/*surgery ; Female ; Human ; Neoplasm Recurrence, Local/drug therapy/mortality/*surgery ; Pelvic Exenteration/adverse effects/methods

This study was carried out for the burden of disease of major cancers assessment using years of lives with disability in Korea. With the years of lives with disability, this indicator was applied in order to estimate burden of major cancer disease. For this work, We also estimated incidence rate, remission rate, case fatality rate, average age of onset, expected duration with disability in each cancer disease. As sources of information, national health insurance data and national mortality registration data were analyzed. The results of the study are as follows; The top five causes of the burden of major cancer disease are evaluated as stomach cancer, liver cancer, colon and rectum cancer , esophageal cancer, lung cancer in male. The top five causes of the burden of major cancer disease are evaluated as stomach cancer, esophageal cancer, liver cancer, uterine cervix cancer ovarian cancer in female. The process of evaluating the burden disease of major cancers in Korea has not finished with this paper. This study should be seen as the first in a series in Korea. It is necessary to analyse with more accuracy the assumptions behind the methodology.
Age of Onset ; Cervix Uteri ; Colon ; Esophageal Neoplasms ; Female ; Humans ; Incidence ; Korea* ; Liver Neoplasms ; Lung Neoplasms ; Male ; Mortality ; National Health Programs ; Ovarian Neoplasms ; Rectal Neoplasms ; Stomach Neoplasms

Cervical cancer is a well-known preventable cancer worldwide. Many countries including Korea have pursued the positive endpoint of a reduction in mortality from cervical cancer. Our aim is to examine changing trends in cervical cancer incidence and mortality after the implementation of a national preventive effort in Korea. Cervical cancer incidence data from 1999 to 2011 and mortality data from 1983 to 2013 were collected from the Korean Statistical Information Service. Yearly age-standardized rates (ASR) per 100,000 were compared using two standards: the 2005 Korean population and the world standard population, based on Segi's world standard for incidence and the World Health Organization for mortality. In Korea, the age-standardized incidence of cervical cancer per 100,000 persons declined from 17.2 in 2000 to 11.8 in 2011. However, the group aged 25 to 29 showed a higher rate in 2011 (ASR, 6.5) than in 2000 (ASR, 3.6). The age-standardized mortality rate per 100,000 persons dropped from 2.81 in 2000 to 1.95 in 2013. In the worldwide comparison, the incidence rates remained close to the average incidence estimate of more developed regions (ASR, 9.9). The decreasing mortality trend in Korea approached the lower rate observed in Australia (ASR, 1.4) in 2010. Although the incidence rate of cervical cancer is continuously declining in Korea, it is still high relative to other countries. Moreover, incidence and mortality rates in females aged 30 years or under have recently increased. It is necessary to develop effective policy to reduce both incidence and mortality, particularly in younger age groups.
Australia ; Cervix Uteri ; Female ; Humans ; Incidence* ; Information Services ; Korea ; Mortality* ; Republic of Korea* ; Uterine Cervical Neoplasms* ; World Health Organization

Sixty patients, treated with postoperative radiation therapy following radical hysterectomy and pelvic lymphadenectomy for stage lb carcinoma of the uterine cervix between Jan. 1980 and Dec. 1984 at Department of Radiation Oncology, Yonsei University College of Medicine, were retrospectively analysed. The minimum follow-up period was 5 years. The indications for postoperative radiotherapy were positive pelvic lymph node (34 pts), a large tumor size more than 3 cm in longest diameter (18 pts), positive surgical margin (10 pts), deep stromal invasion (10 pts), and lymphatic permeation (9 pts). The overall 5-year survival rate was 81.8%. The univariate analysis of prognostic factors disclosed tumor size (less than 3cm, greater than or equal to 3cm) and the status of the surgical margin (positive, negative) as significant factors (tumor size; 88.1% vs 6.3%, surgical margin; 85.5% vs 60%, p less than 0.05). Age (less than or equal to 40, greater than 40 yrs) was marginally significant (90.2% vs 73.1%, p less than 0.1). Multivariate analysis clarified two independent prognostic factors; tumor size (p = 0.010) and surgical margin (p = 0.004). Analysis of the tumor factors with the radiation dose disclosed a better survival rate for patients with a positive surgical margin who were given over 50 Gy than for those who were given below 50 Gy in patients (4/4, 100% vs 2/6, 33.4%; p = 0.06). Significant complications requiring surgical correction were not observed. In conclusion, it is believed that the status of the surgical margin and tumor size both have important prognostic significance, and that a radiation dose over 50 Gy is advisable for patients with a positive surgical margin.
Adult ; Carcinoma/mortality/*radiotherapy/surgery ; Cervix Neoplasms/mortality/*radiotherapy/surgery ; Combined Modality Therapy ; Female ; Human ; Hysterectomy ; Lymph Node Excision ; Lymphatic Metastasis ; Prognosis ; Retrospective Studies ; Support, Non-U.S. Gov't

PURPOSE: We estimated the incidence of cancer in Korea. MATERIALS AND METHODS: The indicence of cancer was estimated using national mortality data, and the incidence data from four frontier regional cancer registries, including Kangwha, Seoul, Busan and Deagu. These four registries served a population about seventeen million, which is almost 38% of entire population in Korea. RESULTS: The overall age-standardized incidence rates (ASR) were 287.0 and 163.1 per 100,000 for males and females, respectively. Among males, stomach cancer was the most frequent (ASR 69.6), followed by lung cancers, including bronchus cancer (ASR 54.5), liver cancer (ASR 47.0) and colo-rectal cancer (ASR 25.2). The most frequent sites of cancer in females, by rank order, were stomach (ASR 26.8), breast (ASR 20.1), uterine cervix (ASR 18.0), colo-rectum (ASR 15.9), lung (ASR 13.0) and liver (ASR 12.0). CONCLUSION: It is hoped that these results will provide valuable leads for cancer research and cancer control in Korea.
Breast ; Bronchi ; Busan ; Cervix Uteri ; Daegu ; Female ; Hope ; Humans ; Incidence* ; Korea* ; Liver ; Liver Neoplasms ; Lung ; Lung Neoplasms ; Male ; Mortality ; Registries ; Seoul ; Stomach ; Stomach Neoplasms

Current status of cancer screening rate and epidemiologic study for evaluating the effectiveness of cancer screening in Korea are reviewed. There are only few studies for an analysis of the current cancer screening status and associated factors in a community. Among these, a study which were done at Uijongbu city, showed the results on follows ; in the case of the screening of the stomach cancer, 16.1% of male subjects and 25.8% of female subjects turned out to have had one or more screenings for the cancer. In the cases of the breast and cervical cancers, 21.6% and 62.6% of the subjects turned out to have had one or more screenings respectively. The main epidemiologic studies which were for cancer screening effectiveness evaluation were case-control studies for stomach, cervix and breast cancer. According to these studies ; odds ratio was 0.71(95% confidence interval 0.36-1.40) for stomach cancer, 0.53(95% confidence interval 0.33-0.85), cervix cancer and 0.43(95% confidence interval 0.25-0.75) for breast cancer. Establishing cancer screening recommendation to promote national cancer control program and increasing cancer screening rate are needed to reach the goal of reducing cancer mortality and morbidity.
Breast ; Breast Neoplasms ; Case-Control Studies ; Cervix Uteri ; Early Detection of Cancer* ; Epidemiologic Studies* ; Female ; Humans ; Korea* ; Male ; Mass Screening ; Mortality ; Odds Ratio ; Stomach ; Stomach Neoplasms ; Uterine Cervical Neoplasms

Pelvic exenteration is a salvage procedure performed for centrally recurrent gynecologic cancers. The procedure involve en bloc resection to a greater or lesser degree of all pelvic structures, including the uterus, cervix, vagina, bladder and rectum. It was first reported by Brunschwig in 1948 as an ultra-radical surgical treatment for advanced and recurrent cervical cancer. Most patients who are candidates for the procedure have a diagnosis of recurrent cervical cancer that previously has been treated with surgery and radiation or radiation alone. In some cases, patients with recurrent uterine, vulvar, or vaginal cancers may benefit from pelvic exenteration. Currently, operative mortality rates range from 3% to 5%, the rate of major perioperative complications is 30-22% and the overall 5-year survival rate is those patients who successfully undergo the procedure ranges from 20-50%. We experience a case of total pelvic exenteration for recurrent cervical carcinoma found after simple hysterectomy. It is presented with a brief reviews of literatures.
Cervix Uteri ; Diagnosis ; Female ; Humans ; Hysterectomy* ; Mortality ; Pelvic Exenteration* ; Rectum ; Survival Rate ; Urinary Bladder ; Uterine Cervical Neoplasms ; Uterus ; Vagina ; Vaginal Neoplasms

BACKRGROUND: Cervix cancer is the most common form of cancer among Korea women. In spite of proof that cervical cancer screening could reduce death rates substantially, the screening rates reported by previous Korean studies remain stubbornly very low. Behavioral studies to increase the cervix cancer screening rate are essential in order to develop the cancer screening program. OBJECTIVE: To evaluate the factors which are related to the intention and behavior for cervix cancer screening using the Theory of Planned Behavior (TPB) and the Theory of Reasoned Action (TRA). METHODS: The survey was conducted from July 21st to 26th in 1998. Of 3,218 women, 393(12.2%) between 30 and 65 years old, voluntarily participated in the survey in the 3 Myeons in Choongju city. Charge-free cervix cancer screening was provided for the subjects 3 months later. RESULTS: The R-square of both TPB and TRA to the intention (30% and 42%, respectively) was greater than the actual behavior (21% and 13%, respectively. TPB and TRA were found to provide an appropriate framework for the study of cervix cancer screening behavior. However, TRA was more powerful in explaining the intention, not only because the perceived behavioral control component exhibited lower reliability and validity than other components(attitude and subjective norm), but also because there may have been a few limitations in this study design. Consequently, the use of TRA is preferred in attempting to explain intention and actual behavior in this study. CONCLUSIONS: This study suggests that a successful intervention program should focus on changing attitudes and reducing psychologic barriers, rather than on just providing information. Physician recommendations, and the support of family members and friends are also very important factors in cervix cancer program participation. Physicians, friends, family members, and opinion leaders in rural areas, all of whom could affect the individual subjective norm, may all have the potential to play great roles as facilitators.
Aged ; Cervix Uteri* ; Chungcheongbuk-do ; Early Detection of Cancer ; Female ; Friends ; Health Behavior ; Humans ; Intention ; Korea ; Mass Screening* ; Mortality ; Reproducibility of Results ; Uterine Cervical Neoplasms*

OBJECTIVE: To investigate the 5-year relative survival rates in gynecological cancers diagnosed and treated in Turkey by year 2009 and to compare the results with developed countries. METHODS: Data of patients diagnosed for ovarian, corpus uteri or cervix uteri cancer at year 2009 are collected from 9 national cancer registry centers. Date of deaths are retracted from governmental Identity Information Sharing System (KPS). In order to calculate relative survival rates, national general population mortality tables are obtained from Turkish Statistical Institute (TurkStat). Hakulinen method is used for computing curves by R program. Data for European, Asian and some developed countries were obtained from official web pages. RESULTS: A total of 1,553 patients are evaluated. Among these, 713 (45.9%) are corpus uteri cancers, while remaining 489 (31.5%) are ovarian and 351 (22.6%) are cervix uteri. Five-year overall relative survival rates are 85%, 50%, and 62% for corpus uteri, ovarian, and cervix uteri, respectively. These figures are between 73%–87% for corpus uteri, 31%–62% for ovarian and 61%–80% for cervix uteri in developed countries. Stage is the most important factor for survival in all cancers. Five-year relative survival rates in corpus uteri cancers are 92%, 66%, and 38% for localized, regional, and distant metastatic disease, respectively. These figures are 77%, 57%, and 29% for ovarian; 80%, 50%, and 22% for cervix uteri. CONCLUSION: This is the first report from Turkey giving national overall relative survival for gynecological cancers from a population based cancer registry system.
Asian Continental Ancestry Group ; Cervix Uteri ; Developed Countries ; Female ; Genital Neoplasms, Female ; Humans ; Information Dissemination ; Methods ; Mortality ; Ovarian Diseases ; Survival Rate ; Turkey* ; Uterus