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

OBJECTIVETo evaluate the feasibility of surgical management for patients with locally advanced carcinomas of uterine cervix after radical radiation therapy who were prone to develop central recurrence.

METHODSThese 40 patients were treated by combined pre-operative radiotherapy with dose at point A of > 70 Gy in 30 patients, 60 approximately 70 Gy in 7, 50 approximately 59 Gy in 2 and 44 Gy in 1. The interval between radiation and surgery was 1 - 6 weeks. Extrafascial hysterectomy was performed in 15 patients, subradical hysterectomy in 23 and radical hysterectomy with pelvic lymphadenectomy in 2 cases.

RESULTSThese patients have been followed up for 1 - 8 years with 2 died of other diseases and 12 died of cancer. Eighteen of the 26 survivors have been followed up for more than 5 years. The 3- and 5-year survival rates were 74.9% and 66.8%. Half of the death occurred within the first year after treatment. The 2-year death rate was 9/12 (75.0%). Three patients suffered from long term complications after the treatment, but all were cured by conservative management.

CONCLUSIONThe combination of hysterectomy performed shortly after radical radiotherapy, ie, for patients with locally poor prognostic cervical carcinoma is reasonable and feasible.

Adult ; Cervix Uteri ; Combined Modality Therapy ; Female ; Humans ; Hysterectomy ; Middle Aged ; Neoplasm Staging ; Survival Rate ; Uterine Cervical Neoplasms ; mortality ; radiotherapy ; surgery

INTRODUCTION: The prevalence and mortality of patients with invasive cervical carcinoma have decreased. However, therapeutic results in advanced cervical carcinoma with systemic metastasis was not satisfactory and the therapeutic modalities had lots of morbidities. To know exact extent of disease is important in order to decide pertinent therapeutic modality to each patient. OBJECTIVES: We intended to evaluate the risk factors, clinical characteristics, and survival of the cervical cancer patients with scalene lymph node metastasis and, to assess the need of the scalene lymph node biopsy in baseline study of advanced carcinoma of cervix or recurrent carcinoma of cervix. Materials and METHODS: We have reviewed clinical charts of total 3624 patients treated for carcinoma of cervix at the department of Obstetrics and Gynecology, Yonsei University College of medicine, from Jan.1981 to Dec.1995. 25 patients (0.68%) were proven to have scalene lymph node metastasis by way of studies including radiologic imaging, physical examination, and lymph node biopsy. RESULTS: Patient' s age ranged from 22 to 80 years with a median of 50 years. The incidence of metastasis was related with the stage at initial diagnosis, pathological type of tumor, existence of para-arotic lymph node metastasis. The patients had other metastasis in 14 cases(66%) and 5 cases had multiple metastatic sites. In spite of aggressive systemic chemotherapy or radiotherapy, the survivial after diagnosis of metastasis was extremely poor, 2- year survival rate was only 9.52%, respectively. CONCLUSION: The incidence of scalene lymph node metastasis in patients with carcinoma of cervix was very rare in our series, we couldn' t recommend the scalene lymph node biopsy as a modality of baseline study. In patients with paraaortic lymph node metastasis or clinically palpable lymph node, the scalene lymph node biospy may help patients omit aggressive, unnecessary treatment. To prove the value of biopsy of scalene lymph node, well-designed large prospective study would be necessary.
Biopsy ; Cervix Uteri ; Diagnosis ; Drug Therapy ; Female ; Gynecology ; Humans ; Incidence ; Lymph Nodes* ; Mortality ; Neoplasm Metastasis* ; Obstetrics ; Physical Examination ; Prevalence ; Radiotherapy ; Risk Factors ; Survival Rate ; Uterine Cervical Neoplasms