| Invited Lecture (JSGCS) |
| Thu. November 1st 11:00 - 11:40 Room 7: Portopia Hotel South Wing Ohwada C |
| Korean experience of national stomach cancer screening by endoscopy - progress and outcomes | |||
| Yeol Kim | |||
| Korean National Cancer Center | |||
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| Background Cancer screening is one of the most effective methods for cancer control. Korean National Cancer Screening Program (KNCSP) started from 1999 to provide organized cancer screening for reducing cancer burden in the low income people. Since 2002, KNCSP has expanded the target population and provided all people to take regular cancer screening when they come to certain age. This program covers five major cancers; stomach, colon, liver, breast, and uterine cervix cancer. Stomach cancer screening has been provided to 40 or over aged population by endoscopy or radiography biennially. National Stomach Cancer Screening Progress Stomach cancer screening participation rate has been increased from 11.4% in 2002 to 45.0% in 2016 in KNCSP. For the stomach cancer screening methods, only 17.0% of the participants choose radiography and 83.0% choose endoscopy in 2016. When stomach cancer screening rate is calculated including both KNCSP and private screening, the rate is as high as 73.0% in 2016. For quality assurance, KNCC and related academic societies developed the quality control guidelines for national cancer screening in 2008. The guidelines has been disseminated and educated to health care workers in cancer screening units. Based on the guidelines, the quality assessment items were extracted for evaluating cancer screening units. The evaluation of quality of screening units in KNCSP has been regularly conducted with 3 year interval. Recently, the guidelines for quality were revised and published after 2 year study by evidence review and consensus building in the committee comprised with multidisciplinary experts and representatives of screening units. The revised quality control guideline for stomach cancer screening recommend that physicians who provide screening endoscopy in KNCSP need 500 or more experience of stomach endoscopy. Also the physicians are recommended to attend the continuous education on screening endoscopy provided by academic society at least 12 hours during 3 years. Name and license number of physicians who provide exam should be fill up in the report of cancer screening results. At least eight images of important parts in the stomach were recommended to take photograph in the revised guideline. Outcomes of National Stomach Cancer Screening in Korea Through the efforts of improving stomach cancer screening participation rate and quality level, the detection rate in restricted stage of stomach cancer is 61.6% among all diagnosed stomach cancers from 2011 to 2015 in Korea National Cancer Registry. The five-year relative survival rate has been much increased from 42.8% of total stomach cancer patients diagnosed during 1993~1995 to 75.4% of patients diagnosed during 2011~2015. From retrospective cohort analysis based on KNCSP data, endoscopic stomach cancer screening reduced about 40% of stomach cancer mortality compared than non-screening participants. Also the mortality has been more reduced by participating in repeated screening. The screening effect on mortality reduction and early detection of stomach cancer is much higher by endoscopy than radiography in KNCSP. Based on the evidence, stomach cancer screening program was revised to recommend endoscopy as first-line screening method and radiography as optional method in KNCSP from 2018. |
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