Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2020; 26(27): 3963-3974
Published online Jul 21, 2020. doi: 10.3748/wjg.v26.i27.3963
Acceptance on colorectal cancer screening upper age limit in South Korea
Xuan Quy Luu, Kyeongmin Lee, Yun Yeong Lee, Mina Suh, Yeol Kim, Kui Son Choi
Xuan Quy Luu, Kyeongmin Lee, Kui Son Choi, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si 10408, South Korea
Yun Yeong Lee, Mina Suh, Yeol Kim, Kui Son Choi, National Cancer Control Institute, National Cancer Center, Goyang-si 10408, South Korea
Author contributions: Luu XQ, Suh M, Kim Y, and Choi KS designed study; Lee Y administered survey; Luu XQ and Lee K participated in the data analysis and interpretation; Luu XQ drafted the initial manuscript; all authors have reviewed and approved the manuscript.
Supported by Grant-in-Aid for Cancer Research and Control from the National Cancer Center of Korea, No. #1910231-2.
Institutional review board statement: This study was approved by the Institutional Review Board of the National Cancer Center, South Korea (approval number: NCC2019-0233).
Informed consent statement: All study participants provided informed consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kui Son Choi, PhD, Professor, Department Chair, Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang-si 10408, South Korea. kschoi@ncc.re.kr
Received: March 26, 2020
Peer-review started: March 26, 2020
First decision: April 25, 2020
Revised: May 6, 2020
Accepted: July 4, 2020
Article in press: July 4, 2020
Published online: July 21, 2020
Processing time: 117 Days and 3.7 Hours
Research background

Colorectal cancer (CRC) is one of the most common types of cancer worldwide. Screening for CRC is recognized as an effective intervention through which to reduce the numbers of new cancer cases and cancer deaths. In South Korea, although the Korea National Cancer Center recommends CRC screening for adults aged 45 to 80 years, the Korea National Cancer Screening Program currently provides CRC screening for individuals aged 50 years and older with no upper age limit.

Research motivation

In general, people are likely to only pay attention to the benefits of cancer screening and to neglect its risks. Most consider the benefits of cancer screening as being far greater than the risks and are unaware that any potential benefits and harms can vary with age. Although several CRC screening guidelines recommend setting an upper age, there is a lack of information on perceptions and acceptance of an upper age limit for CRC screening.

Research objectives

In this study, we aimed to investigate acceptance of an upper age limit for CRC screening and factors associated therewith among cancer-free individuals targeted for screening in South Korea.

Research methods

The present study analyzed data from the Korea National Cancer Screening Survey 2017, a nationally representative survey targeted for cancer screening. A total of 1922 participants were included in the final analysis. The baseline characteristics of the study population are presented as unweighted numbers and weighted proportions. Both univariate and multivariate logistic regression models were developed to examine factors related with acceptance of an upper age limit for CRC screening. Subgroup analysis was also applied.

Research results

About 80% of the respondents agreed that CRC screening should not be offered for individuals aged older than 80 years, especially respondents who had never been screened for CRC (91%). Overall, the factors significantly associated with acceptance of an upper limit age among the respondents were residential region, cancer screening history, family history of cancer, and physical activity. By subgroup analysis, we found gender, marital status, and lifetime smoking history among never-screened individuals and residential region, family history of cancer, and physical activity among never-screened individuals to be associated with acceptance of an upper age limit.

Research conclusions

The majority of the participants in this study agreed with the recommendation of the National Cancer Center of Korea to stop CRC screening at the age of 80 years. CRC screening history was a strong factor associated with acceptance. In order to reduce unnecessary burden of cancer screening programs, it is recommended to provide balanced information on the benefits and risks of screening.

Research perspectives

Our study results provide perspectives that should be considered, in addition to scientific evidence, when developing population-based cancer screening policies and programs. In the future, further research on attitudes and preferences toward cancer screening policies in the general population are required.