Stomach cancer screening and preventive behaviors in relatives of gastric cancer patients

doi:10.3748/wjg.v17.i30.3518

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Brief Article

World J Gastroenterol. Aug 14, 2011; 17(30): 3518-3525
Published online Aug 14, 2011. doi: 10.3748/wjg.v17.i30.3518

Table 1 The national cancer screening program in Korea

Cancer	Target population	Frequency	Test or procedure	Co-payment¹ (US $)
Stomach	40 and over (adults)	Every 2 yr	Endoscopy or Upper Gastrointestinal Series	7
Colorectal	50 and over (adults)	Every 1 yr²	Fecal Occult Blood Test³	0.5
Breast	40 and over (women)	Every 2 yr	Mammography and Clinical breast exam	3.5
Cervix	30 and over (women)	Every 2 yr	Pap smear	0

¹Co-payments only applied to people with a higher income (i.e., upper 50%), and account for 20% of the total price. No co-payment is applied to the low-income population (i.e., lower 50%). There is no co-payment for cervical cancer screening regardless of income level;

²Colorectal screening is provided every 2 years to most of the target population, with the exception of low-income people or manual laborers;

³Colonoscopy or barium enema are performed if the fecal occult blood test is positive.

Table 2 Characteristics of gastric cancer relatives and controls n (%)

	Controls (n = 2842)	Non-gastric cancer relatives (n = 454)	Gastric cancer relatives (n = 261)	P¹
Sex
Male	1258 (44.3)	190 (41.9)	105 (40.2)	0.321
Female	1584 (55.7)	264 (58.2)	156 (59.8)
Age (yr)
40-49	1024 (36.0)	211 (46.5)	104 (39.9)	< 0.001
50-59	710 (25.0)	118 (26.0)	85 (32.6)
60-69	665 (23.4)	85 (18.7)	51 (19.5)
≥ 70	443 (15.6)	40 (8.8)	21 (8.1)
Education
Elementary	1136 (40.0)	116 (25.6)	79 (30.3)	< 0.001
Middle to high school	1271 (44.7)	246 (54.2)	146 (55.9)
University and higher	435 (15.3)	92 (20.3)	36 (13.8)
Marital status
Married	2188 (77.0)	387 (85.4)	211 (80.8)	< 0.001
Single	653 (23.0)	66 (14.6)	50 (19.2)
Smoking status
Non-smoker	1588 (57.3)	260 (59.8)	152 (59.6)	0.657
Ex-smoker	582 (21.0)	86 (19.8)	45 (17.7)
Current smoker	602 (21.7)	89 (20.5)	58 (22.8)
Alcohol drinking
None	1524 (55.0)	241 (55.4)	145 (56.9)	0.841
More than once a month	1248 (45.0)	194 (44.6)	110 (43.1)
Income (US $/mo)²
< 1000	801 (28.2)	87 (19.2)	48 (18.4)	< 0.001
1000-5000	1825 (64.2)	315 (69.4)	192 (73.6)
≥ 5000	216 (7.6)	52 (11.5)	21 (8.1)
Self-reported health status
Good	873 (30.8)	149 (33.0)	82 (31.7)	0.502
Intermediate	1017 (35.9)	171 (37.8)	96 (37.1)
Bad	946 (33.4)	132 (29.2)	81 (31.3)
Stress
Low	1822 (65.7)	294 (67.6)	168 (65.9)	0.703
Moderate	770 (27.8)	120 (27.6)	73 (28.6)
High	180 (6.5)	21 (4.8)	14 (5.5)

¹P values were calculated by using a χ² test;

²1 US $ = 1000 won.

Table 3 Prevalence of cancer screening n (%)

	Controls (n = 2842)	Non-gastric cancer relatives (n = 454)	Gastric cancer relatives (n = 261)
Stomach cancer screening (within 2 yr)
Crude rate	894 (32.3)	162 (37.2)	100 (39.2)
Adjusted rate (%, 95% CI)²	32.2 (30.5, 34.0)	35.2 (30.8, 39.8)	38.1 (32.3, 44.2)
Crude OR (95% CI)	1 (referent)	1.16 (0.89, 1.50)	1.47 (1.08, 2.00)^a
Adjusted OR (95% CI)¹	1 (referent)	1.08 (0.83, 1.41)	1.43 (1.05, 1.95)^a
Breast cancer screening (within 2 yr)
Crude rate	456 (29.6)	102 (40.8)	61 (40.9)
Adjusted rate (%, 95% CI)²	28.9 (26.7, 31.4)	36.5 (30.7, 42.8)	38.5 (31.0, 46.7)
Crude OR (95% CI)	1 (referent)	1.68 (1.21, 2.33)^a	1.53 (1.05, 2.23)^a
Adjusted OR (95% CI)¹	1 (referent)	1.42 (1.02, 2.00)^a	1.40 (0.95, 2.08)
Cervical cancer screening (within 2 yr)
Crude rate	596 (39.9)	133 (53.9)	71 (47.7)
Adjusted rate (%, 95% CI)²	39.1 (36.5, 41.8)	47.3 (40.7, 54.1)	43.2 (35.1, 51.7)
Crude OR (95% CI)	1 (referent)	1.90 (1.35, 2.68)^a	1.33 (0.90, 1.97)
Adjusted OR (95% CI)¹	1 (referent)	1.51 (1.04, 2.20)^a	1.14 (0.76, 1.71)
Colon cancer screening (within 5 yr)
Crude rate	309 (17.5)	55 (23.6)	33 (21.4)
Adjusted rate (%, 95% CI)²	17.2 (15.4, 19.0)	22.6 (17.7, 28.5)	20.2 (14.6, 27.3)
Crude OR (95% CI)	1 (referent)	1.17 (0.78, 1.74)	1.48 (0.85, 2.56)
Adjusted OR (95% CI)¹	1 (referent)	1.10 (0.73, 1.67)	1.41 (0.83, 2.41)

^aP < 0.05.

¹Calculated via multiple logistic regression and adjusted for age, sex, education, marital status, smoking, alcohol consumption, income, and self-reported health status;

²Calculated via analysis of covariance adjusted for age, sex, education, marital status, smoking, alcohol consumption, income, and self-reported health status. OR: Odds ratio.

Table 4 Gastric cancer screening prevalence by education level, age and income subgroups

	Controls (n = 2842)	Non-gastric cancer relatives (n = 454)	Gastric cancer relatives (n = 261)
Education level
Elementary
n (%)	322 (29.2)	37 (32.5)	27 (35.1)
aOR (95% CI)¹	1 (referent)	0.93 (0.57, 1.51)	1.59 (0.85, 2.96)
Middle and higher
n (%)	572 (34.3)	125 (38.9)	73 (41)
aOR (95% CI)¹	1 (referent)	1.13 (0.82, 1.55)	1.36 (0.97, 1.92)
Age group (yr)
40-59
n (%	585 (34.5)	118 (37.7)	78 (42.4)
aOR (95% CI)¹	1 (referent)	1.11 (0.82, 1.49)	1.53 (1.07, 2.17)^a
≥ 60
n (%)	309 (28.8)	44 (36.1)	22 (31)
aOR (95% CI)¹	1 (referent)	0.99 (0.57, 1.69)	1.08 (0.59, 1.98)
Income (US $/mo)
< 1000
n (%)	214 (27.1)	22 (26.2)	8 (17)
aOR (95% CI)¹	1 (referent)	0.86 (0.47, 1.57)	0.70 (0.28, 1.77)
1000-5000
n (%)	580 (32.8)	113 (37.7)	79 (41.8)
aOR (95% CI)¹	1 (referent)	1.16 (0.84, 1.60)	1.56 (1.10, 2.21)^a
≥ 5000
n (%)	100 (47.4)	27 (53.0)	13 (68.4)
aOR (95% CI)¹	1 (referent)	1.02 (0.46, 2.26)	2.70 (0.82, 8.88)

^aP < 0.05.

¹Adjusted odds ratios (aOR) were calculated via multiple logistic regression.

Table 5 Gastric cancer-preventive behaviors

	Controls (n = 2842)		Non-gastric cancer relatives (n = 454)		Gastric cancer relatives (n = 261)
	Crude	Adjusted	Crude	Adjusted	Crude	Adjusted
Na (mg)
Mean intake (SE)²	5582 (66)	5602 (64)	5574 (166)	5522 (162)	5516 (213)	5483 (212)
P value			0.86	0.99	0.76	0.50
High sodium intake (> 2000 mg)
Rate, n (%)²	2625 (92.4)	93.8	429 (94.5)	94.9	247 (94.6)	95.1
Odds ratio¹	1 (referent)	1 (referent)	1.67 (1.04, 2.67)^a	1.56 (0.95, 2.57)	1.34 (0.71, 2.54)	1.17 (0.61, 2.26)
Vitamin C (mg)
Mean intake (SE)²	98.5 (1.6)	100.0 (1.6)	114.1 (4.9)	109.7 (4.1)	110.0 (6.2)	107.2 (5.4)
P value			0.03^a	0.15	0.07	0.19
Low vitamin C intake (< 60 mg)
Rate, n (%)²	922 (32.4)	30.7	129 (28.4)	30.5	78 (29.9)	30.8
Odds ratio¹	1 (referent)	1 (referent)	0.79 (0.59, 1.06)	0.91 (0.67, 1.23)	0.79 (0.55, 1.13)	0.89 (0.62, 1.28)
Dietary fiber (g)
Mean intake (SE)²	8.0 (0.1)	8.0 (0.1)	8.4 (0.2)	8.3 (0.2)	8.3 (0.3)	8.3 (0.3)
P-value			0.20	0.30	0.08	0.14
Low fiber intake (< 20 g)
Rate, n (%)²	2447 (86.1)	87	383 (84.4)	86.9	225 (86.2)	87.4
Odds ratio¹	1 (referent)	1 (referent)	0.86 (0.44, 1.66)	0.86 (0.44, 1.68)	1.17 (0.50, 2.72)	1.20 (0.50, 2.85)
Current smoking status
Rate, n (%)²	602 (21.7)	12.9	89 (20.5)	13.2	58 (22.8)	15.4
Odds ratio¹	1 (referent)	1 (referent)	0.95 (0.69, 1.29)	1.04 (0.73, 1.47)	1.10 (0.78, 1.55)	1.18 (0.76, 1.83)

^aP < 0.05.

¹Adjusted odds ratios were calculated via multiple logistic regression and adjusted for age, sex, education, marital status, smoking, alcohol consumption, income, and self-reported health status;

²Adjusted means and adjusted rates were calculated via analysis of covariance adjusted for age, sex, education, marital status, smoking, alcohol consumption, income, and self-reported health status.

Table 6 Perception of the benefits of screening n (%)

	Controls (n = 2842)	Non-gastric cancer relatives(n = 454)	Gastric cancer relatives (n = 261)
Beneficial	1783 (64.4)	292 (67.1)	163 (63.9)
Not beneficial	292 (10.5)	47 (10.8)	36 (14.1)
Have never received	696 (25.1)	96 (22.1)	56 (22.0)

Citation: Kang JM, Shin DW, Kwon YM, Park SM, Park MS, Park JH, Son KY, Cho BL. Stomach cancer screening and preventive behaviors in relatives of gastric cancer patients. World J Gastroenterol 2011; 17(30): 3518-3525
URL: https://www.wjgnet.com/1007-9327/full/v17/i30/3518.htm
DOI: https://dx.doi.org/10.3748/wjg.v17.i30.3518