Hai-Rim Shin

Background: HGF (hepatocyte growth factor) is also known as a scatter factor and is multifunctional cytokine that modulates processes such as growth, adhesion, motility, matrix degradation, invasion, and angiogenesis. We investigated whether serum HGF was a biomarker for the early detection and diagnosis of gastric cancer in a nested case-control study. Methods: The study population was composed of 282 cases and 282 matched controls within the Korean Multicenter Cancer Cohort. Plasma HGF was measured by enzyme-linked immunosorbent assay (ELISA). Conditional logistic regression models were used to compute the odds ratio (OR) and 95% confidence intervals (CI). Results: According to stratified analysis on age, sex, H. pylori infection, CagA and smoking, gastric cancer patients which are older, female, H. pylori positive, CagA positive and non-smokers had significantly higher serum HGF concentrations than normal controls. When conducting a logistic regression analysis of a group with the lowest concentration as a reference after dividing them into quartile according to serum HGF concentration, also, a group with the highest serum HGF concentration(≥393.7 pg/mL) showed a significantly increased risk of gastric cancer(OR=2.4 95% CI 1.4-3.9). In addition, higher serum HGF concentrations were associated with an increased risk for gastric cancer and it was statistically significant (p for trend=0.0054). Conclusions: Our finding suggested the possibility that HGF protein can be a biomarker to predict the risk of gastric cancer. Citation Format: Seung Hyun Ma, Jae Jeong Yang, Ko Kwang-Pil, Aesun Shin, Hai-Rim Shin, Daehee Kang, Keun-Young Yoo, Sue K. Park. Predictive value of plasma hepatocyte growth factor levels in gastric cancer risk: A nested case-control study within the Korean Multicenter Cancer Cohort. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr A20. Note: This abstract was not presented at the conference.

The goals of cancer control strategies are generally uniform across all constituencies and are to reduce cancer incidence, reduce cancer mortality, and improve quality of life for those affected by cancer. A well-constructed strategy will ensure that all of its elements can ultimately be connected to one of these goals. When a cancer control strategy is being implemented, it is essential to map progress towards these goals; without mapping progress, it is impossible to assess which components of the strategy require more attention or resources and which are not having the desired effect and need to be re-evaluated. In order to monitor and evaluate these strategies, systems need to be put in place to collect data and the appropriate indicators of performance need to be identified. Session 2 of the 4th International Cancer Control Congress (ICCC-4) focused on how to manage population health to prevent and detect cancers and non-communicable diseases through two plenary presentations and four interactive workshop discussions: 1) registries, measurement, and management in cancer control; 2) use of information for planning and evaluating screening and early detection programs; 3) alternative models for promoting community health, integrated care and illness management; and 4) control of non-communicable diseases. Workshop discussions highlighted that population based cancer registries are fundamental to understanding the cancer burden within a country. However, many countries in Africa, Asia, and South/ Central America do not have them in place. A new global initiative is underway, which brings together several international agencies, and aims to establish six IARC regional registration resource centres over the next five years. These will provide training, support, infrastructure and advocacy to local networks of cancer registries, and, it is hoped, improve the host countries' ability to assess and act on cancer issues within their jurisdictions. Multiple methods of programme evaluation were presented across workshops, but all were attuned to both the resource base and the specific questions to be addressed. Where innovative strategies were being tested, customized evaluation strategies should be undertaken. Where programmes are well-developed and data is being collected for evaluation, there is the opportunity for sophisticated analytical methods to be used to pinpoint specific areas or delivery sites for future quality improvement. Finally, unique opportunities now exist to integrate the strategies developed in cancer control and evaluation with those under development for other non-communicable diseases. This area will likely be one for future development.

China, Mongolia, Korea and Japan constitute North-East Asia. For reasons of largely shared ethnicity and culture, with various degress of mixed Chinese and Altaic elements, as well as geographical contiguity, they can be usefully grouped together for studies of chronic disease prevalence and particularly cancer. The fact of problems shared in common, with increasing disease rates, underlines the necessity for a coordinated approach to research and development of control measures. To provide a knowledge base, the present review of cancer registration and epidemiology data was conducted. The most frequent cancers in males of North-East Asia are in the lung, liver and stomach, with considerable geographical and temporal variation in their respective prevalences. However, colorectal cancer is also of increasing importance. In females the breast, together with the lung in China, the liver in Mongolia and the stomach in Korea and Japan, are most frequent. Variation in risk factors depends to a large extent on the local level of economic development but overall the countries of the region face similar challenges in achieving effective cancer control.

To describe the HPV genotype distribution and to investigate the underlying secular trend in the relative contribution of HPV types 16-18 in invasive cervical cancer (ICC) over a period of 47 years (1958-2004) in South Korea. Paraffin embedded ICC samples were obtained from historical archives of two hospitals in Korea. HPV detection and genotyping was performed by SPF10 PCR, DEIA and LiPA25 assays (version 1). Of 874 ICC cases, 742 were considered suitable for HPV DNA testing after histological evaluation. Squamous cell carcinoma was the major histological type (93.0%). HPV was detected in 674 of the 742 specimens (90.8%). The five most common types identified as single types among HPV-positive cases were HPV16 (63.1%), HPV18 (8.5%), HPV33 (4.5%), HPV58 (3.9%) and HPV31 (3.0%). Multiple infections were detected in 5%. HPV16-18 together accounted for 72% of all HPV-positive cervical cancers with no statistically significant differences by time at diagnosis (adjusted model-p>0.05). This present study confirmed the role of HPV infection as the main factor in cervical cancer in Korea. HPV16-18 accounted for more than 70% in cervical cancer and there was no statistically significant secular trend for the past 50 years.

Cancer has been the most common cause of death in Korea since 1983 and is a major public concern. The aim of this study was to analyze the secular trend of cancer mortality in Korea from 1983 to 2007. Mortality and population data from 1983 to 2007 were obtained from the Korea Statistical Office. The annual cancer death rates for 18 age groups were estimated, and joinpoint regression was applied to detect significant changes in cancer mortality. The age-standardized mortality rate for all sites combined increased until the mid-1990s and has been decreasing thereafter, this also being the case for cancers of the esophagus, liver, lung and bladder, as well as leukemia. With stomach and uterine cancers a constant reduction was evident throughout the period. The declines in stomach, liver, and uterine cancer mortality have made major contributions to the recent overall favorable trend. Mortality for cancers of the colon and rectum and the prostate increased in the early 2000s and then leveled off, whereas female breast cancer mortality has displayed a constant increasing trend. In conclusion, overall cancer mortality is decreasing in men and women in Korea, and this trend will probably continue and improve further in line with advances in management as well as the expected impact of the national screening program for major five cancers over the next decades.

Although survival rates are very useful for monitoring the effects of early cancer detection and treatment, at present there are only limited population-based estimates of long-term survival rates in Korea. Furthermore, published data are only available for 5-year survival; 10-year survival rates have hitherto not been reported. We therefore analysed data from the Korean National Cancer Incidence Database between 1993 and 2007 and followed through into 2008 to estimate long-term survival rates and trends at 5 and 10 years after diagnosis of all cancers combined. Further analysis was conducted on the 19 most common cancers in Korea. From 1993 to 2007, the 10-year relative survival rates (RSRs) for all cancer types combined were 36.3% and 56.4% in Korean men and women, respectively. The 10-year RSRs for all cancers combined improved from 29.5% and 50.5% during 1993-1998 to 39.2% and 58.9% during 1999-2007 in Korean men and women, respectively. From 1993 to 2007, the 5-year and 10-year RSRs thus improved in both sexes for the most common cancers. In the 75 years and older group, increases of the 5-year and 10-year RSR for all combined, and for most of the major cancers were lower than all other age groups. This study provides population-based estimates of long-term survival and confirms improvements of long-term survivals for all cancer sites and for most of the major cancer sites. Improvements of survival for young patients are more significant than for older patients. The results may help clinicians and patients assess long-term prognosis.

Oh JK, et al. Korean J Epidemiol. 2008 Dec;30(2):178-187. http://dx.doi.org/10.4178/kje.2008.30.2.178

Little is known about the natural history of human papillomavirus (HPV) infection in Asian women.

Period analysis estimates up-to-date survival rates of cancer patients. In this approach, analysis is restricted to recent time period by left-truncating all observations at the beginning of the period and right-censoring at its end. Here, we applied period analysis to examine changes in 5-year relative survival (RS) by age group for 1997 and for 2002. Using the National Cancer Incidence Database, 5-year RS was estimated for 1997 and 2002 in four age groups (15-54, 55-64, 65-74, and 75 years old and over) using period analysis. After excluding death certificate-only cases, patients with an unknown date of diagnosis or follow-up length, a total of 813,889 patients diagnosed with a first primary invasive cancer during 1992-2002 were included for analysis. Followup for vital status was included until 31 December 2002. Five-year RS increased from 41.7% for 1997 to 46.7% for 2002. Increases in survival occurred in all age groups except in the 75 and over group. The age gradient in cancer prognosis seems to have widened between 1997 and 2002, a finding that requires further study of prognostic factors, including stage at diagnosis. Period analysis accurately estimates survival rates, especially for cancers with better prognosis.

Cervical cancer is a major health problem for Korean women, accounting for 9.8% of new female cancer cases, even though incidence rates have been decreasing. The Korean cervical cancer mortality rate for 1993–2002 based on National Statistical Office data shows an increasing trend, but the actual rates are thought to have decreased by epidemiologists, clinicians and other cancer experts. To explain this gap and solve this problem, we corrected the number of cervical cancer deaths by comparing death certificate cases of unspecified uterine cancer data with the national cancer incidence databases of entire cancer registries in Korea. We used 2 different methods to make a correction. First, we considered “uterus, unspecified” deaths previously registered as “cervix, uterine” cases misclassified and added them to the cervical cancer deaths. Alternatively, we multiplied the total number of registered unspecified uterine cancer deaths by age-specific proportions of registered incident cervical cancer cases among all cancers and added the product to cervical cancer deaths. The overall corrected age-standardized cervical cancer mortality rates per 100,000 women decreased from 5.2 in 1993 to 3.9 in 2002 (estimated annual percentage change (EAPC): −4.05%, 95% CI: −4.88, −3.22). While cervical cancer mortality showed a decreasing tendency in women aged 30–69 years, it increased substantially in women aged ≥70 years (EAPC: 3.62%, 95% CI: 1.92–5.35). Results of this study will provide evidence-based foundation for the evaluation of the existing cervical cancer-screening programs.