title: Cancer Screening Adherence of Asian Women According to Biochemically-verified Smoking Status: Korea National Health and Nutrition Examination Survey.
abstract: BACKGROUND
  Men and women who smoke tend to show less compliance to screening guidelines than non- smokers. However, a recent study in Korea showed that self-reported female smokers constituted less than half of cotinine-verified smokers. Therefore, the aim of this study was to identify hidden smokers using cotinine- verified method and examine cancer screening behavior according to biochemically verified smoking status.
  
  
  METHODS
  Among 5,584 women aged 30 years and older who participated in the Fourth and Fifth Korea National Health and Nutrition Examination Survey (KNHANES), 372 (6.66%) hidden smokers were identified based on interview responses and verified by urinary cotinine levels. We compared cancer-screening behavior (cervical, breast, stomach, and colon cancer) of female hidden smokers to that of non-smokers and self- reported smokers by cross-sectional analysis.
  
  
  RESULTS
  Hidden female smokers had significantly lower adherence to breast cancer screening compared to non-smokers (aOR (adjusted odds ratio) [95% CI] = 0.71 [0.51-0.98]). Adherence to stomach cancer (aOR [95% CI] = 0.75 [0.54-1.03]) and cervical cancer (aOR [95% CI] = 0.85 [0.66-1.10]) screening was also lower among hidden female smokers compared to non-smokers. Self-reported (current) smokers showed lowest adherence to cervical cancer (aOR: 0.64, 95% CI0.47-0.87), breast cancer (0.47 [0.32-0.68]), stomach cancer (0.66[0.46-0.95]), and colon cancer (0.62 [0.38-1.01]) screening compared to non-smokers, followed by female hidden smokers, then non-smokers. These lower adherence rates of current smokers were attenuated after we incorporated hidden smokers into the current smoker group.
  
  
  CONCLUSIONS
  Cancer screening adherence of female hidden smokers was lower than cotinine-verified non-smokers but higher than current smokers. Considering the risk of smoking-related cancer among women, identifying hidden smokers is important to encourage appropriate cancer screening.
authors.affiliation: Department of Family Medicine, Korea Cancer Center Hospital, Seoul, Korea E-mail : bigbangx.snuh@gmail.com.
authors.forename: Young-Jin
authors.initials: YJ
authors.lastname: Ko
authors.forename: Soyeun
authors.initials: S
authors.lastname: Kim
authors.forename: Kyae-Hyung
authors.initials: KH
authors.lastname: Kim
authors.forename: Kiheon
authors.initials: K
authors.lastname: Lee
authors.forename: Cheol Min
authors.initials: CM
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D055088:Early Detection of Cancer / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D009749:Nutrition Surveys; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D012907:Smoking