The Effect of National Cancer Screening on Disparity Reduction in Cancer Stage at Diagnosis by Income Level.
BACKGROUND
Early detection of cancer is an effective and efficient cancer management strategy. In South Korea, the National Health Insurance administers the National Cancer Screening Program to its beneficiaries. We examined the impact of the National Cancer Screening Program on socioeconomic disparities in cancer stage at diagnosis.


METHODS
Cancer patients registered in the Korean Central Cancer Registry from January 1, 2010 to December 31, 2010 with a diagnosis of gastric cancer (n = 22,470), colon cancer (n = 16,323), breast cancer (n = 10,076), or uterine cervical cancer (n = 2,447) were included. Income level was divided into three groups according to their monthly contribution of National Health Insurance. We employed absolute (age-standardized prevalence rate, slope index of inequality) and relative (relative index of inequality) measures to separately examine social disparities among participants and non-participants of the National Cancer Screening Program in terms of the early-stage rate.


RESULTS
Age-standardized prevalence rates of early-stage by income group were always higher in participants than in non-participants. Furthermore, the age-standardized prevalence rate of early-stage in the low income group of the participants was also higher than that of the high income group of the non-participants. The sizes of disparities (both slope index of inequality and relative index of inequality) are smaller in participants compared to non-participants.


CONCLUSIONS
National Cancer Screening Program participation reduced income disparity in cancer stage at diagnosis. Population-based cancer screening programs can be used as an effective measure to reduce income disparity in cancer care.
Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea.
Hye-Min
HM
Jung
Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea; Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea.
Jin-Seok
JS
Lee
School of Public Health, University of Texas Health Science Center at Houston, Houston, Texas, United States of America.
David R
DR
Lairson
Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea; Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea.
Yoon
Y
Kim
D055088:Early Detection of Cancer / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D007182:Income; D008297:Male; D009313:National Health Programs; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis* / Q000191:economics*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011379:Prognosis; D056910:Republic of Korea; D018426:SEER Program; D012923:Social Class; D012959:Socioeconomic Factors