Factors Associated with Compliance with Recommendations for Liver Cancer Screening in Korea: A Nationwide Survey in Korea

Boyoung Park,Jae Kwan Jun,Kui Son Choi,Mina Suh,Ji-Yeon Shin,Hiromu Suzuki

doi:10.1371/journal.pone.0068315

Abstract

To investigate the factors associated with compliance with recommendations regarding liver cancer screening intervals and methods among individuals at high-risk for liver cancer in the Republic of Korea. We used data from the fourth Korean National Health and Nutrition Examination Survey (KNHANES IV), a representative cross-sectional nationwide survey conducted between 2007 and 2009. The liver cancer screening rate and factors associated with compliance with recommended screening intervals (6 months) and methods (both abdominal ultrasonography and serum alpha-fetoprotein testing) among individuals at high risk for liver cancer such as hepatitis B virus (HBV) carriers were investigated. Out of 24,871 KNHANES IV participants, 604 HBV carriers aged ≥20 years were included in our analysis. 39.6% of our study sample reported attending liver cancer screening at least once in their lifetime, 12.3% had attended within the previous 6 months, and 14.6% were screened using both recommended methods. Older age was associated with increased compliance with screening intervals (P-trend 0.011) and methods (40–49 year: OR = 3.25, 95% CI: 1.62–6.51; 50–59 years: OR = 3.09, 95% CI: 1.44–6.66; 60–69 years: OR = 3.17, 95% CI: 1.28–7.82). Unawareness of HBV infection status was negatively related to compliance with screening intervals and methods (OR = 0.30, 95% CI: 0.17–0.53; OR = 0.45, 95% CI: 0.26–0.79). Female sex (OR = 0.45, 95% CI: 0.25–0.78), lower household income (P-trend 0.011), and routine and manual occupations (OR = 0.46, 95% CI: 0.22–0.97) were associated with decreased compliance with screening methods. The liver cancer screening rate among high-risk individuals is much less suboptimal. Considering that those unaware of their HBV infection status got regular and complete liver cancer screening much less often, efforts should be made not only to decrease sociodemographic disparities, but also to better identify the high-risk population.

Highlights

Liver cancer is the fifth most common cancer in men, the seventh most common in women, and the third most common cause of cancer death worldwide [1]
In Western countries, such as Europe and the US, abdominal ultrasonography at 6-month intervals is recommended for liver cirrhosis patients, hepatitis B virus (HBV) carriers, or hepatitis C virus (HCV) carriers at high risk [7,8]
Among the 604 KNHANES IV participants without previous history of liver cancer and with hepatitis B surface antigen (HBsAg)-positive included in our study sample, 297 (49.2%) were male and 307 (50.8%) were female

Summary

Introduction

Liver cancer is the fifth most common cancer in men, the seventh most common in women, and the third most common cause of cancer death worldwide [1]. In Western countries, such as Europe and the US, abdominal ultrasonography at 6-month intervals is recommended for liver cirrhosis patients, HBV carriers, or hepatitis C virus (HCV) carriers at high risk [7,8]. Eastern countries, such as Japan and Korea, recommend abdominal ultrasonography combined with measurements of tumor markers, such as AFP, for groups at high risk of liver cancer [9,10]

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