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- - 1, 1, 1, 2, 2 1 2 : 28 T el: 82-2 - 740-8324, FA X : 82-2 - 3673-3540 1997.

Incidence of F emale Bre ast Cancer in a Defined A re a in Kore a * K e un - Y oun g Y o o, M.D. 1, S u e K y un g P ark 1, M.D., Jo oh un S u n g 1, M.D., D on g - Y oun g N oh, M.D. 2, K u k - Jin Ch oi, M.D. 2 Departm ent of Prev entiv e M edicin e 1 an d Departm ent of Surg ery 2, Seoul Nation al Univ ersity Colleg e of M edicine, Seoul, Korea T his study w as conducted to estimate in ciden ce rate of fem ale breast cancer in a defin ed area of Chun gchon gbuk - do in Korea. T he presumptiv e brea st can cer cases w ere selected fr om t w o differ ent sour ces, i.e., m edical utilization datab ase of th e Nation al H ealth In dur an ce Corpor ation an d the dat aba se fr om the National Can cer Registry. M edical stu dent s visited each hospital w here the presumptiv e cases had been treated as a brea st cancer patient, and m ade a dictation of medical record of each patient based on the claim s stored in the In surance Corporation from Janu ary to December 1995. T h e diagnoses in the claim s included one of the following diagnostic codes ; ICD - 9 174-175 (m align ant neoplasm s of the breast ), 233 (carcin om a in situ of th e breast and g enito- urinary sy stem )or ICD - 10 C50(m align ant n eoplasm s of the breast ), D05 (carcinom a in situ of th e breast and g enito- urinary sy stem ). Each case has been confirm ed as h aving a breast can cer by a breast surg eon throu gh a m edical record review. A ge- stan dardized incidence rate of fem ale breast cancer to the Korean population w as estim ated to be 10.5 (95%confiden ce interv al : 8.1-12.9)per 100,000 per son s in 1995. A ge- stan dardized rate to the w orld population w a s 9.8 per 100,000 per son s, and the trun cated rate for ages 35-64 w as 27.2 per 100,000 per son s. V alidity of these estim ates is discu s sin g in com parison w ith pr eviou s m ethods of incidence estim ation in Korea. Key w ords : fem ale brea st n eopla sm s, in ciden ce, Korea

, (, 1993). 10 3.9 5.9% (, 1992)., 1988-89 10 10.9 (Ahn, 1994), 1991 15.9 (Kim, 1995), 1986-92 (IARC, 1998) 10 8.7. (Ahn, 1994)..,. 1. (ba se population ) 1995, 1995 1 1995 12. 2. 1991-95 1995.

, ICD - 9 174-175 (m alignant n eoplasm s of th e breast ), ICD - 9 233 (carcin om a in situ of the breast and g enito- urinary sy stem ), ICD - 10 C50(m alignant n eopla sm s of th e breast ), ICD - 10 D05 (carcin om a in situ of the breast an d g enito- urinary sy stem ).,. 1995 ( ) 1995. 1991-1995.,.,, 1995 (potential brea st cancer )., 95 91-94. 1995 ( ),. 95,..

3.., 1,. 3... 4. 1991-1995.. * gr ou p 1 ( ) : 2 1 (7 ) gr ou p 2 ( ) :, gr ou p 3 ( ) : gr ou p 4 ( ) : 5. 1995

1995 1995 1995. 95% 35-64 (truncated in ciden ce rate). 1. (1) 1995 75. Group 1 : 9, 7, 1, 1. Group 2 : 3, Group 3 : 4 1, 3. Group 4 : 59 6 ( 1 94 ), 18, 7, 17, 1 2 7. Group 4 4. 5 70 Group 1 8 ( 1 ) 7, 1. (Group 2-4) 62 ( 4 ) 7 2 94, 55

( 1). 87.5 %, 88.7 %, 50.0 %, 98.2 %, 1.8 %, 50.0 %. 5,, 88% Group 1 1 3 12, 5 57. 4 35. (2) 1995 95, 1995 78. 39, 25, 14 ( 1), 50% (39/ 78).. -, 1995 95 1991-1994., 95. 2. 1995 78 10 11.2 ( 2). 10 10.5 (95% 8.1-12.9).

30-34 6.8, 35-39 21.5, 40-44 28.6, 45-49 28.1, 50-54 28.4, 55-59 21.5, 60-64 6.8, 65-69 21.5, 70-74 6.8, 75 4.2, 40 60-64 ( 2)., 1995 10 9.8,, ( 3).,,,. 20 40 65 ( 2)., 60 ( 3). < 4> truncated incidence rate. < 3> 35-64 trun cated incidence rate. 1. (H ender son 1993).,,, (IARC 1998).,, (Ahn, 1994).

,., (Ahn, 1994)., 2.5., (, 1993).,. 1960 - -. 1 2 (Buell 1973; Shimizu, 1991). ( 2). 45, 1975 1985 (W akai, 1995).,, (Schottenfeld Fraumeni 1982). (biologic ag e effect ) (cohort effect ) (, 1993). (, 1993). 2. (Ahn, 1994 ; Kim, 1995)..

.,,.,. 1,.., 1991-95 1995 1995 10 7.6, 95 10 9.2.. 1995 1996.. 1 1 95 96. ( 5% ). 3. 1995.

, 87.5 %, 90.2 %, 53.8 %, 98.2 %, 1.8 %, 46.2 %,.. 90%., 10%..,. /,. 91-94,,.,. 95 1 2 7, 1 Group 2( ), 6 Group 4,, 37 2, 33 2, 3 25.. 1 3. 5. 50%.

25, 14.,,., 1-2.,, 3,., 93-95, 95 101,220 1,328 (2.8% ), 6 7 143 ( 62, 114, 29 ), 1185 ( 685, 500 )., 1 1, 95 96., 3....,., 1995.

1.,,,.... 2..,,.,,,. 53.8 %, 98.2 %, 1.8 %, 46.2 %,. 90%.. 1 3 5., 1995

. 95 95,..., 1993,,.. 1995;17:30-47,,., - -. 1992;25 (2):1-12. 1995.,, 1997 A hn YO, Park BJ, Yoo KY, Lee M S, Kim H, Noh DY, Park T S. In ciden ce estim ation fo fem ale brea st cancer am ong Korean s. J Korean M ed Scien ce 1994;9 (4):328-334 Buell P. Changing incidence of breast cancer in Japanese- American women. J Natl Cancer In st 1973;51:1479-83 H en derson M. Current approach es to breast can cer prev ention. Scien ce 1993;259:630-2 IA RC. Can cer incidence in fiv e contienet s Vol.. Parkin DM, W helan SL, F erlay J, Raym ond L, Young J, eds. Internation al A g en cy for Research on Can cer, W H O, IARC S cientific Pub. N o. 143, 1998 Kim JP, Park IS, Ahn YO, Shin MH, Ahn DH, Kan g T W, Ko UR, Ku PS, Kim KY, Kim KH, Kim NK, Kim DJ, Kim DH, Kim BS, Kim SH, P ark BH, Yoo H, Lee SW, Lee SJ, Ch o KS, Joo HZ, Ham EK. 1991 Cancer in ciden ce in Seoul, Korea : result s of the implem entation study of the Seoul cancer registry. J Korean M ed Science 1995;10(2):74-84 Schottenfeld D, Fraumeni JF, Jr. Can cer Epidemiology and Prev ention. 1st ed., W.B. Saunder s Co., Philadelphia, London, T oronto, M exico City, Rio de Janeiro, Sy dney, T oky o, 1982 Shimizu H, Ross RK, Bern stein L. Can cer s of the prostate and breast am on g an d w hite immigrant s in Los A ng eles County. Br J Can cer 1991;63:963-6 Japan ese W akai K, Su zuki S, Ohno Y, et al. E pidem iology of breast can cer in Japan. Int J Epidemiol 1995;24:285-91

T able 1. Ev aluation of criteria for 'potential breast can cer ' by ch art review (+) (- ) (+) 7 1 8 (- ) 7* 55 62 14 56 70 * 7 2 95. 95 mer ge 22 5 25 7 10 5 4 F igure 1. con sisten cy

T able 2. A ge - specific annual in ciden ce rate of g em ale brea st can cer am on g Chun gch on gbuk - do in Korea, 1995 Age group No. of obse rve d No. of pe rsons in Incide nce rate incide nce Chungchongbuk- do, 1995* pe r 100,000 unde r 29 0 325,75 1 0.0 30-34 4 58,922 6.8 35-39 12 55,88 1 2 1.5 40-44 13 45,397 28.6 45-49 9 32,0 11 28.1 50-54 10 35,230 28.4 55-59 11 40,3 14 27.3 60-64 10 32,278 3 1.0 65-69 4 25,143 15.9 70-74 4 20,753 19.3 75- up 1 23,9 18 4.2 Tota l 78 695,598 11.2 A ge adju sted rate for th e Korean population as of 1995 (95% CI)= 10.5 (8.1-12.9) A ge adju sted rate for th e w orld population = 9.8 T run cated incidence rate (35-64 y ear of age )by W orld population = 27.2 * :, 1997 T able 3. A ge - specific in ciden ce rate an d age - adju sted rate of fem ale brea st can cer among some selected races and areas Age gr oup Kor eans / Chungbuk ' 95 Kor eans / Kangwha ' 86- ' 92 Kor eans / LA ' 83- ' 87 J apane se / Osaka ' 83- ' 87 Japane se / Hawa i i ' 83- '87 Japane se / LA ' 83- '87 Chi ne se / Shangha i '83- ' 87 Chi ne se / Si ngapor e ' 83- ' 87 Chi nese / Hawa i i Chi ne se / LA ' 83- '87 ' 83- ' 87 Non- Jews / I sr ae l ' 83- ' 87 Whi t e / CTR, USA ' 83- '87 Bl ack / CTR, USA ' 83- '87-14 - - - - - - - - - - - - - 15-19 - - - - - - 0.2 0.7 - - - - - 20-24 - - 4.8 1.1 7.7-0.6 1.9 - - 1.1 1.4 1.3 25-29 - - 13.0 3.9 2.4 7.9 3.5 5.5-4.8 4.5 9.0 10.4 30-34 6.8-5.2 11.4 28.0 33.4 12.1 16.2 9.2 20.5 11.7 29.3 50.9 35-39 21.5-17.3 29.1 63.2 45.9 30.0 45.2 35.8 50.3 28.4 63.2 65.1 40-44 28.6 52.2 23.6 47.8 107.0 102.1 59.0 61.0 184.3 76.2 31.3 120.6 109.0 45-49 28.1 5.5 75.3 62.7 155.1 159.0 47.4 100.9 88.6 88.8 58.8 188.4 148.1 50-54 28.4 16.6 35.0 60.9 165.7 188.2 54.1 82.0 230.7 14 1.4 47.6 222.0 147.1 55-59 27.3 36.0 39.3 62.2 181.8 225.0 50.0 86.9 188.2 133.2 48.4 274.7 197.4 60-64 31.0 22.2 23.8 68.5 209.5 307.0 64.1 79.3 345.0 156.0 39.5 321.7 225.2 65-69 15.9 8.6 63.6 62.7 276.2 295.5 64.9 102.8 280.4 225.6 46.9 389.8 244.9 70-74 19.3 11.9 10 1.5 60.1 328.3 505.1 70.5 96.7 308.7 253.9 24.0 4 15.3 237.5 75-79 - - 51.7 199.7 75.3 65.4 77.8 473.2 147.4 463.6 217.4 80-84 4.2 - - 50.3 179.2 104.6 73.3 597.2 258.6 48.0 444.4 252.8 99.0 85- - - 48.6 67.0 148.6 53.0 275.2 188.4 431.9 323.2 IR* 9.8 7.1 16.9 21.9 64.0 72.7 2 1.2 31.6 75.6 48.7 17.0 88.9 64.7 IR *, A g e adju sted incidence r at e for th e w orld population CT R,Conn ecticut T um or Reg stry (CT R )

T able 4. Comparison of the ag e- stan darized of fem ale breast can cer am ong som e selected races and areas Race/Area Year World Truncated Koreans/Chungcheongbukdo '95 9.8 27.2 /L.A Japanese/Osaka /Hawaii /L.A Chinese/Shanghai /Singapore /Hawaii 16.9 21.9 64.0 72.7 21.2 36.3 53.8 140.2 158.4 49.9 /L.A 48.7 101.8 Non- Jews./Israel 17.0 41.9 White/CT, USA 88.9 184.8 Black/CT, USA * Ahn et al. 1994 31.6 75.6 64.7 74.8 165.7 140.6