Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang-si, Republic of Korea.
Department of Geography, University of Oregon, Eugene, Oregon, USA.
Cancer Med. 2023 Aug;12(16):17418-17427. doi: 10.1002/cam4.6365. Epub 2023 Jul 25.
The temporal investigation of high-risk areas of cancer incidence and mortality can provide practical implications in cancer control. We aimed to investigate the changes in spatial clusters of incidence and mortality from 1999 through 2013 by major cancer types in South Korea.
We applied flexible scan statistics to identify spatial clusters of cancer incidence and mortality by three 5-year periods and seven major cancer types using the counts of new cases and deaths and population in 244 districts during 1999-2013. Then, we compared the changes across three periods in the locations of primary clusters of incidence and mortality by cancer types. To explore the determinants that possibly affect cancer cluster areas, we compared geographic characteristics between clustered and non-clustered areas.
While incidence clusters for lung, stomach, and liver cancer remained in the same areas over 15 years, mortality clusters were relocated to the areas similar to those of incidence clusters. In contrast, colorectal, breast, cervical, and prostate cancer displayed consistently different locations of clusters over time, indicating the disappearance of existing clusters and the appearance of new clusters. Cluster areas tended to show higher portions of older population, unemployment, smoking, and cancer screening compared to non-cluster areas particularly for mortality.
Our findings of diverse patterns of changes in cancer incidence and mortality clusters over 15 years can indicate the degree of effectiveness in cancer prevention and treatment depending on the area and suggest the need for area-specific applications of different cancer control programs.
对癌症发病率和死亡率高危地区进行时间性研究可为癌症防治提供实际意义。本研究旨在调查韩国 1999 年至 2013 年期间七种主要癌症发病率和死亡率的空间集群变化。
我们应用了灵活扫描统计方法，使用 1999 年至 2013 年间 244 个地区每 5 年的新发病例和死亡人数以及人口数，分析了三种 5 年期间 7 种主要癌症发病率和死亡率的空间集群。然后，我们比较了不同癌症类型在三个时期中主要发病和死亡集群的位置变化。为了探讨可能影响癌症集群区域的决定因素，我们比较了集群区域和非集群区域的地理特征。
15 年来，肺癌、胃癌和肝癌的发病率集群一直位于同一区域，而死亡率集群则迁移到与发病率集群相似的区域。相比之下，结直肠癌、乳腺癌、宫颈癌和前列腺癌的集群位置随时间变化一直不一致，表明现有的集群消失了，新的集群出现了。与非集群区域相比，集群区域的老年人口比例、失业率、吸烟率和癌症筛查率往往较高，尤其是在死亡率方面。
本研究发现，15 年来癌症发病率和死亡率集群的变化模式各不相同，这可能表明不同地区癌症防治的有效性程度不同，并提示需要根据不同地区的情况，应用不同的癌症控制方案。
