Chest radiography surveillance for lung cancer: Results from a National Health Insurance database in South Korea

Hyun Jung Koo, Chang Min Choi, Sojung Park, Han Na Lee, Dong Kyu Oh, Won Jun Ji, Seulgi Kim, Mi Young Kim

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: Lung cancer screening with low-dose computed tomography reduced mortality in selected high risk patients. However, the use of chest radiography for lung cancer screening in Asian populations is still controversial. We investigated the effectiveness of chest radiographic surveillance using a nationwide health service data in South Korea. Methods: Data from the Korean National Health Insurance Service examinee cohort of 2004 to 2013 were examined, and 63,228 patients with lung cancer were identified, 38,494 (57%) of whom underwent chest radiography screening. The others did not undergo lung cancer screening and were considered as a control group. Clinical data including age, smoking, screening intervals, lung cancer stages, treatments, and survival were collected. Survival gain from surveillance after adjustment for lead-time bias based on the sojourn time was calculated. Cox-proportional hazard analyses were performed to evaluate the effectiveness of screening and to determine the appropriate screening interval for chest radiography surveillance. Results: Early lung cancer was found in 38% of patients receiving chest radiography versus 26% of those without surveillance. A patient age of more than 65 years (hazard ratio [HR], 1.53; 95% confidence limits [CL], 1.50–1.56), male (HR, 1.66; 95% CL, 1.62–1.70), and high lung cancer stages at the time of diagnosis were independent factors associated with mortality (each, P < 0.001). Chest radiography surveillance was a factor for decreasing mortality in female (HR, 0.81; 95% CL, 0.77–0.84, P < 0.001), with mortality reduction of 10% at the 3- and 5-year survival time-points. In female patients, chest radiography surveillance at intervals of less than 3 years was an independent predictor of improved survival. Conclusions: Surveillance chest radiography increased survival in a female screened population in South Korea. Chest radiography intervals of less than 3 years may help to detect lung cancer in female patients.

Original languageEnglish
Pages (from-to)120-126
Number of pages7
JournalLung Cancer
StatePublished - Feb 2019

Bibliographical note

Funding Information:
The National Health Information Database (NHIS-2017-4-005) was provided by the National Health Insurance Service (NHIS) of Korea. The authors would like to thank the National Health Insurance Service for their cooperation. The authors declare no conflict of interest with the NHIS. Data used for this study were also provided by the Korean Association for Lung Cancer & Ministry of Health and Welfare, Korean Central Cancer Registry. This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI18C1735 )

Publisher Copyright:
© 2018


  • Chest radiography
  • Lung cancer
  • Screening
  • Surveillance


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