The National Cancer Screening Program for Breast Cancer in the Republic of Korea: Is it Cost-Effective?

  • Kang, Moon Hae (Graduate School of Yonsei University) ;
  • Park, Eun-Cheol (Institute of Health Services Research, Yonsei University College of Medicine) ;
  • Choi, Kui Son (National Cancer Control Institute, National Cancer Center) ;
  • Suh, MiNa (National Cancer Control Institute, National Cancer Center) ;
  • Jun, Jae Kwan (National Cancer Control Institute, National Cancer Center) ;
  • Cho, Eun (College of Pharmacy, Sookmyung Women's University)
  • 발행 : 2013.03.30


This goal of this research was to evaluate the cost-effectiveness of the National Cancer Screening Program (NCSP) for breast cancer in the Republic of Korea from a government expenditure perspective. In 2002-2003 (baseline), a total of 8,724,860 women aged 40 years or over were invited to attend breast cancer screening by the NCSP. Those who attended were identified using the NCSP database, and women were divided into two groups, women who attended screening at baseline (screened group) and those who did not (non-screened group). Breast cancer diagnosis in both groups at baseline, and during 5-year follow-up was identified using the Korean Central Cancer Registry. The effectiveness of the NCSP for breast cancer was estimated by comparing 5-year survival and life years saved (LYS) between the screened and the unscreened groups, measured using mortality data from the Korean National Health Insurance Corporation and the National Health Statistical Office. Direct screening costs, indirect screening costs, and productivity costs were considered in different combinations in the model. When all three of these costs were considered together, the incremental cost to save one life year of a breast cancer patient was 42,305,000 Korean Won (KW) (1 USD=1,088 KW) for the screened group compared to the non-screened group. In sensitivity analyses, reducing the false-positive rate of the screening program by half was the most cost-effective (incremental cost-effectiveness ratio, ICER=30,110,852 KW/LYS) strategy. When the upper age limit for screening was set at 70 years, it became more cost-effective (ICER=39,641,823 KW/LYS) than when no upper age limit was set. The NCSP for breast cancer in Korea seems to be accepted as cost-effective as ICER estimates were around the Gross Domestic Product. However, cost-effectiveness could be further improved by increasing the sensitivity of breast cancer screening and by setting appropriate age limits.


연구 과제 주관 기관 : Ministry of Health and Welfare


  1. Bobo JK, Shapiro JA, Brustrom J (2006). Efforts to locate low-income women for a study on mammography rescreening: implications for public health practice. Journal of Community Health, 31, 249-61.
  2. Bobo JK, Shapiro JA, Schulman J, et al(2004). On-schedule mammography rescreening in the national breast and cervical cancer early detection program. Cancer Epidemiology Biomarkers & Prevention, 13, 620-30.
  3. Canadian Task Force on Preventive Health Care (2011). Screening for Breast Cancer. Summary of recommendations for clinicians and policy-makers. Available from:
  4. Carles M, Vilaprinyo E, Cots F, et al (2011). Cost-effectiveness of early detection of breast cancer in Catalonia (Spain). BMC Cancer, 11, 192.
  5. de Gelder R, Bulliard JL, de Wolf C, et al (2009). Costeffectiveness of opportunistic versus organised mammography screening in Switzerland. Eur J Cancer, 45, 127-38.
  6. El-Bastawissi AY, White E, Mandelson MT, et al(2001). Variation in mammographic breast density by race. Annals of epidemiology, 11, 257-63.
  7. Graham-Rowe D (2012). Risk analysis: A dense issue. Nature, 485, S60-S1.
  8. Gram I, Lund E, Slenker S (1990). Quality of life following a false positive mammogram. British journal of cancer, 62, 1018.
  9. Han MA, Jun JK, Choi KS, et al (2012). Satisfaction in the National Cancer Screening Program for breast cancer with and without clinical breast examination. Asian Pac J Cancer Prev, 13, 63-7.
  10. Jatoi I, Zhu K, Shah M, et al(2006). Psychological distress in US women who have experienced false-positive mammograms. Breast cancer research and treatment, 100, 191-200.
  11. Jeon J-H, Kang J-H, Kim Y, et al (2011). Reproductive and Hormonal Factors Associated with Fatty or Dense Breast Patterns among Korean Women. Cancer Res Treat, 43, 42-8.
  12. Jung KW, Shin HR, Kong HJ, et al (2010). Long-term trends in cancer mortality in Korea (1983-2007): a joinpoint regression analysis. Asian Pac J Cancer Prev, 11, 1451-7.
  13. Lee EH, Lee HY, Choi KS, et al (2011). Trends in Cancer Screening Rates among Korean Men and Women: Results from the Korean National Cancer Screening Survey (KNCSS), 2004-2010. Cancer Res Treat, 43, 141-7.
  14. Lee SY, Jeong SH, Kim YN, et al (2009). Cost-effective mammography screening in Korea: high incidence of breast cancer in young women. Cancer Sci, 100, 1105-11.
  15. Ministry of Helalth & Welfare (2002). National Cancer Screening Program. Available from:
  16. Ministry of Helalth & Welfare, National Cancer Center (2011). . Available from:
  17. National Cancer Center (2009). Cancer Prevention and Screening. Available from:
  18. National Cancer Screening Committe (2010). Breast Cancer Screening. Available from:
  19. Oh D, Jung DW, Jun JK, et al (2011). On-schedule mammography rescreening in the National Cancer Screening Program for breast cancer in Korea. Asian Pac J Cancer Prev, 12, 2865-70.
  20. Oh DK, Shim JI, Han M, et al (2010). Breast Cancer Screening in Korean Women: Report of the National Cancer Screening Program in 2008. J Breast Cancer AID - 10.4048/jbc.2010.13.3.299 [doi], 13, 299-304.
  21. Okubo I, Glick H, Frumkin H, et al (1991). Cost-effectiveness analysis of mass screening for breast cancer in Japan. Cancer, 67, 2021-9.<2021::AID-CNCR2820670802>3.0.CO;2-L
  22. Park B, Choi KS, Lee YY, et al (2012a). Cancer screening status in Korea, 2011: results from the korean national cancer screening survey. Asian Pac J Cancer Prev, 13, 1187-91.
  23. Park B, Choi KS, Lee YY, et al (2012b). Trends in Cancer Screening Rates among Korean Men and Women: Results from the Korean National Cancer Screening Survey (KNCSS), 2004-2011. Cancer Res Treat, 44, 113-20.
  24. Park MJ, Park EC, Choi KS, et al (2011). Sociodemographic gradients in breast and cervical cancer screening in Korea: the Korean National Cancer Screening Survey (KNCSS) 2005-2009. BMC Cancer, 11, 257.
  25. Park SK, Kang D, Kim Y, et al(2009). Epidemiologic characteristics of the breast cancer in Korea. Journal of the Korean Medical Association, 52, 937-45.
  26. Salz T, DeFrank JT, Brewer NT (2011). False positive mammograms in Europe: do they affect reattendance? Breast cancer research and treatment, 127, 229-31.
  27. Schousboe JT, Kerlikowske K, Loh A, et al (2011). Personalizing mammography by breast density and other risk factors for breast cancer: analysis of health benefits and cost-effectiveness. Ann Intern Med, 155, 10-20.
  28. Song L, Fletcher R (1998). Breast cancer rescreening in lowincome women. American journal of preventive medicine, 15, 128-33.
  29. Stout NK, Rosenberg MA, Trentham-Dietz A, et al (2006). Retrospective cost-effectiveness analysis of screening mammography. J Natl Cancer Inst, 98, 774-82.
  30. U.S. Preventive Service Task Force (2009). Recommendations on breast cancer screening. Available from:
  31. Wong IO, Kuntz KM, Cowling BJ, et al (2007). Cost effectiveness of mammography screening for Chinese women. Cancer, 110, 885-95.
  32. Wong IO, Kuntz KM, Cowling BJ, et al (2010). Costeffectiveness analysis of mammography screening in Hong Kong Chinese using state-transition Markov modelling. Hong Kong Med J, 16 Suppl 3, 38-41.
  33. Wong IO, Tsang JW, Cowling BJ, et al(2012). Optimizing resource allocation for breast cancer prevention and care among Hong Kong Chinese women. Cancer.

피인용 문헌

  1. Is Mammography for Breast Cancer Screening Cost-Effective in Both Western and Asian Countries?: Results of a Systematic Review vol.14, pp.7, 2013,
  2. Spectrum of very early breast cancer in a setting without organised screening vol.110, pp.9, 2014,
  3. Influence of Service Characteristics on High Priority Performance Indicators and Standards in the BreastScreen Australia Program vol.15, pp.14, 2014,
  4. Factors Associated with Organized and Opportunistic Cancer Screening: Results of the Korea National Health and Nutrition Examination Survey (KNHANES) 2007-2011 vol.15, pp.7, 2014,
  5. Cost-Effectiveness Analysis of Breast Cancer Screening in Rural Iran vol.17, pp.2, 2016,
  6. Real world epidemiology of myeloproliferative neoplasms: a population based study in Korea 2004–2013 vol.96, pp.3, 2017,
  7. Interpreting Performance of Mammograms by Radiology Residents Trained in Breast Imaging: Comparison with Radiologists Who Attended Mammography Boot Camp vol.71, pp.6, 2014,
  8. The Efficacy of Mammography Boot Camp to Improve the Performance of Radiologists vol.15, pp.5, 2014,
  9. Performance of Screening Mammography: A Report of the Alliance for Breast Cancer Screening in Korea vol.17, pp.4, 2016,
  10. Cost-effectiveness and health-related outcomes of screening for hepatitis C in Korean population pp.14783223, 2018,