PH-M23856
30-69
Impact of Telephone and automatic speech recognition on
30 to 69 years of cervical cancer screening attendance
Yao Yu Chin
100070856
F4 3 2013 7
2009 ( 9.9 ) ( 4.2 ) 1995 ( ) ( ) ( ) ( )
randomized clinical trial, RCT
2012
7 9 30-69 3 18,651
483 18,168
9,797
) (
) (
) Microsoft Excel SAS 9.3
14.6% 9.8% 13.3% 12.4% 0.4% 2 (9.8%) 2 (14.6%) 2 (13.3% 12.4%) 89 75 53 24.5 30-39 9 3 3 p<0.05 1
Abstract
Background:
Cervical cancer is a major public health concern in Taiwan. From the Cancer Registry Report in 2009, the age-standardized incidence of cervical cancer is 9.9 per 100,000 ,it’s the second leading cause of women’s related-cancers. Its age-standardized mortality is 4.2 per 100,000, also as the seventh place within women’s ten leading death causes of cancers.
No matter the incidence and mortality of cervical cancer in Taiwan are lower than that of Southeast Asia, Africa, and Central and South America and other developing or underdeveloping countries. The statistics reveals that they are still higher than Europe and the United States and other developed countries.
In Taiwan, due to the expand period for cervical cancer screening began on the year of 1995, the attendance rate was far behind the rates of Europe and the United States. How to extensively use automated telephone with speech recognition as one useful cancer screening tactics in health plane is the study inquiry.
Objective:
High screening rate can reduce the high mortality of cervical cancer. How to improve the screening coverage rate is an important policy of the National Cancer Control Program in Taiwan. The study objectives are: (a)to study the associations between sociodemographic characteristics and the accessibility of medical resources for four interventions of telephone and automatic speech recognitions .(b)to investigate the associations of Pap
Smear’s attendance rate between women’s demographic characteristics and the accessibility of medical resources for screening. (c)To compare the impact of four different telephone and automatic speech recognition on cervical cancer screening attendance. (d)To understand the factors associated with participant and non-participate to the screening program.
Methods:
This is a randomized clinical trial (RCT) by using the Changhua County databank of “Management System of Cervical Screening (MSCS)” from the Bureau of Health. The MSCS registers all cervical cancer. This study will seized women of 30-69 years old who have not registered smear for the past three or/more years from July to September 2012, there were 18,651 women in the initial listing. After excluding the 483 who were not census registers in our study county, 18,168 individuals were random assigned to four different intervention programs. Another excluding factors such as not have a telephone, error number, no answered call for three times, a total of 9,797 women from twelve townships completed baseline telephone reminding invitation. Intervention-Women were assigned randomly to one of four reminder groups:(1)two calls by nurse(Nurse); (2)two calls by automatic speech recognition(ASR); (3) first call by nurse and by ASR later(Nur- ASR);(4)first call by ASR and by Nurse later(ASR-Nur).Descriptive statistical analysis and chisquare test will be proceed before multivariate logistic regression in this study.
Results:
Each intervention got adherence proportion was 14.6% in NURSE, 9.8% in ASR, 13.3% in NUR-ASR, and 12.4% in ASR-NUR
higher than not-complete attendance 0.4%. About reminded screening cost, it was 89 NT dollars in NURSE group, and 75 dollars in NUR-ASR, 53 dollars in ASR-NUR, and 24.5 dollars in ASR group. Attendance was positively associated with age 30-39, being married, high-school education, screening interval greater than nine years, screened more than three times, and women without screening history within three years but lived at the townships of high accessibility of medical resources.
Conclusions:
Although attendance was lowest in the group of ASR in comparing with the other three interventions, but less cost spent in reminded invitation. In two time’s reminded calls, intervention one time by ASR can be used as an
auxiliary tool followed by nurse’s phone call to increase smear attendance proportion in the situation of less cost. Moreover, phone call by automatic speech recognition system can be executed at anytime and repeatable under the conditions of default.
Keywords Cervical cancer Pap smear automatic speech recognition；
... I ... II Abstract ... V ... X ... XII ... XIII ... 1 ... 1 ... 5 ... 6 ... 7 ... 9 ... 9 ... 11 ... 12 ... 14 ... 17 ... 19 ... 19 ... 20 ... 21 ... 22 ... 25 ... 27 ... 28 ... 28
... 38 ... 42 ... 44 ... 54 ... 54 ... 58 ... 59 ... 61 ... 64 ... 64 ... 66 ... 67 ... 68 ... 68 ... 71
... 74 ... 75 ... 76 ... 77 ... 78 ... 79 ... 80 ... 81 100 .... 82 ... 83 ... 84 ... 85 ( ) ... 86 ... 87 ... 88 ( ) ... 89 ... 90 ... 91 ( ) ... 92 ... 93 ... 94 ( ) ... 95 ... 96 ... 97 ( ) ... 98 ... 99 ... 100 ( ) ... 101
... 102 ... 103 ( )... 104 ... 105 ... 106 ( )... 107 ... 108 ... 109 ( ) ... 110 ... 111 ... 112 ( )... 113 ... 114 ... 115 ( )... 116 ... 117 ... 118 ( ) ... 119 ... 120
1-1 ... 2 4-1 (N=18,168)32 4-2 (N=18,168) ... 33 4-3 (N=9,797) ... 34 4-4 (N=9,797) ... 35 4-5 (N=3,750) ... 36 4-6 (N=3,750) ... 37 4-7 (N=13,547) ... 40 4-8 (N=13,547) ... 41 4-9 (N=13,547) ... 43 4-10 (N=9,797) ... 46 4-10 (N=9,797)( ) ... 47 4-11 ... 48 4-12 (N=9,797) ... 52 4-13 (N=13,547) ... 53
1-1 ... 2 1-2 30-69 ... 3 2-1 ... 10 2-2 (TTS) ... 16 2-3 ... 18 3-1 ... 26 4-1 ... 56 4-1 ( )... 57
(World Health Organization,WHO)
(International Agency for Research on Cancer IARC) 184
GLOBOCAN (WHO, 2013) 2008 529,800 ( 15.2) 275,100 ( 7.8) 85% (Ahmedin et al.,2011) 1995 2011 20.4 9.9 2009 11.9 4.2( 1-1) ( ,1998)( ,2012) 10 10 50.6% ( 1- 1)( ,2012) (Ahmedin et al., 2011) 1995
0.0 10.0 20.0 30.0 40.0 50.0 60.0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 1/ 1-1 1-1 (2012) 100 Papanicolaou 1928 1950
( , 2005) 1995 7 1 30-69 1 10.5% 2011 31.7% ( 1-2) 3 37.3% 2011 59.8% 5 58.7% 2011 71.3% ( , 2012) 75-85% (Arroyave et al, 2011) : 100 1-2 30-69
3
4.5 5.5豋 2
1995 30-69 3 37.3% 2011 59.8% 60% 75-85% (Arroyave et al, 2011) 101 30-69 ( , 2013)
Koong, Shin-Lan 100% 80% 50% 40% 3 1 1 Koong et al., 2006 30 1 30-69 3 30-69 3 37.3% 2011 59.8%( , 2012) 2010-2013 ( , 2009) 70 75-85% (Arroyave et al, 2011) ( )
( ) ( ) ( ) ( ) ( )
(CIN 1) (CIN 2) (CIN 3) ( ) ( 2-1)(IARC, 2005) 10-20
1928 Dr. Papanicolaou
1941 (Vilos , 1998)
(Vilos, 1998)
(National Cancer Institute NCI)
90.7% 16.2%(NCI, 2012) 93-97 20,220 5 0 1 5 96% 88% 2-4 64% 53% 23% 0 1 2 5.8 2-4 10-12 ( , 2011)
24 1973~1977 10 12.39 1993~1996 7.79 36.9%(Smith et al., 2000) 1960 1963 1970 1996 5 93% 98% Koong 100% 80% 1955~1964 10 15 1991~1995 2.8~4.5 1955~1964 10 7 1991~1995 0.8 70-80% Anttila et al., 2000 1982 30 1975 10 13.4 1998 7.2 1962 10 12.1 1994 4.0 66.6% 30-79 70,157 10 4.2 Cox
(hazard ratio) 0.30 (95% CI = 0.12–0.74) Aklimunnessa et al., 2006 1995 30-69 3 37.3% 2009 58.6% 1995 20.4 9.9 11.9 4.2( , 1998)( , 2012) 50.6%
(Automatic speech recognition ASR)
(Simon et al., 2010) (ASR)
(Speech Recognition)
2000 Duan
2004 Eaker
2.7% 2 11.3~14.1%
, 2009
(ASR) Blue Cross
(Business Wire, 2006) 2005 Crawford (MCO) 2009 DeFrank (ASR) TTS ( Text-to-Speech) 3 ( 2-2)
(Text Processing Module)
(Prosody Generating Module)
:
12 30-69 3 ( 2 1 2 ) --2 --2 -- 1 2 --1 2 3
2-3 (3嬿-69 ) ♦ ( 2 ) ♦ ♦ 1 ♦ 2 ♦ 3 ( ) 嬿 1-5 6-1嬿 11 ♦ 3-5 ♦ 6 ♦ ( 2 1 2 ) 1. :2 2. :2 3. : 1 2 4. : 1 2
30-69 3
randomized clinical trial, RCT
12 2012 7 9
(Management System of Cervical Screening MSCS) 2012 7
9 30-69 3 18,651 18,168 4 ( ) 2 1 2 ( ) 2 2 ( ) 4,621 13,547 3 9,797
2012 7 9 MSCS
12 30-69 3 2012 1
102 4 30
CMUH102-REC3-043(
2 3 3 2 1 2-3 2 --2 --2 -- 1 2 -- 1 2 ( ) (2012 - )
10 30~39 40~49 50~59 60~69 ( ) ( ) ( ) ( ) ( ) 1 2 3 4 ( ) MSCS 3 6,000 ( ) 2,500 -6,000 ( ) 2,500 ( ) 3
( ) MSCS 3 -101 3-5 6 3 ( ) MSCS 3 14 ( ) ( ) ( ) 0 1-5 6-10 11
2012 7 9
MSCS 12 30-69 3 2012
Microsoft Excel SAS 9.3
(Chi-square)
(Logistic Regression Analysis)
(ORs) 95%
4-1~4-2 4-3~4-4 4-5~4-6 18,168 ( 4-1 4-2) 9,797
3,750 ( 4-3 4-4) 50-59 5,288 30-39 3,955 ( 4-1) 50-59 30-39 60-69 ( 4-3 4-5) 50-59 ( 4-1 4-3 4-5) 49.6(±10.8) 49.5~49.8(±10.8~10.9) ( 4-1) 50.1 (±10.9) 49.9~50.3(±10.7~11.1) ( 4-3) 49.6(±10.5) 49.3~49.8(±10.2 ~10.7) ( 4-5) 14,553 50 8,144 18 2,894 3 ( 4-1 4-3 4-5) 5,412 320
( 4-1) 2887 170 ( 4-3) 1,159 47 ( 4-5) ( ) ( 4-1 4-3 4-5) 8,690 3,336 ( 4-1) 4,738 1,852 ( 4-3) 1,709 665 ( 4-5) ( 4-1 4-3 4-5) 1-5 7,094 11 1,714 ( 4-1) 1-5 3272 11 927 ( 4-2) 1-5 1,310 11 307 ( 4-3) 1-5 ( 4-1 4-3 4-5) ( ) 3-5 7,018 4,899 ( 4-2) 3-5 5001
1793 ( 4-4) 3-5 1,772 731 ( 4-6) 3-5 6 ( 4-2 4-4 4-6) 9 6,012 6 9 1 3 109 ( 4-2) 9 2,258 6 9 1 3 88 ( 4-4) 3,754 21 ( 4-6) 9 ( 4-2 4-4 4-6) (p 0.05)( 4-1) (p 0.05)( 4-1) (p 0.05) ( 4-3 4-5)
4-1 (N=18,168) 100豋 a b ANOVA c MSCS 3 2,500 2,500 6,000 6,000 (%) (%) (%) (%) p-valuea 18168 4542 4541 4541 4544 ( ) 30-39 40-49 50-59 60-69 3955 4855 5288 4070 969(21.3) 1190(26.2) 1381(30.4) 1002(22.1) 985(21.7) 1207(26.6) 1310(28.8) 1039(22.9) 1018(22.4) 1218(26.8) 1274(28.1) 1031(22.7) 983(21.6) 1240(27.3) 1323(29.1) 998(22.0) 0.5221 0.7274 0.7807 0.2136 0.7427 ( ) 49.6(±10.8) 49.8(±10.7) 49.7(±10.9) 49.5(±10.9) 49.6(±10.8) 0.7585b 50 14553 1688 1877 8( 0.2) 3624(79.8) 418( 9.2) 492(10.8) 12( 0.3) 3651(80.4) 415( 9.1) 463(10.2) 15( 0.3) 3635(80.1) 434( 9.5) 457(10.1) 15( 0.3) 3643(80.2) 421( 9.3) 465(10.2) 0.8522 0.4505 0.9907 0.9194 0.6720 ( ) ( ) 508 5143 3540 5412 3245 320 127( 2.8) 1302(28.7) 892(19.6) 1309(28.8) 835(18.4) 77( 1.7) 138( 3.0) 1298(28.6) 868(19.1) 1375(30.3) 788(17.4) 74( 1.6) 119( 2.6) 1262(27.8) 849(18.7) 1430(31.5) 794(17.5) 87( 1.9) 124( 2.7) 1281(28.2) 931(20.5) 1298(28.6) 828(18.2) 82( 1.8) 0.2499 0.6759 0.8546 0.2370 0.0383 0.5571 0.7470 c 3336 6142 8690 835(18.4) 1535(33.8) 2172(47.8) 834(18.4) 1535(33.8) 2172(47.8) 833(18.4) 1536(33.8) 2172(47.8) 834(18.4) 1536(33.8) 2172(47.8) 1.0000 1.0000 1.0000 1.0000 0 1-5 6-10 11 5113 7094 4247 1714 1279(28.2) 1773(39.0) 1062(23.4) 428( 9.4) 1278(28.1) 1774(39.1) 1061(23.4) 428( 9.4) 1278(28.1) 1772(39.0) 1062(23.4) 429( 9.5) 1278(28.1) 1775(39.1) 1062(23.4) 429( 9.4) 1.0000 1.0000 1.0000 1.0000 1.0000
4-2 (N=18,168) 100豋 a MSCS ( ) (%) (%) (%) (%) P value 18168 4542 4541 4541 4544 3-5 6 7018 6251 4899 1792(39.5) 1544(34.0) 1206(26.6) 1730(38.1) 1599(35.2) 1212(26.7) 1777(39.1) 1539(33.9) 1225(27.0) 1719(37.8) 1569(34.5) 1256(27.6) 0.5674 0.5418 0.6934 0.7489 a 9 3 3 3 3 =2 3 =2 3 1 3 1 3 6-9 2 3 2 3 1 3 1 3 6 1293 990 884 1589 567 3258 6012 210 158 109 298 456 460 1884 330( 7.3) 258( 5.7) 222( 4.9) 422( 9.3) 145( 3.2) 811(17.9) 1485(32.7) 50( 1.1) 46( 1.0) 19( 0.4) 67( 1.5) 119( 2.6) 110( 2.4) 458(10.1) 354( 7.8) 253( 5.6) 210( 4.6) 398( 8.8) 125( 2.8) 774(17.0) 1532(33.7) 51( 1.1) 34( 0.8) 28( 0.6) 67( 1.5) 117( 2.6) 125( 2.8) 473(10.4) 289( 6.4) 241( 5.3) 229( 5.0) 397( 8.7) 158( 3.5) 832(18.3) 1473(32.4) 59( 1.3) 45( 1.0) 36( 0.8) 73( 1.6) 111( 2.4) 124( 2.7) 474(10.4) 320( 7.0) 238( 5.2) 223( 4.9) 372( 8.2) 139( 3.1) 841(18.5) 1522(33.5) 50( 1.1) 33( 0.7) 26( 0.6) 91( 2.0) 109( 2.4) 101( 2.2) 479(10.5) 0.3980 0.0811 0.7763 0.8351 0.3693 0.2647 0.3523 0.6562 0.7805 0.2993 0.1457 0.1581 0.8972 0.3213 0.9140
4-3 (N=9,797) 100豋 a b ANOVA C MSCS 3 2,500 2,500 6,000 6,000 (%) (%) (%) (%) p-valuea 9797 2655 2315 2531 2296 ( ) 30-39 40-49 50-59 60-69 2068 2513 2827 2389 539(20.3) 669(25.2) 812(30.6) 635(23.9) 493(21.3) 577(24.9) 658(28.4) 587(25.4) 565(22.3) 650(25.7) 693(27.4) 623(24.6) 471(20.5) 617(26.9) 664(28.9) 544(23.7) 0.2438 0.0141 0.0508 <.0001 0.0381 ( ) 50.1(±10.9) 50.3(±10.7) 50.2(±11.0) 49.9(±11.1) 50.1(±10.8) 0.6671b 18 8144 690 945 3( 0.1) 2209(83.2) 180( 6.8) 263( 9.9) 4( 0.2) 1914(82.7) 171( 7.4) 226( 9.8) 9( 0.4) 2120(83.8) 168( 6.6) 234( 9.3) 2( 0.1) 1901(82.8) 171( 7.5) 222( 9.7) 0.4751 0.0919 <.0001 0.9255 0.2256 ( ) ( ) 287 2827 1829 2887 1797 170 76( 2.9) 781(29.4) 513(19.3) 759(28.6) 482(18.2) 44( 1.7) 83( 3.6) 673(29.1) 409(17.5) 699(30.2) 419(18.1) 35( 1.5) 67( 2.7) 721(28.5) 444(17.5) 792(31.3) 458(18.1) 49( 1.9) 61( 2.7) 652(28.4) 466(20.3) 637(27.3) 438(19.1) 42( 1.8) 0.1328 0.2679 0.0030 0.0044 0.0002 0.1811 0.1980 c 1852 3207 4738 500(18.8) 898(33.8) 1257(47.3) 400(17.3) 738(31.9) 1177(50.8) 507(20.0) 844(33.4) 1180(46.6) 445(19.4) 727(31.7) 1124(49.0) 0.0421 0.0009 <.0001 0.0552 0 1-5 6-10 11 3080 3272 2518 927 867(32.7) 879(33.1) 693(26.1) 216( 8.1) 694(30.0) 747(32.3) 630(27.2) 244(10.5) 823(32.5) 886(35.0) 621(24.5) 201( 7.9) 696(30.3) 760(33.1) 574(25.0) 266(11.6) <.0001 <.0001 <.0001 0.0097 0.0125
4-4 (N=9,797) 100豋 a MSCS ( ) (%) (%) (%) (%) (%) p value 9797 2655 2315 2531 2296 3-5 6 5001 3003 1793 1328(50.0) 824(31.0) 503(19.0) 1203(52.0) 700(30.2) 412(17.8) 1281(50.6) 778(30.7) 472(18.7) 1189(51.8) 701(30.5) 406(17.7) 0.7941 0.0156 0.0019 0.0019 a 9 3 3 3 3 =2 3 =2 3 1 3 1 3 6-9 2 3 2 3 1 3 1 3 6 964 707 635 1018 421 1935 2258 157 98 88 182 208 325 801 257( 9.7) 195( 7.3) 170( 6.4) 285(10.7) 109( 4.1) 529(19.9) 633(23.8) 40( 1.5) 27( 1.0) 18( 0.7) 43( 1.6) 60( 2.3) 77( 2.9) 212( 8.0) 259(11.2) 168( 7.3) 146( 6.3) 252(10.9) 91( 3.9) 424(18.3) 532(23.0) 38( 1.6) 22( 1.0) 22( 1.0) 37( 1.6) 48( 2.1) 90( 3.9) 186(18.0) 221( 8.7) 170( 6.7) 160( 6.3) 263(10.4) 115( 4.5) 500(19.8) 584(23.1) 46( 1.8) 31( 1.2) 30( 1.2) 46( 1.8) 55( 2.2) 90( 3.6) 220( 8.7) 227( 9.9) 174( 7.6) 157( 6.9) 218( 9.5) 106( 4.6) 482(21.0) 509(22.2) 33( 1.4) 18( 0.8) 18( 0.8) 56( 2.4) 45( 2.0) 68( 3.0) 183( 8.0) 0.4078 0.1808 0.4543 0.6081 0.0268 0.3960 0.0068 0.0010 0.5299 0.2659 0.2248 0.2453 0.4481 0.2340 0.1620
4-5 (N=3,750) 100豋 a b ANOVA c MSCS 3 2,500 2,500 6,000 6,000 (%) (%) (%) (%) p valuea 3750 768 1075 782 1125 ( ) 30-39 40-49 50-59 60-69 785 1068 1121 776 174(22.6) 214(27.9) 231(30.1) 149(19.4) 209(19.4) 310(28.8) 331(29.5) 225(20.9) 171(21.9) 214(27.4) 230(29.4) 167(21.3) 231(20.5) 330(29.3) 329(29.2) 235(20.9) 0.8535 0.0052 <.0001 <.0001 <.0001 ( ) 49.6(±10.5) 49.3(±10.7) 49.8(±10.2) 49.6(±10.7) 49.5(±10.4) 0.7313b 3 2894 399 454 0( 0.0) 589(76.7) 80(10.4) 99(12.9) 1( 0.1) 825(76.7) 120(11.2) 129(12.0) 1( 0.1) 605(77.4) 86(11.0) 90(11.5) 1( 0.1) 875(77.8) 113(10.0) 136(12.1) 0.9837 1.0000 <.0001 0.0086 0.0040 ( ) ( ) 110 1025 766 1159 643 47 24( 3.1) 204(26.6) 151(19.7) 231(30.9) 147(19.1) 11( 1.4) 36( 3.4) 297(27.6) 238(22.1) 316(29.4) 175(16.3) 13( 1.2) 23( 2.9) 201(25.7) 148(18.9) 254(32.5) 144(18.4) 12( 1.5) 27( 2.4) 323(28.7) 229(20.4) 358(31.8) 177(15.7) 11( 1.0) 0.5428 0.2818 <.0001 <.0001 <.0001 0.1203 0.9719 c 665 1376 1709 185(24.1) 252(32.8) 331(43.1) 172(16.0) 425(39.5) 478(44.5) 138(17.7) 236(30.2) 408(52.2) 170(15.1) 463(41.2) 492(43.7) <.0001 0.0658 <.0001 <.0001 0 1-5 6-10 11 1050 1310 1083 307 192(25.0) 331(43.1) 167(21.7) 78(10.2) 328(30.5) 369(34.3) 308(28.7) 70( 6.5) 167(21.3) 232(29.7) 257(32.9) 126(16.1) 363(32.3) 378(33.6) 351(31.2) 33( 2.9) <.0001 <.0001 <.0001 <.0001 <.0001
4-6 (N=3,750) 100豋 a MSCS ( ) (%) (%) (%) (%) p value 3750 768 1075 782 1125 3-5 6 1772 1247 731 359(46.7) 260(33.9) 149(19.4) 512(47.6) 358(33.3) 205(19.1) 382(48.8) 238(30.4) 162(20.7) 519(46.1) 391(34.8) 215(19.1) 0.6367 <.0001 <.0001 0.0007 a 9 3 3 3 3 =2 3 =2 3 1 3 1 3 6-9 2 3 2 3 1 3 1 3 6 301 233 221 416 127 754 1001 52 51 20 82 58 122 312 58( 7.6) 41( 5.3) 43( 5.6) 87(11.3) 31( 4.0) 150(19.5) 201(26.2) 9( 1.2) 13( 1.7) 1( 0.1) 14( 1.8) 14( 1.8) 30( 3.9) 76( 9.9) 94( 8.7) 78( 7.3) 63( 5.9) 114(10.6) 33( 3.1) 220(20.5) 286(26.6) 13( 1.2) 11( 1.0) 6( 0.6) 25( 2.3) 15( 1.4) 34( 3.2) 83(7.7) 57(18.9) 54( 6.9) 52( 6.7) 89(11.4) 32( 4.1) 148(18.9) 202(25.8) 13( 1.7) 12( 1.5) 5( 0.6) 13( 1.7) 13( 1.7) 25( 3.2) 67( 8.6) 92( 8.2) 60( 5.3) 63( 5.6) 126(11.2) 31( 2.8) 236(21.0) 312(27.7) 17( 1.5) 15( 1.3) 8( 0.7) 30( 2.7) 16( 1.4) 33( 2.9) 86( 7.6) 0.9151 0.0008 0.0068 0.1659 0.0144 0.9934 <.0001 <.0001 0.4823 0.8764 0.1577 0.0170 0.9514 0.6579 0.4329
18,168 4,621 13,547 9,797 3,750 ( 4-7~4-8) ( 4-7) 50-59 28.9% 40-49 25.7% 30-39 21.1% 50.1(±10.9) 49.6(±10.7) 0.5 29.5 28.9% 2.9豋 48.4% 32.7豋 18.9% 1-5 33.4% 11 9.5% ( 4-8)
3-5 51.1% 18.3豋 9 1 3 ( 4-7 4-8) ( 4-7 4-8) ANOVA 6 9 (p>0.05) (p 0.05)
4-7 (N=13,547) 100豋 a b ANOVA c MSCS 3 2,500 2,500 6,000 6,000 (%) (%) p-valuea 13547 9797 3750 ( ) 30-39 40-49 50-59 60-69 2853 3581 3948 3165 2068(21.1) 2513(25.7) 2827(28.9) 2389(24.4) 785(20.9) 1068(28.5) 1121(29.9) 776(20.7) <.0001 <.0001 <.0001 <.0001 <.0001 ( ) 50.0(±10.8) 50.1(±10.9) 49.6(±10.5) 0.0072b 21 11038 1089 1399 18( 0.2) 8144(83.1) 690( 7.0) 945( 9.7) 3( 0.1) 2894(77.2) 399(10.6) 454(12.1) <.0001 0.0011 <.0001 <.0001 <.0001 ( ) ( ) 397 3852 2595 4046 2440 217 287( 2.9) 2827(28.9) 1829(18.7) 2887(29.5) 1797(18.3) 170( 1.7) 110( 2.9) 1025(27.3) 766(20.4) 1159(30.9) 643(17.2) 47( 1.3) 0.0125 <.0001 <.0001 <.0001 <.0001 <.0001 <.0001 c 2517 4583 6447 1852(18.9) 3207(32.7) 4738(48.4) 665(17.7) 1376(36.7) 1709(45.6) <.0001 <.0001 <.0001 <.0001 0 1-5 6-10 11 4130 4582 3601 1234 3080(31.4) 3272(33.4) 2518(25.7) 927( 9.5) 1050(28.0) 1310(34.9) 1083(28.9) 307( 8.2) <.0001 <.0001 <.0001 <.0001 <.0001
4-8 (N=13,547) 100豋 a MSCS ( ) (%) (%) P value 13547 9797 3750 3-5 6 6773 4250 2524 5001(51.1) 3003(30.6) 1793(18.3) 1772(47.3) 1247(33.3) 731(19.5) 0.0004 <.0001 <.0001 <.0001 a 9 3 3 3 3 =2 3 =2 3 1 3 1 3 6-9 2 3 2 3 1 3 1 3 6 1265 940 856 1434 548 2689 3259 209 149 108 264 266 447 1113 964( 9.8) 707( 7.2) 635( 6.5) 1018(10.4) 421( 4.3) 1935(19.8) 2258(20.1) 157( 1.6) 98( 1.0) 88( 0.9) 182( 1.9) 208( 2.1) 325( 3.3) 801( 8.2) 301( 8.0) 233( 6.2) 221( 5.9) 416(11.1) 127( 3.4) 754(20.1) 1001(26.7) 52( 1.4) 51( 1.4) 20( 0.5) 82( 2.2) 58( 1.6) 122( 3.3) 312( 8.3) <.0001 <.0001 <.0001 <.0001 <.0001 <.0001 <.0001 <.0001 <.0001 0.0001 <.0001 <.0001 <.0001 <.0001 <.0001
4-9 9,797 (72.3%) 3,750 (27.7%) 2,655 (77.6%) 2,531 (76.4%) 2,315(68.3%) 2,296 (67.1%) 1237 12.6% 388 (14.6%) 337(13.3%) 285 (12.4%) (9.8%) 0.4% 385 (31.1%) 1 285 (23.0%) 2 249 (20.1%) 3 197 (15.9%) 121 (9.8%) (45.4%) (32.3%) 1 33.9% 2 25.3%
p 0.05 1 2 3 p 0.05 4-9 (N=13,547) (%) (%) (%) (%) (%) p-value 13547 3423 3390 3313 3421 3750 9797 768(22.4) 2655(77.6) 1075(31.7) 2315(68.3) 782(23.6) 2531(76.4) 1125(32.9) 2296(67.1) <.0001 <.0001 <.0001 1237 8560 16 3734 388( 14.6) 2267(85.4) 1( 0.1) 767(99.9) 227( 9.8) 2088(90.2) 3( 0.3) 1072(99.7) 337(13.3) 2194(86.7) 0( 0.0) 782(100) 285(12.4) 2011(87.6) 12( 1.1) 1113(98.9) <.0001 <.0001 0.0005 0.0016 <.0001 ( ) 1 2 3 1237 121 385 285 249 197 388 27( 7.0) 176(45.4) 77(19.8) 57(14.7) 51(13.1) 227 18( 7.9) 31(13.7) 77(33.9) 55(24.2) 46(20.3) 337 43(12.8) 109(32.3) 64(19.0) 65(19.3) 56(16.6) 285 33(11.6) 69(24.2) 67(23.5) 72(25.3) 44(15.4) 0.0121 <.0001 0.5893 0.4016 0.6234
4-10~11 4-12 ( 4-10) 9,797 50-59 2,827 (28.8%) 30-39 2,068 (21.1%) 50-59 40-49 8,144 (83.1%) 18 (0.2%) 2,887 (29.5%) 170 (1.7%) 4,738 (48.4%) 1-5 3,272 (33.4%) 11 927 (9.5%) 0
1-5 ( 4-10) 4-11 3-5 5001 (51.1%) 1793 (18.3%) 9 2258 (20.1%) 6 9 1 3 88 (0.9%) 9 3 3 9
4-10 (N=9,797) (n=2655) (n=2315) (n=2531) (n=2296) (%) (%) (%) (%) (%) (%) (%) (%) p-value 9797 388 2267 227 2088 337 2194 285 2011 ( ) 30-39 40-49 50-59 60-69 2068 2513 2827 2389 103(26.6) 101(26.0) 113(29.1) 71(18.3) 436(19.2) 568(25.1) 699(30.8) 564(24.9) 68(30.0) 71(31.3) 55(24.2) 33(14.5) 425(20.4) 506(24.2) 603(28.9) 554(26.5) 111(32.9) 98(29.1) 77(22.9) 51(15.1) 454(20.7) 552(25.1) 616(28.1) 572(26.1) 67(23.5) 81(28.4) 89(31.2) 48(16.9) 404(20.1) 536(26.6) 575(28.6) 496(24.7) 0.2438 0.0134 0.3817 0.0048 0.0065 18 8144 690 945 0( 0.0) 348(89.7) 24( 6.2) 16( 4.1) 3( 0.1) 1861(82.1) 156( 6.9) 247(10.9) 2( 0.9) 192(84.6) 13( 5.7) 20( 8.8) 2( 0.1) 1722(82.4) 158( 7.6) 206( 9.9) 4( 1.2) 290(86.1) 20( 5.9) 23( 6.8) 5( 0.2) 1830(83.4) 148( 6.8) 211( 9.6) 1( 0.4) 256(89.8) 15( 5.3) 13(4.5) 1( 0.1) 1645(81.8) 156( 7.7) 209(10.4) 0.4751 0.5053 <.0001 0.2636 0.2646 ( ) ( ) 287 282 1829 2887 1797 170 11( 2.8) 93(24.0) 64(16.5) 135(34.8) 77(19.9) 8( 2.0) 65( 2.8) 688(30.3) 449(19.8) 624(27.5) 405(18.0) 36( 1.6) 5( 2.2) 42(18.5) 44(19.4) 76(33.5) 54(23.8) 6( 2.6) 78( 3.7) 631(30.2) 362(17.3) 623(29.9) 365(17.5) 29( 1.4) 3( 0.9) 63(18.7) 59(17.5) 115(34.1) 81(24.0) 16( 4.8) 64( 2.9) 658(30.0) 385(17.5) 677(30.9) 377(17.2) 33( 1.5) 3( 1.0) 56(19.7) 52(18.2) 92(32.3) 77(27.0) 5( 1.8) 58( 2.9) 596(29.6) 414(20.6) 545(27.1) 361(18.0) 37( 1.8) 0.1328 0.0750 0.0023 0.6500 0.0028 0.1892 0.0818
4-10 (N=9,797)( ) 100豋 a MSCS 3 2,500 2,500 6,000 6,000 (n=2655) (n=2315) (n=2531) (n=2296) (%) (%) (%) (%) (%) (%) (%) (%) p-value a 1852 3207 4738 77(19.9) 116(29.9) 195(50.3) 423(18.7) 782(34.5) 1062(46.8) 44(19.4) 76(33.5) 107(47.1) 356(17.1) 662(31.7) 1070(51.2) 84(24.9) 80(23.8) 173(51.3) 423(19.3) 764(34.8) 1007(45.9) 64(22.5) 75(26.3) 146(51.2) 381(19.0) 652(32.4) 978(48.6) 0.0421 0.1105 0.1084 <.0001 0 1-5 6-10 11 3080 3272 2518 927 105(27.1) 145(37.4) 89(22.9) 49(12.6) 762(33.6) 734(32.4) 604(26.6) 167( 7.4) 61(26.9) 94(41.4) 44(19.4) 28(12.3) 633(30.3) 653(31.3) 586(28.1) 216(10.3) 82(24.3) 154(45.7) 60(17.8) 41(12.2) 741(33.8) 732(33.4) 561(25.6) 160( 7.3) 76(26.7) 106(37.2) 59(20.7) 44(15.4) 620(30.8) 654(32.5) 515(25.6) 222(11.0) <.0001 0.1772 0.0258 0.0053 0.0093
4-11 (n=2655) (n=2315) (n=2531) (n=2296) (n=9797) (n=388) (n=2267) (n=227) (n=2088) (n=337) (n=2194) (n=285) (n=2011) P value 3-5 6 5001 3003 1793 272(70.1) 81(20.9) 35( 9.0) 1056(46.6) 743(32.8) 468(20.6) 146(64.3) 50(20.0) 31(13.7) 1057(50.6) 650(31.1) 381(18.3) 236(70.0) 69(20.5) 32( 9.5) 1045(47.6) 709(32.3) 440(20.1) 180(63.2) 70(24.5) 35(12.3) 1009(50.2) 631(31.4) 371(18.4) 0.7941 <.0001 0.2129 0.7299 a 9 3 3 3 3 =2 3 =2 3 1 3 1 3 6-9 2 3 2 3 1 3 1 3 6 964 707 635 1018 421 1935 2258 157 98 88 182 208 325 801 77(19.8) 35( 9.0) 36( 9.3) 42(10.8) 17( 4.4) 55(14.2) 33( 8.5) 11( 2.8) 5( 1.3) 3( 0.8) 10( 2.6) 8( 2.1) 21( 5.4) 35( 9.0) 180( 7.9) 160( 7.1) 134( 5.9) 243(10.7) 92( 4.1) 474(20.9) 600(26.5) 29( 1.3) 22( 1.0) 15( 0.7) 33( 1.5) 52( 2.3) 56( 2.5) 177( 7.8) 44(19.40) 20( 8.8) 19( 8.4) 22( 9.7) 6( 2.6) 30(13.2) 22( 9.7) 0( 0.0) 4( 1.8) 3( 1.3) 3( 1.3) 6( 2.6) 16( 7.0) 32(14.1) 215(10.3) 148( 7.1) 127( 6.1) 230(11.0) 85( 4.1) 394(18.9) 510(24.4) 38( 1.8) 18( 0.9) 19( 0.9) 34( 1.6) 42( 2.0) 74( 3.5) 154( 7.4) 60(17.8) 31( 9.2) 35(10.4) 38(11.3) 14( 4.2) 32( 9.5) 24( 7.1) 12( 3.6) 7( 2.1) 11( 3.3) 3( 0.9) 4( 1.2) 19( 5.6) 47(13.9) 161( 7.3) 139( 6.3) 125( 5.7) 220(10.3) 101( 4.6) 468(21.3) 560(25.5) 34( 1.5) 24( 1.1) 19( 0.9) 43( 2.0) 51( 2.3) 71( 3.2) 173( 7.9) 61(21.4) 29(10.2) 21( 7.4) 26( 9.1) 7( 2.5) 46(16.1) 34(11.9) 5( 1.8) 6( 2.1) 2( 0.7) 3( 1.1) 3( 1.1) 9( 3.2) 33(11.6) 166( 8.3) 145( 7.2) 138( 6.9) 192( 9.5) 99( 4.7) 436(21.7) 475(23.6) 28( 1.4) 12( 0.6) 16( 0.8) 53( 2.6) 42( 2.1) 59( 2.9) 150( 7.5) 0.4078 0.0043 0.3538 0.0507 0.1372 0.0869 0.0686 0.1799 0.0044 0.6381 0.0990 0.0180 0.5591 0.1841 0.5749 100豋
p >0.05 p <0.05 4-12 9,797 0.6 (95%CI:0.50-0.71 p<0.0001) 0.79 (95%CI:0.67-0.94 p=0.0073) 0.88 (95%CI:0.74-1.03 p=0.1075) 3 2 30-39 40-49 0.77 (95%CI:0.63-0.95 p=0125) 50-59
0.75 (95%CI:0.61-0.93 p=0.0089) 60-69 0.59 (95%CI:0.46-0.76 p<0.0001) 3 30-39 p <0.05 ( ) 5.61 (95%CI:2.09-15.02 p=0.0006) 1.36 (95%CI:1.12-1.64 p=0.0016) 2 ( ) p <0.05 1.21 (95%CI:1.04-1.41 p=0.0118) p <0.05 9 9 , ≧3 3 5.70 (95%CI:4.47-7.26 p<0.0001) 9 , ≧3 3 2 3 6-9 ≧2 3 3.38 (95%CI:2.66-4.28 p<0.0001) 9 2 3 1 3 2.39 (95%CI:1.86-3.07 p<0.0001) 6-9 , 2 ≧ 3 1 3 6 3.04 (95%CI:2.17-4.25 p<0.0001) 9
1 3 6-9 1 3 0 6 1.84 (95%CI:1.46-2.33 p<0.0001) p <0.05 0 1-10 11 1-10 2.07 (95%CI:1.66-2.59 p<0.0001) 11 1.92 (95%CI:1.54-2.38 p<0.0001) 2 0 p <0.05 101 1/3 2/3 1/3 1.27 (95%CI:1.09-1.48 p=0.0018) p <0.05 (intention-to-treat;ITT) 13,547 9,797 ( 4-13) 4-12
4-12 (N=9,797) a MSCS ( ) ( ) OR(95%CI) p-value -2.97(0.18) -0.52(0.09) -0.13(0.08) -0.23(0.09) 1.00 0.60(0.50-0.71) 0.88(0.74-1.03) 0.79(0.67-0.94) <.0001 <.0001 0.1075 0.0073 ( ) 30-39 40-49 50-59 60-69 -0.26(0.10) -0.29(0.11) -0.53(0.13 1.00 0.77(0.63-0.95) 0.75(0.61-0.93) 0.59(0.46-0.76) 0.0125 0.0089 <.0001 ( ) 1.72(0.50) 0.30(0.10) 5.61(2.09-15.02) 1.36(1.12-1.64) 1.00 0.0006 0.0016 0.19(0.08) 1.00 1.21(1.04-1.41) 0.0118 a 9 , 9 , 3 3 9 , 3 ,3 2 ,3 6-9 , 2 ,3 9 , 2 ,3 1 ,3 9 , 1 ,3 6-9 1 ,3 0 , 6 , 6-9 , 2 ,3 1 ,3 6 , 1.74(0.12) 1.22(0.12) 0.87(0.13) 0.61(0.12) 1.11(0.17) 1.00 5.70(4.47-7.26) 3.38(2.66-4.28) 2.39(1.86-3.07) 1.84(1.46-2.33) 3.04(2.17-4.25) <.0001 <.0001 <.0001 <.0001 <.0001 0 1-1嬿 11 0.73(0.11) 0.65(0.11) 1.00 2.07(1.66-2.59) 1.92(1.54-2.38) <.0001 <.0001 2/3(8 ) 1/3(4 ) 0.24(0.08) 1.27(1.09-1.48) 1.00 0.0018
4-13 (N=13,547) a MSCS ( ) ( ) OR(95%CI) p-value -3.43(0.18) -0.60(0.09) -0.14(0.08) -0.34(0.08) 1.00 0.55(0.46-0.65) 0.87(0.75-1.02) 0.72(0.61-0.84) <.0001 <.0001 0.0920 <.0001 ( ) 30-39 40-49 50-59 60-69 -0.26(0.10) -0.24(0.11) -0.40(0.12) 1.00 0.77(0.63-0.94) 0.79(0.64-0.97) 0.67(0.53-0.85) 0.0095 0.0237 0.0011 ( ) 1.99(0.48) 0.44(0.09) 7.29(2.83-18.73) 1.55(1.29-1.87) 1.00 <.0001 <.0001 0.21(0.07) 1.00 1.24(1.07-1.43) 0.0046 a 9 , 9 , 3 3 9 , 3 ,3 2 ,3 6-9 , 2 ,3 9 , 2 ,3 1 ,3 9 , 1 ,3 6-9 1 ,3 0 , 6 , 6-9 , 2 ,3 1 ,3 6 , 1.78(0.12) 1.28(0.12) 0.89(0.13) 0.65(0.12) 1.14(0.17) 1.00 5.95(4.69-7.54) 3.59(2.84-4.53) 2.44(1.91-3.12) 1.92(1.52-2.43) 3.12(2.25-4.33) <.0001 <.0001 <.0001 <.0001 <.0001 0 1-1嬿 11 0.74(0.11) 0.61(0.11) 1.00 2.10(1.69-2.60) 1.84(1.49-2.27) <.0001 <.0001 2/3(8 ) 1/3(4 ) 0.17(0.08) 1.19(1.02-1.38) 1.00 0.0233
p>0.05 18,168 4,621 13,547 9,797 3,750 p<0.05 ( 4-3~4-6) ( 4-3) (47.3%) (46.6%) (50.8%) (49.0%) 1 2 4-1( ) 77.7 76.6%
2013 30-64
57%
50%
4542 1119(24.6) 2655(77.6) 1 2 (豋) (豋) 1 2 3 347( 13.1) 11嬿( 31.7) 1 82 15 6 6 81( 3.1) 7( 8.6) 嬿 2 2 2 1 118( 4.4) 21( 17.8) 嬿 15 3 1 2 112( 4.2) 21( 18.8) 嬿 13 3 3 2 4( 嬿.2) 4(1嬿嬿.嬿) 4 嬿 嬿 嬿 嬿 129( 4.9) 37( 28.7) 1 18 8 6 4 724( 27.3) 66( 9.1) 11 8 17 17 13 12嬿( 4.5) 24( 2嬿.嬿) 嬿 22 1 嬿 1 13嬿( 4.9) 8( 6.2) 1 嬿 2 3 2 264( 9.9) 2嬿( 7.6) 1 9 3 3 4 2嬿9( 7.9) 28( 13.4) 1 3 1嬿 7 7 嬿( 嬿.嬿) 嬿( 嬿.嬿) 嬿 嬿 嬿 嬿 嬿 5( 嬿.2) 嬿( 嬿.嬿) 嬿 嬿 嬿 嬿 嬿 2嬿4( 7.7) 4嬿( 19.6) 7 4 12 1嬿 7 2嬿8( 7.8) 2( 1.嬿) 嬿 嬿 嬿 嬿 2 2655(1嬿嬿.嬿) 388( 14.6) 27 176 76 58 51 2315(68.3) 1 2 (豋) (豋) 1 2 3 133( 5.7) 17(12.8) 嬿 2 6 8 1 嬿( 嬿.嬿) 嬿( 嬿.嬿) 嬿 嬿 嬿 嬿 嬿 166( 7.2) 19(11.4) 2 6 4 3 4 13( 嬿.6) 嬿( 嬿.嬿) 嬿 嬿 嬿 嬿 嬿 嬿( 嬿.嬿) 嬿( 嬿.嬿) 嬿 嬿 嬿 嬿 嬿 178( 7.7) 23(12.9) 4 3 1嬿 5 1 嬿( 嬿.嬿) 嬿( 嬿.嬿) 嬿 嬿 嬿 嬿 嬿 1( 嬿.嬿) 嬿( 嬿.嬿) 嬿 嬿 嬿 嬿 嬿 8( 嬿.3) 1(12.5) 嬿 嬿 1 嬿 嬿 364(15.7) 39(1嬿.7) 1 2 12 1嬿 14 278(1嬿.嬿) 33(11.9) 4 4 11 8 6 嬿( 嬿.嬿) 嬿( 嬿.嬿) 嬿 嬿 嬿 嬿 嬿 592(25.6) 65(11.嬿) 4 12 22 16 11 4( 嬿.2) 1(25.嬿) 嬿 嬿 1 嬿 嬿 嬿( 嬿.嬿) 嬿( 嬿.嬿) 嬿 嬿 嬿 嬿 嬿 446(19.3) 23( 5.2) 1 2 9 4 7 1( 嬿.嬿) 嬿( 嬿.嬿) 嬿 嬿 嬿 嬿 嬿 7( 嬿.3) 嬿( 嬿.嬿) 嬿 嬿 嬿 嬿 嬿 26( 1.1) 1( 3.8) 1 嬿 嬿 嬿 嬿 嬿( 嬿.嬿) 嬿( 嬿.嬿) 嬿 嬿 嬿 嬿 嬿 3嬿( 1.3) 1( 3.3) 嬿 嬿 嬿 嬿 1 43( 1.9) 4( 9.3) 1 嬿 嬿 2 1 嬿( 嬿.嬿) 嬿( 嬿.嬿) 嬿 嬿 嬿 嬿 嬿 25( 1.1) 嬿( 嬿.嬿) 嬿 嬿 嬿 嬿 嬿 2315(1嬿嬿.嬿) 227( 9.8) 18 31 76 56 46 339嬿(74.7) 3423(75.4) 388(14.6) 227( 9.8) 4541 768(22.4) 768(1嬿嬿.嬿) 597( 77.7) 85( 11.1) 33( 4.3) 53( 6.9) 1151(25.3) 1(嬿.1) 1嬿75(31.7) 1嬿75(1嬿嬿.嬿) 24( 2.2) 262( 24.4) 嬿( 嬿.嬿) 79( 7.3) 7嬿2( 65.3) 8( 嬿.7) 3(嬿.3) 3 18168 4-1
4-7 4-8 ( 4-1) 65.3 62.0% 77.7 76.6% ( ) 57 9
( 4-9) (77.6%) (76.4%) (68.3%) (67.1%) p<0.05 4-1 65.3 62.0% ( ) 14.6% 13.3% 12.4% 9.8豋 0.4豋 2 11.3~14.1% , 2009 14.6% 13.3% 12.4% 4-12 p 0.05
1 24.5 ( ) 89 75 53 2MG 30 3 600 3 3 3 600 10
2/3 ( 4-12) 30-39 40-49 1.23 50-59 1.25 60-69 1.41 (Juon et al., 2003; Leung et al., 2008; , 2005 , 1997 , 1998) >60 ( , 2003) ( ) 5.61 1.36 MSCS 3 3 ( , 2002) ( ) (Juon et al.,
2003 , 2003 , 2008) (1:1.21) Leung et al., 2008 , 2005 , 2008 ( , 2002) 57 9 9 3 5.7 100 3-5 9.1~11.9% 5 6.3~15.4% 3.4~18.2豋 1-10 2.07 11 1.92
( , 1995 , 2002
, 1998 ( )
( , 2008)
3 9.8%~14.6% 0.4% 14.6% 13.3% 12.4% 9.8% 89 75 53 24.5 2MG 1 .30
MSCS
3 59.8%(100 ) 70~80%
80% (Anttila et al., 2004)
4.5 5.5豋( , 2009)
Ahmedin Jemal, Freddie Bray, Melissa MC, et al. Global Cancer Statistics.
CA Cancer J Clin. 2011;61:69–90.
Aklimunnessa K, Mori M, Khan MM, et al. Effectiveness of cervical cancer screening over cervical cancer mortality among Japanese women. Jpn J Clin Oncol. 2006;36(8):511-518.
Anttila A, Nieminen P. Cervical cancer screening programme in Finland.Eur J Cancer.2000;36(17):2209-2214.
Anttila A, Ronco G, Clifford G, et al. Cervical cancer screening programmes and policies in 18 European countries .British Journal of Cancer. 2004；
91：935–941.
Arroyave AM, Penaranda EK, Lewis CL. Organizational change: A way to increase colon, breast and cervical cancer screening in primary care practices. Journal of Community Health 2011;36(2) 281-288.
Crawford AG, Sikirica V, Goldfarb N, et al. Interactive voice response
reminder effects on preventive service utilization. Am J Med Qual. 2005;20(6):329-336.
DeFrank JT, Rimer BK, Gierisch M, et al. Impact of Mailed and Automated Telephone Reminders on Receipt of Repeat Mammograms.Am J Prev Med. 2009 ; 36(6): 459–467.
Duan N, Fox SA, Derose KP, Carson S. Maintaining mammography
adherence through telephone counseling in a church-based trial. Am J Public Health. 2000;90(9):1468-1471.
Eaker S, Adami HO, Granath F, et al. A large population- based randomized controlled trial to increase attendance at screening for cervical
cancer.Cancer Epidemiol Biomarkers Prev. 2004;13(3):346-354.
Eliza Corporation Places Its 100 Millionth Call Supporting Personalized Health Care Outreach. Business Wire Web site . Available at:
http://www.businesswire.com/portal/site/google/?ndmViewId=news_vie w&newsId=20061116005760&newsLang=en. Accessed February 28,2013.
Gustafsson L, Sparen P, Gustafsson M, et al. Efficiency of organised and opportunistic cytological screening for cancer in situ of the cervix. British Journal of Cancer 1995 72 498-505.
IARC.Cervix cancer screening. Lyon, IARC Press,2005(IARC Handbooks of Cancer Prevention, Volume 10).
Koong SL, Yen AM, Chen TH. Efficacy and cost-effectiveness of nationwide cervical cancer screening in Taiwan. J Med Screen. 2006;13: S44-47.
Leung GM, Woo PP, Cowling BJ, Tsang CS, Cheung AN, Ngan
HY,Galbraith K, Lam TH. Who receives, benefits from and is harmed bycervical and breast cancer screening among Hong Kong Chinese? JPublic Health (Oxf) 2008;30(3):282-92.
Macgregor JE, Moss S, Parkin DM, Day NE.Cervical cancer screening in north-east Scotland. IARC Sci Pub1 1986;76:25-36.
Mitchell H, Medley G, Gordon I, Giles G.Cervical cytology reported as
negative and risk of adenocarcinoma of the cervix: no strong evidence of benefit. British journal of cancer 1995 71 894-897.
National Cancer Institute. SEER Stat Fact Sheets: Cervix Uteri. Available at: http://seer.cancer.gov/statfacts/html/cervix.html#incidence-mortality. Accessed March 10,2013.
Simon SR, Zhang F, Soumerai SB, et al.Failure of Automated Telephone
Outreach With Speech Recognition to Improve Colorectal Cancer Screening. ARCH INTERN MED. 2010 170 (3):264-270.
Smith HO, Tiffany MF, Qualls CR, Key CR. The rising incidence of adenocarcinoma relative to squamous cell carcinoma of the uterine cervix in the United States--a 24-year population-based study. Gynecol Oncol. 2000;78(2):97-105.
Vilos GA. The history of the papanicolaou smear and the Odyssey of George and Andromache Papanicolaou. Obstetrics & Gynecology . 1998;
91(3):479-483.
World Health Organization.Fact Sheet:Cancer. Available at:
http://www.who.int/mediacentre/factsheets/fs297/en/. Accessed February 28,2013.
100 2012 84 1998 98 2012 100 2012 http://www.hpa.gov.tw/BHPNet/Web/Stat/StatisticsShow.aspx?No=2013 04150001. 2013/07/28 16 25 (2011) http://www.bhp.doh.gov.tw/BHPNet/Web/News/ News.aspx?No=201102240002 2013/03/10. HPV 8% (2010) http://www.bhp.doh.gov.tw/BHPNet/ Web/News/News.aspx?No=201010060001 2013/03/10 (2013) http://www.bhp.doh.gov.tw/BHPnet/Web/News/News.aspx?No=201301 280008 2013/05/10
- 99-102 http://www.hpa.gov.tw/BHPNet/Web/HealthTopic/TopicBulletin.aspx?id =200712250207&parentid=200712250030 2013/07/28 (2013) http://www.stat.gov.tw/ ct.asp?xItem=30304&ctNode=517&mp=4 2013/05/10 1997 16(3) 198-210 2003 22(2) 127-133 1998 17(1) 28-35 2005 2005 24(5) 440-451 2002 15(3) p31-p66
2002 13 p1-p12
DOH97-HP-1505
2008
2008 27(3) 231-242
13 14 11 12 21 22 31 32 41 42 52 61 62 71 72 81 82 91 92 01 02 03 04 / 22
MSCS : 14 ( ) 1 14) 1 1 2 2 3 3 4 4 5 5 6 6 7 7 8 8 9 9 10 10 11 11 12 12 13 13 14 14
:
單位:% 99 年 100 年 101 年 項目別 總計 男 女 總計 男 女 總計 男 女 總計 58.07 66.51 49.89 58.17 66.67 49.97 58.35 66.83 50.19 年齡 15~24 歲 28.78 26.46 31.06 28.56 26.43 30.70 29.08 26.94 31.23 15~19 歲 8.93 9.09 8.76 8.69 8.92 8.44 8.45 8.72 8.15 20~24 歲 50.26 46.56 53.68 50.27 46.92 53.39 51.65 48.34 54.73 25~44 歲 84.72 93.15 76.51 85.56 93.89 77.53 86.33 94.60 78.38 25~29 歲 86.88 90.17 83.69 89.39 92.01 86.91 91.87 94.66 89.22 30~34 歲 85.18 93.90 76.71 85.89 94.59 77.50 86.40 95.05 78.08 35~39 歲 84.56 95.23 74.25 84.13 94.76 73.94 83.96 94.36 74.00 40~44 歲 82.22 93.37 71.17 82.92 94.07 71.97 83.60 94.28 73.17 45~64 歲 60.31 75.36 45.61 60.36 75.54 45.59 60.48 75.39 46.01 45~49 歲 77.20 90.53 63.97 77.84 91.22 64.63 78.70 91.49 66.09 50~54 歲 65.93 81.67 50.49 67.14 82.74 51.85 67.73 82.89 52.89 55~59 歲 50.67 67.59 34.33 51.66 68.62 35.31 52.52 69.32 36.36 60~64 歲 32.20 45.73 19.32 32.01 46.37 18.38 32.56 47.24 18.67 65 歲以上 8.09 12.07 4.43 7.93 12.00 4.23 8.10 12.46 4.20 教育程度 國中及以下 41.62 56.00 28.67 41.18 55.99 27.62 41.25 55.95 27.34 國小及以下 27.89 39.21 20.17 27.40 39.07 19.39 27.36 38.84 19.22 國中 61.23 73.02 45.51 60.56 72.78 43.86 60.51 72.75 43.23 高中(職) 62.25 70.87 53.78 62.36 70.93 53.97 62.30 71.19 53.51 高中 49.45 57.45 40.60 49.62 57.35 41.16 49.62 58.00 40.45 高職 67.88 77.30 59.11 68.05 77.50 59.24 68.04 77.62 59.00 大專及以上 68.43 71.17 65.64 68.23 71.29 65.19 68.00 71.37 64.78 專科 76.87 83.36 70.54 76.28 83.36 69.46 75.51 82.50 68.81 大學 63.91 64.87 62.91 62.40 62.65 62.17 62.65 63.53 61.89 研究所 - - - 71.26 73.69 67.42 71.24 73.72 67.76 婚姻狀況 未婚 59.74 60.01 59.43 60.39 60.62 60.14 60.95 61.29 60.57 有配偶或同居 60.70 72.54 49.03 60.60 72.37 48.97 60.51 72.14 49.05 離婚、分居或喪偶 37.63 51.78 30.76 37.33 52.43 30.17 37.87 53.34 30.35 註：99 年（含）以前，「大學」係含研究所者。 資料來源：人力資源調查統計年報。
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