Cancer Research and Treatment

Original Articles

Fraction of Cancer Attributable to Occupational Carcinogens in Korea between 2015 and 2030: Eun Mi Kim, Dong-Hee Koh, Soseul Sung, Youjin Hong, Sungji Moon, Jung Eun Lee, Kwang-Pil Ko, Sue K. Park, Jeehee Min, Sangjun Choi, Ju-Hyun Park, Sang-Gil Lee, Hwan-Cheol Kim, Dong-Uk Park, Inah Kim; Received February 8, 2025 Accepted September 17, 2025 Published online September 18, 2025; DOI: https://doi.org/10.4143/crt.2025.193 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Purpose
This study aimed to estimate the contribution of occupational carcinogens to cancer incidence and mortality in the Korean population between 2015 and 2030.
Materials and Methods
We selected occupational carcinogens classified as International Agency for Research on Cancer (IARC) group 1 and estimated the prevalence of exposure using data from the Korean CARcinogen EXposure (K-CAREX) and previous studies. Relative risks were calculated using published literature through a meta-analysis. Levin’s formula was used to estimate population attributable fraction (PAF) while considering a 15-year latency period between exposure, cancer incidence, and death. Additionally, trends in cancer PAF were calculated up to 2030, assuming constant relative risks and a 15-year latency period.
Results
In 2015, the PAFs for occupational carcinogen–related cancer incidence and mortality were 1.00% (men, 1.75%; women, 0.15%) and 1.97% (men, 2.98%; women, 0.33%), respectively, with asbestos being the largest contributor (incidence, 0.48%; mortality, 0.98%). In 2030, the PAFs for occupational carcinogen-related cancer incidence and mortality were 0.34% (men, 0.62%; women, 0.07%) and 0.80% (men, 1.22%; women, 0.15%), respectively, with diesel engine exhaust being projected to become the largest contributor by 2030 (incidence, 0.16%; mortality, 0.39%).
Conclusion
The PAFs of occupational carcinogens in Korea between 2015 and 2030 were estimated to be very low in the general population, and the values are expected to decrease over time owing to various regulations to prevent exposure to occupational carcinogens. Therefore, while regulating well-known occupational carcinogens, efforts should be made to monitor newly identified ones to ensure prompt implementation of preventive measures.

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General

Estimation of Population Attributable Fraction by Hormone and Reproductive Factors on Female Cancer in the Republic of Korea, 2015 to 2030: Youjin Hong, Soseul Sung, Woojin Lim, Sungji Moon, Kwang-Pil Ko, Jung Eun Lee, Inah Kim, Sun Ha Jee, Sun-Seog Kweon, Min-Ho Shin, Sangmin Park, Seung-Ho Ryu, Sun Young Yang, Jeongseon Kim, Sang-Wook Yi, Yoon-Jung Choi, Jeong-Soo Im, Hong Gwan Seo, Sue K. Park; Cancer Res Treat. 2025;57(3):649-658. Published online November 19, 2024; DOI: https://doi.org/10.4143/crt.2024.707

Abstract PDF Supplementary Material PubReader ePub

Purpose
Population attributable fractions (PAFs) for hormone and reproductive factors have been estimated in several countries. International Agency for Research on Cancer (IARC) designated as group 1 and group 2A carcinogen for hormone factors in breast, ovarian, endometrial and uterine cervix cancer. This study aimed to estimate the PAFs of hormone/reproductive factor attributed to cancer incidence and deaths in Korean women and projected trends from 2015 to 2030.
Materials and Methods
The PAF was estimated with using the 2005 standardized prevalence rates and 2020 incidence and deaths with a 15-year latency. Based on the Levin’s formula, prevalence rates were calculated using the Korea National Health and Nutrition Examination Survey (KNHANES) and the relative risks, which were the risk of selected female cancer associated with oral contraceptive, hormone replacement therapy and duration of breastfeeding, were estimated from the meta-analysis of studies performed in Korean women population. Studies based on the Asian and Global populations were calculated as a sensitivity analysis.
Results
The estimation PAFs for hormone was 1.02% with 1,192 cases and reproductive was 2.67% with 3,112 cases. Moreover, 0.40% (125 deaths) and 1.09% (342 deaths) in female-related cancer deaths in order. Estrogen-progesterone combined hormone replacement therapy (HRT) accounted the most proportion in hormone factors and breastfeeding in reproductive factors. Also, the breast cancer had the highest percent in both hormone and reproductive factors.
Conclusion
Through this study, 1.02% and 2.67% of female-related cancer incidence will be reduced by encouraging avoiding the use of oral contraceptives and HRT and breastfeeding for more than 6 months in reproductive factors. Additionally, among four selected female cancers in this study, breast cancer was observed to be a significant level of prevention.

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Application and interpretation of attributable fraction measures from clinical practice to policy: a narrative review
Sue Kyung Park
Journal of the Korean Medical Association.2026; 69(5): 411. CrossRef
Fraction of cancer incidence and mortality attributable to dietary factors in Korea from 2015 to 2030
Hyun Jeong Cho, Jin Young Yoo, Ga-Eun Yie, An Na Kim, Soseul Sung, Sungji Moon, Youjin Hong, Sangjun Lee, Inah Kim, Kwang-Pil Ko, Sun-Seog Kweon, Jung Eun Lee, Sue K. Park
Epidemiology and Health.2025; 47: e2025065. CrossRef

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Fraction of Cancer Attributable to Carcinogenic Drugs in Korea from 2015 to 2030: Woojin Lim, Soseul Sung, Youjin Hong, Sungji Moon, Sangjun Lee, Kyungsik Kim, Jung Eun Lee, Inah Kim, Kwang-Pil Ko, Sue K. Park; Cancer Res Treat. 2025;57(3):635-648. Published online November 6, 2024; DOI: https://doi.org/10.4143/crt.2024.644

Abstract PDF Supplementary Material PubReader ePub

Purpose
This study aims to estimate and project the population attributable fraction (PAF) of cancer incidence and death due to carcinogenic drug use in Korea from 2015 to 2030, to estimate the degree of cancer prevention from exposure to carcinogenic drugs in Korea. Selected carcinogenic drugs were immunosuppressive and antineoplastic drugs classified as group I by the International Agency for Research on Cancer.
Materials and Methods
Systematic review and meta-analyses were conducted to estimate the relative risk of cancer associated with carcinogenic drug use. Age was standardized using the annual prevalence rate of the National Health Insurance Service sample cohort (NHIS-NSC) from 2002 to 2013 to calculate the standardized prevalence rate of carcinogenic drug use each year. The PAF of specific cancer incidence and death were calculated using Levin’s formula and Monte Carlo methods. The prevalence rates were extrapolated to estimate the trend of PAF from 2015 to 2030.
Results
In 2015, carcinogenic drugs attributed to 0.003% and 0.002% among the causes of cancer incidence and death in Korea. However, carcinogenic drugs attributed to 1.1% among the causes of both cancer incidence and death in patients with clinical indications of carcinogenic drugs.
Conclusion
The PAF in patients with clinical indications of carcinogenic drugs were significantly high and expected to increase rapidly over time. Since these drugs are listed as essential by the World Health Organization, and may be difficult to replace, a surveillance system on susceptible populations using group I carcinogenic drugs must be discussed and implemented.

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IARC Group 1 Pharmaceuticals and Associated Cancer Risks: A Nationwide Population-Based Cohort Study in Korea
Woojin Lim, Na Rae Lee, Ho Gyun Shin, Su-Yeon Yu, Sue K. Park
Cancer Research and Treatment.2026; 58(2): 376. CrossRef
Application and interpretation of attributable fraction measures from clinical practice to policy: a narrative review
Sue Kyung Park
Journal of the Korean Medical Association.2026; 69(5): 411. CrossRef
Fraction of cancer incidence and mortality attributable to dietary factors in Korea from 2015 to 2030
Hyun Jeong Cho, Jin Young Yoo, Ga-Eun Yie, An Na Kim, Soseul Sung, Sungji Moon, Youjin Hong, Sangjun Lee, Inah Kim, Kwang-Pil Ko, Sun-Seog Kweon, Jung Eun Lee, Sue K. Park
Epidemiology and Health.2025; 47: e2025065. CrossRef

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High-Dose Metformin Plus Temozolomide Shows Increased Anti-tumor Effects in Glioblastoma In Vitro and In Vivo Compared with Monotherapy: Jung Eun Lee, Ji Hee Lim, Yong Kil Hong, Seung Ho Yang; Cancer Res Treat. 2018;50(4):1331-1342. Published online January 10, 2018; DOI: https://doi.org/10.4143/crt.2017.466

Abstract PDF Supplementary Material PubReader ePub

Purpose
The purpose of the study is to investigate the efficacy of combined treatment with temozolomide (TMZ) and metformin for glioblastoma (GBM) in vitro and in vivo.
Materials and Methods
We investigated the efficacy of combined treatment with TMZ and metformin using cell viability and apoptosis assays. A GBM orthotopic mice model was established by inoculation of 5×105 U87 cells and treatedwith metformin, TMZ, and the combination for 4weeks. Western blotting and immunofluorescence of tumor specimens were analyzed to investigate AMP-activated protein kinase (AMPK) and AKT pathway.
Results
The combination of TMZ and metformin showed higher cytotoxicity than single agents in U87, U251, and A172 cell lines. A combination of high-dose metformin and TMZ showed the highest apoptotic activity. The combination of TMZ and metformin enhanced AMPK phosphorylation and inhibited mammalian target of rapamycin phosphorylation, AKT phosphorylation, and p53 expression. The median survival of each group was 43.6, 55.2, 53.2, 65.2, and 71.3 days for control, metformin treatment (2 mg/25 g/day or 10 mg/25 g/day), TMZ treatment (15 mg/kg/day), combination treatment with low-dose metformin and TMZ, and combination treatment with high-dose metformin and TMZ, respectively. Expression of fatty acid synthase (FASN) was significantly decreased in tumor specimens treated with metformin and TMZ.
Conclusion
The combination of metformin and TMZ was superior to monotherapy using metformin or TMZ in terms of cell viability in vitro and survival in vivo. The combination of high-dose metformin and TMZ inhibited FASN expression in an orthotopic model. Inhibition of FASN might be a potential therapeutic target of GBM.

Citations

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Optimal Timing for the Administration of Capecitabine with Preoperative Chemoradiation for Locally Advanced Rectal Cancer: Young Ju Noh, Won Sik Choi, Jong Hoon Kim, Jin Cheon Kim, Chang Sik Yu, Hee Cheol Kim, Tae Won Kim, Heung Moon Chang, Min Hee Ryu, Seung Do Ahn, Sang-wook Lee, Seong Soo Shin, Jung Eun Lee, Eun Kyung Choi; Cancer Res Treat. 2006;38(1):30-34. Published online February 28, 2006; DOI: https://doi.org/10.4143/crt.2006.38.1.30

Abstract PDF PubReader ePub

Purpose

Capecitabine is an oral fluoropyrimidine carbamate and it is known as an effective radiosensitizer. Capecitabine and its metabolite reach their peak concentration in the plasma at 1~2 hours after a single oral administration of capecitabine and the levels fall rapidly thereafter. To verify the radiosensitizing effect of capecitabine that is based on such pharmacokinetic characteristics, we performed a retrospective analysis on the optimal timing of capecitabine administration with performing preoperative chemoradiation for locally advanced rectal cancer.

Materials and Methods

Among 171 patients who were treated with preoperative radiotherapy and concurrent capecitabine administration for rectal cancer, 56 patients were administered capecitabine at 1~2 hours before radiotherapy (group A), and at other time in the other 115 patients (group B). Total mesorectal excision was done at 4 to 6 weeks after the completion of chemoradiation. The radiosensitizing effect of capecitabine was evaluated on the basis of the pathological response.

Results

Complete pathological regression of the primary tumor was observed in 12 patients (21.4%) for group A and in 11 patients (9.6%) for group B (p=0.031). Residual disease less than 0.5 cm (a good response) was observed in 19 patients (33.9%) for group A and in 23 patients (20.0%) for group B (p=0.038). On multivariate analysis, the capecitabine ingestion time showed marginal significance.

Conclusion

When performing preoperative chemoradiation for locally advanced rectal cancer, the radiosensitizing effect of capecitabine was enhanced when it was administered 1 hour before radiotherapy.

Citations

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Systematic review of treatment intensification using novel agents for chemoradiotherapy in rectal cancer
R Clifford, N Govindarajah, J L Parsons, S Gollins, N P West, D Vimalachandran
British Journal of Surgery.2018; 105(12): 1553. CrossRef

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