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

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 Res Treat. 2026;58(2):376-392. Published online April 24, 2025; DOI: https://doi.org/10.4143/crt.2024.1201

Abstract PDF Supplementary Material PubReader ePub: Purpose
The aim of this study is to summarize cancer risk among patients with clinical indications of immunosuppressive and antineoplastic drugs in Korea, which are pharmaceuticals defined as group 1 by International Agency for Research on Cancer.
Materials and Methods
We conducted a nationwide population-based retrospective cohort study using the Korean National Health Insurance Service claims data from 2002 to 2018. Patients with clinical indications for group 1 pharmaceuticals from 2002 to 2017 were selected as baseline population, and followed up until 2018. Cox proportional hazards regression model was used to analyze the risk of cancer and dose-response relationship between group 1 pharmaceuticals and cancer.
Results
Azathioprine use increased the risk of skin and hematologic cancer (hazard ratio [HR], 4.63; 95% confidence interval [CI], 2.91 to 7.39 and HR, 3.15; 95% CI, 2.41 to 4.13). Cyclosporine use increased the risk of skin and hematologic cancer (HR, 2.30; 95% CI, 1.79 to 2.95 and HR, 2.96; 95% CI, 2.59 to 3.40). Cyclophosphamide use increased the risk of bladder and hematologic cancer (HR, 2.69; 95% CI, 1.92 to 3.78 and HR, 3.83; 95% CI, 3.20 to 4.59). Chlorambucil use increased the risk of hematologic cancer (HR, 3.51; 95% CI, 2.53 to 4.87) and melphalan use increased the risk of hematologic cancer (HR, 16.31; 95% CI, 13.41 to 19.85). Methoxsalen use increased the risk of skin cancer (HR, 2.32; 95% CI, 1.36 to 3.95).
Conclusion
Group 1 pharmaceuticals were associated with increased risk of cancer. The results are expected to help establish alternative clinical strategies and policies for patients with clinical indications of group 1 pharmaceuticals, by continuous risk analysis and discussions on the surveillance systems.

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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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Active and Passive Smoking, BRAF^V600E Mutation Status, and the Risk of Papillary Thyroid Cancer: A Large-Scale Case-Control and Case-Only Study: Kyoung-Nam Kim, Yunji Hwang, Kyungsik Kim, Kyu Eun Lee, Young Joo Park, June Young Choi, Do Joon Park, BeLong Cho, Daehee Kang, Sue K. Park; Cancer Res Treat. 2019;51(4):1392-1399. Published online February 20, 2019; DOI: https://doi.org/10.4143/crt.2018.612

Abstract PDF Supplementary Material PubReader ePub

Purpose
The association between tobacco smoking and thyroid cancer remains uncertain. We evaluated the associations of active and passive smokingwith the risk of papillary thyroid cancer (PTC), the most common type of thyroid cancer, and with the BRAFV600E mutation, the most common oncogenic mutation in PTC related to poor prognosis.
Materials and Methods
We conducted this study with newly diagnosed PTC patients (n=2,142) and community controls (n=21,420) individually matched to cases for age and sex. Information on active and passive smoking and potential confounders were obtained from structured questionnaires, anthropometric measurements, and medical records. BRAF^V600E mutation status was assessed in PTC patients. We evaluated the associations of active and passive smoking with PTC and BRAF^V600E mutation risk using conditional and unconditional logistic regression models, respectively.
Results
We did not find associations between exposure indices of active and passive smoking and PTC risk in both men and women, except for the association between current smoking and lower PTC risk. Cumulative smoking ≥ 20 pack-years was associated with lower BRAFV600E mutation risk in male PTC patients (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.30 to 1.00). The CI for the association was wider in female PTC patients (OR, 0.23; 95% CI, 0.02 to 2.62), possibly owing to a smaller sample size in this stratum.
Conclusion
We did not find consistent associations between active and passive smoking and PTC risk. Cumulative smoking ≥ 20 pack-years was associated with lower BRAFV600E mutation risk in male PTC patients.

Citations

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Family History of Hypertension Predicts Thyroid Cancer Risk in Women: A Population‐Based Cross‐Sectional Study With Integrative Machine Learning and Genomic Analyses
Zijin Wang, Yanhui Lin, Fanke Meng, Yuxin Sun, Ziran Zhang, Tong Wu, Min Fu, Fanye Wu, Zhengran Li, Zejun Chen
Cancer Medicine.2025;[Epub] CrossRef
The Correlation Between Biological Markers and Prognosis in Thyroid Cancer
Rami Hajjar, Ciprian Duta, Ionut Flaviu Faur, Catalin Prodan-Barbulescu, Hadi Alhajjar, Stelian Pantea
Biomedicines.2024; 12(12): 2826. CrossRef
Geographic variation in the association between Hashimoto’s thyroiditis and Papillary thyroid carcinoma, a meta-analysis
Nabil W. G. Sweis, Ayman A. Zayed, Mira Al Jaberi, Lina AlQirem, Tala Basheer Hyasat, Farah A. Khraisat, Ward Maaita, Ahmad Moayad Naser, Abdullah Nimer, Mamoon Qatamin, Jaleel J. G. Sweis, Nadia Sweis, Abdallah T. Al-Ani, Ahmad M. Alghrabli, Alireza Hagh
Endocrine.2023; 81(3): 432. CrossRef
Sex-specific Associations between Body Mass Index and Thyroid Cancer Incidence among Korean Adults
Kyoung-Nam Kim, Kyungsik Kim, Sangjun Lee, Sue K. Park
Cancer Epidemiology, Biomarkers & Prevention.2023; 32(9): 1227. CrossRef
Effect of Cigarette Smoking on Thyroid Cancer: Meta-Analysis
Joon-Hyop Lee, Young Jun Chai, Ka Hee Yi
Endocrinology and Metabolism.2021; 36(3): 590. CrossRef
Tobacco smoking and risk of thyroid cancer according to BRAFV600E mutational subtypes
Sabbir T. Rahman, Nirmala Pandeya, Rachel E. Neale, Donald S. A. McLeod, Peter D. Baade, Philippa H. Youl, Roger Allison, Susan Leonard, Susan J. Jordan
Clinical Endocrinology.2021; 95(6): 891. CrossRef
circFAT1(e2) Promotes Papillary Thyroid Cancer Proliferation, Migration, and Invasion via the miRNA-873/ZEB1 Axis
Jiazhe Liu, Hongchang Li, Chuanchao Wei, Junbin Ding, Jingfeng Lu, Gaofeng Pan, Anwei Mao, Tao Huang
Computational and Mathematical Methods in Medicine.2020; 2020: 1. CrossRef

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Association between Body Mass Index and Gastric Cancer Risk According to Effect Modification by Helicobacter pylori Infection: Jieun Jang, Eun-Jung Cho, Yunji Hwang, Elisabete Weiderpass, Choonghyun Ahn, Jeoungbin Choi, Soung-Hoon Chang, Hai-Rim Shin, Min Kyung Lim, Keun-Young Yoo, Sue K. Park; Cancer Res Treat. 2019;51(3):1107-1116. Published online November 21, 2018; DOI: https://doi.org/10.4143/crt.2018.182

Abstract PDF Supplementary Material PubReader ePub

Purpose
Few studies investigated roles of body mass index (BMI) on gastric cancer (GC) risk according to Helicobacter pylori infection status. This study was conducted to evaluate associations between BMI and GC risk with consideration of H. pylori infection information.
Materials and Methods
We performed a case-cohort study (n=2,458) that consists of a subcohort, (n=2,193 including 67 GC incident cases) randomly selected from the Korean Multicenter Cancer Cohort (KMCC) and 265 incident GC cases outside of the subcohort. H. pylori infection was assessed using an immunoblot assay. GC risk according to BMI was evaluated by calculating hazard ratios (HRs) and their 95% confidence intervals (95% CIs) using weighted Cox hazard regression model.
Results
Increased GC risk in lower BMI group (< 23 kg/m²) with marginal significance, (HR, 1.32; 95% CI, 0.98 to 1.77) compared to the reference group (BMI of 23-24.9 kg/m²) was observed. In the H. pylori non-infection, both lower (< 23 kg/m²) and higher BMI (≥ 25 kg/m²) showed non-significantly increased GC risk (HR, 10.82; 95% CI, 1.25 to 93.60 and HR, 11.33; 95% CI, 1.13 to 113.66, respectively). However, these U-shaped associations between BMI and GC risk were not observed in the group who had ever been infected by H. pylori.
Conclusion
This study suggests the U-shaped associations between BMI and GC risk, especially in subjects who had never been infected by H. pylori.

Citations

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The Influence of Metabolic Syndrome on the Development of Gastrointestinal Malignant Tumors—A Review
Vesna Brzački, Andrija Rančić, Snežana Tešić Rajković, Ivan Nagorni, Marko Stamenković, Elena Stanković, Nikola Milutinović, Aleksandar Vukadinović
Medicina.2025; 61(6): 1025. CrossRef
Ethnic-specific associations between body mass index and gastric cancer: a Mendelian randomization study in European and Korean populations
Sangjun Lee, Sue K. Park
Gastric Cancer.2024; 27(1): 19. CrossRef
Cross-phenotype association analysis of gastric cancer: in-silico functional annotation based on the disease–gene network
Sangjun Lee, Han-Kwang Yang, Hyuk-Joon Lee, Do Joong Park, Seong-Ho Kong, Sue K. Park
Gastric Cancer.2023; 26(4): 517. CrossRef
Association between metabolic syndrome and gastric cancer risk: results from the Health Examinees Study
Dan Huang, Woo-Kyoung Shin, Katherine De la Torre, Hwi-Won Lee, Sukhong Min, Aesun Shin, Jong-Koo Lee, Daehee Kang
Gastric Cancer.2023; 26(4): 481. CrossRef
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Priya Alagesan, Jessica C. Goodwin, Katherine S. Garman, Meira Epplein
Cancer Epidemiology, Biomarkers & Prevention.2023; 32(4): 473. CrossRef
Obesity at early adulthood increases risk of gastric cancer from the Health Examinees-Gem (HEXA-G) study
Hwi-Won Lee, Dan Huang, Woo-Kyoung Shin, Katherine de la Torre, Jae Jeong Yang, Minkyo Song, Aesun Shin, Jong-koo Lee, Daehee Kang, Shengxu Li
PLOS ONE.2022; 17(2): e0260826. CrossRef
Association between Body Mass Index and Risk of Gastric Cancer by Anatomic and Histologic Subtypes in Over 500,000 East and Southeast Asian Cohort Participants
Jieun Jang, Sangjun Lee, Kwang-Pil Ko, Sarah K. Abe, Md. Shafiur Rahman, Eiko Saito, Md. Rashedul Islam, Norie Sawada, Xiao-Ou Shu, Woon-Puay Koh, Atsuko Sadakane, Ichiro Tsuji, Jeongseon Kim, Isao Oze, Chisato Nagata, Shoichiro Tsugane, Hui Cai, Jian-Min
Cancer Epidemiology, Biomarkers & Prevention.2022; 31(9): 1727. CrossRef
Impact of a Fermented High-Fiber Rye Diet on Helicobacter pylori and Cardio-Metabolic Risk Factors: A Randomized Controlled Trial Among Helicobacter pylori-Positive Chinese Adults
Kun Xue, Yuwei Liu, Kia Nøhr Iversen, Mohsen Mazidi, Zheng Qu, Chenglin Dong, Tayi Jin, Göran Hallmans, Per Åman, Anders Johansson, Gengsheng He, Rikard Landberg
Frontiers in Nutrition.2021;[Epub] CrossRef
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C.R. Akshatha, Smitha Bhat, R. Sindhu, Dharini Shashank, Sarana Rose Sommano, Wanaporn Tapingkae, Ratchadawan Cheewangkoon, Shashanka K. Prasad
Saudi Journal of Biological Sciences.2021; 28(9): 5371. CrossRef
The U‐shaped association between body mass index and gastric cancer risk in the Helicobacter pylori Biomarker Cohort Consortium: A nested case–control study from eight East Asian cohort studies
Jieun Jang, Tianyi Wang, Hui Cai, Fei Ye, Gwen Murphy, Taichi Shimazu, Philip R Taylor, You‐Lin Qiao, Keun‐Young Yoo, Sun Ha Jee, Jeongseon Kim, Sheau‐Chiann Chen, Christian C Abnet, Shoichiro Tsugane, Wei Zheng, Xiao‐Ou Shu, Michael Pawlita, Sue K. Park,
International Journal of Cancer.2020; 147(3): 777. CrossRef

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Effectiveness of Gastric Cancer Screening on Gastric Cancer Incidence and Mortality in a Community-Based Prospective Cohort: Heewon Kim, Yunji Hwang, Hokyung Sung, Jieun Jang, Choonghyun Ahn, Sang Gyun Kim, Keun-Young Yoo, Sue K. Park; Cancer Res Treat. 2018;50(2):582-589. Published online June 9, 2017; DOI: https://doi.org/10.4143/crt.2017.048

Abstract PDF Supplementary Material PubReader ePub

Purpose
This study was performed to investigate the effectiveness of gastric cancer (GC) screening methods in a community-based prospective cohort of the Korean Multi-center Cancer Cohort (KMCC) with over a 10-year follow-up.
Materials and Methods
A total 10,909 and 4,773 subjects from the KMCC with information on gastroendoscopy (GE) and upper gastrointestinal series (UGIS) were included in this study. Cox proportional hazard model adjusted for age, sex, Helicobacter pylori infection, cigarette smoking, and alcohol drinking was used to estimate the hazard ratios (HRs) and 95% confidence interval (CI).
Results
The GE screened subjects had almost half the risk of GC-specific death than that of unscreened subjects (HR, 0.58; 95% CI, 0.36 to 0.94). Among the GC patients, GE screenees had a 2.24-fold higher survival rate than that of the non-screenees (95% CI, 1.61 to 3.11). In particular, GE screenees who underwent two or more screening episodes had a higher survival rate than that of the non-screenees (HR, 13.11; 95% CI, 7.38 to 23.30). The effectiveness of GE screening on reduced GC mortality and increased survival rate of GC patients was better in elderly subjects (≥ 65 years old) (HR, 0.47; 95% CI, 0.24 to 0.95 and HR, 8.84; 95% CI, 3.63 to 21.57, respectively) than that in younger subjects (< 65 years old) (HR, 0.66; 95% CI, 0.34 to 1.29 and HR, 1.83; 95% CI, 1.24 to 2.68, respectively). In contrast, UGIS screening had no significant relation to GC mortality and survival.
Conclusion
The findings of this study suggest that a decreased GC-specific mortality and improved survival rate in GC patients can be achieved through GE screening.

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Age-Period-Cohort Analysis of Female Breast Cancer Mortality in Korea: Yunhee Choi, Yeonju Kim, Sue K. Park, Hai-Rim Shin, Keun-Young Yoo; Cancer Res Treat. 2016;48(1):11-19. Published online May 14, 2015; DOI: https://doi.org/10.4143/crt.2015.021

Abstract PDF PubReader ePub

Purpose
Despite the low mortality rate of breast cancer among women in Korea, the breast cancer mortality rate has increased. The aim of this study was to examine trends in breast cancer mortality from 1983 to 2012 in Korea, assessing the importance of age, period, and birth cohort as risk factors.
Materials and Methods
Data on the annual number of deaths due to female breast cancer and on female population statistics from 1983 to 2012 were obtained from Statistics Korea. A log-linear Poisson ageperiod- cohort model was used to estimate age, period, and cohort effects.
Results
The increasing breast cancer mortality can be explained predominantly by a birth cohort effect: the risk of breast cancer death showed a steady increase until the 1968 birth cohort, and decreased thereafter. There was a sharp increase in the magnitude of the age effect up to 60 years old, then a moderate increase in the effect during the sixties, followed by another sharp increase from 70 years old. The period effect on breast cancer mortality seems negligible based on its adjusted relative risk, even though it was statistically significant after adjusting for age and cohort effects.
Conclusion
In this study, the mortality pattern of breast cancer in Korea can be explained predominantly by a birth cohort effect. Hence, the overall mortality rate of breast cancer may increase for a while, and show a gradual decrease in the future, which will start from the younger age group.

Citations

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