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Original Articles
Latency period of lung cancer in relation to tobacco smoking in Korea
Thi Tra Bui, Hee-Yeon Kang, Eunjung Park, Jin-Kyoung Oh
Epidemiol Health. 2026;48:e2026014.   Published online March 30, 2026
DOI: https://doi.org/10.4178/epih.e2026014
  • 12,139 View
  • 164 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This mixed-methods observational study aimed to examine the temporal relationship between trends in cigarette smoking prevalence and lung cancer mortality and incidence rates, and to estimate the latency period between smoking initiation and lung cancer diagnosis among smokers at the individual level.
METHODS
Smoking prevalence data for 1960–2022 were reconstructed using data from the Korea National Health and Nutrition Examination Survey (1998–2022). Lung cancer mortality data (1983–2022) and incidence data (1999–2022) were obtained from Statistics Korea and the Korea Central Cancer Registry. The population latency period was estimated using peak comparison and distributed lag non-linear models. The individual latency period was estimated as the average time interval between age at smoking initiation and age at lung cancer diagnosis using individual-level data from the National Health Insurance Service cohort.
RESULTS
In men, smoking prevalence peaked around 1985, whereas lung cancer mortality peaked around 2000 during 1960–2022, indicating a lag time of approximately 15 years. In women, lung cancer mortality peaked in 2002, while smoking prevalence peaked around the same time. The population-level latency period between smoking and lung cancer incidence was estimated to be 15 years after adjustment for age, gender, and year of outcome. The individual latency period was estimated to be 42.6 years (standard deviation [SD], 12.5) in men and 34.4 years (SD, 14.2) in women. Smoking intensity and age at initiation did not appear to shorten the individual latency period.
CONCLUSIONS
Estimates of the smoking-attributable lung cancer burden should account for historical smoking prevalence from approximately 15 years earlier.
Summary
Korean summary
한국의 흡연율과 폐암 사망률 및 발생률은 뚜렷한 시간적 추세를 보였으며, 특히 남성에서 인구집단 수준에서 약 15년의 시차가 관찰되었다. 개인 수준 분석에서는 흡연 시작부터 폐암 진단까지의 잠복기가 훨씬 더 길게 나타나 남성에서는 40년 이상, 여성에서는 30년 이상이었다. 이러한 결과는 인구 건강에 대한 흡연 기인 폐암 부담을 평가할 때 최소 15년 이전의 과거 흡연 패턴을 반영해야 함을 시사한다.
Key Message
Smoking prevalence and lung cancer mortality and incidence rates in Korea showed clear temporal trends, particularly among men, with an approximate 15-year lag at the population level. Individual-level analyses indicated much longer latency periods from smoking initiation to lung cancer diagnosisover 40 years in men and over 30 years in women. These findings suggest that assessments of the smoking-attributable lung cancer burden on population health should incorporate historical smoking patterns from at least 15 years earlier.
Association between humidifier disinfectant use duration and lung cancer development in Korea
Sungchan Kang, Jeong-In Hwang, Su Hwan Kim, Hyungryul Lim, Dong-wook Lee, Woojoo Lee, Jong Hun Kim, Sol Yu, Jungyun Lim, Younghee Kim, Kyoung-Nam Kim
Epidemiol Health. 2025;47:e2025023.   Published online May 2, 2025
DOI: https://doi.org/10.4178/epih.e2025023
  • 15,084 View
  • 224 Download
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study was conducted to assess the association between the duration of humidifier disinfectant use and lung cancer development.
METHODS
We analyzed data from 3,605 applicants registered for compensation from the Korean government due to health conditions related to humidifier disinfectant exposure. Among these individuals, 121 were diagnosed with lung cancer at least 4 years after their initial exposure (through December 2021). Hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer incidence were estimated according to the duration of disinfectant use using Cox proportional hazards models.
RESULTS
Compared with <5 months of use, the HRs for lung cancer were 1.81 (95% CI, 0.41 to 7.97) for 5-14 months, 2.45 (95% CI, 0.58 to 10.41) for 15-29 months, and 4.61 (95% CI, 1.12 to 18.91) for ≥30 months. Using never smokers with <15 months of use as the reference category, the HRs were 2.97 (95% CI, 1.34 to 6.56) for never smokers with ≥15 months of use, 2.73 (95% CI, 0.94 to 7.95) for current or former smokers with <15 months of use, and 4.74 (95% CI, 1.94 to 11.61) for current or former smokers with ≥15 months of use.
CONCLUSIONS
Our study provides some of the first robust epidemiological evidence that prolonged humidifier disinfectant use contributes to lung cancer development. Future studies—particularly those including unexposed populations—are needed to confirm these findings.
Summary
Korean summary
* 장기간의 가습기 살균제 사용과 폐암 발생의 위험 간에는 정량적 연관성을 발견할 수 있었습니다. * 가습기살균제를 30개월 이상 사용했다고 응답한 사람들은, 가습기살균제를 5개월 미만 사용했다고 응답한 사람들과 비교하여 폐암 발생 위험이 4배 높았습니다.
Key Message
* There is a quantitative association between prolonged humidifier disinfectants use and the risk of lung cancer incidence. * Individuals reported they used humidifier disinfectants for more than 30 months had more than four times higher risk of lung cancer than those of individuals who reported they used humidifier disinfectants for less than five months.
Association of decreased estimated glomerular filtration rate with lung cancer risk in the Korean population
Soonsu Shin, Min-Ho Kim, Chang-Mo Oh, Hyejin Chun, Eunhee Ha, Hyo Choon Lee, Seong Ho Moon, Dong-Young Lee, Dosang Cho, Sangho Lee, Min Hyung Jung, Jae-Hong Ryoo
Epidemiol Health. 2024;46:e2024041.   Published online March 20, 2024
DOI: https://doi.org/10.4178/epih.e2024041
  • 21,458 View
  • 184 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Inconsistent results are available regarding the association between low estimated glomerular filtration rate (eGFR) and lung cancer risk. We aimed to explore the risk of lung cancer according to eGFR category in the Korean population.
METHODS
We included 358,293 adults who underwent health checkups between 2009 and 2010, utilizing data from the National Health Insurance Service-National Sample Cohort. Participants were categorized into 3 groups based on their baseline eGFR, as determined using the Chronic Kidney Disease Epidemiology Collaboration equation: group 1 (eGFR ≥90 mL/min/1.73 m<sup>2</sup>), group 2 (eGFR ≥60 to <90 mL/min/1.73 m<sup>2</sup>), and group 3 (eGFR <60 mL/min/1.73 m<sup>2</sup>). Incidences of lung cancer were identified using the corresponding codes from the International Classification of Diseases, 10th revision. Multivariate Cox proportional hazard models were employed to calculate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for lung cancer incidence up to 2019.
RESULTS
In multivariate analysis, group 2 exhibited a 26% higher risk of developing lung cancer than group 1 (HR, 1.26; 95% CI, 1.19 to 1.35). Furthermore, group 3 demonstrated a 72% elevated risk of lung cancer relative to group 1 (HR, 1.72; 95% CI, 1.58 to 1.89). Among participants with dipstick proteinuria of 2+ or greater, group 3 faced a significantly higher risk of lung cancer than group 1 (HR, 2.93; 95% CI, 1.37 to 6.24).
CONCLUSIONS
Low eGFR was significantly associated with increased lung cancer risk within the Korean population. A particularly robust association was observed in individuals with severe proteinuria, emphasizing the need for further investigation.
Summary
Korean summary
이번 연구에서는 한국인 인구집단에서 단백뇨와 동반된 낮은 사구체 여과율이 페암의 발생 위험을 증가시켰다. 이는 신장기능의 저하가 폐암의 위험을 증가시킬 수 있음을 시사한다. 신장기능이 저하된 환자들의 면밀한 추적관찰이 필요할 수 있다.
Key Message
Our research found that lower estimated glomerular filtration rate with proteinuria increased the risk of lung cancer in a Korean population. These findings suggest that decreased kidney function may increase the risk of lung cancer, indicating the need for careful observation of patients with impaired kidney function.

Citations

Citations to this article as recorded by  
  • Mendelian randomization study of the relationship between blood and urine biomarkers and lung cancer
    Haihua Huang, Haijun Zheng
    Frontiers in Oncology.2024;[Epub]     CrossRef
Androgen deprivation therapy is associated with decreased second primary lung cancer risk in the United States veterans with prostate cancer
Kyungsuk Jung, Jong Chul Park, Hyunseok Kang, Johann Christoph Brandes
Epidemiol Health. 2018;40:e2018040.   Published online August 11, 2018
DOI: https://doi.org/10.4178/epih.e2018040
  • 28,643 View
  • 210 Download
  • 8 Web of Science
  • 8 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
We investigated whether androgen deprivation therapy (ADT) in prostate cancer patients was associated with a decreased risk for second primary lung cancer in US veterans.
METHODS
Prostate cancer diagnoses in the US Veterans Affairs Cancer Registry between 1999 and 2008 were identified. Use of hormonal therapy and diagnoses of second primary lung cancer were determined from the registry. Synchronous prostate and lung cancers, defined as 2 diagnoses made within 1 year, were excluded from the analysis. Cancer-free survival was estimated using the Kaplan-Meier method and hazard ratios were estimated using Cox proportional hazard models.
RESULTS
Among the 63,141 identified patients with prostate cancer, 18,707 subjects were eligible for the study. Hormonal therapy was used in 38% of patients and the median follow-up period was 28 months. ADT use was associated with longer lung cancer-free survival in prostate cancer patients (log-rank p=0.01). After adjusting for age, race, smoking and prostate cancer stage, ADT use was associated with decreased lung cancer risk by 15, 21, and 24% after 1, 2, and 3 years, respectively.
CONCLUSIONS
ADT in prostate cancer patients may be associated with decreased second primary lung cancer risk among US veterans.
Summary
Korean summary
비소세포성 폐암이 호르몬 수용체에 의해 영향을 받을 수 있다는 기존의 연구 결과를 바탕으로, 이 연구는 미국 재향 군인 병원 암등록 자료를 분석하여 전립선암 환자 중, 안드로겐 박탈 요법으로 치료를 받은 경우와 그렇지 않은 경우의 비소세포성 폐암 발생율을 비교분석하였다. 분석 결과, 전립선암을 진단받은 미국 재향군인들 중 안드로겐 박탈 요법으로 치료를 받은 환자들이 그렇지 않은 환자들에 비해 비소세포성 폐암 발생율이 통계적으로 유의미하게 감소하는 것이 관찰되었다.

Citations

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  • Risk and survival of third primary cancers in a population-based cohort of prostate cancer survivors
    Patrícia Sá, José Taveira-Barbosa, Samantha Morais, Teresa Garcia, Maria José Bento, Nuno Lunet
    European Journal of Cancer Prevention.2026; 35(3): 281.     CrossRef
  • Study of benign prostatic hyperplasia and androgen pathway manipulation on lung cancer survivals
    Po-Hsin Lee, Pang-Ting Cheng, Ayse Celik, Chuan-Yueh Lien, Muhammet Oner, Mei-Chih Chen, Jeng-Sen Tseng, Yen-Hsiang Huang, Yu-Wei Hsu, Kuo-Hsuan Hsu, Jer-Tsong Hsieh, Tsung-Ying Yang, Ho Lin
    Journal of Advanced Research.2026;[Epub]     CrossRef
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    Xinyu Wang, Meiyuan Zeng, Xueming Ju, Anqi Lin, Chaozheng Zhou, Junyi Shen, Zaoqu Liu, Bufu Tang, Quan Cheng, Youyu Wang, Jian Zhang, Peng Luo
    British Journal of Surgery.2024;[Epub]     CrossRef
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    Chihiro Inoue, Yasuhiro Miki, Takashi Suzuki
    Cancers.2023; 15(14): 3620.     CrossRef
  • Role of sex and sex hormones in PD-L1 expression in NSCLC: clinical and therapeutic implications
    Vianey Rodriguez-Lara, Giovanny Soca-Chafre, Maria Rosa Avila-Costa, Juan Jose Juarez-Vignon Whaley, Jeronimo Rafael Rodriguez-Cid, José Luis Ordoñez-Librado, Emma Rodriguez-Maldonado, Nallely A. Heredia-Jara
    Frontiers in Oncology.2023;[Epub]     CrossRef
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    Yingya Zhao, Yu‐Tang Gao, Xianglan Zhang, Alan L. Rockwood, Mark M. Kushnir, Qiuyin Cai, Jie Wu, Jiajun Shi, Qing Lan, Nathaniel Rothman, Yu Shyr, Xiao‐Ou Shu, Wei Zheng, Gong Yang
    International Journal of Cancer.2022; 151(5): 699.     CrossRef
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    Diana R. Withrow, Sara J. Schonfeld, Rochelle E. Curtis, Lindsay M. Morton, Michael B. Cook, Eboneé N. Butler, Amy Berrington de González
    Cancer Causes & Control.2020; 31(11): 1011.     CrossRef
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    Teeranut Asavasupreechar, Monica S.M. Chan, Ryoko Saito, Yasuhiro Miki, Viroj Boonyaratanakornkit, Hironobu Sasano
    The Journal of Steroid Biochemistry and Molecular Biology.2019; 193: 105440.     CrossRef
Physician’s awareness of lung cancer screening and its related medical radiation exposure in Korea
Seri Hong, Suyeon Kim, Mina Suh, Boyoung Park, Kui Son Choi, Jae Kwan Jun
Epidemiol Health. 2018;40:e2018002.   Published online January 20, 2018
DOI: https://doi.org/10.4178/epih.e2018002
  • 30,571 View
  • 271 Download
  • 4 Web of Science
  • 3 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Through a survey on perception of lung cancer screening and accompanying medical radiation exposure in Korea, the present study was to investigate its current situations and evaluate various perception of physicians regarding it in order to propose measures for improvements.
METHODS
Medical specialists in national cancer screening institutions selected through stratified random sampling were subjected to face-to-face interview using a structured questionnaire. We investigated physicians’ perception on effectiveness of lung cancer screening depending on screening modality, selection criteria for subjects of screening, types of equipment used to screen, and perception for seriousness of adverse effects following the test. In addition, odds ratios to underestimate risk of radiation exposure from screening were calculated through logistic regression analysis.
RESULTS
Each response that chest X-ray is effective for lung cancer screening and that smoking history is not considered prior to screening recommendation accounted for more than 60% of respondents, suggesting the chance of unnecessary screening tests. Regarding adverse effects of lung cancer screening, about 85% of respondents replied that false positive, radiation exposure, and overdiagnosis could be ignored. About 70% of respondents underestimated radiation dose from lung cancer screening, and a low proportion of physicians informed patients of radiation exposure risk.
CONCLUSIONS
It was found that most physicians underestimated harms of lung cancer screening including radiation exposure and were lack of awareness regarding lung cancer screening. It should be noted that physicians need to have proper perceptions about screening recommendation and accompanying possible harms, for successful implementation of the screening program.
Summary
Korean summary
전국 100여개 국가암검진 기관을 대상으로 폐암검진 관련 설문을 수행한 결과, 효과적인 폐암검진의 수단이나 방법에 대한 이해 및 검사에 수반되는 각종 부작용에 대한 의사들의 인식이 확연히 부족한 것으로 조사되었다. 그 중에서도 특히 의료방사선 노출에 대한 낮은 인지도는, 촬영 시 피폭량에 대한 전반적인 과소평가 및 방사선 노출 위험과 관련한 환자 교육의 부재를 통해 확인할 수 있었다. 인구집단 대상 선별검사의 도입에 따른 잠재적인 위해 가능성과 그 결과에 대한 고민은 반드시 필요하며, 이와 관련된 의료제공자들의 인식 개선을 촉구하는 본 연구는 정책 도입에 앞서 선결되어야 할 과제로서 공중보건학적 측면에서 중요한 의의를 지닌다.

Citations

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  • Assessment of radiation knowledge and awareness among radiology staff in tertiary hospitals: a study in Wuxi, China
    J. Yuan, D. Liu, J. Ni
    Radioprotection.2024; 59(3): 184.     CrossRef
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    Charlotte Poon, Tim Wilsdon, Iqra Sarwar, Alexander Roediger, Megan Yuan
    Frontiers in Public Health.2023;[Epub]     CrossRef
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    Justin H. Lam, Kristen Pickles, Fiona F. Stanaway, Katy J. L. Bell
    BMC Health Services Research.2020;[Epub]     CrossRef
Perspective
The effect of smoking on lung cancer: ethnic differences and the smoking paradox
Keum Ji Jung, Christina Jeon, Sun Ha Jee
Epidemiol Health. 2016;38:e2016060.   Published online December 20, 2016
DOI: https://doi.org/10.4178/epih.e2016060
  • 57,338 View
  • 728 Download
  • 58 Web of Science
  • 48 Crossref
AbstractAbstract AbstractSummary PDF
Abstract
The objectives of this review were to determine whether the smoking paradox still exists and to summarize possible explanations for the smoking paradox. Based on published data, we compared the risk of cigarette smoking for lung cancer in Western and Asian countries. We extracted data from the relevant studies about annual tobacco consumption, lung cancer mortality rates according to smoking status from each country, and possible explanations for the smoking paradox. A significantly greater risk of lung cancer death was found among current smokers in Asian countries than among nonsmokers, with relative risks (RRs) of 4.0 to 4.6 for Koreans, 3.7 to 5.1 for Japanese, and 2.4 to 6.5 for Chinese. Although a significantly greater risk of lung cancer was present among current smokers in Asian countries, the RRs in Asian countries were much lower than those reported in Western countries (range, 9.4 to 23.2). Possible explanations for the smoking paradox included epidemiologic characteristics, such as the smoking amount, age at smoking initiation, and the use of filtered or mild tobacco. The smoking paradox definitely exists, but may be explained by major epidemiologic characteristics. Therefore, the smoking paradox should not be interpreted as indicating that tobacco is safer or less harmful for Asians.
Summary
Korean summary
흡연이 폐암에 미치는 관련성의 인종 차이 흡연은 폐암의 가장 큰 원인으로 알려져 있다. 그러나 흡연이 폐암에 미치는 관련성의 크기는 영국, 미국 등 서양에서 발표된 연구결과에서 10-20배 정도로 보고되고 있으나 한국, 일본, 중국 등 동양에서 발표된 연구에서 3-5배 정도로 낮게 보고되고 있다. 이러한 차이는 흡연유행, 담배성분, 흡연자 특성, 그리고 유전적인 차이로 일부 설명되고 있으나 아직 완전히 이해되어진 상태는 아니다. 이는 공중보건학적으로 매우 중요한 의미를 가지므로 동서양의 직접적인 비교연구가 필요할 것으로 생각된다.

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Review
Human papillomavirus infection and risk of lung cancer in never-smokers and women: an ‘adaptive’ meta-analysis
Jong-Myon Bae, Eun Hee Kim
Epidemiol Health. 2015;37:e2015052.   Published online November 17, 2015
DOI: https://doi.org/10.4178/epih/e2015052
  • 35,045 View
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  • 16 Crossref
AbstractAbstract PDFSupplementary Material
Abstract
OBJECTIVES
The incidence of lung cancer in Koreans is increasing in women and in both men and women with a never-smoking history. Human papillomavirus (HPV) infection has been suggested as a modifiable risk factor of lung cancer in never-smokers and women (LCNSW). This systematic review (SR) aimed to evaluate an association between HPV infection and lung cancer risk in LCNSW.
METHODS
Based on a prior SR and some expert reviews, we identified refereed, cited, or related articles using the PubMed and Scopus databases. All case-control studies that reported the odds ratio of HPV infection in LCNSW were selected. An estimate of the summary odds ratio (SOR) with 95% confidence intervals (CI) was calculated.
RESULTS
A total of four case-control studies were included. The fixed-effect model was applied because of homogeneity (I-squared=0.0%). The SORs in women and in never-smokers were 5.32 (95% CI, 1.75 to 16.17) and 4.78 (2.25 to 10.15) respectively.
CONCLUSIONS
These results showed a significant effect of HPV infection in LCNSW. It is evident that developing a preventive plan against LCNSW may be necessary.
Summary

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Hypothesis
Modifiable risk factors of lung cancer in “never-smoker” women
Jong-Myon Bae
Epidemiol Health. 2015;37:e2015047.   Published online October 29, 2015
DOI: https://doi.org/10.4178/epih/e2015047
  • 34,625 View
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
Korean women with a history of never smoking and with adenocarcinoma showed an increasing trend in lung cancer occurrence during 2002 to 2012. The two modifiable factors of never-smoker lung cancer in women are hormone and oncogenic virus infection. Based on previous studies, hormone replacement therapy (HRT) and human papillomavirus (HPV) infection might afford protection or be a risk factor, respectively. It is necessary to perform a pooled analysis of cohort studies to evaluate HRT and never-smoker lung cancer in women and a systematic review of case-control studies to determine the association between HPV infection and never-smoker lung cancer.
Summary
Korean summary
2002년에서 2012년간 폐암 통계를 살펴보면 비흡연 여성에서 선암종의 발생이 크게 증가하는 것으로 확인된다. 이렇게 여성에서 비흡연 폐암발생과 관련한 요인들로는 호르몬 대체요법 (HRT)과 인유두종바이러스 (HPV) 감염이 알려져 있다. 환자-대조군연구를 이용한 메타분석에 따르면 호르몬대체요법은 폐암발생을 억제하는 것으로 나왔다. HPV에 대한 메타분석은 아직 없는 가운데 위험요인으로 의심하고 있다. 따라서 HRT에 대하여는 코호트 연구 결과를 이용한 연합분석 (pooled analysis)이 필요하며, HPV에 대하여는 환자-대조군연구 결과를 이용한 메타분석이 수행될 필요가 있다.

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Editorial
Epidemiological evidence in law: a comment on Supreme Court Decision 2011Da22092, South Korea
Alex Broadbent
Epidemiol Health. 2015;37:e2015025.   Published online May 31, 2015
DOI: https://doi.org/10.4178/epih/e2015025
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AbstractAbstract PDF
Abstract
This paper offers a commentary on three aspects of the Supreme Court’s recent decision (2011Da22092). First, contrary to the Court’s finding, this paper argues that epidemiological evidence can be used to estimate the probability that a given risk factor caused a disease in an individual plaintiff. Second, the distinction between specific and non-specific diseases, upon which the Court relies, is shown to be without scientific basis. Third, this commentary points out that the Court’s finding concerning defect of expression effectively enables tobacco companies to profit from the efforts of epidemiologists and others involved in public health to raise awareness of the dangers of smoking.
Summary

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