Abstract
BackgroundSmoking is by far the most important cause of cancer that can be modified at the individual level. Cancer incidence and mortality rates in Korea are the highest among all Asian countries, and smoking prevalence in Korean men is one of the highest in developed countries. The purpose of the current study was to perform a systematic review and provide an evidence-based assessment of the burden of tobacco smoking-related cancers in the Korean population.MethodsSex- and cancer-specific population-attributable fractions (PAF) were estimated using the prevalence of ever-smoking and second-hand smoking in 1989 among Korean adults, respectively, and the relative risks were estimated from the meta-analysis of studies performed in the Korean population for ever-smoking and in the Asian population for passive smoking. National cancer incidence data from the Korea Central Cancer Registry and national cancer mortality data from Statistics Korea for the year 2009 were used to estimate the cancer cases and deaths attributable to tobacco smoking.ResultsTobacco smoking was responsible for 20,239 (20.9%) cancer incident cases and 14,377 (32.9%) cancer deaths among adult men and 1,930 (2.1%) cancer incident cases and 1,351 (5.2%) cancer deaths among adult women in 2009 in Korea. In men, 71% of lung cancer deaths, 55%–72% of upper aerodigestive tract (oral cavity, pharynx, esophagus and larynx) cancer deaths, 23% of liver, 32% of stomach, 27% of pancreas, 7% of kidney and 45% of bladder cancer deaths were attributable to tobacco smoking. In women the proportion of ever-smoking-attributable lung cancer was 8.1%, while that attributable to second-hand smoking among non-smoking women was 20.5%.ConclusionsApproximately one in three cancer deaths would be potentially preventable through appropriate control of tobacco smoking in Korean men at the population level and individual level. For Korean women, more lung cancer cases and deaths were attributable to second-hand than ever-smoking. Effective control programs against tobacco smoking should be further developed and implemented in Korea to reduce the smoking-related cancer burden.
Highlights
Smoking is by far the most important cause of cancer that can be modified at the individual level
Among all cancer sites reviewed in this study, laryngeal cancer had the highest Relative risk (RR) estimate (RR = 4.65 for current smoking men and 9.10 for current smoking women for cancer incidence; RR = 4.50 for current smoking men and RR = 3.60 for current smoking women for cancer mortality, Table 1)
The results from meta-analysis showed that the effect of second-hand smoking on lung cancer incidence for men was not significant, that for women showed a significantly elevated risk of lung cancer incidence (RR = 1.32 for second-hand smoking at home; RR = 1.37 for secondhand smoking at workplace, Table 2)
Summary
Smoking is by far the most important cause of cancer that can be modified at the individual level. Several possible explanations for the differences in RRs among Asians and individuals in Western countries have been suggested They are a longer duration of heavy smoking in Americans, a more toxic formulation of American-manufactured cigarettes, a higher efficiency of filters in Japanese cigarettes, lower alcohol consumption by Japanese males, differences in genetic susceptibility to tobacco carcinogens, and a higher background risk of lung cancer among non-smokers [9]. The lung cancer mortality rates among non-smokers in the Asian population (rate = 35.6 in Japanese men and 24.6 in Japanese women) were shown to be higher than those in the US (rate =15.7 in a CPS-I study and 14.7 in a CPS-II study) [10,11] This raises an important question regarding whether it would be appropriate to apply the PAF estimated from studies performed in Western populations to other countries. It would seem to be essential to develop an estimate of the PAF of risk factors for cancer that are specific to each region of the world
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