Korean J Intern Med.  2020 May;35(3):692-702. 10.3904/kjim.2019.283.

Risk factors for primary lung cancer among never-smoking women in South Korea: a retrospective nationwide population-based cohort study

Affiliations
  • 1Division of Oncology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 2Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 3Division of Pulmonology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 4Department of Pathology, Konkuk University Medical Center, Seoul, Korea
  • 5Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 6Department of Internal Medicine, Chonnam National University Hwasun Hospital, Hwasun, Korea
  • 7Department of Radiation Oncology, National Cancer Center, Goyang, Korea
  • 8Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
  • 9Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
  • 10Department of Radiology, Korea University Anam Hospital, Seoul, Korea
  • 11Department of Occupational and Environmental Medicine, Seoul St. Mary’s Hospital, of Medicine, The Catholic University of Korea, Seoul, Korea

Abstract

Background/Aims
We performed a large-scale, retrospective, nationwide, cohort study to investigate the risk factors for lung cancer among never-smoking Korean females.
Methods
The study data were collected from a general health examination and questionnaire survey of eligible populations conducted between January 1, 2003 and December 31, 2004; the data were acquired from the tailored big data distribution service of the National Health Insurance Service. After a 1-year clearance period, 5,860,922 of 6,318,878 never-smoking female participants with no previous history of lung cancer were investigated. After a median follow-up of 11.4 years, 43,473 (0.74%) participants were defined as “newly diagnosed lung cancer”.
Results
After adjusting for all variables at baseline, the variables older age, lower body mass index (BMI), less exercise, frequent alcohol drinking, meat-based diet, rural residence, and previous history of cancer were associated with a higher incidence of lung cancer. Low BMI (< 18.5 kg/m2: hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.27 to 1.40) was a significant independent risk factor; as BMI decreased, HR increased. Negative associations between BMI and lung-cancer development were also observed after controlling for age (p for trend < 0.001). Drinking alcohol one to two times a week (HR, 1.25; 95% CI, 1.21 to 1.28) and eating a meat-based diet (HR, 1.08; 95% CI, 1.01 to 1.15) were associated with lung-cancer incidence.
Conclusions
Modifiable baseline characteristics, such as BMI, exercise, alcohol consumption, and diet, are risk factors for lung-cancer development among never- smoking females. Thus, lifestyle modifications may help prevent lung cancer.

Keyword

Lung neoplasm; Never-smoking women; Risk factor; Cohort studies
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