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

  • 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


We performed a large-scale, retrospective, nationwide, cohort study to investigate the risk factors for lung cancer among never-smoking Korean females.
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”.
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.
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.


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