Occupational lung cancer surveillance in South Korea, 2006-2009

Our plain-English summary of Occupational lung cancer surveillance in South Korea, 2006-2009, by J.H. Leem, H.C. Kim, J.S. Ryu, et al (Safety and Health at Work, 2010).

The study

• Authors: J.H. Leem, H.C. Kim, J.S. Ryu, J.U. Won, J.D. Moon, Y.C. Kim, S.B. Koh, S.J. Yong, S.G. Kim, J.Y. Park, I. Kim, J.I. Kim, J.W. Kim, E.C. Lee, H.R. Kim, D.H. Kim, D.M. Kang, Y.C. Hong
• Journal: Safety and Health at Work
• Published: 2010;1(2):134-9
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objectives: The lung cancer mortality in Korea has increased remarkably during the last 20 years, and has been the first leading cause of cancer-related deaths since 2000. The aim of the current study was to examine the time trends of occupational lung cancer and carcinogens exposure during the period 2006-2009 in South Korea, by assessing the proportion of occupational burden.

Methods: We defined occupational lung cancer for surveillance, and developed a reporting protocol and reporting website for the surveillance of occupational lung cancer. The study patients were chosen from 9 participating university hospitals in the following 7 areas: Seoul, Incheon, Wonju, Daejeon, Daegu, Busan, and Gwangju.

Results: The combined proportion of definite and probable occupational lung cancer among all lung cancers investigated in this study was 10.0%, 8.6%, 10.7%, and 15.8% in the years 2006 to 2009, respectively, with an average of 11.7% over the four-year study period. The main carcinogens were asbestos, crystalline silica, radon, polyaromatic hydrocarbons (PAHs), diesel exhaust particles, chromium, and nickel.

Conclusion: We estimated that about 11.7% of the incident lung cancer was preventable. This reveals the potential to considerably reduce lung cancer by intervention in occupational fields.

In plain English

This was a surveillance study of occupational lung cancer in South Korea. Nine university hospitals in seven areas reported lung cancer patients through a shared protocol and website from March 2006 to November 2009, and 3,353 patients were interviewed. Cases were classed as definite, probable or possible occupational lung cancer according to the kind of carcinogen the patient had worked with and the time since exposure. Overall, 77 cases (2.3%) were classed as definite, 316 (9.4%) as probable and 314 (9.4%) as possible. The combined definite and probable share was 10.0%, 8.6%, 10.7% and 15.8% in 2006 to 2009, averaging 11.7%. Asbestos was the most common carcinogen, accounting for 29% of cases exposed to definite and probable carcinogens (114 exposures). The article does not name asbestos fiber types. The largest asbestos-exposed job groups were elementary construction workers, ship engineers, building boiler fitters and mechanics, and ship mechanics. The authors estimated that about 11.7% of incident lung cancer was preventable. They noted that exposure information relied on patients' memories and that smoking habits were not recorded.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Hospital-based surveillance (case-reporting) study using a reporting protocol and website, with patient interviews
• Who was studied: 3,353 lung cancer patients interviewed at nine university hospitals in seven areas of South Korea (Seoul, Incheon, Wonju, Daejeon, Daegu, Busan, Kwangju), March 2006 to November 2009
• Exposure: Occupational exposure to carcinogens and carcinogenic processes classified by IARC as group 1 or group 2A. These included asbestos (fiber type not specified), crystalline silica, diesel engine exhaust, PAHs, hexavalent chromium, radon, nickel and others. Exposure was defined as working at least more than 6 months at a carcinogenic process. Definite cases required a group 1 exposure plus 10 or more years since exposure. Probable cases required a group 1 exposure with less than 10 years, or a group 2A exposure with 10 or more years.
• Main results:
  • Of all 3,353 interviewed patients, 77 (2.3%) were classed as definite, 316 (9.4%) as probable and 314 (9.4%) as possible occupational lung cancer
  • The remaining 2,646 of 3,353 cases (78.9%) were classed as not related to occupation
  • The combined proportion of definite and probable occupational lung cancer among all lung cancers investigated was 10.0% (2006), 8.6% (2007), 10.7% (2008) and 15.8% (2009), with an average of 11.7% over the four years
  • Asbestos was the most common occupational carcinogen, accounting for 29% of all cases exposed to definite and probable carcinogens (114 asbestos exposures of a total of 393 in Table 2)
  • Among the 114 asbestos-related cases (Table 3), the largest job groups were elementary workers in construction (16, 14.0%), ship engineers (14, 12.3%), building boiler fitters and mechanics (10, 8.8%) and ship mechanics (10, 8.8%)
  • Besides asbestos, the main carcinogens included crystalline silica, radon and PAHs. Table 2 also lists diesel engine exhaust (99), crystalline silica (83) and PAHs (59) among definite and probable exposures.
• The authors' conclusion: The authors estimated that about 11.7% of incident lung cancer was preventable
• Limitations the authors state:
  • Possible recall bias, because exposure assessment depended only on patients' memories
  • Information on smoking habits was not collected
  • Exposure to environmental tobacco smoke was not included. The authors say this suggests the occupational share may have been more than 11.7%.
  • The assumption that exposure means more than 6 months of work may make the study less sensitive to the effects of new carcinogens
  • The surveillance case definition was deliberately made less strict to encourage clinicians to report cases
  • The surveillance case definitions may differ from the criteria used to decide compensation and disability

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Crystalline.

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• Occupational and environmental asbestos exposure and the risk of lung cancer in Korea: A case-control study in South Chungcheong Province of Korea — D.A. Huh, M.S. Kang, et al. (2021)
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