REVIEW

http://dx.doi.org/10.4046/trd.2016.79.2.58 ISSN: 1738-3536(Print)/2005-6184(Online) • Tuberc Respir Dis 2016;79:58-69

Epidemiology of Lung Cancer in Korea: Recent Trends Ji Young Park, M.D.1 and Seung Hun Jang, M.D., Ph.D.2,3 1

Division of Pulmonary, Department of Internal Medicine, The Armed Forces Daejeon Hospital, Daejeon, 2Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, 3Lung Research Institute of Hallym University, Chuncheon, Korea

Lung cancer causes the most cancer deaths in Korea. Although the smoking rate has begun to decrease, the prevalence of lung cancer is still increasing. We reviewed the national lung cancer registry data and the data published about lung cancer in Korea. In 2012, the crude incidence rate of lung cancer was 43.9 per 100,000. The age-standardized mortality rate of lung cancer was 19.8 per 100,000. The 5-year relative survival rate for lung cancer was 11.3% from 1993 to 1995 and increased to 21.9% in the period from 2008 to 2012. Lung cancer occurring in never-smokers was estimated to increase in Korea. Adenocarcinoma is steadily increasing in both women and men and has replaced squamous cell carcinoma as the most common type of lung cancer in Korea. In patients with adenocarcinoma, the frequency of EGFR mutations was 43% (range, 20%–56%), while that of the EMK4-ALK gene was less than 5%. Keywords: Lung Neoplasms; Korea; Incidence; Mortality; Survival; Prevalence

Introduction Cancer has been the leading cause of death in Korea since 1983; and in 2013, it was the second leading cause of death after cardiovascular disease worldwide. Lung cancer is the most common cause of cancer death worldwide, both in developing and developed countries. In 2013, the estimated global lung cancer incidence was 1.8 million and the estimated number of fatal cases was 1.6 million1. The annual 2012 report

Address for correspondence: Seung Hun Jang, M.D., Ph.D. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Korea Phone: 82-31-380-3718, Fax: 82-31-380-3973 E-mail: [email protected] Received: Dec. 4, 2015 Revised: Dec. 12, 2015 Accepted: Dec. 14, 2015 cc

It is identical to the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

Copyright © 2016 The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

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of cancer statistics from the Korea Central Cancer Registry (KCCR) estimated that lung cancer was the most commonly diagnosed cancer among men >60 years old and women >70 years old2. Although the smoking rate in Korea recently began to decrease, the prevalence of lung cancer is still increasing and is expected to rise for the next 10–20 years3. This is due to the lag time between smoking exposure and its long-term consequences and because the Korean population aging (the fraction of the population ≥65 of age was 6.1% in 1996 and 12.7% in 2014)4,5. Interest in lung cancer in patients without a smoking history has increased. Moreover, several reports found that the number of lung cancer in never-smokers is increasing6,7. Recently, a Korean study showed that among 5,456 cases with lung cancer in a community cancer center the proportion of neversmokers increased from 19.1% in 2004–2008 to 25.4% in 2009–20128. Lung cancer occurring in never-smokers (LCINS) is now regarded as a distinct disease entity; clinical and epidemiologic studies identified biologic and genetic differences between smoking-associated lung cancer and LCINS7,9. Never-smoker East Asian females have a tendency to develop adenocarcinoma, and these patients exhibit higher treatment response rates to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors10. To estimate the lung cancer cases, including the pathologic type of cancer, data from the KCCR, a hospital-based nation-

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http://dx.doi.org/10.4046/trd.2016.79.2.58

33.3 34.1 55.5 152.6 212.3 263.4 236.8 203.3 162.6 108.5

Source: Annual report of cancer statistics in Korea in 2012 (Korea Central Cancer Registry, 2015) . Crude rate: rate per 100,000 people; KASIR: age-standardized rate in the Korean population (1/105); WASIR: age-standardized rate in the world population (1/105); incidence case: number of cases; incidence rate: rate per 100,000 people; 5YPR: 5-year prevalence rate per 100,000 people.

2

66.0 32.5 16.4 8.9 2.9 1.4 0.6 0.5 0.1 0.1 Female

0.2

72.1

50.2 50.8

72.9 99.7

77.6 233.0

470.7 762.1

384.6 473.2

806.6 724.3

449.4 347.0

510.0 336.3

247.7 140.9

173.6 78.7

72.4 33.0

33.5 16.3

16.3 7.8

6.8 2.9

2.9 1.3

1.2 0.8

0.7 0.5

0.5 -

0.0

Male

0.1 0.1

0.1

Total

5YPR

Female

-

14.9

44.3 45.0

15.3 26.8

61.0 628.6

203.3 181.1

685.1 599.1

148.0 104.0

439.5 286.3

82.5 63.2

177.6 88.0

40.4 25.6

38.7 16.4

14.0 6.1

8.2 3.0

3.5 1.1

1.3 0.4

0.6 0.2

0.1 0.4

0.2 -

0.1 Male

-

43.9 310.8 339.0 322.2 250.3 178.0 119.2 64.1 32.2 15.2 7.2 3.2 1.2 0.5 0.2 0.3 0.0 Total

Incidence rates

0

-

27.4 27.9

613 788 1,048 992 823 755 660 544 284 137 70 21 10 3 3 0

-

Female

0

-

-

641

1,254 2,148

1,360 2,668

3,716 4,235

3,243 2,518

3,341 2,790

2,035 1,422

2,082 1,380

836 348

632 328

191 62

132 47

26 7

17 5

2 7

10 0

1 Male

0 1 Total

Incidence cases

0

≥85 5–9 10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84 0–4

Age (yr)

According to the KCCR, in 2012, 22,118 new lung cancer cases were diagnosed in Korea (men, 69.5%; women, 30.5%), accounting for 9.9% of all newly diagnosed cancer cases and ranked fourth by incidence2. The crude incidence rate was 43.9 per 100,000. The age-standardized lung cancer incidence rate age-adjusted to the Korean standard population (Korean age-standardized incidence rate, KASIR) was 27.9 per 100,000 in 2012 and the age-standardized lung cancer incidence rate adjusted to the world population (world age-standardized incidence rate, WASIR) was 27.4 per 100,0002. The cumulative incidence rate was 1.2% among patients 0 to 64 years of age and 3.4% among patients aged 0 to 74 years2. The third most commonly diagnosed cancer among Korean men was lung cancer. In men, the crude incidence rate was 61.0 per 100,000, whereas the KASIR was 45.0 per 100,000. In women, the crude incidence rate was 26.8 per 100,000, whereas the KASIR was 15.3 per 100,0002. Globally, occurrence of lung cancer between 0 and 79 years of age was higher in men than women (1 in 18 men and 1 in 51 women)1. In 2013, the global lung cancer WASIR in men was 45.17 per 100,000 and 16.15 per 100,000 in women1. The mean lung cancer KASIR in large cities or urban areas was lower than in local provinces or rural areas in Korea (27.9 vs. 29.5 per 100,000, p=0.039). This difference was more obvious in men (43.9 vs. 49.3 per 100,000, p

Epidemiology of Lung Cancer in Korea: Recent Trends.

Lung cancer causes the most cancer deaths in Korea. Although the smoking rate has begun to decrease, the prevalence of lung cancer is still increasing...
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