Cancer Research and Treatment

Original Articles

Gastrointestinal cancer

Korean Colorectal Cancer Screening Guidelines for Asymptomatic, Average-Risk Adults: The 2025 Revision: EunKyo Kang, Jae Myung Cha, Seo Young Kang, Kiheon Lee, Su Young Kim, Younghoon Kim, An Na Seo, Hyo-Jin Kang, Jong Keon Jang, Kwang-Pil Ko, Aesun Shin, Dae Kyung Sohn, Youngki Hong, Eun-Jung Cho, Minje Han, Soo Young Kim, Hyeon Ji Lee, Chang Kyun Choi, Mina Suh; Cancer Res Treat. 2026;58(3):872-883. Published online March 13, 2026; DOI: https://doi.org/10.4143/crt.2026.014

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Purpose
This study aimed to develop the 2025 update to the Korean colorectal cancer (CRC) screening guidelines by systematically assessing recent evidence, integrating domestic data, and addressing changes since the 2015 guideline revision, and accordingly, provide an evidence-based standard for clinicians and policymakers.
Materials and Methods
A multidisciplinary committee developed the guidelines using the Grading of Recommendations, Assessment, Development and Evaluation methodology. The process involved establishing three key questions focused on efficacy, accuracy, and optimal age and interval for screening. A systematic review of international guidelines and primary literature (327 studies included) was conducted. A utility-based analysis using the Markov model was also performed to determine optimal screening ages and intervals.
Results
The review identified high-certainty evidence for fecal immunochemical test (FIT) in reducing CRC mortality and moderatecertainty evidence for colonoscopy. Evidence for computed tomography colonography (CTC) and stool DNA testing showed very low certainty. Based on this synthesis and cost-utility analysis, the committee conditionally recommends screening for asymptomatic, average-risk adults aged 45-74 years using either colonoscopy every 10 years or FIT every 1-2 years. CTC and stool DNA testing were not recommended owing to insufficient evidence.
Conclusion
The 2025 Korean Guidelines for Colorectal Cancer Screening provide the latest evidence-based recommendations tailored to the domestic context. By conditionally adopting both colonoscopy and FIT for individuals aged 45-74 years, these guidelines aim to optimize public health outcomes and reduce the colorectal cancer burden in South Korea.

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Age-dependent effects of gastric cancer screening endoscopy on mortality: a nationwide cohort study
Seokho Myeong, Jaehun Jung, Ki-Hwan Bae, Ilsoo Kim, Donghoon Kang, Yu Kyung Cho, Hyeon Woo Yim, Jae Myung Park
Endoscopy.2026;[Epub] CrossRef

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Fraction of Cancer Attributable to Occupational Carcinogens in Korea between 2015 and 2030: Eun Mi Kim, Dong-Hee Koh, Soseul Sung, Youjin Hong, Sungji Moon, Jung Eun Lee, Kwang-Pil Ko, Sue K. Park, Jeehee Min, Sangjun Choi, Ju-Hyun Park, Sang-Gil Lee, Hwan-Cheol Kim, Dong-Uk Park, Inah Kim; Received February 8, 2025 Accepted September 17, 2025 Published online September 18, 2025; DOI: https://doi.org/10.4143/crt.2025.193 [Epub ahead of print]

Abstract PDF Supplementary Material PubReader ePub: Purpose
This study aimed to estimate the contribution of occupational carcinogens to cancer incidence and mortality in the Korean population between 2015 and 2030.
Materials and Methods
We selected occupational carcinogens classified as International Agency for Research on Cancer (IARC) group 1 and estimated the prevalence of exposure using data from the Korean CARcinogen EXposure (K-CAREX) and previous studies. Relative risks were calculated using published literature through a meta-analysis. Levin’s formula was used to estimate population attributable fraction (PAF) while considering a 15-year latency period between exposure, cancer incidence, and death. Additionally, trends in cancer PAF were calculated up to 2030, assuming constant relative risks and a 15-year latency period.
Results
In 2015, the PAFs for occupational carcinogen–related cancer incidence and mortality were 1.00% (men, 1.75%; women, 0.15%) and 1.97% (men, 2.98%; women, 0.33%), respectively, with asbestos being the largest contributor (incidence, 0.48%; mortality, 0.98%). In 2030, the PAFs for occupational carcinogen-related cancer incidence and mortality were 0.34% (men, 0.62%; women, 0.07%) and 0.80% (men, 1.22%; women, 0.15%), respectively, with diesel engine exhaust being projected to become the largest contributor by 2030 (incidence, 0.16%; mortality, 0.39%).
Conclusion
The PAFs of occupational carcinogens in Korea between 2015 and 2030 were estimated to be very low in the general population, and the values are expected to decrease over time owing to various regulations to prevent exposure to occupational carcinogens. Therefore, while regulating well-known occupational carcinogens, efforts should be made to monitor newly identified ones to ensure prompt implementation of preventive measures.

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General

Estimation of Population Attributable Fraction by Hormone and Reproductive Factors on Female Cancer in the Republic of Korea, 2015 to 2030: Youjin Hong, Soseul Sung, Woojin Lim, Sungji Moon, Kwang-Pil Ko, Jung Eun Lee, Inah Kim, Sun Ha Jee, Sun-Seog Kweon, Min-Ho Shin, Sangmin Park, Seung-Ho Ryu, Sun Young Yang, Jeongseon Kim, Sang-Wook Yi, Yoon-Jung Choi, Jeong-Soo Im, Hong Gwan Seo, Sue K. Park; Cancer Res Treat. 2025;57(3):649-658. Published online November 19, 2024; DOI: https://doi.org/10.4143/crt.2024.707

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Purpose
Population attributable fractions (PAFs) for hormone and reproductive factors have been estimated in several countries. International Agency for Research on Cancer (IARC) designated as group 1 and group 2A carcinogen for hormone factors in breast, ovarian, endometrial and uterine cervix cancer. This study aimed to estimate the PAFs of hormone/reproductive factor attributed to cancer incidence and deaths in Korean women and projected trends from 2015 to 2030.
Materials and Methods
The PAF was estimated with using the 2005 standardized prevalence rates and 2020 incidence and deaths with a 15-year latency. Based on the Levin’s formula, prevalence rates were calculated using the Korea National Health and Nutrition Examination Survey (KNHANES) and the relative risks, which were the risk of selected female cancer associated with oral contraceptive, hormone replacement therapy and duration of breastfeeding, were estimated from the meta-analysis of studies performed in Korean women population. Studies based on the Asian and Global populations were calculated as a sensitivity analysis.
Results
The estimation PAFs for hormone was 1.02% with 1,192 cases and reproductive was 2.67% with 3,112 cases. Moreover, 0.40% (125 deaths) and 1.09% (342 deaths) in female-related cancer deaths in order. Estrogen-progesterone combined hormone replacement therapy (HRT) accounted the most proportion in hormone factors and breastfeeding in reproductive factors. Also, the breast cancer had the highest percent in both hormone and reproductive factors.
Conclusion
Through this study, 1.02% and 2.67% of female-related cancer incidence will be reduced by encouraging avoiding the use of oral contraceptives and HRT and breastfeeding for more than 6 months in reproductive factors. Additionally, among four selected female cancers in this study, breast cancer was observed to be a significant level of prevention.

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Application and interpretation of attributable fraction measures from clinical practice to policy: a narrative review
Sue Kyung Park
Journal of the Korean Medical Association.2026; 69(5): 411. CrossRef
Fraction of cancer incidence and mortality attributable to dietary factors in Korea from 2015 to 2030
Hyun Jeong Cho, Jin Young Yoo, Ga-Eun Yie, An Na Kim, Soseul Sung, Sungji Moon, Youjin Hong, Sangjun Lee, Inah Kim, Kwang-Pil Ko, Sun-Seog Kweon, Jung Eun Lee, Sue K. Park
Epidemiology and Health.2025; 47: e2025065. CrossRef

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Fraction of Cancer Attributable to Carcinogenic Drugs in Korea from 2015 to 2030: Woojin Lim, Soseul Sung, Youjin Hong, Sungji Moon, Sangjun Lee, Kyungsik Kim, Jung Eun Lee, Inah Kim, Kwang-Pil Ko, Sue K. Park; Cancer Res Treat. 2025;57(3):635-648. Published online November 6, 2024; DOI: https://doi.org/10.4143/crt.2024.644

Abstract PDF Supplementary Material PubReader ePub

Purpose
This study aims to estimate and project the population attributable fraction (PAF) of cancer incidence and death due to carcinogenic drug use in Korea from 2015 to 2030, to estimate the degree of cancer prevention from exposure to carcinogenic drugs in Korea. Selected carcinogenic drugs were immunosuppressive and antineoplastic drugs classified as group I by the International Agency for Research on Cancer.
Materials and Methods
Systematic review and meta-analyses were conducted to estimate the relative risk of cancer associated with carcinogenic drug use. Age was standardized using the annual prevalence rate of the National Health Insurance Service sample cohort (NHIS-NSC) from 2002 to 2013 to calculate the standardized prevalence rate of carcinogenic drug use each year. The PAF of specific cancer incidence and death were calculated using Levin’s formula and Monte Carlo methods. The prevalence rates were extrapolated to estimate the trend of PAF from 2015 to 2030.
Results
In 2015, carcinogenic drugs attributed to 0.003% and 0.002% among the causes of cancer incidence and death in Korea. However, carcinogenic drugs attributed to 1.1% among the causes of both cancer incidence and death in patients with clinical indications of carcinogenic drugs.
Conclusion
The PAF in patients with clinical indications of carcinogenic drugs were significantly high and expected to increase rapidly over time. Since these drugs are listed as essential by the World Health Organization, and may be difficult to replace, a surveillance system on susceptible populations using group I carcinogenic drugs must be discussed and implemented.

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IARC Group 1 Pharmaceuticals and Associated Cancer Risks: A Nationwide Population-Based Cohort Study in Korea
Woojin Lim, Na Rae Lee, Ho Gyun Shin, Su-Yeon Yu, Sue K. Park
Cancer Research and Treatment.2026; 58(2): 376. CrossRef
Application and interpretation of attributable fraction measures from clinical practice to policy: a narrative review
Sue Kyung Park
Journal of the Korean Medical Association.2026; 69(5): 411. CrossRef
Fraction of cancer incidence and mortality attributable to dietary factors in Korea from 2015 to 2030
Hyun Jeong Cho, Jin Young Yoo, Ga-Eun Yie, An Na Kim, Soseul Sung, Sungji Moon, Youjin Hong, Sangjun Lee, Inah Kim, Kwang-Pil Ko, Sun-Seog Kweon, Jung Eun Lee, Sue K. Park
Epidemiology and Health.2025; 47: e2025065. CrossRef

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Erratum

Correction: Long Term Trends and the Future Gastric Cancer Mortality in Korea: 1983~2013: Yunhee Choi, Jin Gwack, Yeonju Kim, Jisuk Bae, Jae-Kwan Jun, Kwang-Pil Ko, Keun-Young Yoo; Cancer Res Treat. 2007;39(1):44-46. Published online March 31, 2007; DOI: https://doi.org/10.4143/crt.2007.39.1.44; Corrects: Cancer Res Treat 2006;38(1):7

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Original Article

Long Term Trends and the Future Gastric Cancer Mortality in Korea: 1983~2013: Yunhee Choi, Jin Gwack, Yeonju Kim, Jisuk Bae, Jae-Kwan Jun, Kwang-Pil Ko, Keun-Young Yoo; Cancer Res Treat. 2006;38(1):7-12. Published online February 28, 2006; DOI: https://doi.org/10.4143/crt.2006.38.1.7; Correction in: Cancer Res Treat 2007;39(1):44

Abstract PDF PubReader ePub

Purpose

In spite of gastric cancer's decreasing incidence and mortality rates, it is still the most common cancer in Korea. In the present study, we examined the temporal trends of gastric cancer mortality during the past 20 years in Korea by using an age-period-cohort model, and we predicted the mortality rates for the next 10 years.

Materials and Methods

Data on the annual number of deaths due to gastric cancer and data on population statistics from 1984 to 2003 were obtained from the Korean National Statistical Office. A log-linear Poisson age-period-cohort model was used to estimate age, period and birth cohort effects. To project two periods (10 years) into the future, the new cohort values were estimated by performing linear regression that was applied to a chosen number of the most recent cohort values.

Results

The trends of gastric cancer mortality were predominantly explained by the cohort effect; the risk of gastric cancer death decreased since the 1919 birth cohort for both genders. The predicted, expected age-adjusted mortality rates per 100,000 for males and females are 45.72 and 23.75, respectively, during 2004~2008, and 34.62 and 17.93 respectively, during 2009~2013. During 2004~2008 and 2009~2013, the predicted numbers of deaths due to gastric cancer in males are 36,922 and 27,959, respectively, whereas those in females are 19,698 and 14,869, respectively.

Conclusions

Not only the mortality, but also the incidence of gastric cancer in Korea is expected to further decrease in both men and women if the trends of the past 20 years continue.

Citations

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Early cardia neoplasms in the upper gastrointestinal tract have a higher detection rate under sedation: a retrospective cohort study based on the Chinese population
Xuanran Chen, Shunhai Zhou, Mingzhi Feng, Chaoyi Shi, Diyun Shen, Yan Sun, Yuzhen Bi, Jun Zhang
Frontiers in Medicine.2026;[Epub] CrossRef
Magnifying endoscopy is superior at detecting easy-missed neoplastic lesions on the upper gastrointestinal tract
Bo Jin, Xiaoliang Jin, Liang Huang, Chunli Zhang, Bin Lyu
Surgical Endoscopy.2023; 37(7): 5094. CrossRef
Descriptive Analysis of Gastric Cancer Mortality in Korea, 2000-2020
Tung Hoang, Hyeongtaek Woo, Sooyoung Cho, Jeeyoo Lee, Sayada Zartasha Kazmi, Aesun Shin
Cancer Research and Treatment.2023; 55(2): 603. CrossRef
Risk of lymph node metastasis and feasibility of endoscopic submucosal dissection in undifferentiated-type early gastric cancer
Pengyue Zhang, Tingting Xu, Hui Feng, Zhen Zhu, Jingjing Wang, Yalei Wang
BMC Gastroenterology.2023;[Epub] CrossRef
Status of Endoscopic Screening Strategies for Upper Gastrointestinal Tract Cancer
Bin Lyu, Xiao-Liang Jin
Cancer Screening and Prevention.2022; 000(000): 000. CrossRef
Clinical Features and Risk Factors for Lymph Node Metastasis in Early Signet Ring Cell Gastric Cancer
Xiaoliang Jin, Wei Wu, Jing Zhao, Shuang Song, Chunli Zhang, Wenyong Sun, Bin Lv
Frontiers in Oncology.2021;[Epub] CrossRef
Operable gastric adenocarcinoma with different histological subtypes: Cancer-specific survival in the United States
Chun-Lin Lin, Guang-Wei Zhu, Yong-Jian Huang, Wei Zheng, Shu-Gang Yang, Jian-Xin Ye
Saudi Journal of Gastroenterology.2020; 26(1): 46. CrossRef
Surgical Strategy and Outcome in Patients Undergoing Pancreaticoduodenectomy After Gastric Resection: A Three‐Center Experience with 39 Patients
Dooin Lee, Jae Hoon Lee, Dongho Choi, Chang Moo Kang, Jae Uk Chong, Song‐Chul Kim, Kyeong Geun Lee
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Differential Prognostic Implications of Gastric Signet Ring Cell Carcinoma
Hong Jae Chon, Woo Jin Hyung, Chan Kim, Sohee Park, Jie-Hyun Kim, Chan Hyuk Park, Joong Bae Ahn, Hyunki Kim, Hyun Cheol Chung, Sun Young Rha, Sung Hoon Noh, Hei-Cheul Jeung
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Second primary malignancy risk among patients with gastric cancer: a nationwide population-based study in Taiwan
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Age and sex interactions in gastric cancer incidence and mortality trends in Korea
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Gastric Cancer.2015; 18(3): 580. CrossRef
Ultrasonically activated shears versus electrocautery in open gastrectomy for gastric cancer: a randomized controlled trial
Min-Gew Choi, Seung Jong Oh, Jae Hyung Noh, Tae Sung Sohn, Sung Kim, Jae Moon Bae
Gastric Cancer.2014; 17(3): 556. CrossRef
The Effects ofHelicobacter pylorion the prognosis of patients with curatively resected gastric cancers in a population with high infection rate
Hoon Hur, Sang Rim Lee, Yi Xuan, Young Bae Kim, Young Ae Lim, Yong Kwan Cho, Sang-Uk Han
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