Smoke load/cancer death rate associations in Korea females, 1985–2004

Background Korea female death rates from many cancers have risen rapidly since 1985. The sources of those cancer death epidemics are unclear but may be related to rising cumulative tobacco smoke damage (smoke load). We assessed Korea female smoke load/cancer death rate associations from 1985 to 2004. Methods Lung cancer rates were used as a smoke load bio-index. Subtracting lung, stomach, and uterine corpus cancer death World age standard rates (rates) from all-sites rates gave us non-lung–stomach–uterine corpus (NLSUc) rates. Lung/NLSUc linear regressions were run, adjusted for autocorrelation. Estimated, lower, and upper bound smoking-attributable fractions (SAFs) were calculated using the formula SAF = 1 − {(unexposedsʹ cancer death rate) / (observed rate)}, based on the linear regression and respective best, upper, and lower bound estimated lung, stomach, and uterine cancer death rates in the unexposed. Results Lung cancer death rates (smoke load) can explain 88% of the variance in NLSUc rates from 1985 to 2004 after adjusting for autocorrelation. The estimated Korea female all-sites cancer death rate SAF in 2004 was 43% (sensitivity range 29–56%). Conclusions Smoke load, probably from tobacco given the epidemic time course, may cause a large cancer death burden in Korea females despite their very low self-reported prevalence of smoking.