Longitudinal Changes in Smoking Behaviors and Cancer-Related Mortality Risk in Middle-Aged Korean Women

Sep 28, 2026

A cohort study examined how changes in smoking habits relate to cancer-related and all-cause mortality among Korean women. Women aged ≥40 years completed biennial cancer screenings in 2009–2012 and were followed through 2020. Participants were classified as sustained nonsmokers, sustained quitters, new quitters, relapsers/smoking initiators, and sustained smokers. Cox regression and competing risk models were used. Mortality risk increased across all smoking-change groups versus sustained nonsmokers, with higher intensity smokers showing elevated hazard ratios, underscoring earlier cessation as critical.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Purpose

Materials and Methods

Study participants

Results

Conclusion

Introduction

pISSN 1598-2998, eISSN 2005-9256 | [https://doi.org/10.4143/crt.2023.341](https://doi.org/10.4143/crt.2023.341) Cancer Res Treat. 2024;56(1):18-26

Original Article
Longitudinal Changes in Smoking Behaviors and Cancer-Related Mortality Risk in Middle-Aged Korean Women
Thi Xuan MaiTran1,2 , Soyeoun Kim1,2 , Seonju Kim3 , Boyoung Park1,4
1Department of Preventive Medicine, Hanyang University College of Medicine, Seoul, 2Institute for Health and Society, Hanyang University, Seoul, 3Department of Epidemiology and Health Statistics, Graduate School of Public Health, Hanyang University, Seoul, 4Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, Korea | | | --- | --- | | Purpose This study investigated association between smoking habit change and cancer-related mortality risk in Korean women. Materials and Methods Study population were women aged ≥ 40 years who underwent two biennial cancer screenings during 2009-2012 and were followed up until 2020. Participants were grouped into sustained nonsmokers, sustained quitters, new quitters, relapsers/smoking initiators, and sustained smokers. Outcomes included all-cause and cancer-related deaths. Cox regression and competing risk analysis was used to assess association between smoking habit change and mortality risk.
Results Of 2,892,590 women, 54,443 death cases were recorded (median follow-up of 9.0 years). Compared with sustained nonsmokers, mortality risk from all causes and cancer-related causes increased in all other smoking groups. Cancer-related risk increased 1.22-fold among sustained quitters (95% confidence interval [CI], 1.10 to 1.36), 1.56-fold (95% CI, 1.40 to 1.75) in new quitters, 1.40-fold (95% CI, 1.21 to 1.62) in relapsers/smoking initiators, and 1.61-fold (95% CI, 1.46 to 1.78) in sustained smokers compared with sustained nonsmokers. Women who were sustained smokers with higher smoking intensity had a higher mortality risk in terms of hazard ratios compared to nonsmokers (< 5 pack-years 2.12-fold, 5-10 pack-years 2.15-fold, and > 10 pack-years 2.27-fold).
Conclusion Quitting smoking earlier is critical for preventing death from all causes and cancer among female smokers. Key words Smoking, Smoking cessation, Neoplasms, Mortality, Cancer death, Cancer prevention | | | Introduction | logical studies on the effect of smoking on Korean women have remained limited. Therefore, this cohort study was con- | | More than one-fifth of total cancer deaths are attributable | ducted to provide an updated evaluation of the association | | to smoking, making it a strong risk factor and the most sig- | between longitudinal changes in smoking habits and mor- | | nificant preventable cause of cancer [1,2] . Tobacco use inc- | tality risk, especially in Asian women. This study assessed | | reases the risk of several types of cancer [3] and smoking | the association between changes in smoking habits and the | | cessation is associated with a delay and reduction in cancer- | risk of death from all and cancer-related causes. We further | | related deaths, particularly lung cancer [4-7] . | assessed how mortality risk differed according to smoking | | Despite the abundant evidence on cancer mortality risk in smokers, most existing studies measured the changes in | intensity among current smokers. | | smoking behavior informer and past smokers using only one baseline survey and did not consider longitudinal changes in smoking behaviors during the study period. In addition, epi- | Materials and Methods | | demiological evidence on the association between smoking and mortality from cancer has remained limited or outdated
[8,9] and is mainly found in Western populations [8,9] .
In Asian countries, where smoking prevalence in women is much lower than in men [10], smoking or changes in | 1. Study participants
We used data from the National Health Insurance Service– National Health Information Database (NHIS-NHID) [12] . In Korea, the NHI

FAQs

How were participants grouped in the study?

Participants were categorized into sustained nonsmokers, sustained quitters, new quitters, relapsers/smoking initiators, and sustained smokers based on longitudinal smoking behavior.

What statistical methods were used to evaluate mortality risk?

Cox regression and competing risk analysis were used to assess associations between smoking habit change and mortality outcomes.

What was the main finding regarding smoking behavior changes and mortality?

Compared with sustained nonsmokers, mortality risk from all causes and cancer-related causes increased in all other smoking groups, and higher smoking intensity among sustained smokers was linked to higher hazard ratios.

Sep 28, 2026

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