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Adherence to the Korean National Code Against Cancer and mortality: a prospective cohort study from the Health Examinees-Gem study
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Jeeyoo Lee, Aesun Shin, Woo-Kyoung Shin, Ji-Yeob Choi, Daehee Kang
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Epidemiol Health. 2025;e2025026. Published online May 9, 2025
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DOI: https://doi.org/10.4178/epih.e2025026
[Accepted]
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Abstract
OBJECTIVES
The Korean National Code Against Cancer was released in 2006. These guidelines aimed to promote a healthy lifestyle to prevent cancer risk through 10 recommendations. The objective of this study was to investigate the associations between adherence to the Korean National Code Against Cancer and the risk of all-cause, cancer, and cardiovascular disease (CVD) mortality among Koreans.
METHODS This prospective cohort study included 109,160 Korean adults aged 40 to 69 years, recruited from 2004 to 2013 in the population-based Health Examinees-Gem Study (HEXA-G). The adherence total score was calculated based on 6 items from the Korean National Code Against Cancer: smoking, consuming vegetables and fruits, limiting salty foods, restricting alcohol intake, engaging in physical activity, and maintaining a healthy weight. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations of adherence scores with mortality risk were estimated using a Cox proportional hazards regression model.
RESULTS During a mean follow-up period of 12.0 years, 3,799 deaths were recorded. According to the multivariable-adjusted model, men in the highest tertile of adherence scores had a lower risk of all-cause, cancer, and CVD mortality compared to those in the lowest tertile (all-cause: HR=0.67, 95% CI=0.60–0.74; cancer: HR=0.63, 95% CI=0.54–0.74; CVD: HR=0.56, 95% CI=0.43–0.73). A similar association was observed among women for all-cause and CVD mortality (all-cause: HR=0.85, 95% CI=0.76–0.96; CVD: HR=0.70, 95% CI=0.51–0.97).
CONCLUSIONS Adherence to the Korean National Code Against Cancer was associated with a reduced risk of all-cause, cancer, and CVD mortality.
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Summary
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Adherence to the World Cancer Research Fund/American Institute for Cancer Research and Korean Cancer Prevention Guidelines and cancer risk: a prospective cohort study from the Health Examinees-Gem study
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Jeeyoo Lee, Aesun Shin, Woo-Kyoung Shin, Ji-Yeob Choi, Daehee Kang, Jong-Koo Lee
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Epidemiol Health. 2023;45:e2023070. Published online August 1, 2023
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DOI: https://doi.org/10.4178/epih.e2023070
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Abstract
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 Supplementary Material
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Abstract
OBJECTIVES
The purpose of this study was to explore the association between adherence to 2 cancer prevention recommendations and cancer risk.
METHODS In total, 104,386 individuals aged 40-69 years old who were recruited between 2004 and 2013 in the Health Examinees-Gem study were included. Adherence scores were constructed based on 8 items from the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations, including body weight, physical activity, diet, alcohol consumption and breastfeeding, and on 6 items from the Korean cancer prevention guidelines (smoking status, eating vegetables and fruits, salty foods, alcohol intake, physical activity, and body weight). A Cox proportional hazards model was used to estimate the associations between adherence scores and the risk of total and 5 major cancers.
RESULTS The multivariable hazard ratio (HR) for total cancer with the high adherence score versus the lowest score (4.25-7.00 vs. 0.00-3.25) for the WCRF/AICR guidelines was 0.91 (95% confidence interval [CI], 0.82 to 1.00) in men. A reduced breast cancer risk was observed among women with the highest score. Men within the highest category of the Korean cancer prevention guideline score (3.25-6.00) had an HR of 0.80 (95% CI, 0.73 to 0.88) for developing total cancer compared to men within the lowest score (0.00-2.50). The higher adherence group among men showed lower risks of developing stomach, colorectal, and lung cancers.
CONCLUSIONS Adhering to guidelines for cancer prevention can help to reduce the risk of developing cancer in Korean men. The association might differ by cancer type and gender.
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Summary
Korean summary
- 암예방 가이드라인 준수가 실제로 암 발생을 예방하는지에 대한 해외 연구들이 다수 있으나 한국을 포함한 아시아 국가에서 수행된 연구는 없다.
- 국제암연구재단 암예방수칙과 한국 암예방수칙을 준수하는 한국인 남성에서 암 발생 감소가 관찰되었다. 이러한 관련성은 암종에 따라 다르게 나타났다.
Key Message
- The adherence to the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) guidelines on cancer prevention has been addressed in several studies in Western countries.
-Among the Korean population, adherence to WCRF/AICR cancer prevention guidelines as well as the Korean cancer prevention guidelines helps prevent cancer in men. Association varies by gender and type of cancer.
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Citations
Citations to this article as recorded by  - Heterogeneous Clustering of Multiomics Data for Breast Cancer Subgroup Classification and Detection
Joseph Pateras, Musaddiq Lodi, Pratip Rana, Preetam Ghosh
International Journal of Molecular Sciences.2025; 26(4): 1707. CrossRef - Compliance with the WCRF/AICR Recommendations in Qualitative Adaptation and the Occurrence of Breast Cancer: A Case-Control Study
Beata Stasiewicz, Lidia Wadolowska, Maciej Biernacki, Malgorzata Anna Slowinska, Ewa Stachowska
Cancers.2024; 16(2): 468. CrossRef - Transforming public health and economic outcomes by reducing risky behaviors: the potential for South Korea
Joan E. Madia, Ji Yoon Baek, Aesun Shin
Discover Social Science and Health.2024;[Epub] CrossRef - Alcoholic beverage consumption and female breast cancer risk: A systematic review and meta‐analysis of prospective cohort studies
Ivneet Sohi, Jürgen Rehm, Marian Saab, Lavanya Virmani, Ari Franklin, Gonzalo Sánchez, Mihojana Jhumi, Ahmed Irshad, Hiya Shah, Daniela Correia, Pietro Ferrari, Carina Ferreira‐Borges, Beatrice Lauby‐Secretan, Gauden Galea, Susan Gapstur, Maria Neufeld, H
Alcohol, Clinical and Experimental Research.2024; 48(12): 2222. CrossRef - Adherence to the Cancer Prevention Recommendations from World Cancer Research Fund/American Institute for Cancer Research After Cancer Diagnosis on Mortality in South Korea
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Nutrients.2024; 16(23): 4049. CrossRef
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