In a recent single-center observational case-control study published in Cureus, researchers evaluated the risk factors for the development of lung cancer among individuals who were nonsmokers.

The authors wrote, “This study aims to gain a deeper understanding of the factors contributing to this risk among non-smokers. Therefore, we have made efforts to establish stronger evidence for causal relationships and evaluate the association of lung cancer in those who have never smoked. Furthermore, this knowledge will add to planning strategies for early detection, screening, and prevention of the disease.”

The study was conducted between January 2022 and July 2023. The authors noted that this study’s secondary objectives included assessing histological subtype, staging, and performance status and investigating the correlation between risk factors and common driver mutations.

Patients diagnosed with lung cancer who were never smokers (never smoked/smoked less than 100 cigarettes in their lifetime) admitted to pulmonary medicine were categorized as “cases,” whereas other patients who were never smokers with no symptoms or signs, normal chest radiographs, and also accompanying attendants of patients who are asymptomatic and nonsmokers were documented as “control.”

To evaluate correlations between risk factors and lung cancer—considering factors such as socioeconomic status, BMI, occupation, outdoor and indoor air pollution, personal habits, and medical history—researchers conducted statistical analysis employing chi-square tests and logistic regression.

The study included 145 lung cancer cases in nonsmokers and 297 controls. Upon review of the data, researchers discovered that 92.4% (134/145) of cases had adenocarcinoma, 6.9% (10/145) had squamous cell carcinoma, and 0.7% (1/145) had small cell carcinoma.

The results revealed that there were significant correlations observed for high-risk occupations, indoor biomass use without proper ventilation, low BMI, and family history of lung cancer. The results also indicated that the presence of specific preexisting lung conditions, such as old pulmonary tuberculosis, was correlated with augmented odds of developing lung cancer, while asthma was linked with decreased odds of developing lung cancer. Moreover, significant correlations were demonstrated with environmental factors, residing near heavy industry, and dietary habits such as low consumption of vegetables per week; however, a noteworthy association was not recovered between the driver mutations and the risk factors studied.

The authors wrote, “High-risk occupations, exposure to indoor air pollutants, a low BMI, and a history of prior lung diseases were some of the risk factors identified as having a positive association with lung cancer. Belonging to the middle-class strata, higher BMI status, use of respiratory protective equipment by the high-risk groups, and consuming vegetables in the diet >5 times per week were found to offer protection from lung cancer.”

The authors indicated that their study identified several risk factors, both positively and negatively, linked to the risk of lung cancer and the frequency of various histological subtypes. The associated driver mutations mirror the heterogeneity of lung cancer in the study’s patient population. The authors also noted that these findings provide essential information for future studies and public health initiatives trying to avert the occurrence of lung cancer in nonsmokers.

Based on their findings, the authors wrote, “This single-center study sheds light on significant risk factors influencing lung cancer development among non-smokers. The predominant occurrence of adenocarcinoma and associations with high-risk occupations, indoor biomass exposure, low BMI, and family history emphasize the multifaceted nature of non-smoking-related lung cancer. The findings underscore the importance of comprehensive risk assessment and targeted preventive strategies in this population.”

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