Air pollution may play an important role in development of lung cancers in people who have never smoked, especially among East Asian women. The aim of this study was to compare cumulative ambient air pollution exposure between ever and never smokers with lung cancer.
A consecutive cases series of never and ever smokers with newly diagnosed lung cancer were compared regarding their sex, race, outdoor and household air pollution exposure. Using individual residential history, cumulative exposure to outdoor particulate matter (PM) over a period of 20 years was quantified with a high spatial resolution global exposure model.
Of the 1,005 lung cancer patients, 56% were females and 33% were never smokers. Compared to ever smokers with lung cancer, never smokers with lung cancer were significantly younger, more frequently Asian, less likely to have chronic obstructive pulmonary disease or a family history of lung cancer and had higher exposure to outdoor PM but lower exposure to secondhand smoke. Multivariable logistic regression analysis showed a significant association with never-smoker lung cancer and being female (odds ratio (OR) 4.01, 95% CI 2.76-5.82, p<0.001), Asian (OR 6.48, 95% CI 4.42-9.50, p<0.001), and greater exposure to air pollution (OR 1.79, 95% CI 1.10-7.2.90, p=0.019).
Compared to ever-smoking patients with lung cancer, never smoking patients had strong associations with being female, Asian and air pollution exposures. Our results suggest incorporation of cumulative exposure to ambient air pollutants be considered when assessing lung cancer risk in combination with traditional risk factors.

Copyright © 2021. Published by Elsevier Inc.