Indoor wood-burning from stoves and fireplaces and incident lung cancer among Sister Study participants

Air pollution and its impact on cancer incidence, cancer care and cancer outcomes

Air pollution is an under-recognised global health threat linked to an increased risk of cancers and is due primarily to the burning of fossil fuels. This review provides a high-level overview of the associations between outdoor and indoor air pollution and cancer risk and outcomes. Outdoor air pollutants are largely due to the burning of fossil fuels from human activities, although there is growing data implicating outdoor pollution from wildfire smoke. Indoor air pollution is primarily caused by burning solid fuel sources such as wood, coal and charcoal for household cooking and heating. There is a growing number of pieces of evidence linking exposure to pollution and the risk of developing cancers. The strongest evidence is seen on the positive association of air pollution, particularly particulate matter 2.5 with lung cancer. Emerging data implicate exposure to pollutants in the development of breast, gastrointestinal and other cancers. The mechanisms underlying these associations include oxidative stress, inflammation and direct DNA damage facilitated by pollutant absorption and distribution in the body. References were identified through a PubMed search for articles published in 2000 to October 2024 using the terms 'air pollution' or 'pollutants' and 'carcinoma' or ''cancer'. Air pollution poses significant risks to health. Its health impacts, including cancer risks, are often underestimated. Hazardous pollutants have been studied in several epidemiological cohort studies. Despite the mounting evidence, air pollution is often overlooked in predictive cancer risk models and public health intervention.

A Call for Pediatric Clinicians to Address Environmental Health Concerns in Rural Settings

Children in rural communities encounter unique environmental exposures, many of which can result in negative long-term health consequences. Children are particularly at risk from these exposures due to their close interaction with the environment and developing physiology. The authors describe 3 rural environmental hazards: wood stove smoke, well water contaminants, and agricultural pollutants. Contaminants found in these exposures have adverse respiratory, neurodevelopmental, cardiometabolic, and carcinogenic effects, among others. The authors recommend that rural pediatric clinicians screen for these environmental exposures, and they provide tools and resources related to testing, mitigation, and medical monitoring.

Criteria, Greenhouse Gas, and Hazardous Air Pollutant Emissions Factors from Residential Cordwood and Pellet Stoves Using an Integrated Duty Cycle Test Protocol

Air pollution from residential wood heating (RWH) presents challenges at the intersection of climate and public health. With a revised National Ambient Air Quality Standard (NAAQS, at 9 μg/m3) for particulate matter (PM) in the United States (U.S.), the Environmental Protection Agency (EPA) will likely classify new non-attainment areas due primarily to emissions from RWH. Agencies will use emissions factors (EFs) to develop attainment strategies. Many will rely on EPA modeling platforms based on data from the National Emissions Inventory (NEI). The NEI uses RWH EFs based on data from mid-1990's in-situ studies and a speciation profile from a 2001 study of fireplace emissions. The NEI does not include greenhouse gas (GHG) emissions for this sector, which plays a key role when assessing climate reduction strategies for the buildings sector. Here, we tested seven wood stoves to determine EFs, representing various vintages and control technologies, using a novel test method that reflects in-use operational settings called the Integrated Duty Cycle. The study measured multiple pollutants concurrently: criteria pollutants (particulate matter [PM], CO, and NOx), nonmethane total hydrocarbons (NMTHCs), GHGs, black carbon (eBC), brown carbon (BrC), and multiple hazardous air pollutants (HAPs). We found no significant difference in PM EFs between uncertified and non-catalytic stove technologies. RWH EF results from this study exceeded 2020 NEI RWH EFs for NMTHC and multiple HAPs. Applying our study's EFs to the 2020 NEI suggests that RWH, compared to all other sources, ranks as the 2nd largest source category of formaldehyde; the 3rd largest of benzene, 1,3-butadiene, and acrolein; and the 4th largest of Pb emissions. RWH also emits more methane compared to natural gas or oil residential heating, raising questions about substitution of wood as a climate neutral heating fuel. However, compared to uncertified stoves, pellet stove EFs (except toxic metals) were significantly lower (p < 0.01). In summary, RWH appears to be an underestimated source of PM (non-catalytic technology), methane, NMTHC, toxic metals, and other HAPs, which has important implications for climate and public health policy in the U.S. and globally.

Lung cancer in patients who have never smoked - an emerging disease

Lung cancer is the most common cause of cancer-related deaths globally. Although smoking-related lung cancers continue to account for the majority of diagnoses, smoking rates have been decreasing for several decades. Lung cancer in individuals who have never smoked (LCINS) is estimated to be the fifth most common cause of cancer-related deaths worldwide in 2023, preferentially occurring in women and Asian populations. As smoking rates continue to decline, understanding the aetiology and features of this disease, which necessitate unique diagnostic and treatment paradigms, will be imperative. New data have provided important insights into the molecular and genomic characteristics of LCINS, which are distinct from those of smoking-associated lung cancers and directly affect treatment decisions and outcomes. Herein, we review the emerging data regarding the aetiology and features of LCINS, particularly the genetic and environmental underpinnings of this disease as well as their implications for treatment. In addition, we outline the unique diagnostic and therapeutic paradigms of LCINS and discuss future directions in identifying individuals at high risk of this disease for potential screening efforts.