Air Pollution, Genetic Factors and the Risk of Lung Cancer: A Prospective Study in the UK Biobank

Ambient air pollution and the risk of cancer: Evidence from global cohort studies and epigenetic-related causal inference

The correlation between air pollution and cancer incidence has been a longstanding concern, understanding the need to elucidate the specifics of this relationship. Thus, this study aimed to assess the association between exposure to air pollution and cancer incidence, and to identify the possible biological links between the two. We examined global cohort studies investigating the association between air pollution and cancer and performed a univariate Mendelian randomization (MR) analysis. Our analysis revealed that the presence of particulate matter (PM)2.5, PM10, NO2, and NOx substantially impacted the risk of developing cancer. MR analysis identified 130 CpGs sites associated with three ambient air pollutants that have significant casual effects on the risk of 14 cancer sites (false discovery rate<0.05). Gene annotation was conducted using g-Profiler by screening for single nucleotide polymorphisms significantly associated with outcome, followed by analysis of the gene interaction network using GeneMANIA, and visualization using igraph. In conclusion, this study demonstrates that air pollution has a significant impact on cancer incidence, provides strong evidence for an epigenetic causal link between the two, and provides new insights into the molecular mechanisms by which air pollution affects cancer development.

The Association Between Plasma Fatty Acids and Risk of Lung Cancer: A Prospective Cohort Study of the UK Biobank

CONTEXT

Fatty acids (FAs) have emerged as significant contributors to tumorigenesis, yet prospective evidence regarding their specific effects on lung cancer risk remains scarce.

OBJECTIVE

To investigate the association between plasma FAs and lung cancer incidence, as well as a potential modification effect of genetic susceptibility on lung cancer risk.

METHODS

A cohort study was conducted involving 112 547 cancer-free participants from the UK Biobank, with measurements of plasma FAs, including saturated fatty acids (SFAs), monounsaturated fatty acids (MUFAs), and polyunsaturated fatty acids (PUFAs), at baseline (2006-2010). Cox regression models were employed to assess lung cancer risk according to plasma FA quartiles or 1-SD increments. Furthermore, interaction between plasma FAs and polygenic risk score was evaluated using an additive model.

RESULTS

Over an average 10.9-year follow-up, 1122 lung cancer cases occurred. After multivariable adjustment, MUFAs were positively associated with lung cancer risk (hazard ratio [HR] per 1-SD = 1.32; 95% CI, 1.13-1.54). In contrast, PUFAs, particularly n-3 PUFAs, n-6 PUFAs, docosahexaenoic acid, and linoleic acid, were associated with a lower risk of lung cancer, with HRs ranging from 0.79 (95% CI, 0.72-0.87) to 0.89 (95% CI, 0.83-0.95). SFAs were not significantly associated with lung cancer risk. Moreover, we observed an additive interaction between plasma PUFAs and genetic risk. Individuals with a high genetic risk and the lowest quartile of plasma PUFAs had the highest risk of lung cancer (HR = 2.20, 95% CI, 1.43-3.38).

CONCLUSION

Our findings suggest that plasma PUFAs may serve as protective factors, while MUFAs represent risk factors for lung cancer, offering novel insights into lung cancer carcinogenesis and prevention.

[Self-perceived risk of cancer in Spain: a cross-sectional study]

OBJECTIVE

To identify the variables that influence the most the self-perceived risk of developing cancer and to explore the main reasons associated with the degree of self-perceived risk.

METHOD

A cross-sectional study was carried out using a questionnaire designed ad hoc, between February and September 2020. A total of 4769 responses were collected by telephone from men and women over 18 years of age residing in Spain, with a response rate of 29.6%. A descriptive analysis and a binary logistic regression model were performed using the self-perceived risk of developing cancer as the dependent variable.

RESULTS

More than 60% of the participating population believe they have a very high or high risk of being diagnosed at some point in their lives. Having experienced cancer either firsthand or through close family members substantially increased the probability of having a very high or high risk of developing the disease (aOR: 3.243, 95% CI: 2.284-4.605, and aOR: 3.950, 95%CI: 3.316-4.706, respectively). In addition, other sociodemographic and attitudinal variables have been shown to influence the self-perceived risk of developing cancer.

CONCLUSIONS

Close experiences with cancer, either one's own or someone else's, have a significant impact on the higher perception of risk of suffering from the disease. Other variables related to lifestyle or sociodemographic profile that increase the probability that this perception is higher. Therefore, these findings highlight the importance of reinforcing public policies in the field of primary and secondary prevention in order to improve the perception of cancer risk in less aware people.

Polysocial risk score, lifestyle, genetic factors and risk of incident lung cancer

OBJECTIVES

Lung cancer (LC) is the most frequently diagnosed cancer globally; however, the role of social risk factors in its development is not well understood. While previous studies have identified various lifestyle and genetic factors contributing to LC, the interplay between these elements and broader social determinants of health is still unclear. In this study, we aimed to construct a polysocial risk score (PsRS) that captures the multifaceted nature of social environment risk exposure and its relationship with incident LC, and to explore whether the effect of PsRS is influenced by lifestyle behaviours and heritable risk.

STUDY DESIGN

Cohort study.

METHODS

In the UK Biobank cohort, 349,553 participants without previous a cancer diagnosis were recruited. For PsRS construction, 12 social determinants of health were calculated across three domains consistently associated with incident LC. Cox models were used to estimate the association between PsRS and incident LC. Healthy lifestyle and LC genetic risk scores were constructed to evaluate whether lifestyle behaviours and genetic susceptibility modified the effect of PsRS on LC incidence. Mediation analysis was used to estimate whether a healthy lifestyle mediates the effect of PsRS' on LC incidence.

RESULTS

Compared with participants with low PsRS (≤3), the fully adjusted hazard ratio (HR) (95 % CI) for high PsRS (≥7) in developing LC was 2.75 (2.43-3.12). We observed an additive interaction between PsRS and lifestyle. The proportion of mediation effect of lifestyle in the association between PsRS and LC was 6.41 % (95 % CI: 5.74-7.08 %). Individuals with high PsRS and genetic risk had a 4.63-fold higher risk of incident LC.

CONCLUSION

A high PsRS is associated with a higher risk of LC, and lifestyle influences this association. High heritable susceptibility and unfavourable social vulnerability may synergistically contribute to higher LC incidence.

Association between long-term benzene exposure and inflammatory bowel disease in a national cohort: The modifying effect of genetic susceptibility

BACKGROUND

This study aimed to investigate the effects of environmental benzene exposure and its interaction with genetic susceptibility on inflammatory bowel disease (IBD), with a specific focus on ulcerative colitis (UC) and Crohn's disease (CD).

METHODS

A total of 432,727 participants from the UK Biobank who were free of IBD at baseline were included in the analysis. The annual average benzene concentrations during the follow-up period were evaluated by air dispersion models. The study assessed the incidence of IBD in relation to ambient benzene exposure using Cox proportional hazard models and estimated the exposureresponse relationships using restricted cubic spline models. Additive interactions included relative excess risk due to interaction (RERI) and the attributable proportion (AP) to evaluate the interaction between ambient benzene exposure and genetic predisposition.

RESULTS

A significant association was identified between ambient benzene exposure and the incidence of IBD, with hazard ratios (95 % confidence intervals) of 1.06 (1.03, 1.09) for IBD, 1.08 (1.04, 1.12) for UC, and 1.03 (0.98, 1.09) for CD per 0.1 μg/m3 increase. Furthermore, genetic predispositions were found to significantly modify the relationship between ambient benzene exposure and IBD risk. Individuals with the highest genetic risk and benzene exposure had the highest risk of UC.

CONCLUSION

This study provides compelling evidence of the interaction between environmental factors and genetic susceptibility in the pathogenesis of UC. These findings underscore the importance of considering both genetic and environmental influences in future prevention and intervention strategies for IBD.

Associations of Socioeconomic Status and Phenotypic Frailty With Incident COPD: Findings From UK Biobank Participants

BACKGROUND

The independent, mediation, interaction, and joint effects of socioeconomic status (SES) and phenotypic frailty on the incidence of COPD are unclear.

RESEARCH QUESTION

Do SES and frailty increase the risk of COPD independently or jointly? Is there an interaction between the 2 factors in incident COPD? Does frailty play a mediating role between SES and COPD?

STUDY DESIGN AND METHODS

This study included 396,106 UK Biobank participants without COPD at baseline. Latent class analysis was used to define the SES of participants. Frailty was defined by the frailty phenotypes according to 5 factors. Cox regression models were used to examine the associations and calculate hazard ratios (HRs) and 95% CIs. Mediation and interaction analyses were used to explain the associations between SES and frailty on COPD risk.

RESULTS

During a median follow-up period of 13.5 years, 12,626 individuals were diagnosed with COPD. Compared with high SES or robust individuals, low SES (HR, 2.69; 95% CI, 2.48-2.92) or frailty (HR, 2.75; 95% CI, 2.58-2.93) increased the risk of COPD, respectively; 11.80% of the association between SES and COPD was mediated by frailty. In addition, there was a statistically significant additive interaction of low SES and frailty with COPD incidence (relative risk due to interaction, 3.591; 95% CI, 2.189-4.992; attributable proportion due to the interaction, 0.433; 95% CI, 0.276-0.589). Compared with robust individuals with high SES, frail individuals with low SES have the highest risk of COPD (HR, 7.85; 95% CI, 6.96-8.86).

INTERPRETATION

Our findings indicate that low SES and frailty are independent risk factors for COPD, and these 2 factors also have synergistic interaction in COPD. Frailty partially mediated the association between SES and COPD. Thus, the early identification and reversal of frailty may minimize the risk of COPD, especially in individuals with low SES.

Natural products as promising therapeutics for fine particulate matter-induced skin damage: a review of pre-clinical studies on skin inflammation and barrier dysfunction

Background

Particulate matter less than 2.5 µm (PM2.5) is a significant air pollutant and is linked to an increased risk of health conditions, including skin diseases. The skin, as the first barrier and the largest organ, is primarily damaged by PM2.5 through different pathways. Several studies have shown that PM2.5 upregulates inflammatory responses through the excessive production of reactive oxygen species (ROS) and several inflammatory cytokines, leading to PM2.5-induced skin damage. The ROS/mitogen-activated protein kinase (MAPK) and Cyclooxygenase-2-Prostaglandin E2 (COX2/PGE2) inflammatory pathways are activated by free radical scavenging and phase II detoxification. Natural products have been suggested as therapeutic agents for mitigating PM2.5-induced skin damage.

Objectives

We elaborate on the mechanisms of action of natural products and their functions as protectants against environmental skin diseases. This review highlights the optimal doses of natural products for clinical study, which may benefit dermatologists, molecular biologists, clinicians, and healthcare professionals in preventive and alternative medicine.

Methodology

The available scientific literature published between 1999 and 2024 was searched using PubMed and Google Scholar. Multiple keywords related to the topic were used. Only 41 of the screened articles were chosen for this review, as they were the most relevant publications on the topic of the preventive advantages of natural products and specific pathways targeting PM2.5-induced skin injury. All relevant articles meeting the criteria of being original full articles and written in English were included.

Results

This review summarized the natural products, including phenolic/polyphenolic compounds and flavonoids, that can act as anti-inflammatory and antioxidant agents by protecting the skin against oxidative stress, inhibiting enzymes that promote free radical formation, enhancing antioxidant enzyme activity, and reducing overall ROS formation. Several natural products have demonstrated efficacy in alleviating intracellular ROS, oxidative stress, mitochondrial dysfunction, autophagy, and apoptosis caused by PM2.5. In addition, phytochemical agents support the restoration of the skin wound healing process and muscle contraction impaired by environmental pollutants, such as PM2.5 and UV rays.

Conclusion

This review highlights promising natural agents that can protect against environment-mediated health problems by focusing on their mechanisms of action. Particular emphasis is placed on antioxidant and anti-inflammatory compounds, including sulforaphane, hesperidin, quercetin, catechin, diphloroethohydroxycarmalol, resveratrol, and ginsenoside, which have become interesting candidates as nutraceuticals due to their potential to reduce reliance on conventional medicines. However, the low stability and bioavailability of natural products remain significant challenges to their clinical use; therefore, further research and development are warranted.

Long-term exposure to air pollution and esophageal cancer incidence: A large-scale prospective cohort study

BACKGROUND

Epidemiological evidence regarding the association between long-term air pollution exposures and esophageal cancer is limited and controversial. This study aims to investigate this association further and assess its impact on different histological subtypes of esophageal cancer.

METHODS

Data from the UK Biobank cohort, which included 444,932 participants, was utilized for this study. High-resolution 1 × 1 km data from the UK's Department for Environment, Food and Rural Affairs was used to estimate annual concentrations of air pollutants based on participants' residential addresses. The Time-Dependent Cox proportional hazard model was employed to estimate the hazard ratios (HRs) and 95 % confidence intervals (CIs) for the incidence of esophageal cancer associated with air pollutant exposure.

RESULT

Over a follow-up duration of 4,777,149 person-years, 1008 new esophageal cancer cases were observed. No association between PM2.5 and PM10 exposure and esophageal cancer was found. However, long-term exposure to NO2, NOx, SO2 and benzene demonstrated a linear relationship with the risk of esophageal cancer incidence. The HRs were 1.278 (95 % CI: 1.104-1.480) per 10 μg/m3 for NO2, 1.129 (95 % CI: 1.046-1.218) per 10 μg/m3 for NOx, 1.109 (95 % CI: 1.041-1.182) per 1 μg/m3 for SO2 and 1.086 (95 % CI: 1.010-1.167) per 0.1 μg/m3 for benzene, respectively. No statistically significant heterogeneity was detected between the histological subtypes of squamous cell carcinoma and adenocarcinoma. Elderly individuals were more vulnerable to nitrogen oxides, while smokers or former smokers were more susceptible to the effects of sulfur dioxide.

CONCLUSION

Long-term exposure to air pollutants may significantly increase the risk of esophageal cancer. Effective and targeted control of ambient air pollutant concentrations could potentially reduce the disease burden of esophageal cancer.

Identifying environmental factors and biological metrics associated with cancer prevalence and mortality: An environment-wide association study

BACKGROUND

Present knowledge about determinants of oncogenesis and cancer mortality remains incomplete, inconsistent, and controversial. We aimed to conduct an environment-wide association study (EWAS) to systematically investigate and tentatively validate correlations of environmental factors and biological metrics with prevalence and mortality of cancer.

METHODS

All eligible participants were selected from the US National Health and Nutrition Examination Survey (NHANES) and randomly split into training and testing sets by survey years. Environmental and biological exposures were assessed through either physical examinations or laboratory tests. We conducted survey-weighted logistic regression and COX proportional hazards regression models to investigate the relationships of 398 factors with cancer prevalence and 380 factors with cancer mortality, respectively. To adjust for multiple comparisons, positive findings in the training set (false discovery rate [FDR] < 5 %) were tentatively validated in the testing set (P value < 0.05). Random forest models were further fitted to evaluate the importance and diagnostic value of identified factors in relation to cancer prevalence.

RESULTS

Overall, 55,021 general participants and 5163 cancer survivors were included in the study of cancer prevalence and mortality, respectively. After adjusting potential confounders, we identified 7 environmental or biological factors (e.g. total bilirubin, testosterone, and beta-cryptoxanthin) associated with cancer prevalence in the general population, as well as 21, 8, and 6 indicators associated with all-cause (e.g. C-reactive protein), cancer-specific (e.g. blood selenium), and noncancer mortality (e.g. albumin) among individuals with cancer, respectively. EWAS-identified factors contributed to better performance of random forest models in predicting cancer prevalence.

CONCLUSIONS

Employing an EWAS approach, this study provided novel insights into potential targets for prevention and control of cancer.

The Current Roadmap of Lung Cancer Biology, Genomics and Racial Disparity

Globally, lung cancer is the most prevalent cause of cancer-related death. There are two large histological groups of lung cancer: small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC). Based on histopathological and molecular features, adenocarcinoma (ADC) and squamous cell carcinoma (SCC) are the two major histologic subtypes of NSCLC. Various epidemiological and environmental factors are linked with an increased risk of lung cancer. However, these risk factors show disparities in patients with divergent racial and ethnic backgrounds. Interestingly, different populations were found to harbor distinct molecular features as evidenced by variations in genetic mutation profiles. Moreover, diverse histological and molecular progression patterns are identified in lung cancer, which could be crucial in improving diagnosis, prognosis, and therapeutic planning. In concert with a plethora of nuclear genetic alterations, mitochondrial alteration, epigenetic reprogramming, microbial dysbiosis, and immune alteration signatures have been identified in various lung cancer types. This review article provides a comprehensive overview of screening tests and the treatment strategies for NSCLC and SCLC, including surgery, radiation therapy, chemotherapy, targeted therapies, and immunotherapies. Through the unification of these diverse aspects, this review article aspires to a complete understanding of lung cancer's genomics, biology, microbial landscapes, and racial disparity and seeks to understand the essential role of racial and ethnic factors in lung cancer occurrence and treatment.

Association of SNPs in nAChRs genes, areca nut chewing and smoking, and their interaction with lung cancer in Hainan, China: a case control study

BACKGROUND

Areca nut (AN) was classified as a carcinogen by the International Agency for Research on Cancer (IARC) of the WHO in 2003. AN has the same carcinogenic components as cigarettes, such as benzo[a]pyrene (B[a]P) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), but its effects on interactions with genetic factors related to lung cancer have rarely been investigated.  METHODS: Here, a propensity score-matched case‒control study was conducted in Hainan, which included 445 patients with lung cancer and 445 cancer-free controls. Then, the associations between single-nucleotide polymorphisms (SNPs) in the CHRNA5-CHRNA3-CHRNB4 gene cluster and their interaction effects with AN chewing and smoking on lung cancer were analyzed. In addition, we explored the associations among AN, cigarettes, and genes related to lung cancer using the Comparative Toxicogenomics Database (CTD).

RESULTS

The results indicate that the CHRNA3 rs938682 (A > G) GG genotype (OR = 0.669, 95% CI = 0.454 ~ 0.984, P = 0.042) can decrease the risk of lung cancer. The CHRNB4 rs7178270 (C > G) GG genotype (OR = 1.729, 95% CI = 1.168 ~ 2.571, P = 0.006) can increase the risk of lung cancer. The CHRNA5 rs17486278 CC genotype was associated with a high risk in males, smokers, and drinkers. The CHRNA3 rs938682 GG genotype was associated with a low risk in AN chewers. The CHRNB4 rs7178270 GG genotype was associated with high risk in drinkers and AN chewers. CHRNB4 rs7178270 and AN chewing have an interaction effect on lung cancer in Hainan.

CONCLUSIONS

This study is the first to elucidate the hidden impacts of AN on lung cancer and provides a key evidence regarding the interactive effects of AN and cigarettes with SNPs in nAChRs genes on lung cancer.

Benzo[a]pyrene exposure and incident risks of digestive system cancers: Insights from nested case-control studies and adverse outcome pathway network analysis

Benzo[a]pyrene (B[a]P) is a recognized carcinogen for lung cancer, but its associations with digestive system cancers (DSCs) remain unclear and the common carcinogenic mechanisms are not fully understood. We conducted five nested case-control studies within the Dongfeng-Tongji cohort, including esophageal (EC, n = 58), gastric (GC, n = 103), colorectal (CRC, n = 220), hepatic (HC, n = 117), and pancreatic cancers (PC, n = 45). For each case, two sex and age ( ± 5 years) matched healthy controls were selected. We observed significant J-shaped associations between plasma concentrations of benzo[a]pyrene diol epoxide-albumin (BPDE-Alb) adducts and five DSCs (all P for non-linear <0.05). The subjects with high BPDE-Alb exposure exhibited a separate 2.19, 2.14, 1.67, 2.40, and 1.78-fold incident risks of EC, GC, CRC, HC, and PC (95% CI: 1.00-4.83, 1.24-3.67, 1.15-2.43, 1.48-3.90, and 0.71-4.47, respectively) than those with low exposure. Furthermore, the adverse outcome pathway (AOP) network indicated five molecular initiation events and 18 subsequent key events, particularly, the alterations in receptors of AhR, EGFR accompanied by regulations of cell proliferation and apoptosis pathways (e.g., PI3K-Akt, TNF signaling) may facilitate common carcinogenic processes. Our findings revealed the positive associations of B[a]P exposure with five DSCs, and the dysregulation of proliferation and apoptosis may initiate B[a]P-induced cancer development.

Particulate matter air pollution as a cause of lung cancer: epidemiological and experimental evidence

Air pollution has a significant global impact on human health. Epidemiological evidence strongly suggests that airborne particulate matter (PM), the dust components of polluted air, is associated with increased incidence and mortality of lung cancer. PM2.5 (PM less than 2.5 µm) from various sources carries different toxic substances, such as sulfates, organic compounds, polycyclic aromatic hydrocarbons, and heavy metals, which are considered major carcinogens that increase lung cancer risk. The incidence and mortality of lung cancer caused by PM2.5 exposure may be due to significant geographical differences, and can be influenced by various factors, including local sources of air pollution, socioeconomic conditions, and public health measures. This review aims to provide comprehensive insights into the health implications of air pollution and to inform strategies for lung cancer prevention, by summarising the relationship between exposure to PM2.5 and lung cancer development. We explore the different sources of PM2.5 and relevant carcinogenic mechanisms in the context of epidemiological studies on the development of lung cancer from various geographical regions worldwide.

Interplay of Polygenic Risk Score, Smoking Statuses, and Air Pollution on Lung Adenocarcinoma Risk in a Taiwanese Population

BACKGROUND AND OBJECTIVE

We determined the impact of genetic susceptibility and its interaction with smoking and air pollution on the risk of developing lung adenocarcinoma.

METHODS

This retrospective case-control study utilised data from Taiwan Precision Medicine Initiative (TPMI) project conducted between June 2019 and November 2022. The study population consisted of lung adenocarcinoma patients and 1:4 age-, gender-, and index year-matched non-lung cancer controls. We analysed polygenic risk scores (PRS), smoking status, as well as PM2.5 and PM10 exposures.

RESULTS

A total of 681 lung adenocarcinoma patients and 2724 non-lung cancer participants were included. PRS was significantly higher among lung adenocarcinoma patients than controls (p < 0.001). Overall, a higher PRS was associated with a higher risk of lung adenocarcinoma. A high PM2.5 exposure was associated with a higher risk of lung adenocarcinoma (OR 1.88 [95% CI 1.12-3.14], p = 0.0163) among never-smokers with low genetic risk. Never-smokers with a higher genetic risk were associated with a higher OR for lung adenocarcinoma with the highest OR among Q4 participants with high PM2.5 exposure (4.97 [95% CI 3.10-7.97], p < 0.001). There was no significant impact of PM2.5 exposure among individuals with higher genetic risks. Similar phenomena were observed in the PM10 analyses. There were no significant correlations of PRS with risk of lung adenocarcinoma among smokers.

CONCLUSION

PRS significantly predicted lung adenocarcinoma incident cases in a dose-dependent manner among never-smokers. The PRS effect was not noted in smokers. The results were consistent among participants exposed to different air pollution levels.

Residential greenness, air pollution, genetic predisposition and the risk of lung cancer

BACKGROUND

Growing evidence suggests that greenness is associated with multiple health outcomes, but its association with lung cancer risk remains limited and far from consistent. In particular, it is unclear whether this association varies across different types of lung cancer and whether it is influenced by factors such as genetics, air pollution, and physical activity.

METHOD

This prospective cohort study included 425108 participants aged 37-73 years from the UK Biobank. Residential greenness was estimated with the normalized difference vegetation index (NDVI) and the enhanced vegetation index (EVI) within the 500 m buffer. Cox proportional hazards regression was performed to evaluate the hazard ratios (HR) and 95 % confidence intervals (CI) of the relationship between greenness and risk of lung cancer. A genetic risk was calculated using 18 independent susceptibility loci for lung cancer. Mediation analysis was conducted to assess the indirect effects through air pollutants (including PM2.5, PM10, NO2, NOx) and physical activity.

RESULTS

During a median follow-up of 14.0 years, 3814 lung cancer cases identified. An inversely linear correlation between residential greenness and incident lung cancer was found. Specifically, each interquartile range increase in NDVI and EVI within the 500 m buffer was linked to 8 % (HR 0.92, 95 % CI: 0.88, 0.96) and 9 % (HR 0.91, 95 % CI: 0.87, 0.94) decreased in lung cancer risk, respectively. Moreover, the association was particularly pronounced for adenocarcinoma (HR 0.88, 95 % CI: 0.83, 0.94 for NDVI; HR 0.87, 95 % CI: 0.82, 0.92 for EVI). Mediation analysis suggested that reductions in PM2.5 exposure and increased physical activity accounted for approximately 45 % and 1.5 % of the observed association.

CONCLUSION

Increased residential greenness was linearly associated with reduced risk of lung cancer, particularly adenocarcinoma, and such an association may be substantially mediated by mitigating air pollutants, especially PM2.5 and increased physical activity. The study provides promising evidence and strategy of improving greenness during urbanization to reduce the risk of lung adenocarcinoma in the context of the grimmer trend of rapidly increasing risk of adenocarcinoma.

Update in Association between Lung Cancer and Air Pollution

A significant portion of newly diagnosed lung cancer cases occurs in populations exposed to air pollution. The World Health Organization has identified air pollution as a human carcinogen, prompting many countries to implement monitoring systems for ambient particulate matter (PM). PM is composed of a complex mixture of organic and inorganic particles, both solid and liquid, that are found in the air. Given the carcinogenic properties of PM and the high prevalence of lung cancer among exposed populations, exploring their connection and clinical implications is critical for effectively preventing lung cancer in this group. This review explores the relationship between ambient PM and lung cancer. Epidemiological studies have demonstrated a dose-response relationship between PM exposure and lung cancer risk. PM exposure induces oxidative stress, disrupts the body's redox balance, and causes DNA damage, which is a crucial factor in cancer development. Recent findings on the strong correlation between ambient PM and adenocarcinoma highlight the importance of understanding the specific molecular and pathological mechanisms underlying pollution-related lung cancer. In addition to efforts to control emission sources at the international level, a more individualized approach is essential for preventing PM-related lung cancer.

Effect of Long-Term Fine Particulate Matter Exposure on Lung Cancer Incidence and Mortality in Chinese Nonsmokers

Rationale: The association between fine particulate matter (particulate matter ⩽2.5 μm in aerodynamic diameter, PM2.5) and lung cancer incidence in nonsmokers (LCINS) remains inconsistent. Objectives: To investigate the association between long-term PM2.5 exposure and LCINS in a Chinese population and to assess the modifying effect of genetic factors. Methods: Time-dependent Cox proportional hazard models were used to evaluate the hazard ratios (HRs) and 95% confidence intervals (CIs) of PM2.5 with LCINS risk and LCINS-related mortality. The polygenic risk score was constructed to further explore the interactions between genetic risk and PM2.5 exposure. In addition, the population attributable fraction of PM2.5 to lung cancer risk and mortality was calculated. Measurements and Main Results: The results demonstrated significant associations between PM2.5 exposure and LCINS incidence (HR, 1.10 per 10 μg/m3; 95% CI, 1.04-1.17 per 10 μg/m3) and mortality (HR, 1.17 per 10 μg/m3; 95% CI, 1.08-1.27 per 10 μg/m3). Compared with the lowest-risk group, individuals exposed to the high PM2.5 concentration (⩾50.9 μg/m3) and high genetic risk (top 30%) exhibited the highest LCINS incidence (HR, 2.01; 95% CI, 1.39-2.87) and mortality (HR, 2.30; 95% CI, 1.38-3.82). A significant additive interaction between PM2.5 and genetic risk on LCINS incidence was observed. Approximately 33.6% of LCINS cases and 48.5% of LCINS-related deaths in China could be prevented if PM2.5 concentrations were reduced to meet World Health Organization guidelines. Conclusions: Long-term exposure to outdoor PM2.5 increases LCINS risk and LCINS-related mortality, especially in populations with high genetic risk. Strengthening air pollution control measures in China has the potential to significantly reduce the burden of LCINS.

CircDNA2-Educated YTHDF2 Phase Separation Promotes PM2.5-Induced Malignant Transformation Through the Blunting of GADD45A Expression

Substantial epidemiological evidence suggests a significant correlation between particulate matter 2.5 (PM2.5) and lung cancer. However, the mechanism underlying this association needs to be further elucidated. Circular RNAs (circRNAs) have emerged as an important topic in the field of epigenetics and are involved in various cancers. This study aimed to explore the molecular basis of PM2.5-induced lung cancer from an epigenetic perspective and identify potential biomarkers. Initially, the construction of a chronic PM2.5 exposure model confirmed that PM2.5 exposure promoted the malignant transformation of human bronchial epithelial (HBE) cells. Mechanistically, abnormally upregulated circDNA2 inhibited the tumor suppressor gene growth arrest and DNA damage 45 alpha (GADD45A) mRNA in an N6-methyladenosine (m6A)-dependent manner, mediated by YTH N6-Methyladenosine RNA Binding Protein F2 (YTHDF2) after PM2.5 exposure. Further analyses revealed that circDNA2 can specifically bind to the YTHDF2 LC domain to promote YTHDF2 protein liquid-liquid phase separation (LLPS), providing sufficient evidence linking LLPS and particulate pollutant-induced tumorigenesis. In conclusion, this study provides new insights into the role of circDNA2 in PM2.5-induced lung cancer and confirms its clinical value as a potential prognostic biomarker for lung cancer.

A genome-wide cross-trait analysis characterizes the shared genetic architecture between lung and gastrointestinal diseases

Lung and gastrointestinal diseases often occur together, leading to more adverse health outcomes than when a disease of one of these systems occurs alone. However, the potential genetic mechanisms underlying lung-gastrointestinal comorbidities remain unclear. Here, we leverage lung and gastrointestinal trait data from individuals of European, East Asian and African ancestries, to perform a large-scale genetic cross trait analysis, followed by functional annotation and Mendelian randomization analysis to explore the genetic mechanisms involved in the development of lung-gastrointestinal comorbidities. Notably, we find significant genetic correlations between 27 trait pairs among the European population. The highest correlation is between chronic bronchitis and peptic ulcer disease. At the variant level, we identify 42 candidate pleiotropic genetic variants (3 of them previously uncharacterized) in 14 trait pairs by integrating cross-trait meta-analysis, fine-mapping and colocalization analyses. We also find 66 candidate pleiotropic genes, most of which were enriched in immune or inflammatory response-related activities. Causal inference approaches result in 4 potential lung-gastrointestinal associations. Introducing the gut microbiota as a variable establishes a relationship between the genus Parasutterella, gastro-oesophageal reflux disease and asthma. In summary, our findings highlight the genetic relationship between lung and gastrointestinal diseases, providing insights into the genetic mechanisms underlying the development of lung gastrointestinal comorbidities.

Association between air pollution exposure and lower urinary tract symptoms in Korean men

The purpose of this study was to investigate the association between long-term air pollution exposure and Low Urinary Tract Symptoms (LUTS) in Korean men. This study included 7,979 adult men who underwent health checkups. Each subject's annual average air pollution exposure levels were estimated using the Community Multiscale Air Quality model. LUTS were evaluated using the International Prostate Symptom Score (IPSS) questionnaire, and the IPSS values were analyzed for their association with LUTS severity. The study population had an average age of 56.1 years, with a prevalence of LUTS at 39.8%. None of the air pollutants were significantly associated with overall LUTS prevalence after adjusting for potential confounders. Interestingly, when divided into two symptoms of LUTS, exposures to particulate matter ≤ 2.5 μm in diameter (PM2.5) and particulate matter ≤ 10 μm in diameter (PM10) were significantly associated with an increased prevalence of voiding symptoms, but not with storage symptoms. Regarding the LUTS severity, PM2.5 and sulfur dioxide (SO2) exposures were closely related to an increased severity of overall LUTS. We report for the first time that long-term exposure to ambient air pollution, such as particulate matter, is associated with a higher prevalence and severity of LUTS, particularly voiding symptoms.

Mycobiome: an underexplored kingdom in cancer

SUMMARYThe human microbiome, including bacteria, fungi, archaea, and viruses, is intimately linked to both health and disease. The relationship between bacteria and disease has received much attention and intensive investigation, while that of the fungal microbiome, also known as mycobiome, has lagged far behind bacteria. There is growing evidence showing mycobiome dysbiosis in cancer patients, and certain cancer-specific fungi may contribute to cancer progression by interacting with both host and bacteria. It was also demonstrated that the role of fungi-derived products in cancer should also not be underestimated. Therefore, investigating how fungal pathogenesis contributes to the onset and spread of cancer would yield crucial information for cancer diagnosis, prevention, and anti-cancer therapy.

Genetic Ancestry and Lung Cancer in Latin American Patients: A Crucial Step for Understanding a Diverse Population

Lung cancer is the second leading cause of cancer-related deaths in Latin America. While incidence and mortality rates are higher in other populations, the ``Hispanic paradox'' observed in US Hispanics reflects a lower mortality rate for mortality from non-small cell lung cancer (NSCLC) despite socioeconomic disparities, which may be related to epigenetic and cultural factors. Genetic studies have identified single nucleotide polymorphisms associated with ancestry as key contributors to lung cancer risk and outcomes, emphasizing the importance of genomic insights for early detection and personalized treatments. This narrative review explores the impact of genetic ancestry on lung cancer in Hispanic/Latino populations. We searched MEDLINE and Google Scholar for "((SNP) OR (germline) OR (variant)) AND (lung cancer) AND ((Hispanic) OR (Latin))," focusing on Latin American studies. We included articles published up to December 2024. Specific variation in genes such as XRCC1, CYP1A1, CYP1A2, SEMA3B, PADPRP, and mEPHX have been associated with increased lung cancer risk. Lung cancer incidence and prognosis vary significantly among Hispanics due to their diverse genetic ancestry. Understanding ancestry-specific genetic variations may help personalize treatment and improve outcomes for this population.

Disease burden of lung cancer attributable to metabolic and behavioral risks in China and globally from 1990 to 2021

BACKGROUND

There are differences between China and globally in the burden of lung cancer attributed to behavioral and metabolic risks.

METHODS

This research utilized the Global Burden of Disease (GBD) 2021 database to extract the deaths and disability-adjusted life-years (DALYs) of lung cancer attributed to metabolic and behavioral risks in China and globally, along with the age-standardized mortality rates (ASMR) and age-standardized DALYs rates (ASDR). The age-period-cohort model was used to identify age effects, period effects, cohort effects, as well as local and net drift. Decomposition analysis was used to quantify the relative contributions of aging, epidemiological change, and population to the lung cancer burden. Bayesian age-period-cohort model was used for predictive analysis.

RESULTS

From 1990 to 2021, the ASMR of lung cancer attributed to smoking and secondhand smoke significantly decreased globally, but it increased slightly in China. And the ASMR of lung cancer attributed to diet low in fruits significantly decreased, while the ASMR due to high fasting plasma glucose increased both in China and globally. The net drifts of lung cancer deaths attributed to smoking and secondhand smoke were both negative values globally, while the net drifts were small and even close to zero in China. The net drifts attributed to diet low in fruits and high fasting plasma glucose globally were -2.06% and 0.29%, respectively, and the lung cancer deaths among elderly patients has been increasing annually. However, in China, the lung cancer deaths attributed to diet low in fruits has been decreasing annually across all age groups, while the deaths due to high fasting plasma glucose has been increasing year by year. In the next 15 years, the burden of lung cancer attributed to behavioral and metabolic risks was expected to decrease in China and globally, but the burden among Chinese women attributed to smoking and secondhand smoke showed a slow upward trend.

CONCLUSIONS

Over the past thirty years, the global burden of lung cancer attributed to behavioral factors has decreased, while it increased slow in attribution to metabolic factors. In China, only the lung cancer burden attributed to diet low in fruits has decrease, others have exhibited a fluctuating trend. In the next 15 years, the burden of lung cancer attributed to behavioral and metabolic risks decreases globally, but the lung cancer burden attributed to smoking and secondhand smoke shows a slow upward trend among Chinese women. That asks a need for greater attention to the tobacco exposure among women.

Impact of air pollution on the progress-free survival of non-small cell lung cancer patients with anti-PD-1/PD-L1 immunotherapy: A cohort study

Air pollution is a well-established risk factor for lung cancer, but limited evidence exists on its impact on the treatment of lung cancer. The objective of this study was to investigate the impact of key pollutants on the efficacy of PD-1/PD-L1 inhibitor immunotherapy in non-small cell lung cancer (NSCLC) patients, thereby providing clinicians with evidence to potentially enhance the efficacy of PD-1 therapy and inform policy decisions for cancer care. To this end, we conducted a study involving 361 NSCLC patients who received PD-1/PD-L1 inhibitor immunotherapy, examining the correlation between air pollution exposure and progression-free survival (PFS) following immunotherapy treatment. Their moving-average ambient levels up to 1 year of PM2.5 and its constituents (organic matter (OM), black carbon (BC), nitrate (NO3-), sulfate (SO42-), and ammonium (NH4+)), as well as ozone (O3) were estimated using the Tracking Air Pollution in China dataset. Cox proportional hazards models were adopted to estimate the effects of exposure to each pollutant on PFS risk for NSCLC. 179 patients obtained the progression of NSCLC. While PM2.5 exposure prior to the immunotherapy was not associated with NSCLC progression, long-term exposure to BC and OM, the important organic components of PM2.5, were significantly associated with a higher risk of NSCLC progression with corresponding hazard ratios (HRs, 95% confidence intervals) of 2.42 (1.39, 4.23) and 2.41 (1.40, 4.14) for 1-year moving average, respectively. Short-term exposure to O3 was also associated with PFS with a HR of 1.64 (1.08, 2.50) for 3-month averaged exposure. Monotonic increasing dose-response relationships were further observed for the associations of BC, OM and O3 with PFS. Our findings imply the need of implementing effective measures for targeted reduction in specific sources of PM2.5 constituents (especially BC and OM) and O3 at different time windows to improve the prognosis of NSCLC patients especially for their PFS.

Environmental Sustainability and Cancer Imaging

The rising global burden of cancer drives increased demands for medical imaging, which is essential throughout cancer care. However, delivering medical imaging presents significant environmental challenges including high energy use, reliance on single-use supplies, and the production of environmental pollutants. Environmental factors, such as ultraviolet radiation, wildfire smoke, and carcinogenic pollutants contribute to rising cancer rates, while extreme weather events driven by climate change disrupt cancer care delivery-highlighting the close connection between patient and planetary health. This review explores opportunities to improve the environmental sustainability of oncologic imaging, emphasizing the importance of patient-relevant outcomes-such as quality of life and overall survival-as a guiding principle in cancer care. Key strategies include optimizing imaging schedules to reduce low-value imaging, selecting modalities with lower environmental impact where clinically appropriate, minimizing waste streams, and adopting energy-efficient practices. Artificial intelligence offers the potential to personalize imaging schedules and improve efficiency, though its benefits must be weighed against energy use. Mobile imaging programs and integrated scheduling reduce patient travel-related emissions while promoting health equity, particularly in underserved communities. Future research should focus on optimizing imaging intervals to address patient-relevant outcomes better, expanding the use of abbreviated imaging protocols, and the judicious deployment of artificial intelligence, ensuring its benefits justify energy use.

Mediating effect of diabetes in the association between long-term PM2.5 exposure and cancer risk in CHARLS

Long-term exposure to air pollutants and diabetes are both linked to cancer development. However, their combined effect remains unclear. This study examined the relationship between air pollutants and cancer incidence, with diabetes as a potential mediator. Data from 10,590 participants in the 2015 China Health and Retirement Longitudinal Study (CHARLS) were analyzed. Participants were grouped based on cancer diagnosis, and air pollutant exposure levels were estimated using satellite-based spatiotemporal models. Generalized linear regression and restricted cubic spline (RCS) analysis were used to assess the impact of air pollutants and diabetes in covariates-adjusted models. Further analyses, including conditional independence test, mediation effect and sensitivity analysis based on Bayesian networks, were performed to further analyze specific air pollutants. After adjusting for covariates, particulate matter (PM) (PM ≤ 1 μm in aerodynamic diameter [PM1], PM2.5, ammonium (NH4), nitrate (NO3) and diabetes showed significant associations with cancer incidence. RCS analysis confirmed significant direct effects of PM2.5 and PM10 on cancer and the mediated effects of diabetes. The interaction between diabetes and both PM2.5 and PM10 was further supported by conditional independence tests, highlighting diabetes as a significant mediator in the PM2.5-cancer relationship. This study offers a novel perspective by identifying diabetes as a key intermediary in the association between PM2.5 exposure and cancer risk, providing evidence that diabetes plays a significant mediating role in air pollutant-related cancer development.

Plant-based dietary patterns, genetic risk, proteome, and lung cancer risk: a large prospective cohort study

PURPOSE

We aimed to examine the associations between plant-based dietary patterns, genetic risk, proteins, and lung cancer risk.

METHODS

189,541 participants of the UK Biobank were included. The Cox proportional hazards models and restricted cubic splines were performed to assess the associations between overall plant-based diet index(PDI), healthy PDI (hPDI), and unhealthy PDI (uPDI) and lung cancer risk. Polygenic risk score (PRS) was constructed to assess its joint effect with PDIs on lung cancer risk. Mediation analysis was conducted to examine which proteins mediated the associations of PDIs with incident lung cancer.

RESULTS

Higher PDI was significantly correlated with reduced lung cancer risk(HR:0.90, 95% CI: 0.85-0.96, per SD). An elevated uPDI showed a significant correlation with an increased lung cancer risk(HR:1.08, 95% CI: 1.01-1.15, per SD). Individuals with a combination of high PRS and low PDI (HR: 2.09 [95% CI: 1.48-2.95]) or high uPDI (HR: 1.86 [95% CI: 1.36-2.53]) exhibited a notably higher lung cancer risk compared to those with low PRS and a high PDI or low uPDI. 42 proteins mediated the effect of PDI on lung cancer risk, and the association between uPDI with lung cancer was mediated by 117 proteins. The number of proteins displaying pathway enrichment within the cytokine-cytokine receptor interaction was the highest of the proteins mediated the effect of associations of PDI and uPDI with lung cancer risk.

CONCLUSION

A higher PDI correlated with reduced lung cancer risk, while a higher uPDI correlated with an elevated lung cancer risk. Low PDI jointing with high genetic risk increased lung cancer risk. Proteins enriched in cytokine-cytokine receptor interaction may mediate the association between plant-based dietary patterns with lung cancer risk.

Associations between short-term exposure to air pollution and acute exacerbation of chronic bronchitis: A time-stratified case-crossover study

OBJECTIVE

This study aimed to explore the associations between short-term air pollution exposure and acute exacerbation of chronic bronchitis (AECB).

METHODS

AECB data were collected from hospital surveillance systems in Shanghai, China, during 2018-2022. Exposure pollution data were obtained from China high resolution high quality near-surface air pollution datasets and assigned to individuals based on their residential addresses. The time-stratified case crossover design combined with the conditional logistic regression model were used to estimate the associations between air pollution and AECB. Weighted quantile sum regression evaluated combined pollution effects and key pollutants.

RESULTS

A total of 2202 hospitalized cases with AECB were included. On day 7 of the average lag (lag 07-day), the odds ratios (OR) of air pollution (Particulate matter with aerodynamic diameters of ≤2.5 μm (PM2.5), 2.5-10 μm (PM2.5-10), and ≤ 10 μm (PM10), Ozone (O3), Sulfur dioxide (SO2), Nitrogen dioxide (NO2)) with AECB increased by 10 μg/m3 were 1.07 (95 % confidence interval (CI): 1.02-1.12), 1.13 (1.06, 1.21), 1.06 (1.03-1.09), 1.03 (1.01-1.06), 2.05 (1.51-2.80) and 1.11 (1.05-1.18), respectively. Combined exposure was also positively associated with the risk of AECB (OR 1.04, 95 % CI 1.00-1.08), with O3 being the most significant.

CONCLUSIONS

This study demonstrates that short-term exposure to air pollution was significantly associated with higher risk of AECB. O3 might contribute the most to AECB. Policymakers should pay more attention to air pollution control.

Air Pollutants Associated Hospitalization in Pediatric Pneumonia: A National Database Analysis

BACKGROUND

Pneumonia ranks as a leading contributor to hospital admissions and mortality among children worldwide. This study aimed to investigate the association between aerosol components of air pollution and pediatric pneumonia hospitalization.

METHODS

Employing an observational study design, data from hospitalized children under 15 years diagnosed with pneumonia in Thailand from 2015 to 2019 were analyzed to ascertain the relationship between air pollution and health outcomes. Utilizing the Modern-Era Retrospective analysis for Research and Application version 2 (MERRA-2) data for aerosol components, and adjusting for demographic and geographical factors, using Poisson regression models.

RESULTS

A total of 732,700 children were hospitalized with pneumonia, with children under the age of five accounting for the majority of admissions (637,313 cases, 86.9%). Dust had the strongest association with the incidence rate ratio of hospitalization in children with pneumonia across all age groups. The incidence rate ratio was 1.288 (95% CI: 1.271-1.304, p < 0.001), 1.392 (95%CI: 1.344-1.442, p < 0.001), and 1.349 (95%CI: 1.265-1.439, p < 0.001) for children under the age of 5, 5 to under 10, and 10 to under 15, respectively. The association of hospitalization among children with pneumonia increased by 21.0% and 13.8% for each 1 μg/m3 increase in black carbon and dust levels, respectively.

CONCLUSION

The findings reveal a compelling link between certain air pollutants and pediatric pneumonia hospitalization, highlighting the urgent need for targeted interventions to mitigate air pollution's adverse effects.

Exposure to major coronary heart disease events reduces lung cancer risk: a mendelian randomization study based on a European population

OBJECTIVE

This study seeks to elucidate the causal relationship between major coronary heart disease events (MCHDE) and lung cancer incidence through mendelian randomization (MR), with the goal of providing evidence to inform more effective lung cancer screening and prevention strategies.

METHODS

Utilizing data from the IEU OpenGWAS project and FinnGen, this study employed a two-sample MR approach, with genetic variants serving as instrumental variables. Relevant single nucleotide polymorphisms (SNPs) associated with MCHDE and lung cancer were carefully selected, with particular attention given to mitigating potential confounders, such as smoking behaviors and statin use.

RESULTS

The MR analysis, utilizing FinnGen's MCHDE as the exposure factor, revealed a significant reduction in the incidence of non-small cell lung cancer (NSCLC) [odds ratio (OR) 0.893, 95% confidence interval (CI) 0.800-0.998] and small cell lung cancer (SCLC) [OR 0.684, 95% CI 0.500-0.936], highlighting the protective effect of MCHDE against these cancer subtypes. However, this protective effect was not observed for other types of lung cancer. Furthermore, substituting FinnGen's MCHDE with that from IEU OpenGWAS did not yield similar protective effects across various lung cancer subtypes.

CONCLUSIONS

This study suggests that MCHDE reduce the risk of NSCLC in the U.K. population and SCLC in the Finnish population. However, given that the underlying mechanism through which MCHDE reduces the risk of NSCLC and SCLC remains unclear, it is premature to conclude that individuals exposed to MCHDE do not require lung cancer screening.

Green sanctuaries: residential green and garden space and the natural environment mitigate mental disorders risk of diabetic patients

BACKGROUND

The co-occurrence of diabetes and mental disorders is an exceedingly common comorbidity with poor prognosis. We aim to investigate the impact of green space, garden space, and the natural environment on the risk of mental disorders among the population living with diabetes.

METHODS

We performed a longitudinal analysis based on 39,397 participants with diabetes from the UK Biobank. Residential green and garden space modeled from land use data and the natural environment from Land Cover Map were assigned to the residential address for each participant. Cox proportional hazards model was used to analyze the associations between nature exposures and mental disorders of diabetes. Casual mediation analysis was used to quantify indirect effect of air pollution.

RESULTS

During a mean follow-up of 7.55 years, 4513 incident mental disorders cases were identified, including 2952 depressive disorders and 1209 anxiety disorders. Participants with natural environment at 300 m buffer in the second and third tertiles had 7% (HR = 0.93, 95%CI: 0.86-0.99) and 12% (HR = 0.88, 95%CI: 0.82-0.94) lower risks of incident mental disorders compared with those in the first tertile, respectively. The risk of mental disorders incidence among diabetes patients will decrease by 13% when exposed to the third tertile of garden space at 300 m buffer. The natural environment and garden space individually prevented 6.65% and 10.18% of mental disorders incidents among diabetes patients. The risk of incident mental disorders was statistically decreased when exposed to the third tertile of green space at 1000 m buffer (HR = 0.84, 95% CI: 0.78-0.90). Protective effects of three nature exposures against depressive and anxiety disorders in diabetes patients were also observed. Air pollution, particularly nitrogen dioxide, nitrogen oxides, and fine particulate matter, significantly contributed to the associations between nature exposures and mental disorders, mediating 48.3%, 29.2%, and 62.4% of the associations, respectively.

CONCLUSIONS

Residential green and garden space and the natural environment could mitigate mental disorders risk in diabetes patients, with air pollution playing a vital mediator. This highlights the potential for local governments to enhance the sustainability of such interventions, grounded in public health and urban planning, through strategic planning initiatives.

Genetic evidence for the causal effects of air pollution on the risk of respiratory diseases

BACKGROUND

Epidemiological studies have consistently demonstrated a robust association between long-term exposure to air pollutants and respiratory diseases. However, establishing causal relationships remains challenging due to residual confounding in observational studies. In this study, Mendelian randomization (MR) analysis was used to explore the causal and epigenetic relationships between various air pollutants and common respiratory diseases.

METHODS

We utilized a two-sample Mendelian randomization (TSMR) approach to explore the impact of PM2.5, PM2.5-10, PM10, NO2, and NOX on the incidence of nine respiratory diseases using data from large-scale European GWAS datasets (N = 423,796-456,380 for exposures; N = 162,962-486,484 for outcomes). The primary analytical method was inverse variance weighting (IVW), which explored the exposure-outcome relationship using single nucleotide polymorphisms (SNPs) associated with air pollution. Sensitivity analyses, including MR-Egger regression and leave-one-out analyses, were employed to ensure result consistency. Multivariate MR (MVMR) was performed to adjust for potential smoking-related confounders, such as cigarettes per day, household smoking, exposure to tobacco smoke at home, ever smoked, second-hand smoke, smoking initiation, and age at smoking initiation, as well as the independent effects of each air pollutant. Additionally, methylation and enrichment analyses were conducted to further elucidate the potential effects of air pollution on respiratory diseases.

RESULTS

TSMR analysis revealed that exposure to PM2.5 increased the risk of early-onset chronic obstructive pulmonary disease (COPD), pneumonia, pulmonary embolism and lung cancer. PM2.5-10 exposure was associated with an increased risk of lung cancer, while PM10 exposure increased the risk of pneumonia and bronchiectasis. NO2 exposure was associated with increased risks of lung cancer and adult asthma. Importantly, these associations remained robust even after controlling for potential tobacco-related confounders in the MVMR analyses. In the MVMR analysis adjusting for other pollutants, significant associations persisted between PM2.5 and early-onset COPD, and between PM10 and pneumonia. Genetic co-localization analyses confirmed that methylation of PM2.5-associated CpG loci (cg11386376 near c1orf175, cg11846064 near rfx2, cg18612040 near rptor, and cg19765378 near c7orf50) was associated with an increased risk of early-onset COPD. Finally, SNPs significantly associated with exposure and outcome were selected for enrichment analysis.

CONCLUSIONS

Our findings suggest that exposure to air pollutants may play a causal role in the development of respiratory diseases, with a potential role of epigenomic modifications emphasized. Strengthening comprehensive air pollution regulations by relevant authorities could potentially mitigate the risk of these diseases.

Moderate PM10 exposure increases prostate cancer: a longitudinal nationwide cohort study (2010-2020)

Introduction

Fine dust exposure has been reported to affect patients with prostate cancer, making it crucial to understand how environmental pollutants impact health. This study aimed to determine the risk of prostate cancer in South Korea associated with moderate levels of fine dust (PM10) exposure.

Methods

We analyzed data from 20,430 individuals in the National Health Insurance Sharing Service database from 2010 to 2020, comparing a new prostate cancer group (n = 4,071, 19.9%) with a non-prostate cancer group (n = 16,359, 80.1%). Using PM10 data from Air Korea's annual average air quality database, we conducted logistic regression analysis to assess the risk of prostate cancer.

Results

Our findings indicate that even moderate PM10 exposure is a risk factor for developing prostate cancer. Additionally, even at low levels of PM2.5, moderate PM10 exposure significantly impacts prostate cancer development, with lifestyle ha bits potentially lowering this risk.

Discussion

These results underscore the need for stricter environmental standards for PM10 and proactive policies to reduce public health and long-term social costs. Public awareness, including mask use and air quality management, is essential.

Air pollution and breast cancer risk: a Mendelian randomization study

Previous research yields inconsistent findings on the association between air pollution and breast cancer risk, with no definitive causal relationship established. To address this, we conducted a two-sample Mendelian randomization study on data from the IEU open GWAS databases and the Breast Cancer Association Consortium to explore the potential link between air pollution (including PM2.5, PM2.5 absorbance, PM2.5-10, PM10, NO2, and NOx) and breast cancer risk. We found that PM10 (odds ratio (OR) = 1.39, 95% CI: 1.07-1.80, p = 0.013) and NOx (OR = 1.67, 95% CI: 1.16-2.41, p = 0.006) were significantly associated with elevated breast cancer risk. Furthermore, PM2.5 (OR = 2.10, 95% CI: 1.09-4.03, p = 0.027) and NOx (OR = 3.08, 95% CI: 1.24-7.64, p = 0.015) were significantly associated with an elevated risk of luminal B/HER2-negative-like cancer. Results were stable in sensitivity analyses. This suggested that controlling air pollution could potentially reduce breast cancer risk.

Associations of short-term exposure to air pollution with risk of pulmonary space-occupying lesions morbidity based on a time-series study

BACKGROUND

Pulmonary space-occupying lesions are typical chronic pulmonary diseases that contribute significantly to healthcare resource use and impose a large disease burden in China. A time-series ecological trend study was conducted to investigate the associations between environmental factors and hospitalizations for pulmonary space-occupying lesions in North of China from 2014 to 2022.

METHODS

The DLNM was used to quantify the association of environmental factors with lung cancer admissions. The heating-, age-, gender-, malignancy-specific effects were further estimated to identify the susceptible groups.

RESULTS

During the study period, fluctuations in air pollutants and climate conditions closely mirrored changes in hospitalizations for pulmonary space-occupying lesions. Totally, the distributed lag surface showed clear positive associations between pulmonary tumor hospitalization and PM2.5 (RRlag30: 1.000912; 95%CI: 1.000076, 1.00175), PM10 (RRlag30: 1.002246; 95%CI: 1.000474, 1.004021), SO2 (RRlag30: 1.002714; 95%CI: 1.001071, 1.004414), CO (RRlag30: 1.002231; 95%CI: 1.000592, 1.003873). Additionally, the associations between air pollutants and hospitalizations for pulmonary space-occupying lesions were significantly stronger during the heating season. Population aged 65 or older, females and those diagnosed with malignancies were more vulnerable for the risk of pulmonary space-occupying lesions diseases due to air pollution exposure.

CONCLUSIONS

The present study illustrated risk and burden for pulmonary space-occupying lesions hospitalization associated with air pollution, especially among population aged ≥ 65, or female.

Global, regional and national burden of tracheal, bronchus, and lung cancer attributable to ambient particulate matter pollution from 1990 to 2021: an analysis of the global burden of disease study

BACKGROUND

The ambient particulate matter pollution may play a critical role in the initiation and development of tracheal, bronchus, and lung (TBL) cancer. Up to now, far too little attention has been paid to TBL cancer attributable to ambient particulate matter pollution. This study aims to assess the disease burden of TBL cancer attributable to ambient particulate matter pollution in global, regional and national from 1990 to 2021 to update the epidemiology data of this disease.

METHODS

Leveraging data from the Global Burden of Disease (GBD) 2021 study, we analyzed the worldwide burden of TBL cancer resulting from ambient particulate matter pollution using indices including disability-adjusted life years (DALYs), age-standardised rate of DALYs (ASDR). This burden was further segmented based on variables including geographical location, and socio-demographic index (SDI), age and sex.

RESULTS

The ASDR per 100,000 population of TBL cancer attributable to ambient particulate matter pollution increased by 0.2%[95% UI 0.1 to 0.3] to 79.6[95% UI 49.0 to 111.2] from 1990 to 2021 Globally. Middle-aged and elderly individuals accounted for the majority of the disease burden, with the highest value at the 65-69 years. Most of the disease burden was concentrated in countries with High-middle SDI. There was a positive correlation between ASDR of TBL cancer due to particulate matter pollution and the SDI(ρ = 0.66, p < 0.001). East Asia and Central Europe exhibited higher observed values than the fitted curves, while such as Austraiasia South Asia and Western Sub-Saharan Africa had a lower observed values than the fitted curves. Decomposition analysis showed that population aging and growth were the two major drivers of the increase in DALYs.

CONCLUSIONS

The disease burden of TBL cancer attributable to ambient particulate matter pollution has increased, especially in regions and countries with High-middle SDI.

The role of PM2.5 exposure in lung cancer: mechanisms, genetic factors, and clinical implications

Lung cancer is one of the most critical global health threats, as the second most common cancer and leading cause of cancer deaths globally. While smoking is the primary risk factor, an increasing number of cases occur in nonsmokers, with lung cancer in nonsmokers (LCNS) now recognized as the fifth leading cause of cancer mortality worldwide. Recent evidence identifies air pollution, particularly fine particulate matter (PM2.5), as a significant risk factor in LCNS. PM2.5 can increase oxidative stress and inflammation, induce genetic alterations and activation of oncogenes (including the epidermal growth factor receptor, EGFR), and contribute to lung cancer progression. This review summarizes the current understanding of how exposure to PM2.5 induces lung carcinogenesis and accelerates lung cancer development. It underscores the importance of prevention and early detection while calling for targeted therapies to combat the detrimental effects of air pollution. An integrated approach that combines research, public health policy, and clinical practice is essential to reduce the lung cancer burden and improve outcomes for those affected by PM2.5 exposurrre.

Bioinformatics-based modeling of lung squamous cell carcinoma prognosis and prediction of immunotherapy response

Lung squamous cell carcinoma (LUSC) is a subtype of non-small cell lung cancer. It has a grim prognosis for patients, primarily because the disease often remains asymptomatic in its early stages. As a result, it is frequently diagnosed at an advanced stage, limiting treatment options. This underscores the importance of studying potential biomarkers and developing personalized treatment strategies. In this study, we used an advanced bioinformatics approach, integrating two authoritative databases, NCBI's GEO and TCGA, to perform a large-scale cross-platform gene expression analysis. To deeply mine the gene expression data of a large number of lung squamous carcinoma samples, we used a screening strategy based on median absolute deviation to select genes that differed significantly in multiple datasets. The expression variations of these genes between normal and cancerous tissues provided us with valuable clues revealing key molecules that may be involved in the disease process. Through rigorous statistical tests, we identified 36 genes that were significantly associated with patient survival, and further constructed a model using Cox proportional risk model containing 11 key genes (MRPL40, GABPB1AS1, PTPN3, SNCA, PYGB, RAP1, VDR, PHPT1, KIAA0100, TBC1D30, CYP7B1) in a risk prediction model. The prediction model not only reflects the strong correlation between gene expression and LUSC prognosis, but also provides clinicians with an effective tool to predict patients' survival prospects. In the future, this model is expected to guide the development of individualized treatment plans, thereby improving the quality of life and overall prognosis of patients.

Health Risks of Asphalt Emission: State-of-the-Art Advances and Research Gaps

Asphalt-related emissions pose significant health risks due to the release of volatile organic compounds (VOCs) that affect both workers in construction and the general public. Even at low concentrations, certain VOCs are highly toxic, with some of their metabolic byproducts, such as epoxides, known to cause DNA damage, oxidative stress, and other genetic alterations. The health implications are particularly concerning given that these emissions are persistent, and exposure can occur over prolonged periods, especially in urban areas where asphalt is prevalent. However, despite growing awareness, there remain significant gaps in our understanding of the long-term effects of chronic, low-level exposure to asphalt VOCs. Research to date has largely focused on acute exposure effects, particularly in occupational settings, leaving much unknown about the broader impact on the general public, especially vulnerable groups like children and the elderly. Moreover, the complex interactions between asphalt-derived VOCs and other environmental pollutants are not well understood, further complicating our understanding of their cumulative health impact. This paper provides a comprehensive overview of the current research landscape, starting with a discussion of the health risks associated with asphalt VOCs, supported by key findings from recent studies. It then explores the latest technological advancements in VOC detection, characterization, and monitoring, and identifies critical gaps in existing research.

An efficient interpretable stacking ensemble model for lung cancer prognosis

Lung cancer significantly contributes to global cancer mortality, posing challenges in clinical management. Early detection and accurate prognosis are crucial for improving patient outcomes. This study develops an interpretable stacking ensemble model (SEM) for lung cancer prognosis prediction and identifies key risk factors. Using a Kaggle dataset of 1000 patients with 22 variables, the model classifies prognosis into Low, Medium, and High-risk categories. The bootstrap method was employed for evaluation metrics, while SHAP (Shapley Additive Explanations) and LIME (Local Interpretable Model-agnostic Explanations) assessed model interpretability. Results showed SEM's superior interpretability over traditional models, such as Random Forest, Logistic Regression, Decision Tree, Gradient Boosting Machine, Extreme Gradient Boosting Machine, and Light Gradient Boosting Machine. SEM achieved an accuracy of 98.90 %, precision of 98.70 %, F1 score of 98.85 %, sensitivity of 98.77 %, specificity of 95.45 %, Cohen's kappa value of 94.56 %, and an AUC of 98.10 %. The SEM demonstrated robust performance in lung cancer prognosis, revealing chronic lung cancer and genetic risk as major factors.

Lung cancer screening in India: Preparing for the future using smart tools & biomarkers to identify highest risk individuals

There is a growing burden of lung cancer cases in India, incidence projected to increase from 63,708 cases (2015) to 81,219 cases (2025). The increasing numbers are attributed to smoking (India currently has nearly 100 million adult smokers) and environmental pollution. Most patients present with advanced disease (80-85% are incurable), causing nearly 60,000 annual deaths from lung cancer. Early detection through lung cancer screening (LCS) can result in curative therapies for earlier stages of lung cancer and improved survival. Annual low-dose computerized tomography (LDCT) is the standard method for LCS. Usually, high-risk populations (age>50 yr and >20 pack-years of smoking) are considered for LCS, but even such focused screening may be challenging in resource-limited countries like India. However, developing a smart LCS programme with high yield may be possible by leveraging demographic and genomic data, use of smart tools, and judicious use of blood-based biomarkers. Developing this model over the next several years will facilitate a structured cancer screening programme for populations at the highest risk of lung cancer. In this paper, we discuss the demographics of lung cancer in India and its relation to smoking patterns. Further, we elaborate on the potential applications and challenges of bringing a smart approach to LCS in high-risk populations in India.

Current status and perspectives in environmental oncology

Cancer stands as a leading global cause of death, with its etiology characterized by complexity and multifaceted factors. Growing research indicates a strong correlation between environmental factors and cancer incidence, underscoring the critical importance of intervening in environmental risk factors to mitigate cancer occurrence. Despite this, specialized research institutions focusing on the intersection of environment and cancer remain scarce, with global investment in cancer prevention significantly trailing behind efforts in diagnosis and treatment. Against the backdrop of rapid global climate change, industrialization, urbanization, aging populations, and the globalization of lifestyles, we proposed the concept of Environmental Oncology (EO) to address these challenges. We discussed the rationale and necessity of developing EO and presented a comprehensive research framework focusing on cancer prevention and treatment. Future EO research will aim to identify cancer causes and implement early prevention strategies using advanced scientific technologies and methods. By emphasizing multidisciplinary collaboration and integrating molecular biology at the micro level, EO will explore the relationship between external and internal environments and cancer. EO will identify potential therapeutic targets by studying the pathways through which environmental exposures lead to carcinogenesis. EO will develop early warning systems and disseminate research findings by collecting big data, employing robust statistical models, and establishing research centers.

Exposure to air pollution increases susceptibility to ulcerative colitis through epigenetic alterations in CXCR2 and MHC class III region

BACKGROUND

This study aims to confirm the associations of air pollution with ulcerative colitis (UC) and Crohn's disease (CD); to explore interactions with genetics and lifestyle; and to characterize potential epigenetic mechanisms.

METHODS

We identified over 450,000 individuals from the UK Biobank and investigated the relationship between air pollution and incident inflammatory bowel disease (IBD). Cox regression was utilized to calculate hazard ratios (HRs), while also exploring potential interactions with genetics and lifestyle factors. Additionally, we conducted epigenetic Mendelian randomization (MR) analyses to examine the association between air pollution-related DNA methylation and UC. Finally, our findings were validated through genome-wide DNA methylation analysis of UC, as well as co-localization and gene expression analyses.

FINDINGS

Higher exposures to NOx (HR = 1.20, 95% CI 1.05-1.38), NO2 (HR = 1.19, 95% CI = 1.03-1.36), PM2.5 (HR = 1.19, 95% CI = 1.05-1.36) and combined air pollution score (HR = 1.26, 95% CI = 1.11-1.45) were associated with incident UC but not CD. Interactions with genetic risk score and lifestyle were observed. In MR analysis, we found five and 22 methylated CpG sites related to PM2.5 and NO2 exposure to be significantly associated with UC. DNA methylation alterations at CXCR2 and sites within the MHC class III region, were validated in genome-wide DNA methylation analysis, co-localization analysis and analysis of colonic tissue.

INTERPRETATION

We report a potential causal association between air pollution and UC, modified by lifestyle and genetic influences. Biological pathways implicated include epigenetic alterations in key genetic loci, including CXCR2 and susceptible loci within MHC class III region.

FUNDING

Xue Li was supported by the Natural Science Fund for Distinguished Young Scholars of Zhejiang Province (LR22H260001) and the National Nature Science Foundation of China (No. 82204019). ET was supported by the CRUK Career Development Fellowship (C31250/A22804) and the Research Foundation Flanders (FWO). JW was supported by Belgium by a PhD Fellowship strategic basic research (SB) grant (1S06023N). JKN was supported by the National Science Center, Poland (No. 2020/39/D/NZ5/02720). The IBD Character was supported by the European Union's Seventh Framework Programme [FP7] grant IBD Character (No. 2858546).

Transgender and gender diverse individuals embodying endometriosis: a systematic review

Background

Transgender and gender diverse (TGD) people embody social and health inequalities that disproportionately affect this community more than the cisgender population. Endometriosis is a chronic condition of the reproductive tract that affects 5-10% of cisgender women. A recent systematic review with meta-analysis uncovered a pooled prevalence of 25.14% among TGD individuals undergoing gender-affirming surgeries.

Objective

This study aims to investigate the causes of the gap in prevalence of endometriosis between the TGD community and the cisgender population.

Methods

A systematic review with a fit-for-framework analysis was conducted. Results were analysed according to the adjusted developmental framework for embodiment with an intersectional approach. Sources were categorised in multi-levels relating to the framework mechanisms of expression, shaping, interaction, and incorporation.

Results

Four hundred twenty-three (423) studies published between 2001 and 2024 in English and Spanish were identified on the PubMed, Web of Science, Sociological abstracts, and PsycInfo databases. Thirty-two (32) peer-reviewed sources were selected.

Discussion

The higher prevalence of endometriosis among TGD people compared to the cisgender population reflects a complex phenomenon whereby individual biomedical characteristics, and psychological and environmental factors interplay on multiple levels throughout one's lifespan. The prevalence gap is striking in a context where TGD people experience great barriers and delays to access healthcare, and endometriosis is typically understood as a "women's disease." TGD people express lifestyle and environmental factors correlated with endometriosis more often than cisgender women, such as history of trauma, low self-image, obesity. Endometriosis interacts with one's quality of life, and especially with gendered expectations related to menstruations, family planning and sexuality. This interference can result in biographical disruption and gender self-perception changes in both cisgender and TGD people. Exogenous testosterone use as gender-affirming therapy results in amenorrhea in 80% of cases. However, endometrium and follicular activities are still reported upon testosterone use suggesting endometriosis may be active. It is hypothesised that testosterone use could lead to a hyper-estrogenic state that would stimulate endometriosis proliferation.

Air pollution exposure in active versus passive travel modes across five continents: A Bayesian random-effects meta-analysis

Epidemiological studies on health effects of air pollution usually estimate exposure at the residential address. However, ignoring daily mobility patterns may lead to biased exposure estimates, as documented in previous exposure studies. To improve the reliable integration of exposure related to mobility patterns into epidemiological studies, we conducted a systematic review of studies across all continents that measured air pollution concentrations in various modes of transport using portable sensors. To compare personal exposure across different transport modes, specifically active versus motorized modes, we estimated pairwise exposure ratios using a Bayesian random-effects meta-analysis. Overall, we included measurements of six air pollutants (black carbon (BC), carbon monoxide (CO), nitrogen dioxide (NO2), particulate matter (PM10, PM2.5) and ultrafine particles (UFP)) for seven modes of transport (i.e., walking, cycling, bus, car, motorcycle, overground, underground) from 52 published studies. Compared to active modes, users of motorized modes were consistently the most exposed to gaseous pollutants (CO and NO2). Cycling and walking were the most exposed to UFP compared to other modes. Active vs passive mode contrasts were mostly inconsistent for other particle metrics. Compared to active modes, bus users were consistently more exposed to PM10 and PM2.5, while car users, on average, were less exposed than pedestrians. Rail modes experienced both some lower exposures (compared to cyclists for PM10 and pedestrians for UFP) and higher exposures (compared to cyclist for PM2.5 and BC). Ratios calculated for motorcycles should be considered carefully due to the small number of studies, mostly conducted in Asia. Computing exposure ratios overcomes the heterogeneity in pollutant levels that may exist between continents and countries. However, formulating ratios on a global scale remains challenging owing to the disparities in available data between countries.

Association of healthy lifestyle factors and genetic liability with bipolar disorder: Findings from the UK Biobank

BACKGROUND

The interplay between genetic and lifestyle factors in the development of bipolar disorder (BD) remains unclear.

METHODS

A cohort study was carried out on 365,517 participants from the UK Biobank. Lifestyle scores, based on smoking, physical activity, diet, alcohol consumption, sedentary behavior, sleep duration, and social contact, were grouped as favorable (scores 6-7), intermediate (scores 4-5), or unfavorable (scores 0-3). The BD polygenic risk score (PRS) was also categorized into high, intermediate, and low-risk groups using PRS tertiles. Cox regression models determined hazard ratios (HRs) and 95 % confidence intervals (CIs) for BD.

RESULTS

During the 12.9-year follow-up, 529 individuals developed BD. Comparing those with favorable lifestyles to those with unfavorable participants, the HR of developing BD was 3.28 (95 % CI, 2.76-3.89). Similarly, individuals with a high PRS had a risk of 3.20 (95 % CI, 2.83-3.63) compared to those with a low PRS. Notably, individuals with both a high PRS and an unfavorable lifestyle had a significantly higher risk of BD (HR = 6.31, 95 % CI, 4.14-9.63) compared to those with a low PRS and a favorable lifestyle. Additionally, the interaction between PRS and lifestyle contributed an additional risk, with a relative excess risk of 1.74 (95 % CI, 0.40-3.07) and an attributable proportion due to the interaction of 0.37 (95 % CI, 0.16-0.58).

CONCLUSIONS

Our findings suggest that genetic liability for BD, measured as PRS, and lifestyle have an additive effect on the risk of developing BD. A favorable lifestyle was associated with a reduced risk of developing BD.

Planetary boundaries transgressions: A review on the implications to public health

This literature review systematically examines the impacts of violating planetary boundaries from 2009 to 2023, emphasizing the implications for human health. Planetary boundaries define safe operational limits for Earth's systems, and their transgression poses significant threats to environmental stability and public health. This paper reviews extensive research on the health effects of breaches in these boundaries, including climate change, biodiversity loss, freshwater use, and aerosol loading. The review integrates findings from numerous studies, providing a critical overview of health impacts across various global regions. The analysis underscores the intricate links between planetary boundaries breaching impacts, highlighting urgent policy and governance challenges. The study's outcomes aim to inform policymakers, businesses, and communities, promoting sustainable development and resilience in the face of escalating global challenges.