Air Pollution Emerges as Second Leading Risk Factor for Lung Cancer Deaths

In an analysis of Global Burden of Disease data across the 10 most populous countries from 1990 to 2019 published in eClinicalMedicine, tobacco remained the leading risk factor for lung cancer mortality, but air pollution-associated lung cancer mortality increased by 25% globally.¹ Asbestos-associated mortality declined overall, but the rate in the US remained twice the global average.

Chinmay Jani, MD, a medical oncologist at Sylvester Comprehensive Cancer Center of the University of Miami Miller School of Medicine, spoke with CancerNetwork^® in a studio interview about what the study showed regarding contributors to lung cancer deaths beyond tobacco, and which factor he believes is most underappreciated.

Watch or listen to the full conversation for additional insights on lung cancer risk factors and targeted therapy advances.

Transcript:

CancerNetwork: Your study in eClinicalMedicine looked at how much air pollution, asbestos, and other exposures contribute to lung cancer deaths. What did you find, and which of these factors do you think is most underappreciated?

Jani: In this study, one of the main objectives was to look at what other risk factors are impacting lung cancer, especially risk factors beyond tobacco. We knew tobacco has been the number one risk factor, and it still is, but the peak of tobacco smoking and chewing was reached almost a decade ago in most countries, and globally as well…For female [patients], the peak of tobacco consumption has always lagged by around 10 years, but even that has almost been reached. Beyond that, we will start seeing a decline in tobacco-associated lung cancer incidence and mortality, and that’s what we really wanted to look into.

I think the most impactful thing we were able to show was that the second most common risk factor was air pollution, with almost a 25% increase in air pollution-associated lung cancer mortality globally, and in many countries, air pollution accounted for almost 25% to 30% of lung cancer deaths. When we looked particularly at the female population, air pollution-associated deaths were [approaching the number] associated with tobacco. We also looked at other risk factors like asbestos and radon.

But something I really wanted to highlight is that for male [patients] right now, 30% of lung cancer deaths do not have a tobacco history, and for female [patients] at the global level, almost 40% to 45% of lung cancer deaths do not have any history of tobacco.

Reference

Jani CT, Kareff SA, Morgenstern-Kaplan D, et al. Evolving trends in lung cancer risk factors in the ten most populous countries: an analysis of data from the 2019 Global Burden of Disease Study. eClinicalMedicine. 2025;79:103033. doi:10.1016/j.eclinm.2024.103033