Pollution and Progression: Air Quality and Stage of Lung Cancer Diagnosis across the U.S
Recommended Citation
Bell R, Graffy P, Ramdeen S, Siringan M, Horton D, Parker WF, Palis BE, Okereke I, Odell DD. Pollution and Progression: Air Quality and Stage of Lung Cancer Diagnosis across the U.S. J Clin Oncol 2026; 44(16_suppl):8003.
Document Type
Conference Proceeding
Publication Date
5-27-2026
Publication Title
J Clin Oncol
Keywords
adult, air pollution, air quality, cancer diagnosis, cancer growth, cancer incidence, cancer screening, conference abstract, controlled study, diagnosis, environmental factor, epidemiology, female, histology, household income, human, human tissue, low socioeconomic status, lung cancer, major clinical study, male, middle aged, pollution exposure, small cell carcinoma, social status, squamous cell carcinoma, tumor growth
Abstract
Background: Air pollution contributes to increased lung cancer incidence, but whether it accelerates tumor progression, resulting in more advanced stage at diagnosis, is not well understood. Understanding environmental and social factors influencing late-stage presentation can guide targeted prevention efforts. Methods: We identified primary lung cancer cases from the National Cancer Database (NCDB; 2010–2023) across 2, 803 U.S. counties. Individual-level data were linked to county-level annual averages of PM₂.₅ (μg/m³) and NO₂ (ppb). Generalized estimating equation logistic models with county-level clustering assessed associations between chronic pollution exposure and odds of advanced-stage (III–IV vs. I–II) diagnosis, adjusting for median household income and educational attainment. Pollutants were z-score standardized (mean = 0, SD = 1) and summed to create a combined Pollution Burden metric. Effect modification by histology and socioeconomic status was tested. Results: Among 1, 023, 140 patients (mean age 68.5 ± 10.8 years; 51.3% female), 67.1% presented with advanced-stage disease. Each standard deviation increase in PM₂.₅ was associated with 4.8% higher odds of advanced-stage diagnosis (95% CI: 3.5–6.1%; p < 0.001; Table 1). In multi-pollutant models, PM₂.₅ remained significant (OR = 1.062, 95% CI: 1.047–1.076; p < 0.001), with combined pollution burden linked to a 3.1% increase in odds (95% CI: 1.5–4.7%; p < 0.001). Low-SES communities had higher advanced-stage rates regardless of pollution exposure (69.7% vs. 63.6%; p < 0.001), equating to approximately 6, 100 excess annual diagnoses. Effects varied by histology, with small cell carcinoma showing the highest advanced-stage rate (91.2%), followed by adenocarcinoma (67.3%) and squamous cell carcinoma (58.6%). Conclusions: Higher PM₂.₅ exposure and lower socioeconomic status were independently associated with later-stage lung cancer diagnosis across over 1 million cases from 2, 803 U.S. counties. Low-SES communities showed 6 percentage points higher advanced-stage rates irrespective of pollution levels. These findings highlight how environmental factors that may accelerate cancer progression and social barriers to accessing care can jointly delay early-stage diagnosis. Targeted pollution control and expanded lung cancer screening in underserved communities could reduce the burden of advanced-stage disease.
Volume
44
Issue
16_suppl
First Page
8003
