Earlier this year, Joan H. Schiller, MD, FACP, of the Lung Cancer Research Foundation; Oncology Screening Consultant Christine Berg, MD; and Stephen Lam, MD, of the University of British Columbia; in partnership with the IASLC’s Early Detection and Screening Committee’s Environmental Working Group, led the creation of an official position on air pollution from the association.
ILCN had the opportunity to ask Drs. Schiller, Berg, and Lam about the position statement and the importance of raising awareness about the health risks of air pollution. Read what they had to say in the following Q&A.
ILCN: Earlier this year, the IASLC’s Early Detection and Screening Committee’s Environmental Working Group led the creation of an official position statement on air pollution. Tell readers why it’s important for the association to have a position on air pollution.
Dr. Schiller: Air pollution and climate change are not just political issues, or environmental issues, they are also health issues. Of all the health calamities that can affect a person, cancer is among the worse. And air pollution and some of its constituents are carcinogens—cancer causing substances. The cancer they cause is lung cancer. As oncology health professionals, we have a duty to inform our patients and the public and do whatever we can to lessen the danger.
Dr. Berg: Air pollution is responsible for 15% of all lung cancer deaths worldwide, which makes it the second leading cause of lung cancer death. IASLC has championed tobacco control and cessation, which remains critically important. But as air pollution is growing worldwide, organizations should draw attention to the link between air pollution and lung cancer so that providers and patients can take appropriate measures to protect themselves.
Dr. Lam: The Global Burden of Disease 2019 study showed that globally, 15% percent of lung cancers can be attributed to fine particulate matter from sources like fossil fuel emissions and wildfires. The disease burden is second only to tobacco smoke. Recent studies in the US, Canada, and Europe found a significant association between chronic exposure to even low doses of fine particulate matter below current standards and guidelines, including the most stringent World Health Organization Air Quality Guideline.2,3 IASLC acts on air pollution because of the adverse health outcomes in lung cancer, other respiratory illnesses, coronary, and cerebrovascular diseases from air pollution exposure.
Beyond Tobacco: Environmental Risk Factors for Lung Cancer
- Time: 12:00-13:00 CEST
- Date: Tuesday, August 9
- Location: Hall C1 & On-Demand
ILCN: Authors of the statement noted that nearly 15% of lung cancer cases worldwide are thought to be caused by air pollution.1 However, air pollution often does not get the level of attention compared to other lung cancer causes such as smoking, radon, and asbestos. Are you seeing increased discussion of air pollution as a contributor to lung cancer since the release of the statement? Does the Detection and Screening Committee’s Environmental Working Group have upcoming plans for additional awareness or advocacy efforts regarding air pollution?
Dr. Schiller: There certainly is more attention within the cancer care community. In the past, oncologists and other oncology health providers were so focused on smoking and radon as environmental causes of lung cancer, they neglected air pollution, in part because we did not do a good job of making them aware of the danger. I am pleased to say that through the efforts of IASLC, more and more oncologists and allied health professionals—who always were always in the fight against climate change—now know that by combating air pollution and climate change they are also helping their cancer patients and other people at risk. We need to get the individuals who have not paid much attention to air pollution in the past engaged now.
Dr. Berg: Mentions of air pollution in the media are increasing. Statements such as IASLC’s can only help accelerate this trend. It will be important for IASLC to continue the educational sessions on the environmental risk factors for lung cancer at subsequent meetings. While I cannot speak for all members of the committee and their activities, there are other ideas in the planning stage. For example, an episode of the IASLC podcast Lung Cancer Considered addresses climate change, and it was well-received. Perhaps this mechanism can be used further in the coming year.
Dr. Lam: As the smoking rate continues to decline and the use of asbestos is banned or restricted in many parts of the world, there is increasing attention on the health effects of air pollution. This interest is heightened by climate change and increasing wildfire events. The Early Detection and Screening Committee’s Environmental Working Group has plans to publish a scientific paper on air pollution and lung cancer. During WCLC 2022, there will be an educational session on environmental risk factors for lung cancer.
ILCN: In addition to the statement, the working group has said a manuscript is in the works that will discuss a range of data regarding air pollution and its links to lung cancer. Can you give readers an update on that manuscript? How will the information in the manuscript help the profession in addressing the burden of air pollution?
Dr. Schiller: In addition to the white paper you mention, we have several other initiatives that we’re planning for the upcoming year. These include a symposium on air pollution and lung cancer, supporting research on the effects of air pollution on cancer care delivery, identifying ways to decrease the carbon footprint associated with international scientific meetings, and collaborating with other cancer organizations to come up with a united message and strategy.
Dr. Berg: In terms of the manuscript, an outline has been approved by the IASLC Executive Committee and the writing team has chosen sections to write. Further discussion will take place at IASLC as the original timeline has to be modified. The manuscript will provide an additional opportunity to raise awareness and provide ideas for practitioners to help protect their patients from the current burden of air pollution. It may also spur further action internationally to lower the amount of air pollution going forward.
ILCN: Specifically for Dr. Berg, on August 9, you will be moderating an educational session on environmental risk factors for lung cancer. Why would you recommend this session for WCLC attendees? How might the data presented inform clinicians’ thinking about who may be at an increased risk for lung cancer?
Dr. Berg: The WCLC program committee is to be congratulated for starting an Epidemiology Track, which Paolo Boffetta and I had the opportunity to chair. The track includes three sessions and posters. I would recommend IASLC members consider attending these air pollution and climate change talks. Our patients can benefit from our learning about these issues with these up-to-date talks, and IASLC members have an opportunity to ask questions of world experts.
Session ES32—Beyond Tobacco: Environmental Risk Factors for Lung Cancer—will feature presentations on the hazards of outdoor air pollution; indoor air pollution with a focus on Asian women without a smoking history; increasing natural disasters that are taking a toll on our patients with screening and treatment delays and importantly what changes are needed to reach the new WHO particulate standards Dr. Lam mentioned.
Another epidemiology session on Monday, August 8, focused on lung cancer in people who have never smoked, which is a more noticeable problem now that smoking is declining. And the oral abstract session, Evolving Epidemiology of Lung Cancer Beyond Tobacco, on Tuesday, August 9, will include an update on Renelle Myers’ excellent work on air pollution exposure in female non-smokers who have emigrated to Vancouver, British Columbia.
ILCN: Is there anything else you’d like to share with WCLC attendees about air pollution and why those working to prevent and treat thoracic cancers should care?
Dr. Berg: Air pollution and climate change affect all of us as individuals and affect our families. We need to learn about these issues and work together to ameliorate their toll.
Dr. Lam: Since the chronic exposure to air pollutants has significant adverse effects on lung health and there may not be a lower threshold that is safe, it is imperative that we restrict air emission targets to the lowest possible level and conduct further research into the pathophysiological and carcinogenic effects of pollutants.
- 1. Vohra K, Vodonos A, Schwartz J, et al: Global mortality from outdoor fine particle pollution generated by fossil fuel combustion: Results from GEOS-Chem. Environ Res 195:110754, 2021
- 2. Dominici F, Schwartz J, Di Q, Braun D, Choirat C., Zanobetti A. 2019. Assessing Adverse Health Effects of Long-Term Exposure to Low Levels of Ambient Air Pollution: Phase 1. Research Report 200. Boston, MA: Health Effects Institute
- 3. Brauer M, Brook JR, Christidis T, Chu Y, Crouse DL, Erickson A, et al. 2019. Mortality–Air Pollution Associations in LowExposure Environments (MAPLE): Phase 1. Research Report 203. Boston, MA: Health Effects Institute