Jorge Nieva<\/b><\/strong><\/p>\n<\/div>\n The finding suggests an environmental risk factor \u2014 possibly residue from pesticides used to protect commercially produced crops from disease, weeds or pests \u2014 could be contributing to the trend, Jorge Nieva, MD,<\/b> medical oncologist and lung cancer specialist at USC Norris Comprehensive Cancer Center, and colleagues concluded.<\/p>\n
\u201cA healthy diet is very important, but people who consume diets that are high in fruits, vegetables and whole grains consume about three times the average pesticide exposure as people who eat a standard American diet,\u201d Nieva told Healio. \u201cIt makes us wonder if something in food is driving this.\u201d<\/p>\n
\u2018What is going on?\u2019<\/h2>\n In the 1980s, multiple reports by U.S. Surgeon General C. Everett Koo<\/b>p, MD, FACS,<\/b> emphasized the detrimental health impacts of smoking and exposure to second-hand smoke.<\/p>\n
The percentage of U.S. adults who smoked cigarettes, already on the decline from a peak of about 45% in the 1960s, dropped sharply until reaching an all-time low of 9.9% in 2024.<\/p>\n
As smoking declined, so did lung cancer incidence nationwide \u2014 except among nonsmokers aged 50 years or younger.<\/p>\n
Cancers among younger individuals are biologically distinct from lung cancer in older adults. They often harbor actionable driver mutations, such as EGFR<\/i> mutations or ALK<\/i> rearrangements, and they disproportionately affect women.<\/p>\n
\u201cMen and women stopped smoking at approximately the same rate, but incidence of lung cancer among men declined while incidence among women did not. Women have not had what I call the smoking cessation dividend,\u201d Nieva said. \u201cWe\u2019re now seeing around 20,000 to 25,000 lung cancer deaths in the United States each year among nonsmokers. That is more than non-Hodgkin lymphoma or leukemia, so it certainly is not rare. We need to start asking what is going on and what has changed.\u201d<\/p>\n
Nieva and colleagues hypothesized that an alternative carcinogenic pathway \u2014 one that likely emerged around the mid-1980s and has greater effect on women \u2014 could be involved.<\/p>\n
Researchers collaborated with the Addario Lung Cancer Medical Institute and GO2 for Lung Cancer to launch the multi-institutional, observational Epidemiology of Young Lung Cancer study.<\/p>\n
At this year\u2019s American Association for Cancer Research Annual Meeting, Nieva and colleagues presented findings from an analysis of 187 people (78.1% women; 76.4% non-Hispanic white) diagnosed with non-small cell lung cancer prior to age 40.<\/p>\n
Participants completed epidemiological surveys that assessed demographics, physical activity, smoking history and oral contraceptive use. They also completed validated food frequency questionnaires.<\/p>\n
Researchers obtained information about tumor genomics and classified study participants by biological pathway of driver mutations, with 43.9% classified as fusion positive (ALK<\/i>, ROS1<\/i>, RET<\/i> or NTRK<\/i>), 39% classified as having mutations in the EGFR<\/i> pathway, and 17.1% determined to have other or mixed mutations (eg, KRAS<\/i>, BRAF<\/i>, MET<\/i>, etc.).<\/p>\nMaking the connection<\/h2>\n
About 70% of participants overall had never smoked, though percentages varied by pathway group (EGFR<\/i>, 60.3%; fusion positive, 79.3%; other\/mixed, 68.8%).<\/p>\n
\u201cThe epidemiologic surveys did not show anything that stood out as an obvious or conventional exposure, such as radon or something related to the part of the country where they grew up,\u201d Nieva said.<\/p>\n
However, when researchers assessed diet quality using the Healthy Eating Index (HEI)-2020 \u2014 a measure of how well food consumption aligns with recommendations in national dietary guidelines \u2014 they observed an unusual pattern.<\/p>\n
Results showed higher HEI-2020 scores \u2014 based on a 100-point scale \u2014 among those in the EGFR<\/i> pathway group (64.94) and fusion-positive group (65.26) than the national average (57) as calculated from National Health and Nutrition Examination Survey questionnaires. Women had higher scores than men.<\/p>\n
In addition, a comparison of HEI component scores\u2014 measured on 5-point scales \u2014 revealed higher consumption of pesticide-prone food categories in the study cohort than the general population. This finding remained consistent for consumption of total vegetables (4.2 vs. 3.5), dark green vegetables and legumes (4.3 vs. 3.6), total fruit (3.3 vs. 2.5), whole fruit (3.9 vs. 3.8) and whole grains (3.9 vs. 2.6).<\/p>\n
\u201cThis was not an association we were really looking for, and it\u2019s not something we expected,\u201d Nieva said. \u201cIt is counterintuitive.\u201d<\/p>\n
The hypothesis that elevated pesticide exposure may contribute to lung cancer risk among individuals who consume more fruit, vegetables and whole grains is strengthened by prior research that examined the impact of certain occupational exposures.<\/p>\n
Findings from a study published in Occupational & Environmental Medicine<\/i> showed agricultural workers who use pesticides have more than double the risk for lung cancer than the general population (HR = 2.38; 95% CI, 1.07-5.28).<\/p>\n
\u201cI don\u2019t think we would have made the connection [between diet and lung cancer] if it weren\u2019t for the prior study of occupational exposure among pesticide sprayers,\u201d Nieva said.<\/p>\n
\u2018An epidemic\u2019<\/h2>\n Nieva and colleagues reported \u201cconsistently elevated\u201d use of oral contraceptives among the young individuals with lung cancer.<\/p>\n
Oral contraceptives contain progestin and estrogen. These synthetic hormones act as endocrine disruptors to prevent ovulation.<\/p>\n
Many pesticides also fall into the category of endocrine-disrupting chemicals, which interfere with the body\u2019s hormonal system and also can interact with estrogen receptors frequently observed in lung cancers among younger individuals.<\/p>\n
\u201cOur hypothesis is that one of the endocrine-disruptive chemicals is leading to signaling growth and proliferation, and that may be what is causing lung cancer in young people,\u201d Nieva said.<\/p>\n
For now, washing fruits and vegetables \u2014 and purchasing organically grown food \u2014 can help reduce the potential risks of pesticide exposure, Nieva said.<\/p>\n
More investigation will be necessary to clarify if or how these chemicals affect lung cancer risk among younger individuals. A key next step will be getting \u201cmore drilled-down exposure histories\u201d and using blood or urine samples to measure levels of specific chemical entities, Nieva said.<\/p>\n
This type of work ultimately could inform lung cancer prevention strategies or public health recommendations, but funding will be essential to move research forward, Nieva said.<\/p>\n
\u201cWe have a Health and Human Services secretary who is very interested in healthy habits and the connection between lifestyle and disease,\u201d Nieva said. \u201cMy hope is that this spawns a desire to provide grants or other funding for very exciting research projects around this hypothesis and explore what amounts to an epidemic that shouldn\u2019t be there.<\/p>\n
\u201cIt\u2019s hidden, because lung cancer incidence is going down,\u201d he added. \u201cEverybody thinks we\u2019re doing a great job with lung cancer because we\u2019re seeing fewer cases and people aren\u2019t smoking as much. But we\u2019re not recognizing that cases among nonsmokers are going up, and we need to understand why.\u201d<\/p>\n
For more information:<\/h2>\n Jorge Nieva, MD,<\/b> can be reached at jorge.nieva@med.usc.edu.<\/p>\n\n
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Published by:<\/span>\n
Sources\/Disclosures<\/h3>\n Source: <\/h2>\n Gorbatov SD, et al. Abstract 5039. Presented at: American Association for Cancer Research Annual Meeting; April 17-22, 2026; San Diego.<\/p>\n
References:<\/h2>\n\n Agaku I. NEJM Evid<\/i>. 2026;doi:10.1056\/EVIDpha2500339.<\/li>\n Boulanger M, et al. Occup Environ Med<\/i>. 2018;doi:10.1136\/oemed-2017-104976.<\/li>\n de Groot PM, et al. Transl Lung Cancer Res<\/i>. 2018;doi:10.21037\/tlcr.2018.05.06.<\/li>\nEating fruits, vegetables and whole grains may increase chance of early onset lung cancer. https:\/\/news.keckmedicine.org\/eating-fruits-vegetables-and-whole-grains-may-increase-chance-of-early-onset-lung-cancer\/#. Published April 17, 2026. Accessed April 21, 2026.<\/li>\n Islami F, et al. CA Cancer J Clin<\/i>. 2025;doi:10.3322\/caac.70005.<\/li>\nLung cancer risks for people who don’t smoke. https:\/\/www.cancer.org\/cancer\/latest-news\/why-lung-cancer-strikes-nonsmokers.html. Published Oct. 14, 2020. Accessed April 21, 2026.<\/li>\n New study inks dietary exposures to lung cancer in younger adults. https:\/\/go2.org\/blog\/new-study-links-dietary-exposures-to-lung-cancer-in-younger-adults. Published April 17, 2026. Accessed April 21, 2026.<\/li>\n<\/ul>\n\n
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