---
title: "Dietary and Lifestyle Patterns in Young Lung Cancer Patients: Mutation-Specific Analysis"
id: "pubmed-42233968"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42233968"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42233968/"
doi: "10.1158/1055-9965.EPI-26-0057"
published_at: "2026-08-03T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Dietary and Lifestyle Patterns in Young Lung Cancer Patients: Mutation-Specific Analysis
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42233968
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42233968/)
- **DOI:** [10.1158/1055-9965.EPI-26-0057](https://doi.org/10.1158%2F1055-9965.EPI-26-0057)
- **Published At:** 2026-08-03T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Young-onset **lung cancer** shows distinct biology: 84% of patients harbor targetable mutations and most are female non-smokers. Environmental and lifestyle exposures in this group are poorly characterized. - The Epidemiology of Young Lung Cancer cohort included 187 patients; dietary analysis used a subset with complete data (n=169) divided by mutation-based pathway groups: **EGFR Pathway** (EGFR + ERBB2), Fusion-Positive (ALK + ROS1 + RET + NTRK), and Other/Mixed Mutations (KRAS, BRAF, MET exon 14 skipping, TP53, other alterations). - Dietary quality was assessed with the **HEI-2015** and compared to US reference values from NHANES; statistical testing used one-sample t tests against the reference mean. - Tobacco exposure patterns differed from expected mutation associations: in the Other/Mixed Mutations group, 68.8% reported never using tobacco despite those mutations being historically linked to tobacco exposure. Conversely, 32.9% of the EGFR Pathway group had a history of tobacco use. - Female oral contraceptive use was consistently high across groups (range 81.7%–90.2%). - Diet quality (HEI-2015) was higher in the **EGFR Pathway** and Fusion-Positive groups versus the US reference (64.9 ± 10.7 and 65.5 ± 9.8 vs. 58). These groups also consumed more total vegetables (4.2 vs. 3.5), fruits (3.3 vs. 2.5), and whole grains (3.9 vs. 2.6) compared with the reference. - Higher intake in pesticide-prone food categories (vegetables, fruits, whole grains) is noted among EGFR Pathway and Fusion-Positive patients; authors highlight potential relevance of nontobacco environmental exposures, including dietary pesticide residues. - The study concludes that young patients with lung cancer demonstrate mutation-specific environmental exposure patterns distinct from older populations and recommends further investigation of dietary patterns and hormonal factors in mutation-specific pathways.
## Clinical Analysis & Structured Key Points
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more resources ](https://pubmed.ncbi.nlm.nih.gov/42233968/#linkout) Title & authors Abstract Conflict of interest statement Figures Similar articles References MeSH terms Related information Grants and funding LinkOut - more resources Cancer Epidemiol Biomarkers Prev Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Cancer+Epidemiol+Biomarkers+Prev%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Cancer+Epidemiol+Biomarkers+Prev%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42233968/) . 2026 Aug 3;35(8):1453-1462. doi: 10.1158/1055-9965.EPI-26-0057. # Dietary and Lifestyle Patterns among Young Patients with Lung Cancer: Analysis of Mutation-Specific Phenotypes [Sarah D Gorbatov](https://pubmed.ncbi.nlm.nih.gov/?term=Gorbatov+SD&cauthor_id=42233968)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42233968/#full-view-affiliation-1 "College of Medicine, California Northstate University, Elk Grove, California."), [Marisa A Bittoni](https://pubmed.ncbi.nlm.nih.gov/?term=Bittoni+MA&cauthor_id=42233968)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42233968/#full-view-affiliation-2 "The Ohio State University Comprehensive Cancer Center, Columbus, Ohio."), [Anna H Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+AH&cauthor_id=42233968)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42233968/#full-view-affiliation-3 "Keck School of Medicine, University of Southern California, Los Angeles, California."), [Allison Harper](https://pubmed.ncbi.nlm.nih.gov/?term=Harper+A&cauthor_id=42233968)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42233968/#full-view-affiliation-4 "Addario Lung Cancer Medical Institute , San Carlos, California."), [Virginia Kotait](https://pubmed.ncbi.nlm.nih.gov/?term=Kotait+V&cauthor_id=42233968)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42233968/#full-view-affiliation-4 "Addario Lung Cancer Medical Institute , San Carlos, California."), [Narjust Florez](https://pubmed.ncbi.nlm.nih.gov/?term=Florez+N&cauthor_id=42233968)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42233968/#full-view-affiliation-5 "Dana-Farber Cancer Institute , Harvard Medical School, Boston, Massachusetts."), [David P Carbone](https://pubmed.ncbi.nlm.nih.gov/?term=Carbone+DP&cauthor_id=42233968)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42233968/#full-view-affiliation-2 "The Ohio State University Comprehensive Cancer Center, Columbus, Ohio."), [Barbara Gitlitz](https://pubmed.ncbi.nlm.nih.gov/?term=Gitlitz+B&cauthor_id=42233968)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42233968/#full-view-affiliation-3 "Keck School of Medicine, University of Southern California, Los Angeles, California."), [Jorge Nieva](https://pubmed.ncbi.nlm.nih.gov/?term=Nieva+J&cauthor_id=42233968)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42233968/#full-view-affiliation-3 "Keck School of Medicine, University of Southern California, Los Angeles, California.") Affiliations Expand ### Affiliations * 1 College of Medicine, California Northstate University, Elk Grove, California. * 2 The Ohio State University Comprehensive Cancer Center, Columbus, Ohio. * 3 Keck School of Medicine, University of Southern California, Los Angeles, California. * 4 Addario Lung Cancer Medical Institute , San Carlos, California. * 5 Dana-Farber Cancer Institute , Harvard Medical School, Boston, Massachusetts. * PMID: **42233968** * PMCID: [ PMC13340576 ](https://pmc.ncbi.nlm.nih.gov/articles/PMC13340576/) * DOI: [ 10.1158/1055-9965.EPI-26-0057 ](https://doi.org/10.1158/1055-9965.epi-26-0057) Item in Clipboard # Dietary and Lifestyle Patterns among Young Patients with Lung Cancer: Analysis of Mutation-Specific Phenotypes Sarah D Gorbatov et al. Cancer Epidemiol Biomarkers Prev. 2026. Show details Display options Display options Format Abstract PubMed PMID Cancer Epidemiol Biomarkers Prev Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Cancer+Epidemiol+Biomarkers+Prev%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Cancer+Epidemiol+Biomarkers+Prev%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42233968/) . 2026 Aug 3;35(8):1453-1462. doi: 10.1158/1055-9965.EPI-26-0057. ### Authors [Sarah D Gorbatov](https://pubmed.ncbi.nlm.nih.gov/?term=Gorbatov+SD&cauthor_id=42233968)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42233968/#short-view-affiliation-1 "College of Medicine, California Northstate University, Elk Grove, California."), [Marisa A Bittoni](https://pubmed.ncbi.nlm.nih.gov/?term=Bittoni+MA&cauthor_id=42233968)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42233968/#short-view-affiliation-2 "The Ohio State University Comprehensive Cancer Center, Columbus, Ohio."), [Anna H Wu](https://pubmed.ncbi.nlm.nih.gov/?term=Wu+AH&cauthor_id=42233968)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42233968/#short-view-affiliation-3 "Keck School of Medicine, University of Southern California, Los Angeles, California."), [Allison Harper](https://pubmed.ncbi.nlm.nih.gov/?term=Harper+A&cauthor_id=42233968)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42233968/#short-view-affiliation-4 "Addario Lung Cancer Medical Institute , San Carlos, California."), [Virginia Kotait](https://pubmed.ncbi.nlm.nih.gov/?term=Kotait+V&cauthor_id=42233968)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42233968/#short-view-affiliation-4 "Addario Lung Cancer Medical Institute , San Carlos, California."), [Narjust Florez](https://pubmed.ncbi.nlm.nih.gov/?term=Florez+N&cauthor_id=42233968)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42233968/#short-view-affiliation-5 "Dana-Farber Cancer Institute , Harvard Medical School, Boston, Massachusetts."), [David P Carbone](https://pubmed.ncbi.nlm.nih.gov/?term=Carbone+DP&cauthor_id=42233968)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42233968/#short-view-affiliation-2 "The Ohio State University Comprehensive Cancer Center, Columbus, Ohio."), [Barbara Gitlitz](https://pubmed.ncbi.nlm.nih.gov/?term=Gitlitz+B&cauthor_id=42233968)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42233968/#short-view-affiliation-3 "Keck School of Medicine, University of Southern California, Los Angeles, California."), [Jorge Nieva](https://pubmed.ncbi.nlm.nih.gov/?term=Nieva+J&cauthor_id=42233968)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42233968/#short-view-affiliation-3 "Keck School of Medicine, University of Southern California, Los Angeles, California.") ### Affiliations * 1 College of Medicine, California Northstate University, Elk Grove, California. * 2 The Ohio State University Comprehensive Cancer Center, Columbus, Ohio. * 3 Keck School of Medicine, University of Southern California, Los Angeles, California. * 4 Addario Lung Cancer Medical Institute , San Carlos, California. * 5 Dana-Farber Cancer Institute , Harvard Medical School, Boston, Massachusetts. * PMID: **42233968** * PMCID: [ PMC13340576 ](https://pmc.ncbi.nlm.nih.gov/articles/PMC13340576/) * DOI: [ 10.1158/1055-9965.EPI-26-0057 ](https://doi.org/10.1158/1055-9965.epi-26-0057) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** Lung cancer in young adults is biologically distinct, with 84% harboring targetable mutations largely unassociated with active and passive tobacco exposure. Environmental risk factors remain poorly characterized in this predominantly female, non-tobacco smoking population. **Methods:** We analyzed 187 patients in the Epidemiology of Young Lung Cancer study using biological pathway groupings: EGFR Pathway (EGFR + ERBB2), Fusion-Positive (ALK + ROS1 + RET + NTRK), and Other/Mixed Mutations (KRAS, BRAF, MET exon 14 skipping, TP53, and additional alterations). Dietary quality was assessed using the Healthy Eating Index (HEI)-2015 and compared with US reference values from National Health and Nutrition Examination Survey. Statistical comparisons used one-sample t tests. **Results:** Active and passive tobacco use diverged from traditional mutation associations. In the Other/Mixed Mutations group, 68.8% never used tobacco despite these mutations being linked to tobacco exposure. Conversely, the EGFR Pathway group included 32.9% with a history of tobacco use. Oral contraceptive use among females was consistently elevated (81.7%-90.2%). Dietary analysis revealed that EGFR Pathway and Fusion-Positive patients demonstrated higher HEI-2015 scores versus the US reference (64.9 ± 10.7 and 65.5 ± 9.8 vs. 58) and consumed more total vegetables (4.2 vs. 3.5), fruits (3.3 vs. 2.5), and whole grains (3.9 vs. 2.6). **Conclusions:** Young patients with lung cancer demonstrated mutation-specific environmental exposure patterns distinct from older populations. EGFR Pathway and Fusion-Positive patients had the highest diet quality scores, driven primarily by higher intake of vegetables, fruits, and whole grains-food categories with established protective associations and documented pesticide residues. **Impact:** These findings highlight nontobacco environmental exposures in young patients with lung cancer and support further investigation of dietary patterns and hormonal factors in mutation-specific disease pathways. ©2026 American Association for Cancer Research. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Conflict of interest disclosure statement JN received research grants from Genentech and Merck; Personal fees from Aadi Biosciences, ANP Technologies, Astra Zeneca, BioAtla, Bristol Myers Squibb, Catalym, Daiichi Sankyo, Gilead, Genentech, Kalivir, Sanofi, Pfizer, Takeda, Tubulis, and Urogen; and ownership interests in Affyimmune, Cansera, Epic Sciences, Indee Bio, Quantgene, Amgen, Johnson & Johnson, Novartis. BG has employment and stock in Roche/Genentech ## Figures [ ![Figure 1.](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ee32/13340576/3c1126e6e589/nihms-2185911-f0001.gif) ](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ee32/13340576/d6e36c06dc77/nihms-2185911-f0001.jpg) ** Figure 1.. Study Flow Chart ** Detailed enrollment… ** Figure 1.. Study Flow Chart ** Detailed enrollment showing exclusions at each stage: initial recruitment (n=219)… **Figure 1.. Study Flow Chart** Detailed enrollment showing exclusions at each stage: initial recruitment (n=219) → final analysis cohort (n=187) → dietary analysis subset (n=169, with complete dietary data distributed as EGFR Pathway n=66, Fusion-Positive n=72, other/mixed n=28). [ ![Figure 2.](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ee32/13340576/b11e6c73079c/nihms-2185911-f0002.gif) ](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ee32/13340576/443f125e94de/nihms-2185911-f0002.jpg) ** Figure 2.. Overall Diet Quality Compared with… ** ** Figure 2.. Overall Diet Quality Compared with U.S. Reference Population - Pesticide-Prone Food Categories ** HEI-2015… **Figure 2.. Overall Diet Quality Compared with U.S. Reference Population - Pesticide-Prone Food Categories** HEI-2015 component scores for pesticide-prone food categories in the overall young lung cancer cohort (n=169) versus the U.S. reference population (NHANES 2017-2018, ages 31-59). Components shown: Total Vegetables, Dark Green Vegetables & Legumes, Total Fruit, Whole Fruit, and Whole Grains. U.S. reference population values reflect the overall NHANES 2017-2018 dataset for adults aged 31-59 years. [ ![Figure 3.](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ee32/13340576/a11b15726741/nihms-2185911-f0003.gif) ](https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ee32/13340576/6688b5293858/nihms-2185911-f0003.jpg) ** Figure 3.. Diet Quality by Biological Pathway… ** ** Figure 3.. Diet Quality by Biological Pathway Group - Pesticide-Prone Food Categories ** HEI-2015 component scores… **Figure 3.. Diet Quality by Biological Pathway Group - Pesticide-Prone Food Categories** HEI-2015 component scores for pesticide-prone food categories stratified by pathway group: EGFR Pathway (n=66), Fusion-Positive (n=72), Other/Mixed Mutations (n=28), with U.S. reference population means shown for comparison. Components shown: Total Vegetables, Dark Green Vegetables & Legumes, Total Fruit, Whole Fruit, and Whole Grains. Pairwise comparisons across mutation groups were not statistically significant; corresponding p-values are provided in Supplemental Table 1. [See this image and copyright information in PMC](https://pubmed.ncbi.nlm.nih.gov/42233968/) ## Similar articles * [ Dietary Patterns and Breast, Colorectal, Lung, and Prostate Cancer: A Systematic Review [Internet]. ](https://pubmed.ncbi.nlm.nih.gov/35129907/) Boushey C, Ard J, Bazzano L, Heymsfield S, Mayer-Davis E, Sabaté J, Snetselaar L, Van Horn L, Schneeman B, English LK, Bates M, Callahan E, Butera G, Terry N, Obbagy J.Boushey C, et al.Alexandria (VA): USDA Nutrition Evidence Systematic Review; 2020 Jul.Alexandria (VA): USDA Nutrition Evidence Systematic Review; 2020 Jul.PMID: 35129907Free Books & Documents.Review. * [ Correlative analysis of gene mutation and clinical features in patients with non-small cell lung cancer. ](https://pubmed.ncbi.nlm.nih.gov/35116812/) Kuang X, Xiao J, Dai LX, Zhang LH, He BX.Kuang X, et al.Transl Cancer Res. 2019 Jun;8(3):736-751. doi: 10.21037/tcr.2019.04.10.Transl Cancer Res. 2019.PMID: 35116812Free PMC article. * [ Lung Cancer Driver Mutations in Middle Eastern Americans: Associations with Smoking and Comparative Analysis with Middle Eastern Populations. ](https://pubmed.ncbi.nlm.nih.gov/42005086/) Henderson A, Zheng AM, Daraiseh S, Khayyata S.Henderson A, et al.Avicenna J Med. 2026 Mar 24;16(1):40-45. doi: 10.1055/s-0046-1819575. eCollection 2026 Jan.Avicenna J Med. 2026.PMID: 42005086Free PMC
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