Lung cancer arising in younger adults has a distinct biological profile compared with typical older-onset disease. In this cohort, 84% of young patients harbored targetable mutations, and the population was predominantly female and non-smoking. Despite this, environmental risk factors beyond tobacco exposure remain incompletely characterized. The study aimed to examine dietary quality and other lifestyle exposures across mutation-defined disease pathways to identify mutation-specific environmental patterns.
The analysis used data from 187 participants enrolled in the Epidemiology of Young Lung Cancer study. For dietary analyses, a subset of 169 patients had complete dietary data. Patients were grouped into biological pathway categories for analysis:
The dietary subset included EGFR Pathway n=66, Fusion-Positive n=72, and Other/Mixed n=28.
Dietary quality was measured using the HEI-2015 (Healthy Eating Index-2015). Component scores and overall HEI-2015 scores from the study cohort were compared with reference values derived from the National Health and Nutrition Examination Survey (NHANES) for U.S. adults aged 31–59 years. One-sample t tests were used to compare cohort means with the U.S. reference mean where applicable.
The analysis highlighted HEI-2015 component categories identified as pesticide-prone in the literature: total vegetables, dark green vegetables and legumes, total fruit, whole fruit, and whole grains. These components were examined both overall and stratified by mutation pathway group.
Reported active and passive tobacco use did not follow classical mutation associations in this young cohort. Specifically:
Among female participants, oral contraceptive use was consistently elevated across mutation groups, with reported use ranging from 81.7% to 90.2%.
Overall, the cohort demonstrated higher diet quality in certain mutation-defined groups compared with the U.S. reference mean (HEI-2015 = 58). Key findings include:
Component-level differences versus the U.S. reference included higher reported intake of total vegetables (4.2 vs. 3.5), total fruits (3.3 vs. 2.5), and whole grains (3.9 vs. 2.6) in the groups with higher overall HEI-2015 scores. The authors note that these food categories are both associated with protective health effects in some studies and are documented to carry pesticide residues in food supply assessments.
Pairwise comparisons across mutation groups for HEI components were reported; however, the figure legend states that pairwise comparisons across mutation groups were not statistically significant, and corresponding p-values were provided in supplemental materials.
The manuscript includes a study flow chart detailing recruitment and exclusions: initial recruitment (n=219) leading to the final analysis cohort (n=187) and the dietary analysis subset (n=169) distributed among pathway groups as noted above.
Figure content described in the source includes:
These figures compare cohort component scores with NHANES 2017–2018 reference means for adults aged 31–59 years.
Young patients with lung cancer in this cohort exhibited mutation-specific patterns of environmental exposures that differ from patterns typically described in older patients. Notably, groups defined by EGFR Pathway alterations and fusion-positive tumors had higher diet quality scores, driven mainly by greater intake of vegetables, fruits, and whole grains. The authors emphasize the potential relevance of nontobacco environmental exposures—particularly dietary sources that may carry pesticide residues—and elevated hormonal exposures among females (high oral contraceptive use) in the pathogenesis or phenotype of mutation-specific disease.
The study supports further investigation into dietary patterns and hormonal factors in relation to mutation-specific lung cancer pathways in younger patients.
The source discloses that JN received research grants and personal fees from multiple industry entities and has ownership interests in several companies. BG has employment and stock in Roche/Genentech. No additional conflicts beyond those reported were presented in the abstract and conflict of interest statement in the source.