Air pollution and the risk of second primary lung cancer among lung cancer survivors: the prospective UK Biobank cohort study

BACKGROUND: Lung cancer survivors have a high risk of second primary lung cancer (SPLC). While air pollution is associated with the risk of initial primary lung cancer (IPLC), especially in never smokers, its effect on SPLC risk is unknown. METHODS: ) from the EU-wide Land Use Regression model. Associations with SPLC risk were assessed using cause-specific Cox models adjusted for co-pollutants, socioeconomic factors, smoking, and tumour characteristics. RESULTS: showed an aHR of 0.96 (0.93-0.99). The PM10 effect was pronounced in never-smoking (aHR = 2.26 [1.22-4.18]) vs. ever-smoking IPLC patients (aHR = 1.42 [1.21-1.68]) on the risk of non-small cell SPLC. INTERPRETATION: Exposure to PM10 may increase SPLC risk in lung cancer survivors, highlighting the potential value of incorporating environmental factors into SPLC surveillance to identify high-risk individuals.