What proportion of lung cancer in never-smokers can be attributed to known risk factors?

Int J Cancer. 2012 Jul 15;131(2):265-75. doi: 10.1002/ijc.27477. Epub 2012 Mar 27.


Though tobacco smoking is the primary risk factor for lung cancer, a significant fraction of lung cancer deaths occur in lifetime nonsmokers. In this article, we calculate the burden of lung cancer in never-smokers attributable to previously identified risk factors in North America, Europe and China, using population-based estimates of exposure prevalence and estimates of relative risk derived from recently published meta-analyses. Population attributable fractions (PAFs) for individual risk factors ranged from 0.40 to 19.93%. Because of differences in the prevalence of exposures, the PAFs associated with several of the risk factors varied greatly by geographical region. Exposure to the selected risk factors appeared to explain a much larger proportion of lung cancer cases in never-smokers in China than in Europe and North America. Our results demonstrate the geographic variability of the epidemiology of lung cancer in never-smokers and highlight the need for further research in this area, particularly in Europe and North America.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • China / epidemiology
  • Environmental Exposure
  • Europe / epidemiology
  • Female
  • Humans
  • Lung Neoplasms / epidemiology*
  • Lung Neoplasms / etiology
  • Male
  • North America / epidemiology
  • Occupational Exposure / adverse effects
  • Pneumonia / complications*
  • Risk Factors
  • Tobacco Smoke Pollution / adverse effects*
  • Tuberculosis / complications*


  • Tobacco Smoke Pollution