# Evaluate clean-air policies using lung cancer in never-smokers

Source: https://onco.cc/ideas/idea-prev-clean-air-never-smoker-endpoints/  
OnCo record `idea-prev-clean-air-never-smoker-endpoints` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Air pollution causes lung cancer in people who never smoked. Clean air zones and coal phase-outs should be tracked against never-smoker lung cancer rates.

## Summary

Fine particulate pollution promotes EGFR-mutant lung cancer in never-smokers (Francis Crick Institute work). Propose linked-data evaluation of air-quality interventions (London ULEZ, Chinese coal-to-gas conversion) with never-smoker, EGFR-mutant lung cancer incidence as endpoints, and pre-registered modelling.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A sustained 10 micrograms per cubic metre PM2.5 reduction reduces never-smoker lung cancer incidence by at least 10% within 15 years.
- Rationale: Mechanistic and epidemiological evidence exists, and the policies are being enacted anyway, so evaluation is cheap.
- Proposed test: Registry-linked natural experiments with molecular subtyping.
- Maturity: speculative
- Actor: data

## Sources

- Bottleneck evidence (Prevention we already have is not deployed): Islami et al., Proportion of cancer attributable to modifiable risk factors (CA 2018): https://doi.org/10.3322/caac.21440

## Connected records

- roadmaps: [Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch](https://onco.cc/roadmaps/lung-cancer-evidence-roadmap/)
- ideas: [Treat lung cancer in never-smokers as its own disease, with its own detection programme](https://onco.cc/ideas/idea-lung-never-smoker-disease-its-own-programme/)
- cancers: [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/)
- fronts: [Prevention & Risk](https://onco.cc/fronts/prevention/)
- targets: [EGFR](https://onco.cc/targets/egfr/)
- institutions: [The Francis Crick Institute](https://onco.cc/institutions/francis-crick/)
- bottlenecks: [Prevention we already have is not deployed](https://onco.cc/bottlenecks/b-prevention-adoption/)
- key papers: [Doll and Hill 1950: the case-control study that tied smoking to lung cancer](https://onco.cc/key-papers/paper-doll-hill-smoking-lung-cancer-bmj-1950/), [Lung adenocarcinoma promotion by air pollutants](https://onco.cc/key-papers/paper-hill-lung-adenocarcinoma-air-pollutants-nature-2023/), [Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States](https://onco.cc/key-papers/paper-islami-ca-cancer-j-clin/), [TRACERx 421: the full-cohort picture of how lung cancer evolves and which subclones drive relapse](https://onco.cc/key-papers/paper-tracerx-evolution-nature-2023/)

---
JSON: https://onco.cc/api/v1/entities/idea-prev-clean-air-never-smoker-endpoints.json