Narrative review: association between lung cancer development and ambient particulate matter in never-smokers

Objective: To review the association and pathophysiological link between lung cancer in never smokers and ambient particulate matter (PM). Background: Although the association between exposure to PM and lung cancer development is well known, the pathophysiological background is yet to be studied in depth. Never smokers comprise a large proportion of newly diagnosed lung cancer cases and account for 25% of all cases. Considering the carcinogenic nature of ambient PM and the fact that many patients with lung cancer are never smokers, it is necessary to evaluate the interrelation and possible clinical background, in order to effectively prevent lung cancer development in this subgroup. Methods: An online search of literature was conducted. The National Center for Biotechnology Information (NCBI), PubMed, Google Scholar, Cochrane Library and EMBASE were searched. Conclusions: In never smokers, the risk of lung cancer was dose-dependent with the concentration of ambient air pollutants. Regarding the pathophysiological link, involvement of epithelial mesenchymal transition (EMT) and chronic inflammation has been mentioned, but further studies are necessary to enable therapeutic interventions to prevent cancer development. Considering the significant burden of PM on lung cancer development, both public and clinical approaches to cancer prevention are essential. To prevent lung cancer more effectively, clinicians should develop a more individualized approach in patients, focusing on gender and genetic background.