SMOKING, ENVIRONMENTAL EXPOSURES, AND CHRONIC LUNG DISEASE AS KEY RISK FACTORS FOR LUNG CANCER IN NORTH SUMATRA
DOI:
https://doi.org/10.15407/exp-oncology.2026.02.152Keywords:
lung cancer, smoking, occupational exposure, indoor air pollution, tuberculosisAbstract
Background. Lung cancer remains the leading cause of cancer mortality worldwide, with increasing incidence in many developing countries. Understanding region-specific risk factors is essential for effective prevention strategies. This study aimed to identify major determinants of lung cancer in North Sumatra, Indonesia. Materials and Methods. A hospital-based observational study with a case–control analytical approach was conducted between August and November 2024 in three referral hospitals in North Sumatra. A total of 240 patients with histologically confirmed lung cancer and 240 controls without malignancy or chronic respiratory disease were included. Participants were comparable by sex and residential area, while age differences between groups were statistically adjusted in the multivariate regression model. Results. Smoking exposure differed significantly between cases and controls (p = 0.023). The multivariate analysis identified several independent predictors of lung cancer. Age <45 years increased the risk more than two-fold (OR 2.62; 95% CI 1.10—6.21), whereas age >65 years showed a lower relative risk (OR 0.54; 95% CI 0.33—0.88). The occupational exposure signicantly increased lung cancer risk (OR 1.91; 95% CI 1.13—3.25). Unhealthy indoor environments, characterized by poor ventilation and household pollutant exposure, were also associated with an increased risk (OR 2.53; 95% CI 1.45—4.40). Chronic respiratory diseases, particularly tuberculosis and chronic obstructive pulmonary disease, were more prevalent among cases and contributed to the elevated risk. Conclusions. Smoking exposure, occupational hazards, unhealthy indoor environments, and chronic pulmonary diseases are important determinants of lung cancer in North Sumatra. Public health strategies focusing on tobacco control, improved workplace safety, and reduction of indoor air pollution may substantially reduce lung cancer burden in this region.
References
Soeroso N, Soeroso L, Hasibuan P, et al. Kanker paru: Diagnosis dan penatalaksanaan. Medan: USU Press; 2017. ISBN: 9789794589885 (in Indonesian)
Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. https://doi.org/10.3322/caac.21660
World Health Organization. Indonesia cancer country profile 2020. Geneva: WHO; 2020. https://cdn.who.int/media/docs/default-source/country-profiles/cancer/idn-2020.pdf
Kementerian Kesehatan Republik Indonesia. Laporan nasional Riskesdas 2018. Jakarta: Badan Penelitian dan Pengembangan Kesehatan; 2018. https://repository.badankebijakan.kemkes.go.id/id/eprint/3514 (in Indonesian)
O’Keeffe LM, Taylor G, Huxley RR, et al. Smoking as a risk factor for lung cancer in women and men: A systematic review and meta-analysis. BMJ Open. 2018;8(10):e021611. https://doi.org/10.1136/bmjopen-2018-021611
Soeroso NN, Zain-Hamid R, Sinaga BYM, et al. The role of CYP2A6 genetic polymorphism in nicotine dependence and tobacco consumption among Bataknese male smokers. Open Access Maced J Med Sci. 2018;6(5):864-866. https://doi.org/10.3889/oamjms.2018.224
Chen G, Wan X, Yang G, et al. Traffic-related air pollution and lung cancer: a meta-analysis. Thorac Cancer. 2015;6(3):307-318. https://doi.org/10.1111/1759-7714.12185
Guo H, Chang Z, Wu J, et al. Air pollution and lung cancer incidence in China: Who are faced with a greater effect? Environ Int. 2019;132:105077. https://doi.org/10.1016/j.envint.2019.105077
International Agency for Research on Cancer. Agents classified by the IARC monographs. Lyon: IARC; 2020. https://monographs.iarc.who.int/agents-classified-by-the-iarc/
Denholm R, Schüz J, Straif K, et al. Is previous respiratory disease a risk factor for lung cancer? Am J Respir Crit Care Med. 2014;190(5):549-559. https://doi.org/10.1164/rccm.201402-0338OC
Moon SM, Choi H, Kim SH, et al. Increased lung cancer risk and associated risk factors in tuberculosis survivors: A Korean population-based study. Clin Infect Dis. 2023;76(11):1962-1971. https://doi.org/10.1093/cid/ciad373
Ang L, Chan CPY, Yau WP, et al. Association between family history of lung cancer and lung cancer risk: A systematic review and meta-analysis. Lung Cancer. 2020;148:129-137. https://doi.org/10.1016/j.lungcan.2020.08.012
Siegel RL, Miller KD, Wagle NS, et al. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17-48. https://doi.org/10.3322/caac.21763
Islami F, Torre LA, Jemal A. Global trends of lung cancer mortality and smoking prevalence. Transl Lung Cancer Res. 2015;4(4):327-338. https://doi.org/10.3978/j.issn.2218-6751.2015.08.04
Islami F, Ward EM, Sung H, et al. Global patterns of lung cancer incidence and mortality. Lancet Respir Med. 2022;10(10):987–1003. https://doi.org/10.1016/S2213-2600(22)00110-0
Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2024: GLOBOCAN estimates of incidence and mortality worldwide. CA Cancer J Clin. 2024;74(3):229–263. https://doi.org/10.3322/caac.21834
Subramanian J, Govindan R. Lung cancer in never smokers: A review. J Clin Oncol. 2007;25(5):561-570. https://doi.org/10.1200/JCO.2006.06.8015
Doll R, Peto R, Boreham J, et al. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ. 2004;328(7455):1519. https://doi.org/10.1136/bmj.38142.554479.AE
Oberg M, Jaakkola MS, Woodward A, et al. Worldwide burden of disease from exposure to second-hand smoke. Lancet. 2011;377(9760):139-146. https://doi.org/10.1016/S0140-6736(10)61388-8
Zhang Y, Chen R, Zhang L, et al. Interaction between smoking and air pollution exposure in lung cancer risk. Environ Res. 2023;216:114518. https://doi.org/10.1016/j.envres.2022.114518
Wang X, Lin S, Yu IT, et al. Cause-specific mortality in a Chinese chrysotile asbestos mining cohort. Cancer Sci. 2013;104(2):245-249. https://doi.org/10.1111/cas.12076
Balmes JR. Household air pollution from domestic combustion of solid fuels and health. J Allergy Clin Immunol. 2019;143(6):1979-1987. https://doi.org/10.1016/j.jaci.2019.04.016
Takahashi K, Landrigan PJ, Collegium R. Occupational exposure and lung cancer risk: Global evidence and prevention strategies. Occup Environ Med. 2021;78(12):893–899. https://doi.org/10.1136/oemed-2020-107123
Hosgood HD, Boffetta P, Greenland S, et al. In-home coal and wood use and lung cancer risk. Environ Health Perspect. 2010;118(12):1743-1747. https://doi.org/10.1289/ehp.1002217
Loomis D, Huang W, Chen G. The International Agency for Research on Cancer evaluation of the carcinogenicity of outdoor air pollution. Chin J Cancer. 2014;33(4):189-196. https://doi.org/10.5732/cjc.014.10110
Yu YH, Liao CC, Hsu WH, et al. Increased lung cancer risk among patients with pulmonary tuberculosis. J Thorac Oncol. 2011;6(1):32-37. https://doi.org/10.1097/JTO.0b013e3181f68a47
Matakidou A, Eisen T, Houlston RS. Systematic review of the relationship between family history and lung cancer risk. Br J Cancer. 2005;93(7):825-833. https://doi.org/10.1038/sj.bjc.6602769
Huang J, Pan X, Guo X, Li G. Health impact of China’s Air Pollution Prevention and Control Action Plan. Lancet Planet Health. 2022;6(7):e583-e592. https://doi.org/10.1016/S2542-5196(22)00105-7
Sodeifian F, Kian N, Atefi A, et al. Pulmonary tuberculosis and risk of lung cancer: a systematic review and meta-analysis. Respiration. 2025;104(5):360–376. https://doi.org/10.1159/000543319
Kim T, Choi H, Kim SH, et al. Increased risk of lung cancer and associated risk factors in tuberculosis survivors: A Korean population-based cohort study. Clin Infect Dis. 2023;76(9):e1234–e1243. https://doi.org/10.1093/cid/ciad123
Feng J, Hu M, Duan H. Bidirectional association between tuberculosis and chronic obstructive pulmonary disease: a systematic review and meta-analysis. J Clin Med. 2025;14(21):7639. https://doi.org/10.3390/jcm14217639
Kim SH, Lee H, Kim BG, et al. The association between family history of lung cancer and development of lung cancer: Analysis from the KoGES cohort in Korea. Cancers (Basel). 2024;16(11):2063. https://doi.org/10.3390/cancers16112063
Lee YG, Seo D, Gil HI, et al. Family history of lung cancer and risk of incident lung cancer: A prospective cohort study. Clin Lung Cancer. 2025;26(5):364–369.e2. https://doi.org/10.1016/j.cllc.2025.04.003
Submitted: December 16, 2025
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