Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2026
Dietary and Lifestyle Patterns among Young Patients with Lung Cancer: Analysis of Mutation-Specific Phenotypes.
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Gorbatov Sarah D, Bittoni Marisa A, Wu Anna H, Harper Allison, Kotait Virginia, Florez Narjust, Carbone David P, Gitlitz Barbara, Nieva Jorge
Аннотация
BACKGROUND: Lung cancer in young adults is biologically distinct, with 84% harboring targetable mutations largely unassociated with active and passive tobacco exposure. Environmental risk factors remain poorly characterized in this predominantly female, non-tobacco smoking population.
METHODS: We analyzed 187 patients in the Epidemiology of Young Lung Cancer study using biological pathway groupings: EGFR Pathway (EGFR + ERBB2), Fusion-Positive (ALK + ROS1 + RET + NTRK), and Other/Mixed Mutations (KRAS, BRAF, MET exon 14 skipping, TP53, and additional alterations). Dietary quality was assessed using the Healthy Eating Index (HEI)-2015 and compared with US reference values from National Health and Nutrition Examination Survey. Statistical comparisons used one-sample t tests.
RESULTS: Active and passive tobacco use diverged from traditional mutation associations. In the Other/Mixed Mutations group, 68.8% never used tobacco despite these mutations being linked to tobacco exposure. Conversely, the EGFR Pathway group included 32.9% with a history of tobacco use. Oral contraceptive use among females was consistently elevated (81.7%-90.2%). Dietary analysis revealed that EGFR Pathway and Fusion-Positive patients demonstrated higher HEI-2015 scores versus the US reference (64.9 ± 10.7 and 65.5 ± 9.8 vs. 58) and consumed more total vegetables (4.2 vs. 3.5), fruits (3.3 vs. 2.5), and whole grains (3.9 vs. 2.6).
CONCLUSIONS: Young patients with lung cancer demonstrated mutation-specific environmental exposure patterns distinct from older populations. EGFR Pathway and Fusion-Positive patients had the highest diet quality scores, driven primarily by higher intake of vegetables, fruits, and whole grains-food categories with established protective associations and documented pesticide residues.
IMPACT: These findings highlight nontobacco environmental exposures in young patients with lung cancer and support further investigation of dietary patterns and hormonal factors in mutation-specific disease pathways.
METHODS: We analyzed 187 patients in the Epidemiology of Young Lung Cancer study using biological pathway groupings: EGFR Pathway (EGFR + ERBB2), Fusion-Positive (ALK + ROS1 + RET + NTRK), and Other/Mixed Mutations (KRAS, BRAF, MET exon 14 skipping, TP53, and additional alterations). Dietary quality was assessed using the Healthy Eating Index (HEI)-2015 and compared with US reference values from National Health and Nutrition Examination Survey. Statistical comparisons used one-sample t tests.
RESULTS: Active and passive tobacco use diverged from traditional mutation associations. In the Other/Mixed Mutations group, 68.8% never used tobacco despite these mutations being linked to tobacco exposure. Conversely, the EGFR Pathway group included 32.9% with a history of tobacco use. Oral contraceptive use among females was consistently elevated (81.7%-90.2%). Dietary analysis revealed that EGFR Pathway and Fusion-Positive patients demonstrated higher HEI-2015 scores versus the US reference (64.9 ± 10.7 and 65.5 ± 9.8 vs. 58) and consumed more total vegetables (4.2 vs. 3.5), fruits (3.3 vs. 2.5), and whole grains (3.9 vs. 2.6).
CONCLUSIONS: Young patients with lung cancer demonstrated mutation-specific environmental exposure patterns distinct from older populations. EGFR Pathway and Fusion-Positive patients had the highest diet quality scores, driven primarily by higher intake of vegetables, fruits, and whole grains-food categories with established protective associations and documented pesticide residues.
IMPACT: These findings highlight nontobacco environmental exposures in young patients with lung cancer and support further investigation of dietary patterns and hormonal factors in mutation-specific disease pathways.