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Both household and ambient air pollution are classified as Group 1 carcinogens and contain hazardous components, including polycyclic aromatic hydrocarbons, heavy metals, and volatile organic compounds. Exposure contributes to a broad spectrum of systemic diseases and is responsible for more than 14% of global lung cancer deaths while also elevating risks for breast, gastrointestinal, and brain cancers. Mechanistically, air pollutants drive early lung carcinogenesis through intrinsic genomic instability, manifesting as DNA damage, telomere dysfunction, mitochondrial impairment, and specific mutational signatures, alongside epigenetic dysregulation. Concurrently, they foster a tumor-promoting niche via chronic inflammation mediated by CXCL13 and IL-1\u03b2 and facilitate early immune evasion through activation of the PD-L1 and CD47-SIRP\u03b1 axes. In addition, air pollution disrupts the respiratory\u2013gut microbiome, reducing microbial diversity and promoting pathogenic enrichment. A range of early biomarkers\u2014including genomic, epigenomic, inflammatory, and microbiome profiles\u2014have been validated for preventive interventions, with multimarker combinations demonstrating improved efficacy. Multiple chemopreventive targets have also been identified to counteract oxidative stress, inflammation, and immune evasion. Looking ahead, research priorities should include exploring gene\u2013environment interactions, clinically validating biomarkers and therapeutic targets, translating basic discoveries into clinical practice, and developing precision prevention strategies for high-risk populations. Ultimately, integrating biomarker-guided early detection with multi-target chemoprevention will be essential to reducing the global burden of air pollution\u2013induced early-onset lung cancer.<\/jats:p>","DOI":"10.1093\/carcin\/bgag070","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T11:54:57Z","timestamp":1790855697000},"source":"Crossref","is-referenced-by-count":0,"title":["Air pollution and early-onset lung cancer: from environmental carcinogenesis to early intervention strategies"],"prefix":"10.1093","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1226-3073","authenticated-orcid":false,"given":"Yan-Yun","family":"Gao","sequence":"first","affiliation":[{"name":"Henan Academy of Innovations in Medical Science Institute of Cancer Research, , Zhengzhou 451162 ,","place":["China"]},{"name":"State Key Laboratory of Molecular Oncology & Department of Pathology, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing 100021 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5561-9745","authenticated-orcid":false,"given":"Jiao-Jiao","family":"Xu","sequence":"additional","affiliation":[{"name":"Henan Academy of Innovations in Medical Science Institute of Cancer Research, , Zhengzhou 451162 ,","place":["China"]},{"name":"State Key Laboratory of Molecular Oncology & Department of Pathology, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing 100021 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Xin","family":"Wu","sequence":"additional","affiliation":[{"name":"Henan Academy of Innovations in Medical Science Institute of Cancer Research, , Zhengzhou 451162 ,","place":["China"]},{"name":"State Key Laboratory of Molecular Oncology & Department of Pathology, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing 100021 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong-Mei","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Environmental Science and Engineering, Xi\u2019an Jiaotong University , Xi'an 710049 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9153-5427","authenticated-orcid":false,"given":"Gui-Zhen","family":"Wang","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Molecular Oncology & Department of Pathology, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing 100021 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6327-2316","authenticated-orcid":false,"given":"Guang-Biao","family":"Zhou","sequence":"additional","affiliation":[{"name":"Henan Academy of Innovations in Medical Science Institute of Cancer Research, , Zhengzhou 451162 ,","place":["China"]},{"name":"State Key Laboratory of Molecular Oncology & Department of Pathology, National Cancer Center\/National Clinical Research Center for Cancer\/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing 100021 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"2026101306065015500_bgag070-B1","volume-title":"WHO global air Quality Guidelines","author":"WHO","year":"2021"},{"key":"2026101306065015500_bgag070-B2","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1093\/oxfordjournals.aje.a115473","article-title":"Mortality and air pollution in London: a time series analysis","volume":"131","author":"Schwartz","year":"1990","journal-title":"Am J Epidemiol"},{"key":"2026101306065015500_bgag070-B3","doi-asserted-by":"publisher","first-page":"704","DOI":"10.1016\/S0140-6736(00)04135-0","article-title":"The Meuse Valley fog of 1930: an air pollution disaster","volume":"357","author":"Nemery","year":"2001","journal-title":"Lancet"},{"key":"2026101306065015500_bgag070-B4","doi-asserted-by":"publisher","first-page":"188","DOI":"10.17265\/2161-6213\/2017.7-8.003","article-title":"History of Yokkaichi asthma and its anti-pollution measures","volume":"7","author":"Takemoto","year":"2017","journal-title":"J Mater Sci Eng A"},{"key":"2026101306065015500_bgag070-B5","volume-title":"WHO global air Quality Guidelines. 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