The Association between Polluted Neighborhoods and TP53-Mutated Non–Small Cell Lung Cancer

Abstract

Background: Poor patients often reside in neighborhoods of lower socioeconomic status (SES) with high levels of airborne pollutants. They also have higher mortality from non–small cell lung cancer (NSCLC) than those living in wealthier communities. We investigated whether living in polluted neighborhoods is associated with somatic mutations linked with lower survival rates, i.e., TP53 mutations. Methods: In a retrospective cohort of 478 patients with NSCLC treated at a comprehensive cancer center between 2015 and 2018, we used logistic regression to assess associations between individual demographic and clinical characteristics, including somatic TP53 mutation status and environmental risk factors of annual average particulate matter (PM2.5) levels, and neighborhood SES. Results: 277 patients (58%) had somatic TP53 mutations. Of those, 45% lived in neighborhoods with “moderate” Environmental Protection Agency–defined PM2.5 exposure, compared with 39% of patients without TP53 mutations. We found significant associations between living in neighborhoods with “moderate” versus “good” PM2.5 concentrations and minority population percentage [OR, 1.06; 95% confidence interval (CI), 1.04–1.08]. There was a significant association between presence of TP53 mutations and PM2.5 exposure (moderate versus good: OR, 1.66; 95% CI, 1.02–2.72) after adjusting for patient characteristics, other environmental factors, and neighborhood-level SES. Conclusions: When controlling for individual- and neighborhood-level confounders, we find that the odds of having a TP53-mutated NSCLC are increased in areas with higher PM2.5 exposure. Impact: The link between pollution and aggressive biology may contribute to the increased burden of adverse NSCLC outcomes in individuals living in lower SES neighborhoods.

The Role of Neighborhood Air Pollution Exposure on Somatic Non-Small Cell Lung Cancer Mutations in the Los Angeles Basin (2013–2018)

“…Patients who lived in highly-polluted regions had three times higher mutated genes, including TP53 , as those in control, lower-pollution regions. Our previous work found that TP53 -mutated NSCLC was linked to areas with higher PM 2.5 exposure [ 27 ]. However, this work only focused on TP53 -mutated NSCLC and on two pollutants (PM 2.5 and ozone), which were assessed through EPA’s EJScreen in the year or two prior to cancer diagnosis.…”

“…In our previous study among patients who were treated at City of Hope Comprehensive Cancer Center (COH) in California (CA), patients living in areas with higher PM 2.5 exposure had 1.66 (95% CI: 1.02–2.72) increased odds of TP53 -mutated non-small cell lung cancer (NSCLC) [ 27 ]. That study measured air pollution (PM 2.5 and ozone) with the EPA’s Environmental Justice Screening and Mapping Tool (EJScreen).…”

Neighborhood disadvantage and lung cancer risk in a national cohort of never smoking Black women

“…Epidemiological studies have suggested a link between PM 2.5 exposure and increased aggressive biology [51], lung cancer risk and mortality in smokers [52] and never smokers [53]. The literature has also revealed that predominantly Black communities have higher exposure to air pollution, despite producing less of it [54].…”

Inclusion of Social and Structural Determinants of Health to Advance Understanding of their Influence on the Biology of Chronic Disease

“…The United States Environmental Protection Agency's Environmental Justice Screening and Mapping Tool (EJSCREEN) provides a consistent and standardized approach to combining both environmental and demographic indicators by census block across States (EPA, 2021). Common neighborhood‐level structural and social risk exposures measured across studies include a higher proportion of minority populations (Erhunmwunsee et al., 2021), a higher frequency of the population with less than a high school education (Erhunmwunsee et al., 2021), and low socio‐economic status and increased proximity to industrial or facility location (Cifuentes et al., 2019).…”

“…The EJSCREEN tool can be used to indicate associations between the built environment and community exposures to SDOH factors with many adverse health outcomes, such as non‐small cell lung cancer and pregnancy complications (Cifuentes et al., 2019; Erhunmwunsee et al., 2021). A study of the Public Health Exposome in an African‐American Women's cohort in Ohio demonstrated that pregnant women reporting low income were more likely to live in areas with lower air quality, and/or closer to risk management facilities and/or direct discharges in water; all exposures were associated with increased risk of preterm birth and low birth weight (Cifuentes et al., 2019).…”