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Sunday, April 19, 2026

WAIT, WHAT?!

Eating fruits, vegetables and whole grains may increase chance of early onset lung cancer

Pesticide residue may play a role in increased rates of lung cancer in non-smokers under age 50

University of Southern California - Health Sciences

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Jorge Nieva, MD, is a medical oncologist and lung cancer specialist with Keck Medicine of USC and lead investigator of the study.
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Credit: Ricardo Carrasco III

LOS ANGELES — A diet rich in fruit, vegetables and whole grains is generally recommended for better health and to lower the risk of cancer and other diseases.

However, new research from USC Norris Comprehensive Cancer Center, part of Keck Medicine of USC, presented at the annual meeting of the American Association for Cancer Research suggests that this type of diet may put non-smoking Americans under the age of 50 at greater risk of developing lung cancer.

“Our research shows that younger non-smokers who eat a higher quantity of healthy foods than the general population are more likely to develop lung cancer,” said Jorge Nieva, MD, a medical oncologist and lung cancer specialist with USC Norris and lead investigator of the study. “These counter-intuitive findings raise important questions about an unknown environmental risk factor for lung cancer related to otherwise beneficial food that needs to be addressed.”

Nieva and his fellow researchers speculate that this risk factor may be the pesticides used to keep crops pest-free. Commercially produced (non-organic) fruits, vegetables and whole grains are more likely to be associated with a higher residue of pesticides than dairy, meat and many processed foods, according to Nieva. He also notes that agricultural workers exposed to pesticides typically have higher rates of lung cancer, which adds credence to the theory.

The study also showed that young women who don’t smoke have a higher incidence of lung cancer than men, and that women tended to also have a diet higher in produce and whole grains than men.

A New Epidemic of Lung Cancer

Lung cancer has typically been a disease that affects older adults (the average age of lung cancer onset is 71), men more than women, and smokers.

Smoking rates have fallen since the mid-1980s, which has led to fewer lung cancer cases across the United States, except for one unique group — non-smokers age 50 and younger, especially women, who are now more likely to get lung cancer than men.

To investigate this trend, researchers launched the Epidemiology of Young Lung Cancer Project, which surveyed 187 patients who were diagnosed with lung cancer by age 50. Patients provided details on demographics, diet, smoking history and lung cancer diagnosis.

Most patients had never smoked and had a form of lung cancer biologically different from lung cancer caused by smoking. A 2021 study from the Epidemiology of Young Lung Cancer Project, the Genomics of Young Lung Cancer Project, found that the subtypes of lung cancer seen in people under 40 were distinct from lung cancer in older adults.

Researchers used the Healthy Eating Index (HEI), a ranking of the overall quality of Americans’ diet on a scale of 1-100, to compare patients’ diets with the broader United States population. Young non-smoking lung cancer patients had an average HEI score of 65 out of 100, compared to the national average of 57. Among participants in the study, women had higher HEI scores than men.

On average, the young lung cancer patients ate more daily servings of fruit, vegetables and whole grains than the general population. For example, participants averaged 4.3 servings of dark green vegetable and legumes and 3.9 servings of whole grains per day, while the average U.S. adult eats 3.6 servings of dark green vegetables and legumes and 2.6 servings of whole grains per day.

More Research Needed

The link between pesticides and lung cancer in young people, especially women, needs more research, said Nieva.

In the study, researchers did not test specific foods for pesticides. Instead, they used published data on average pesticide levels for food categories such as fruits, vegetables and grains to estimate exposure. The next step, said Nieva, is to confirm the link by directly measuring pesticide levels in blood or urine samples from patients. This could also help reveal whether or not some pesticides increase lung cancer risk more than others.

“This work represents a critical step toward identifying modifiable environmental factors that may contribute to lung cancer in young adults," said Nieva. “Our hope is that these insights can guide both public health recommendations and future investigation into lung cancer prevention.”

The research is supported by the Addario Lung Cancer Medical Institute, a nonprofit focused on advancing lung cancer research and care, as well as AstraZeneca, the Beth Longwell Foundation, Genentech, GO2 for Lung Cancer and Upstage Lung Cancer.

Researchers also received funding from the National Institutes of Health, grant number R25CA225513 and the National Cancer Institute, grant number P30CA014089.

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For more information about Keck Medicine of USC, please visit news.KeckMedicine.org.

Disclosure: Dr. Nieva has received consulting payments from AstraZeneca and Genentech.

MIT study shows youth may increase vulnerability to a carcinogen found in contaminated water and some drugs

The new study suggests that the chemical NDMA is much more likely to cause cancerous mutations after exposure early in life.

Massachusetts Institute of Technology

CAMBRIDGE, MA -- A new study from MIT suggests that a carcinogen that has been found in medications and in drinking water contaminated by chemical plants may have a much more severe impact on children than adults.

In a study of mice, the researchers found that juveniles exposed to drinking water containing this compound, known as NDMA, showed dramatically higher rates of DNA damage and cancer than adults.

The findings may help to explain an epidemiological association between childhood cancer and prenatal exposure to NDMA in people living near a contaminated site in Wilmington, Massachusetts, the researchers say. The study also suggests that it is critical to evaluate the impact of potential carcinogens across all ages.

“We really hope that groups that do safety testing will change their paradigm and start looking at young animals, so that we can catch potential carcinogens before people are exposed,” says Bevin Engelward, an MIT professor of biological engineering. “As a solution to cancer, cancer prevention is clearly much better than cancer treatment, so we hope we can spot dangerous chemicals before people are exposed, and therefore prevent extensive cancer risk.”

MIT postdoc Lindsay Volk is the lead author of the paper. Engelward is the senior author of the study, which appears in Nature Communications.

From DNA damage to cancer

NDMA (N-Nitrosodimethylamine) can be generated as a byproduct of many industrial chemical processes, and it is also found in cigarette smoke and processed meats. In recent years, NDMA has been detected in some formulations of the drugs valsartan, ranitidine, and metformin. It was also found in drinking water in Wilmington, Massachusetts, in the 1990s, as a result of contamination from the Olin Chemical site.

In 2021, a study from the Massachusetts Department of Health suggested a link between that water contamination and an elevated incidence of childhood cancer in Wilmington. Between 1990 and 2000, 22 Wilmington children were diagnosed with cancer. The contaminated wells were closed in 2003.

Also in 2021, Engelward and others at MIT published a study on the mechanism of how NDMA can lead to cancer. In the new Nature Communications paper, Engelward and her colleagues set out to see if they could determine why the compound appears to affect children more than adults.

Most studies that evaluate potential carcinogens are performed in mice that are at least 4 to 6 weeks old, and often older. For this study, the researchers studied two groups of mice — one 3 weeks old (juvenile), and one 6 months old (adult). Each group was given drinking water with low levels of NDMA, about five parts per million, for two weeks.

Inside the body, NDMA is metabolized by a liver enzyme called CYP2E1. This produces toxic metabolites that can damage DNA by adding a small chemical group known as a methyl group to DNA bases, creating lesions known as adducts.

When the researchers examined the livers of the mice, they found that juveniles and adults showed similar levels of DNA adducts. However, there were dramatic differences in what happened after that initial damage. In juvenile mice, DNA adducts led to significant accumulation of double-stranded DNA breaks, which occur when cells try to repair adducts. These breaks produce mutations that eventually lead to the development of liver cancer.

In the adult mice, the researchers saw essentially no double-stranded breaks and significantly fewer mutations compared to juveniles. Furthermore, the livers did not develop severe pathology, including tumors, even though they experienced the same initial level of DNA adducts.

“The initial structural changes to the DNA had very different consequences depending on age,” Engelward says. “The double-stranded breaks were exclusively observed in the young.”

Further experiments revealed that these differences stem from differences in the rates of cell proliferation. Cells in the juvenile liver divide rapidly, giving them more opportunity to turn DNA adducts into mutations, while cells of the adult liver rarely divide.

“This really emphasizes the overall problem that we’re trying to highlight in the paper,” Volk says. “With toxicological studies, oftentimes the standard is to use fully grown mice. At that point, they’re already slowing down cell division, so if we are testing the harmful effects of NDMA in adult mice, then we’re completely missing how vulnerable particular groups are, such as younger animals.”

While most of these effects were seen in the liver, because that is where NDMA is metabolized, a few of the mice developed other types of cancer, including lung cancer and lymphoma.

Adult risk is not zero

For most of these studies, the researchers used mice that had two of their DNA repair systems knocked out. This speeds up the mutation process, allowing the researchers to see the effects of NDMA exposure more easily, without needing to study a large population of mice.

However, a small study in mice with normal DNA repair showed that juveniles experienced NDMA-induced double-strand breaks, regenerative proliferation, and large-scale mutations that were completely absent in adults. This occurs because the fast-growing juveniles possess highly active DNA replication machinery that encounters the DNA adducts before the cell has time to repair them.

The researchers also found that if they treated adult mice with thyroid hormone, which stimulates proliferation of liver cells, those cells began accumulating mutations as quickly as the juvenile liver cells. Previous work done in the Engelward laboratory has shown that inflammation can also stimulate cell proliferation-driven vulnerability to DNA damage, so the findings of this study suggest that anything that causes liver inflammation could make the adult liver more vulnerable to damage caused by agents such as NDMA.

“We certainly don’t want to say that adults are completely resistant to NDMA,” Volk says. “Everything impacts your susceptibility to a carcinogen, whether that’s your genetics, your age, your diet, and so forth. In adults, if they have a viral infection, or a high fat diet, or chronic binge alcohol drinking, this can impact proliferation within the liver and potentially make them susceptible to NDMA.”

The researchers are now investigating how a high-fat diet might influence cancer development in mice that also have exposure to NDMA.

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This collaborative effort across several MIT labs was funded by the National Institutes of Environmental and Health Sciences (NIEHS) Superfund Research Program, a NIEHS Core Center Grant, a National Institutes of Health Training Grant, and the Anonymous Fund for Climate Action.

Journal

Nature Communications

DOI

10.1038/s41467-026-71753-w

Subject of Research

Animals

Article Title

Early life exposure to N-nitrosamine drives genotoxicity, mutagenesis, and tumorigenesis in DNA repair-deficient mice

Article Publication Date

14-Apr-2026

Thursday, April 16, 2026

Merck's Keytruda: A lifesaving drug, a global divide

Pelin Ünker

DW April 13, 2026

A cross-border investigation by DW and ICIJ reveals how pricing and patents helped turn a life-saving medicine into one of the world's best selling drugs while leaving many patients struggling to access it.

The cancer drug in question is manufactured by the US-based company Merck

Image: Rafael Henrique/SOPA Images/Sipa USA/picture alliance

A yearlong international investigation into one of the world's most important cancer drugs shows how a medical breakthrough has also become a fault line in global health, exposing how pricing systems, patent protections and regulatory frameworks determine who can access life-saving treatment and who cannot.

The Cancer Calculus, coordinated by the International Consortium of Investigative Journalists (ICIJ) with Deutsche Welle and 46 media partners, brought together 124 journalists in 37 countries. Drawing on hundreds of interviews with oncologists, patients and their families, lawyers, regulators, pharmacists, pharmaceutical industry insiders and others as well as exclusive pricing data and patent analyses, the project examines how Merck's cancer drug Keytruda became both a therapeutic milestone and a symbol of unequal access. ICIJ's media partners also obtained public health records, meeting minutes, and pricing and reimbursement data through at least 1,018 public records requests across 27 countries.

Partners including The Indian Express, De Tijd, El País, La Nación and DW Turkish documented how the drug's impact varies dramatically across regions — from hospitals forced to ration treatment to patients turning to courts or crowdfunding to survive.
A drug that changed cancer care

Keytruda (pembrolizumab), first approved in 2014, belongs to a class of immunotherapy drugs that enable the immune system to attack cancer cells. Now approved for at least 19 types of tumors, it has extended survival for millions and, in some cases, turned previously fatal diagnoses into manageable conditions.

Cancer immunotherapy drug

Image: SoniPhotography/Pond5 Images/IMAGO

But it has also become one of the most best sellings drugs in pharmaceutical history. Keytruda generated $31.7 billion (€27.1 billion) in sales in 2025 — nearly half of Merck's total revenue — and around $163 billion globally since its launch. About 60% of those sales come from the United States. Meanwhile, the company has funneled nearly $75 billion in dividends to shareholders and $43 billion into share buybacks.

Keytruda's global expansion has accelerated sharply in recent years. From 2020 to 2024, sales rose by 232% in France to $2.8 billion, 265% in Brazil to $753.7 million, 491% in Mexico to $137.3 million, and 584% in Turkey to nearly $100 million, according to exclusive data shared with ICIJ by the IQVIA Institute for Human Data Science.

As drug prices continue to rise, US President Donald Trump met with pharmaceutical executives in December and pledged to lower costs. While companies signaled price cuts, Merck did not publicly commit to reductions for Keytruda.

At the same time, the cost of treatment has placed growing pressure on health systems worldwide. Annual treatment costs — about $80,000 in Germany to $208,000 in the United States, $93,000 in Lebanon to around $130,000 in Colombia, and from roughly $65,000 in South Africa to $116,000 in Croatia — are straining government budgets, even in wealthy countries.

In the United Kingdom, research has shown that the National Health Service has overpaid for Keytruda in some cases, with one study finding that the drug cost up to five times more than its assessed value for certain lung cancer patients.

Prices, patents and power

The investigation found that Merck has relied on a combination of legal and commercial strategies to maintain its dominance.

One of the most significant is its extensive use of the patent system. Reporters identified at least 1,212 patent applications related to Keytruda across 53 jurisdictions. While the drug's main patents are set to expire in 2028, follow-on patents could extend market exclusivity until at least 2042, delaying cheaper alternatives for more than a decade.

Critics describe this as a "patent fortress" designed to deter competition. Merck rejects that characterization, saying its filings reflect ongoing innovation, including new uses, formulations and combinations.

The investigation also points to regulatory pathways and lobbying efforts that helped expand the drug's use, alongside financial relationships with doctors and patient groups. In the United States alone,records show that Merck made Keytruda-related payments to healthcare professionals totaling nearly $52 million between 2018 and 2024.

Merck says such collaborations help inform the medical community and improve patient care, and that any support for patient organizations is independent of prescribing decisions.

The scale of Keytruda's development costs is also contested. In 2024 congressional testimony, Merck CEO Robert M. Davis said the company had invested $46 billion between 2011 and 2023 to research, develop and manufacture the drug, citing more than 2,200 clinical trials and plans to invest another $18 billion in future studies.

But an analysis by Swiss nonprofit Public Eye estimates the drug's R&D costs at around $1.9 billion, or about 1% of its global revenue since launch. Even when costs of failed trials are included that estimate only rises to $4.8 billion, or roughly 3% of total revenue.
Extreme prices, opaque systems

Keytruda's list prices vary widely, from about $850 per vial (100 mg) in Indonesia to more than $6,000 in the United States, reflecting opaque pricing systems shaped by confidential discounts and negotiations.

Even where prices appear lower, affordability is often worse. In the United States, a patient earning the median income can afford fewer than five doses per year.

In South Africa, by contrast, a person earning the median income cannot afford even a single dose (200 mg) in a year, underscoring how differences in income — not just price — determine access.

The drug pembrolizumab helps cancer patients

Image: Julien Behal/PA Wire/empics/picture alliance

According to ICIJ's analysis, people with median incomes in the United States can afford less Keytruda than those in some Western European countries such as France and Belgium, while the drug is even less affordable in lower-income Eastern European countries like Bulgaria and Hungary.

In India, where access largely depends on out-of-pocket payments or limited assistance programs, treatment costs can exceed a patient's annual income, effectively restricting access to a small share of the population.

In Brazil, the high cost of cancer drugs has driven a surge in litigation, with thousands of lawsuits filed in recent years as patients seek court-ordered access to treatment. Similar patterns have been observed across Latin America, where legal systems have become a critical pathway to access.

The investigation also documented cases in which limited supply forced doctors to make life-and-death decisions. In Guatemala, one oncologist described being forced to choose which patients would receive treatment, saying it felt like "playing God."

Since Keytruda came to market in 2014, ICIJ found at least 632 cases in which patients in 51 countries used GoFundMe and other crowdfunding sites to raise money for Keytruda treatments. In some cases, patients have turned to black markets, exposing themselves to counterfeit medicines. Others have taken governments to court — and in some cases died before their claims were resolved.

Across countries, a common feature emerges: secrecy. Authorities in several countries refused to disclose public spending or patient numbers for Keytruda, often citing "trade secrets," making it difficult to compare prices or assess fairness across health systems.

Turkey: Price policy, reimbursement gaps and litigation

Against this global backdrop, Turkey illustrates how pricing policy, reimbursement rules and judicial processes intersect in access to high-cost cancer drugs.

In Turkey, drug prices are calculated based on a government-set fixed euro exchange rate, which is typically below the market rate. As of April 1, 2026, the reference rate was increased to 29.11 Turkish lira, and the retail price rose to 88,783.52 lira per vial (approximately €3,049).

The drug is administered in two doses every three weeks, bringing the cost of a single treatment cycle to approximately 177,567 lira (€6,099). This corresponds to about 6.5 times the monthly net minimum wage in Turkey, which stands at 28,075.50 lira.

For years, Keytruda remained outside the Social Security Institution (SSI) reimbursement system, pushing patients to seek access through the courts. The drug entered reimbursement in July 2025 for six indications, but eligibility restrictions and off-label uses continue to generate disputes.

A DW Turkish analysis of 50 lawsuits filed in Turkey shows how legal processes themselves have become a defining factor in access. In 10 out of 34 open labor court cases, the patient died while proceedings were still ongoing.

This points to a structural problem: even where a legal right to treatment exists, delays in the judicial process can render that right ineffective, particularly in life-threatening conditions such as cancer.
Dosing debates and rising costs

The investigation also raises questions about how the drug is prescribed. Some researchers argue that Keytruda is often administered at higher doses than necessary.

The World Health Organization estimates that switching to weight-based dosing for lung cancer patients alone could save around $5 billion globally over 15 years, based on modeling scenarios.

3D molecular model of the immunotherapy antibody

Image: Kon/YAY Images/IMAGO

Hospitals in several countries have begun testing lower-dose approaches, with early findings suggesting similar effectiveness. Hospitals in Singapore, Malaysia and Taiwan have arrived at the same conclusion, and several nations, including the Netherlands, Canada and Israel, have started to switch to weight-based dosing — in which a patient's body weight determines how much medication to use — with promising results.

Merck maintains that its dosing recommendations are based on extensive clinical evidence and regulatory approvals.

Merck: Prices reflect value

In responses to ICIJ, Merck defended its pricing strategy, saying Keytruda's price "reflects its value to patients and health care systems."

Merck also said that access to medicines is "multifactorial," depending on healthcare systems, reimbursement policies and infrastructure, not just price.

The company said it uses differential pricing across markets and operates patient assistance programs. It added that it actively engages in access programs in low- and middle-income countries to expand availability. In the United States, it reported providing $1.7 billion in free medicines across its portfolio in 2024, along with about $125 million in co-pay assistance.

Merck also pointed to broader systemic factors, including insurers and intermediaries, as major drivers of high costs, particularly in the US.

Merck has not publicly detailed how it calculates R&D costs for individual medicines but has consistently argued that pricing reflects long-term investments and risks across its portfolio.

At the same time, the company acknowledged "increasing political and business pressures" over pricing and access, especially in emerging markets, but said it is working to make healthcare more "affordable, efficient, equitable and sustainable."
A global system under pressure

The investigation concludes that Merck's practices are not unique, but reflect broader dynamics in the pharmaceutical industry where patent protections, pricing strategies and regulatory frameworks often favor manufacturers.

For patients, however, the consequences are immediate.

Nobel Prize in medicine: Why immune system research matters 03:36

Access to a life-extending treatment often depends not only on medical need, but on geography, income and the ability to navigate complex legal and financial systems.

For Nasır Nesanır, chair of the public health branch of the Turkish Medical Association, these disparities point to deeper structural questions. Speaking to DW Turkish, he said the issue goes beyond healthcare itself.

"Should medical innovation be regarded as a common gain of humanity?" Nesanır asked. "Or should it remain a commercial asset under patent protection that deepens global inequality?"

The result is a deep global divide, where a breakthrough drug can mean survival for some, and remain out of reach for many others.

Saturday, April 11, 2026

Study finds no increased risk of respiratory cancers from asbestos-free talc exposure

International Association for the Study of Lung Cancer

image:
Paolo Boffetta, Stony Brook Cancer Center and Department of Family, Population and Preventive Medicine, Renaissance School of Medicine at Stony Brook University
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Credit: Stony Brook Cancer Center and Department of Family, Population and Preventive Medicine, Renaissance School of Medicine at Stony Brook University

(Denver, Colo. April 10, 2026) -- In a systematic review and meta-analysis, researchers found that occupational exposure to talc that is not contaminated with asbestos is not associated with an increase in the risk of lung cancer, mesothelioma, or laryngeal cancer. The findings are published in the Journal of Thoracic Oncology, the official journal of the International Association for the Study of Lung Cancer. Access the complete study here: https://www.jto.org/article/S1556-0864(26)00163-2/.

Evidence suggests a potential link between occupational talc exposure and increased risk of lung cancer and mesothelioma, when talc is contaminated with asbestos, a known carcinogen. However, the findings for non-contaminated talc remained inconclusive.

To resolve this issue, researchers led by Paolo Boffetta, Stony Brook Cancer Center and Department of Family, Population and Preventive Medicine, Renaissance School of Medicine at Stony Brook University, NY, identified 13, 8, and 7 publications reporting on lung cancer, mesothelioma, and laryngeal cancer, respectively. Five studies on lung cancer in talc miners and millers and three studies in other industries were included in the meta-analysis.

The meta-analysis showed:

Lung cancer

Relative risk (RR) of 1.13 (95% CI: 0.97–1.33) among miners and millers

RR of 1.12 (95% CI: 0.79–1.57) among workers in other industries

Mesothelioma

No cases reported among talc miners and millers in the primary analyses

Laryngeal cancer

No association (RR = 0.98; 95% CI: 0.58–1.57)

Talc is a naturally occurring mineral that is mined from the earth and then processed into the soft, powdery substance used in products like cosmetics, ceramics, paper, and plastics. Major talc-producing regions include China, India, Brazil, the United States, France, and Italy.

Lung cancer is the second most common cancer in both men (after prostate cancer) and women (after breast cancer). It accounted in 2022 for an estimated 1,572,000 new cases and 1,233,000 deaths each year among men and 908,000 cases and 587,000 deaths among women.

Mesothelioma is a cancer of the mesothelium which is most frequently diagnosed in the pleura (known as pleural mesothelioma) but also can occur in the abdominopelvic cavity (peritoneal mesothelioma), the heart (pericardial mesothelioma), or the testes (testicular mesothelioma) (1). Mesothelioma was considered a very rare tumor until a large series of cases were reported in the 1960s among workers employed in asbestos mining and manufacturing (2,3).

Laryngeal cancer is one of the most prevalent types of head and neck cancer. According to GLOBOCAN 2022 (4), its Age Standardized Rate (ASR) is only 1.9 per 100,000 and Age-Standardized Mortality Rate (ASMR) is 1 per 100,000 globally.

“In conclusion, current epidemiological evidence does not provide support for an increased risk of lung cancer, mesothelioma, or laryngeal cancer among workers who are primarily exposed to talc that is free from asbestos contamination,” Boffetta and co-authors wrote.

However, according to the study, it is important to continue monitoring occupational groups, enhance the mineralogical characterization of talc deposits, and conduct future studies that include detailed exposure assessments and control for key confounding factors. These steps are essential to better understand any potential low-level risks and to inform strategies for occupational health prevention.

About the IASLC

The International Association for the Study of Lung Cancer (IASLC) is the only global organization dedicated solely to the study of lung cancer and other thoracic malignancies. Founded in 1974, the association's membership includes more than 11,000 lung cancer specialists across all disciplines in over 100 countries, forming a global network working together to conquer lung and thoracic cancers worldwide. The association publishes the Journal of Thoracic Oncology, the primary educational and informational publication for topics relevant to the prevention, detection, diagnosis and treatment of all thoracic malignancies. Visit www.iaslc.org for more information.

About the JTO

Journal of Thoracic Oncology (JTO), the official journal of the International Association for the Study of Lung Cancer, is the primary educational and informational publication for topics relevant to the prevention, detection, diagnosis, and treatment of all thoracic malignancies. JTO emphasizes a multidisciplinary approach and includes original research reviews and opinion pieces. The audience includes epidemiologists, medical oncologists, radiation oncologists, thoracic surgeons, pulmonologists, radiologists, pathologists, nuclear medicine physicians, and research scientists with a special interest in thoracic oncology.