ПАЛІННЯ, ФАКТОРИ ДОВКІЛЛЯ ТА ХРОНІЧНІ ЛЕГЕНЕВІ ХВОРОБИ ЯК КЛЮЧОВІ ФАКТОРИ РИЗИКУ РАКУ ЛЕГЕНІ У ПІВНІЧНІЙ СУМАТРІ
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 Nort...
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| Опубліковано в: | Експериментальна онкологія |
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| Дата: | 2026 |
| Том: | 48 |
| Випуск: | 2 |
| Сторінки: | 152-160 |
| ISSN: | 2312-8852 |
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| Формат: | Стаття |
| Мова: | Англійська |
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2026
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Experimental Oncology| _version_ | 1874183252444446720 |
|---|---|
| author | Aulia Anwar, Putri Novisari Soeroso, Noni Putra Tarigan, Setia Chairani Eyanoer, Putri |
| author_facet | Aulia Anwar, Putri Novisari Soeroso, Noni Putra Tarigan, Setia Chairani Eyanoer, Putri |
| author_institution_txt_mv | [
{
"author": "Putri Aulia Anwar",
"institution": "Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia",
"orcid": ""
},
{
"author": "Noni Novisari Soeroso",
"institution": "Thoracic Oncology Division, Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia\/Prof. dr. Chairuddin P. Lubis Universitas Sumatera Utara Hospital, Medan, Indonesia",
"orcid": ""
},
{
"author": "Setia Putra Tarigan",
"institution": "Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia\/Adam Malik Hospital, Medan, Indonesia",
"orcid": "0000-0002-6242-7013"
},
{
"author": "Putri Chairani Eyanoer",
"institution": "Department of Community and Preventive Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia",
"orcid": ""
}
] |
| author_orcid_str_mv | 0000-0002-6242-7013 |
| author_sort | Aulia Anwar, Putri |
| baseUrl_str | https://exp-oncology.com.ua/index.php/Exp/oai |
| collection | OJS |
| container_end_page | 160 |
| container_issue | 2 |
| container_start_page | 152 |
| container_title | Експериментальна онкологія |
| container_volume | 48 |
| datestamp_date | 2026-08-21T12:36:15Z |
| description | 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. |
| doi_str_mv | 10.15407/exp-oncology.2026.02.152 |
| first_indexed | 2026-08-22T01:00:32Z |
| format | Article |
| fulltext |
152 ISSN 1812-9269. Experimental Oncology 48 (2). 2026
ORIGINAL CONTRIBUTION
C i t a t i o n: Anwar PA, Soeroso NN, Tarigan SP, Eyanoer PC. Smoking, environmental exposures, and chronic lung
disease as key risk factors for lung cancer in North Sumatra. Exp Oncol. 2026; 48(2): 152-160. https://doi.org/10.15407/
exp-oncology.2026.02.152
© PH “Akademperiodyka” of the NAS of Ukraine, 2026. This is an open access article under the CC BY-NC-ND license
(https://creativecommons.org/licenses/by-nc-nd/4.0/)
https://doi.org/10.15407/exp-oncology.2026.02.152
Putri Aulia Anwar 1, Noni Novisari Soeroso 2, *,
Setia Putra Tarigan 3, Putri Chairani Eyanoer 4
1 Department of Pulmonology and Respiratory Medicine,
Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
2 Thoracic Oncology Division, Department of Pulmonology and Respiratory
Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan,
Indonesia/Prof. dr. Chairuddin P. Lubis Universitas Sumatera
Utara Hospital, Medan, Indonesia
3 Department of Pulmonology and Respiratory Medicine,
Faculty of Medicine, Universitas Sumatera Utara, Medan,
Indonesia/Adam Malik Hospital, Medan, Indonesia
4 Department of Community and Preventive Medicine,
Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
* Correspondence: E-mail: noni@usu.ac.id
SMOKING, ENVIRONMENTAL EXPOSURES,
AND CHRONIC LUNG DISEASE AS KEY RISK
FACTORS FOR LUNG CANCER IN NORTH SUMATRA
Background. Lung cancer remains the leading cause of cancer mortality worldwide, with increasing incidence in many devel-
oping 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 observa-
tional study with a case–control analytical approach was conducted between August and November 2024 in three referral hos-
pitals 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 signifi-
cantly between cases and controls (p = 0.023). The multivariate analysis identified several independent predictors of lung can-
cer. 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 de-
terminants 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.
Keywords: lung cancer, smoking, occupational exposure, indoor air pollution, tuberculosis.
https://doi.org/10.15407/exp-oncology.2026.02.152
https://doi.org/10.15407/exp-oncology.2026.02.152
https://creativecommons.org/licenses/by-nc-nd/4.0/
https://doi.org/10.15407/exp-oncology.2026.02.152
mailto:tiwuul@gmail.com
mailto:tiwuul@gmail.com
mailto:noni@usu.ac.id
ISSN 1812-9269. Experimental Oncology 48 (2). 2026 153
Smoking, Environmental Exposures, and Chronic Lung Disease as Key Risk Factors for Lung Cancer
Lung cancer is one of the leading causes of cancer-
related mortality worldwide, responsible for 2.2 mil
lion new cases and 1.8 million deaths in 2020 [1, 2].
It is classified into small cell lung cancer (SCLC)
and non-small cell lung cancer (NSCLC), with ad-
enocarcinoma as the most common subtype [1]. In
Indonesia, lung cancer accounts for 8.6% of new
cancer cases and 12.6% of cancer deaths, represent-
ing a major public health burden [3, 4].
Smoking remains the predominant risk factor, with
smokers having up to ten-fold higher risk than non-
smokers [5]. In Indonesia, nearly a quarter of the pop-
ulation are active smokers, with particularly high
prevalence in North Sumatra [6]. Beyond tobacco, oc-
cupational and environmental exposures such as as-
bestos, radon, cadmium, and air pollutants signifi-
cantly contribute to lung carcinogenesis, many of
which are recognized as carcinogenic by the Interna-
tional Agency for Research on Cancer (IARC) [7—9].
Early initiation of smoking is strongly associated
with increased lifetime nicotine dependence, higher
daily cigarette consumption in adulthood, and pro-
longed exposure to carcinogenic substances found
in tobacco smoke. These factors collectively height-
en the risk of developing tobacco-related malignan-
cies, including lung cancer, head and neck cancers,
tracheobronchial tumors, and other smoking-asso-
ciated diseases. Evidence consistently shows that in-
dividuals who start smoking at a young age face a
substantially higher lifetime risk of cancer compared
to those who initiate tobacco use later.
Chronic pulmonary diseases, including tubercu-
losis (TB) and chronic obstructive pulmonary dis-
ease (COPD), also increase lung cancer susceptibi
lity through long-term inflammation and fibrosis
[10—12]. Given the high mortality and multifacto-
rial etiology of lung cancer, region-specific evidence
is needed to guide prevention and early detection.
This study therefore aimed to investigate the asso-
ciations of smoking, environmental and occupation-
al exposures, and chronic pulmonary diseases with
lung cancer in the North Sumatra population.
Materials and Methods
Study design and setting. This study employed a
hospital-based case–control design conducted be-
tween August and November 2024 at three tertiary
referral hospitals in North Sumatra, Indonesia:
Adam Malik Hospital, Universitas Sumatera Utara
Hospital, and Santa Elisabeth Hospital. Cases and
controls were recruited from the same hospitals to
ensure that both groups originated from a compa-
rable source population. Participants were compa-
rable by sex and residential area, while age was treat-
ed as a potential confounding variable and adjusted
statistically in the multivariate regression analysis.
Participants. The case group consisted of 240 pa-
tients with histologically confirmed lung cancer,
including both SCLC and NSCLC, diagnosed based
on histopathological examination supported by
clinical evaluation.
The control group included 240 individuals
without malignancy or chronic respiratory disease
who were recruited from general outpatient clinics
in the same hospitals during the study period. Con-
trols were selected from patients visiting the clinics
for non-respiratory and non-oncological condi-
tions, ensuring that they represented the same un-
derlying population as the cases.
Participants were eligible if they were ≥ 18 years
old and willing to participate in the study. Indivi
duals with any current malignancy, chronic respira-
tory disease, or acute respiratory illness were ex-
cluded from the control group.
Cases were recruited consecutively from hospi-
talized patients diagnosed with lung cancer. The
minimum sample size required for adequate statis-
tical power was 240 participants per group, calcu-
lated based on case–control study assumptions.
Data collection. Clinical and demographic in-
formation was collected using medical records
and structured data collection forms. The vari-
ables included:
• age;
• sex;
• occupation;
• smoking exposure;
• occupational exposure to carcinogens;
• residential environmental conditions;
• indoor household environment;
• history of chronic respiratory diseases (inclu
ding TB and COPD);
• family history of cancer.
For patients in the case group, additional clinical
information was collected, including:
• histological subtype;
• cancer stage;
• metastasis status;
• EGFR mutation status;
154 ISSN 1812-9269. Experimental Oncology 48 (2). 2026
P.A. Anwar, N.N. Soeroso, S.P. Tarigan, P.C. Eyanoer
• ECOG performance status;
• treatment regimen.
Definition of key exposure variables. Smoking
exposure was categorized into four groups:
• never smokers: individuals who had never
smoked in their lifetime;
• passive smokers: individuals exposed to tobac-
co smoke at home or in the workplace;
• former smokers: individuals who previously
smoked but stopped smoking for at least 12 months
before enrolment;
• current smokers: individuals actively smoking
cigarettes or other tobacco products at the time of
the study.
Additional smoking variables included age at
smoking initiation, number of cigarettes smoked
per day, and duration of smoking.
Occupational exposure referred to the long-term
exposure to known lung carcinogens in the work-
place. Common occupations among participants
included construction workers, factory workers,
drivers exposed to traffic pollution, miners, and ag-
ricultural workers. Relevant exposures included as-
bestos, silica dust, diesel exhaust, industrial chem-
icals, and pesticide aerosols.
Residential environment referred to environmental
pollution surrounding the household, including prox-
imity to industrial areas, major roads with high traffic
density, or other sources of outdoor air pollution.
Indoor household environment was classified as
healthy or unhealthy based on the presence of risk
factors such as poor ventilation, indoor tobacco
smoke exposure, use of biomass fuel for cooking,
and household dampness or mold.
Family history of cancer. Family history of cancer
was defined as a reported history of cancer among
first-degree relatives (parents, siblings, or children).
Information regarding cancer history among sec-
ond-degree relatives was not systematically avai
lable in the medical records and therefore was not
included in the present analysis.
Statistical analysis. Descriptive statistics were
used to summarize baseline participant character-
istics. The categorical variables were compared us-
ing the Chi-square test, while the continuous vari-
ables were analyzed using independent samples
t‑tests. The variables with p < 0.25 in the bivariate
analysis were included in the multivariate logistic
regression model using backward stepwise selec-
tion to identify independent risk factors for lung
cancer. Because the control group was not com-
pletely matched by age, age was included as an ad-
justment variable in the multivariate model to
control for potential confounding. The adjusted
odds ratios (ORs) with 95% confidence intervals
(CIs) were calculated to estimate the strength of the
associations between risk factors and lung cancer.
Statistical significance was defined as p < 0.05.
Ethical approval. The study protocol was approved
by the Ethics Committee of the Faculty of Medicine,
Universitas Sumatera Utara (No. 1134/KEPK/
USU/2024). All procedures were conducted in accor-
dance with ethical standards for medical research in-
volving human subjects. Eligible participants were re-
cruited from three referral hospitals in North Sumatra
between August and November 2024. Cases were de-
fined as patients with histologically confirmed lung
cancer (SCLC or NSCLC) verified by clinical and his-
topathological examinations. Controls were individu-
als without malignancy or chronic respiratory disease
recruited from outpatient clinics in the same hospi-
tals. Exclusion criteria for both groups included any
Flow diagram of participant selection
ISSN 1812-9269. Experimental Oncology 48 (2). 2026 155
Smoking, Environmental Exposures, and Chronic Lung Disease as Key Risk Factors for Lung Cancer
concurrent malignancy or acute or chronic respira-
tory illness. A total of 240 cases and 240 controls were
included in the final analysis (Figure).
Results
Baseline characteristics of participants are presen
ted in Table 1. Sex distribution was similar between
groups, with most participants being male. A sig-
nificant difference in age distribution was observed
between groups (p < 0.001). The control group con-
tained the higher proportion of participants aged
<45 years (20.8%) compared to the cases (6.3%),
indicating potential age imbalance between groups.
The history of cancer, smoking exposure, occupa-
tional exposure, unhealthy indoor environment,
and previous respiratory disease were significantly
more common among cases than controls, whereas
the family history of cancer and general residential
environment showed no significant differences.
Comparison of risk factors between groups is
summarized in Table 2. Lung cancer patients were
more likely to have a history of cancer (p = 0.012),
occupational exposure (p = 0.001), unhealthy in-
door environments (p < 0.001), and respiratory dis-
ease (p < 0.001). They also had higher overall risk
scores (p < 0.001). No significant differences were
observed in mean age, family history of cancer,
smoking exposure, or residential environment.
Multivariate logistic regression analysis identified
several independent risk factors for lung cancer
(Table 3). Smoking exposure was strongly associated
with lung cancer risk. Individuals with former or
current smoking history had more than a three-fold
increased risk compared with never smokers
(OR 3.42; 95% CI 1.96—5.97). Passive smoking was
also associated with increased risk (OR 1.76; 95%
CI 1.02—3.04). Occupational exposure remained a
significant predictor (OR 1.91; 95% CI 1.13—3.25),
and participants living in unhealthy indoor environ-
ments had a more than two-fold higher risk of lung
cancer (OR 2.53; 95% CI 1.45—4.40). Age was in-
cluded as an adjustment variable in the model to
control for potential confounding.
Discussion
This study identified smoking exposure, occupa-
tional hazards, unhealthy indoor environments,
and chronic respiratory diseases as important de-
Table 1. Baseline characteristics
of study participants
Characteristics
Case
group
(n = 240)
Control
group
(n = 240)
p-value
Sex
Female 59 (24.6%) 58 (24.2%)
Male 181 (75.4%) 182 (75.8%) 0.915
Age
<45 years 15 (6.3%) 50 (20.8%)
45—65 years 162 (67.5%) 112 (46.7%)
>65 years 63 (26.3%) 78 (32.5%) <0.001
History of cancer
None 233 (97.1%) 240 (100%)
<5 years ago 5 (2.1%) 0 (0%)
>5 years ago 2 (0.8%) 0 (0%) 0.029
Family history
None 235 (97.9%) 236 (98.3%)
Other cancers 3 (1.3%) 4 (1.7%)
Lung cancer 2 (0.8%) 0 (0%) 0.342
Smoking exposure
Never 18 (7.5%) 32 (13.3%)
Passive 51 (21.3%) 31 (12.9%)
Ex-/current smoker 76 (31.7%) 86 (35.8%)
Active smoker 95 (39.6%) 91 (37.9%) 0.023
Occupational exposure
Yes 116 (48.3%) 80 (33.3%)
No 124 (51.7%) 160 (66.7%) 0.001
Residential environment
Unhealthy 114 (47.5%) 97 (40.4%)
Healthy 126 (52.5%) 143 (59.6%) 0.118
Indoor environment
Unhealthy 74 (30.8%) 41 (17.1%)
Healthy 166 (69.2%) 199 (82.9%) <0.001
Respiratory disease
None 209 (87.1%) 240 (100%)
COPD 18 (7.5%) 0 (0%)
Tuberculosis 13 (5.4%) 0 (0%) <0.001
Risk level
Mild 12 (5.0%) 34 (14.2%)
Moderate 92 (38.3%) 103 (42.9%)
Severe 136 (56.7%) 103 (42.9%) <0.001
Notes: Chi-square test was used for categorical variables.
COPD — chronic obstructive pulmonary disease. Risk
level was categorized based on cumulative exposure to
smoking, occupational, and environmental pollutants.
156 ISSN 1812-9269. Experimental Oncology 48 (2). 2026
P.A. Anwar, N.N. Soeroso, S.P. Tarigan, P.C. Eyanoer
terminants of lung cancer risk in North Sumatra.
These findings are consistent with the global
understanding that lung cancer is largely driven
by modifiable environmental and behavioral ex-
posures. Recent global analyses continue to em-
phasize that tobacco use and environmental ex-
posures remain the dominant contributors to
lung cancer incidence worldwide, particularly in
low- and middle-income countries where tobacco
control and environmental regulations remain
limited [13—15].
The absence of significant sex-related differences
between cases and controls in this study is consis-
tent with previous epidemiological studies. Al-
though the majority of lung cancer patients were
male, reflecting the higher prevalence of smoking
among men in Indonesia, recent international data
suggest that the gap between men and women is
gradually narrowing due to increasing smoking
rates among women and environmental exposure
among non-smokers [13, 14]. Recent global cancer
statistics have also reported an increasing lung can-
cer incidence among women in several regions,
partly driven by changing smoking patterns and
environmental exposures [16].
Age is widely recognized as a major determinant
of lung cancer incidence, with risk generally in-
creasing with advancing age due to cumulative ex-
posure to carcinogens and progressive genetic
damage. In the present study, differences in age dis-
tribution were observed between cases and cont
rols. Because the control group contained the high-
er proportion of younger individuals, age was treat-
ed as a potential confounding variable and included
in the multivariate regression model. This approach
helps ensure that the estimated associations be-
tween environmental exposures and lung cancer
risk are not biased by differences in age distribution
between groups [17].
Smoking exposure remained the most important
behavioral risk factor in this study. The multivari-
ate analysis demonstrated that former or current
smokers had a significantly higher risk of lung can-
cer compared with never smokers. Tobacco smoke
contains thousands of carcinogenic compounds,
including polycyclic aromatic hydrocarbons
(PAHs), nitrosamines, and heavy metals, which in-
duce DNA damage, promote chronic inflamma-
tion, and accelerate carcinogenesis [5, 18]. Large
cohort studies have shown that smokers have a
15—30-fold higher risk of lung cancer compared to
non-smokers, with risk strongly correlated with
smoking duration and intensity [18]. Passive smok-
ing was also associated with an increased risk in
Table 3. Multivariate logistic regression
analysis of risk factors for lung cancer
Variable p-value Adjusted OR
(95% CI)
Age (reference:
45—65 years)
<45 years 0.081 1.62 (0.94—2.79)
>65 years 0.109 1.34 (0.94—1.92)
Smoking exposure
(reference: never smoker)
Passive smoking 0.041 1.76 (1.02—3.04)
Former/current smoker <0.001 3.42 (1.96—5.97)
Occupational exposure 0.017 1.91 (1.13—3.25)
Indoor environment
(unhealthy)
0.001 2.53 (1.45—4.40)
Notes: Multivariate logistic regression analysis adjusted for
age and sex. OR — odds ratio; CI — confidence interval.
Table 2. Comparison of risk factors
between lung cancer cases and controls
Variable Case group
(mean ± SD)
Control group
(mean ± SD) p-value
Age 2.20 ± 0.54 2.12 ± 0.72 0.152
History of
cancer 1.04 ± 0.23 1.00 ± 0.00 0.012
Family history
of cancer 1.04 ± 0.29 1.02 ± 0.13 0.315
Smoking
exposure 3.03 ± 0.95 2.98 ± 1.02 0.580
Occupational
exposure 1.97 ± 1.00 1.67 ± 0.95 0.001
Residential
environment 1.95 ± 1.00 1.81 ± 0.98 0.118
Indoor
environment 1.62 ± 0.93 1.34 ± 0.75 < 0.001
Respiratory
disease 1.18 ± 0.51 1.00 ± 0.00 < 0.001
Risk level 2.52 ± 0.59 2.29 ± 0.70 < 0.001
Notes: Independent samples t-test. Higher mean scores
indicate greater exposure or risk severity. Risk level score
was derived from combined smoking, occupational, and
environmental exposure categories.
ISSN 1812-9269. Experimental Oncology 48 (2). 2026 157
Smoking, Environmental Exposures, and Chronic Lung Disease as Key Risk Factors for Lung Cancer
this study, supporting evidence that second-hand
smoke exposure contributes to lung cancer deve
lopment, particularly among individuals living
with smokers [19]. Recent epidemiological studies
further indicate that the combined effects of tobac-
co smoke and air pollution may amplify lung can-
cer risk in urban populations, particularly in rap-
idly developing Asian regions [20].
Occupational exposure also showed a significant
association with lung cancer risk. Workers exposed
to industrial carcinogens such as asbestos, silica
dust, diesel exhaust, and heavy metals have consis-
tently demonstrated higher lung cancer incidence
in occupational epidemiology studies. The IARC
classifies several occupational agents, including as-
bestos and cadmium, as Group 1 carcinogens for
lung cancer [7]. Similar findings have been report-
ed in large-cohort studies in Asia and Europe,
where long-term occupational exposure signifi-
cantly increased lung cancer mortality [21, 22]. Re-
cent evidence also highlights the role of occupa-
tional particulate exposure and industrial pollut-
ants in the increasing lung cancer risk among
workers in rapidly industrializing regions [23].
Indoor air pollution was another important de-
terminant identified in this study. Participants li
ving in unhealthy indoor environments had more
than twice the risk of developing lung cancer. In-
door air pollution is a major public health concern
in many developing countries, where exposure to
biomass fuels, poor ventilation, and indoor tobacco
smoke is common. Previous studies conducted in
India and China have reported similar findings,
particularly among non-smoking women exposed
to biomass combustion products [24, 25]. Exposure
to fine particulate matter (PM2.5) and volatile or-
ganic compounds such as benzene, toluene, ethyl-
benzene, and xylene (BTEX) contributes to oxida-
tive stress, DNA damage, and chronic inflamma-
tion, which are important mechanisms in lung
carcinogenesis [26, 27]. Recent environmental
health research has further demonstrated that long-
term exposure to fine particulate matter signifi-
cantly increases lung cancer incidence and mortal-
ity in urban populations [28].
Chronic pulmonary diseases, particularly COPD
and TB, were more prevalent among lung cancer
cases in this study. Chronic inflammation associ-
ated with these conditions may contribute to carci-
nogenesis through repeated tissue injury, fibrosis,
and activation of inflammatory pathways. Epide-
miological evidence indicates that a history of TB
or COPD is associated with an increased risk of
lung cancer in the general population. A recent me-
ta-analysis reported that pulmonary TB confers
more than a twofold increase in lung cancer risk
[29]. Consistently, a population-based cohort study
demonstrated a 1.72-fold higher risk of lung cancer
among TB survivors, with a greater risk observed
in those with coexisting COPD [30]. Moreover, TB
has been shown to significantly increase the risk of
developing COPD, further contributing to lung
carcinogenesis through persistent airway inflam-
mation and structural lung damage [31].
In contrast, family history of cancer was not
significantly associated with lung cancer risk in
this study. This finding differs from several large-
scale studies conducted in Korea and Western
populations, which have consistently reported
that a positive family history of lung cancer is as-
sociated with an increased risk of disease, with
estimated risk elevations ranging from approxi-
mately 1.5 to more than 2-fold compared with in-
dividuals without such history [12, 32, 33]. The
discrepancy observed in the present study may re-
flect population-specific factors or the stronger
influence of environmental exposures, particular-
ly smoking and air pollution, in the North Suma-
tran population. Nevertheless, prospective cohort
evidence indicates that the family history of lung
cancer remains an independent risk factor for
lung cancer development even after adjustment
for major confounders, with significantly in-
creased risk observed in both smokers and never-
smokers [33].
Overall, the findings of this study emphasize that
lung cancer in North Sumatra is strongly associated
with modifiable environmental and behavioral fac-
tors. Smoking, occupational exposures, indoor air
pollution, and chronic respiratory diseases appear
to play major roles in disease development. These
findings highlight the importance of strengthening
tobacco control policies, improving occupational
safety, and reducing indoor air pollution as key
strategies to reduce lung cancer burden in high-risk
populations. This study provides important region-
al epidemiological evidence on lung cancer risk
factors in North Sumatra, contributing to the de-
velopment of targeted prevention strategies in
high-burden settings.
158 ISSN 1812-9269. Experimental Oncology 48 (2). 2026
P.A. Anwar, N.N. Soeroso, S.P. Tarigan, P.C. Eyanoer
Strengths and limitations of the study
This study has several important strengths. First, it
included a relatively large sample of lung cancer
patients and controls recruited from three major
referral hospitals in North Sumatra, providing ro-
bust epidemiological data from a high-burden re-
gion. Second, the study simultaneously evaluated
multiple environmental, behavioral, and clinical
risk factors, allowing a more comprehensive assess-
ment of determinants associated with lung cancer
in this population. Third, the use of multivariate
regression analysis enabled adjustment for poten-
tial confounding variables, particularly age differ-
ences between cases and controls, thereby strength-
ening the validity of the observed associations.
This study has several limitations that should be
considered when interpreting the findings. First,
the hospital-based design may introduce selection
bias and limit the generalizability of the results to
the broader population. In addition, the case and
control groups were not strictly age-matched;
therefore, age was included as an adjustment vari-
able in the multivariate regression analysis to re-
duce potential confounding. Information on se
veral exposure variables, including smoking his-
tory, occupational exposure, and household
environmental conditions, was obtained from
medical records and self-reported data, which may
introduce recall bias.
Furthermore, exposure intensity and duration
for smoking and occupational carcinogens were
not quantified in detail, which may have resulted
in residual confounding. Environmental conditions
were assessed using questionnaire-based informa-
tion rather than objective measurements of indoor
air pollutants. In addition, family history of cancer
was limited to first-degree relatives because infor-
mation on second-degree relatives was not system-
atically available in the medical records. Despite
these limitations, this study provides important ep-
idemiological evidence from a relatively large sam-
ple of lung cancer patients and controls in North
Sumatra and highlights key modifiable environ-
mental and behavioral risk factors in this high-bur-
den region.
Acknowledgment
The authors would like to express their deepest
gratitude to the Faculty of Medicine, Universitas
Sumatera Utara, for providing the ethical clearance
and institutional support necessary for the comple-
tion of this research. We are also sincerely thankful
to the management and medical staff of Adam Ma-
lik Hospital, Universitas Sumatera Utara Hospital,
and Santa Elisabeth Hospital in North Sumatra for
granting access to medical records and for their as-
sistance in data collection.
Funding
There is no funding for this research.
Conflict of interest
The authors declare that there is no conflict of in-
terest regarding the publication of this study.
REFERENCES
1. Soeroso N, Soeroso L, Hasibuan P, et al. Kanker paru: Diagnosis dan penatalaksanaan. Medan: USU Press; 2017.
ISBN: 9789794589885 (in Indonesian)
2. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and morta
lity worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. https://doi.org/10.3322/
caac.21660
3. World Health Organization. Indonesia cancer country profile 2020. Geneva: WHO; 2020. https://cdn.who.int/me-
dia/docs/default-source/country-profiles/cancer/idn-2020.pdf
4. 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)
5. 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
6. 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
7. 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
https://doi.org/10.3322/caac.21660
https://doi.org/10.3322/caac.21660
https://cdn.who.int/
https://repository.badankebijakan.kemkes.go.id/id/eprint/3514
https://doi.org/10.1136/bmjopen-2018-021611
https://doi.org/10.3889/oamjms.2018.224
https://doi.org/10.3889/oamjms.2018.224
https://doi.org/10.1111/1759-7714.12185
ISSN 1812-9269. Experimental Oncology 48 (2). 2026 159
Smoking, Environmental Exposures, and Chronic Lung Disease as Key Risk Factors for Lung Cancer
8. 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
9. 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/
10. 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
11. 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
12. Ang L, Chan CPY, Yau WP, et al. Association between family history of lung cancer and lung cancer risk: A sys-
tematic review and meta-analysis. Lung Cancer. 2020;148:129-137. https://doi.org/10.1016/j.lungcan.2020.08.012
13. 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
14. 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
15. 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
16. 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
17. 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
18. 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
19. 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
20. Zhang Y, Chen R, Zhang L, et al. Interaction between smoking and air pollution exposure in lung cancer risk. En-
viron Res. 2023;216:114518. https://doi.org/10.1016/j.envres.2022.114518
21. 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
22. 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
23. Takahashi K, Landrigan PJ, Collegium R. Occupational exposure and lung cancer risk: Global evidence and pre-
vention strategies. Occup Environ Med. 2021;78(12):893–899. https://doi.org/10.1136/oemed-2020-107123
24. Hosgood HD, Boffetta P, Greenland S, et al. In-home coal and wood use and lung cancer risk. Environ Health Per-
spect. 2010;118(12):1743-1747. https://doi.org/10.1289/ehp.1002217
25. 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
26. 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
27. 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
28. 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
29. 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
30. 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
31. 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
32. 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/can-
cers16112063
33. 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
https://doi.org/10.1016/j.envint.2019.105077
https://monographs.iarc.who.int/agents-classified-by-the-iarc/
https://doi.org/10.1164/rccm.201402-0338OC
https://doi.org/10.1093/cid/ciad373
https://doi.org/10.1016/j.lungcan.2020.08.012
https://doi.org/10.3322/caac.21763
https://doi.org/10.3322/caac.21763
https://doi.org/10.3978/j.issn.2218-6751.2015.08.04
https://doi.org/10.1016/S2213-2600(22)00110-0
https://doi.org/10.3322/caac.21834
https://doi.org/10.1200/JCO.2006.06.8015
https://doi.org/10.1200/JCO.2006.06.8015
https://doi.org/10.1136/bmj.38142.554479.AE
https://doi.org/10.1016/S0140-6736(10)61388-8
https://doi.org/10.1016/j.envres.2022.114518
https://doi.org/10.1111/cas.12076
https://doi.org/10.1016/j.jaci.2019.04.016
https://doi.org/10.1136/oemed-2020-107123
https://doi.org/10.1289/ehp.1002217
https://doi.org/10.5732/cjc.014.10110
https://doi.org/10.1097/JTO.0b013e3181f68a47
https://doi.org/10.1038/sj.bjc.6602769
https://doi.org/10.1016/S2542-5196(22)00105-7
https://doi.org/10.1159/000543319
https://doi.org/10.1093/cid/ciad123
https://doi.org/10.1093/cid/ciad123
https://doi.org/10.3390/jcm14217639
https://doi.org/10.3390/cancers16112063
https://doi.org/10.3390/cancers16112063
https://doi.org/10.1016/j.cllc.2025.04.003
160 ISSN 1812-9269. Experimental Oncology 48 (2). 2026
P.A. Anwar, N.N. Soeroso, S.P. Tarigan, P.C. Eyanoer
Путрі Аулія Анвар 1, Ноні Новісарі Соерозо 2,
Сетія Путра Таріган 3, Путрі Чаїрані Ейаноер 4
1 Кафедра пульмонології та респіраторних хвороб,
медичний факультет, Університет Північної Суматри, Медан, Індонезія
2 Відділення торакальної онкології медичного факультету
Університету Північної Суматри, Медан, Індонезія /
госпіталь університету Північної Суматри
ім. проф. Чаїруддін П. Любіс, Медан, Індонезія
3 Кафедра пульмонології та респіраторних хвороб медичного факультету
Університету Північної Суматри, Медан, Індонезія /
Госпіталь Адама Маліка, Медан, Індонезія
4 Кафедра профілактичної та громадської медицини,
медичний факультет, Університет Північної Суматри, Медан, Індонезія
ПАЛІННЯ, ФАКТОРИ ДОВКІЛЛЯ ТА ХРОНІЧНІ ЛЕГЕНЕВІ ХВОРОБИ
ЯК КЛЮЧОВІ ФАКТОРИ РИЗИКУ РАКУ ЛЕГЕНІ У ПІВНІЧНІЙ СУМАТРІ
Стан питання. Рак легені залишається провідною причиною онкологічної смертності у світі. Захворюваність
на рак легені в країнах, що розвиваються, зростає. Визначення специфічних регіональних факторів ризику є
важливим для ефективних стратегій профілактики. Мета дослідження полягала у визначенні основних детер-
мінант раку легені у Північній Суматрі, Індонезія. Матеріали та методи. Проведено спостережне дослідження
на базі трьох клінік у Північній Суматрі, Індонезія, від серпня по листопад 2024 року з включенням 240 хворих
із гістологічно підтвердженим раком легені та 240 осіб контрольної групи без злоякісних новоутворень або
хронічних захворювань дихальних шляхів. Особи, включені до дослідження, мали порівняні характеристики за
статтю та місцем проживання, тоді як вікові відмінності між групами були статистично скориговані за допомо-
гою багатофакторної регресійної моделі. Результати. Паління було найбільш визначальним фактором ризику
порівняно з контрольною групою. Багатофакторний аналіз виявив кілька незалежних предикторів раку легені.
Вік до 45 років збільшував ризик більш ніж удвічі (ВШ 2,62; 95% ДІ 1,10—6,21), тоді як у віці понад 65 років
відносний ризик був нижчим (ВШ 0,54; 95% ДІ 0,33—0,88). Несприятливі виробничі фактори значно збільшу-
вали ризик раку легень (ВШ 1,91; 95% ДІ 1,13—3,25). Підвищений ризик зазначено також щодо несприятливих
побутових умов помешкання, зокрема поганої вентиляції та впливу забруднюючих речовин (ВШ 2,53; 95% ДІ
1,45—4,40). Хронічні респіраторні захворювання, зокрема туберкульоз та хронічна обструктивна хвороба ле-
гень, були більш поширеними в групі хворих на рак легень в порівнянні з контрольною групою і сприяли підви-
щенню ризику. Висновки. Паління, професійні ризики, нездорове середовище в приміщенні та хронічні захво-
рювання легень є важливими детермінантами раку легені у Північній Суматрі. Стратегії громадського здоров’я,
зосереджені на обмеженні тютюнопаління, покращенні безпеки на робочому місці та зменшенні забруднення
повітря в помешканнях, можуть суттєво зменшити поширення раку легені у цьому регіоні.
Ключові слова: рак легені, тютюнопаління, професійні шкідливі фактори, забруднення повітря в помешкан-
нях, туберкульоз.
|
| id | oai:ojs2.ex.aqua-time.com.ua:article-650 |
| institution | Experimental Oncology |
| issn | 2312-8852 |
| keywords_txt_mv | |
| language | English |
| last_indexed | 2026-08-22T01:00:32Z |
| publishDate | 2026 |
| publisher | PH Akademperiodyka |
| record_format | ojs |
| resource_txt_mv | exp-oncologycomua/b5/26b20e09be865af52d30d537f8b514b5.pdf |
| spelling | oai:ojs2.ex.aqua-time.com.ua:article-6502026-08-21T12:36:15Z SMOKING, ENVIRONMENTAL EXPOSURES, AND CHRONIC LUNG DISEASE AS KEY RISK FACTORS FOR LUNG CANCER IN NORTH SUMATRA ПАЛІННЯ, ФАКТОРИ ДОВКІЛЛЯ ТА ХРОНІЧНІ ЛЕГЕНЕВІ ХВОРОБИ ЯК КЛЮЧОВІ ФАКТОРИ РИЗИКУ РАКУ ЛЕГЕНІ У ПІВНІЧНІЙ СУМАТРІ Aulia Anwar, Putri Novisari Soeroso, Noni Putra Tarigan, Setia Chairani Eyanoer, Putri рак легені, тютюнопаління, професійні шкідливі фактори, забруднення повітря в помешканнях, туберкульоз lung cancer, smoking, occupational exposure, indoor air pollution, tuberculosis 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 &lt;45 years increased the risk more than two-fold (OR 2.62; 95% CI 1.10—6.21), whereas age &gt;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. Стан питання. Рак легені залишається провідною причиною онкологічної смертності у світі. Захворюваність на рак легені в країнах, що розвиваються, зростає. Визначення специфічних регіональних факторів ризику є важливим для ефективних стратегій профілактики. Мета дослідження полягала у визначенні основних детермінант раку легені у Північній Суматрі, Індонезія. Матеріали та методи. Проведено спостережне дослідження на базі трьох клінік у Північній Суматрі, Індонезія, від серпня по листопад 2024 року з включенням 240 хворих із гістологічно підтвердженим раком легені та 240 осіб контрольної групи без злоякісних новоутворень або хронічних захворювань дихальних шляхів. Особи, включені до дослідження, мали порівняні характеристики за статтю та місцем проживання, тоді як вікові відмінності між групами були статистично скориговані за допомогою багатофакторної регресійної моделі. Результати. Паління було найбільш визначальним фактором ризику порівняно з контрольною групою. Багатофакторний аналіз виявив кілька незалежних предикторів раку легені. Вік до 45 років збільшував ризик більш ніж удвічі (ВШ 2,62; 95% ДІ 1,10—6,21), тоді як у віці понад 65 років відносний ризик був нижчим (ВШ 0,54; 95% ДІ 0,33—0,88). Несприятливі виробничі фактори значно збільшували ризик раку легень (ВШ 1,91; 95% ДІ 1,13—3,25). Підвищений ризик зазначено також щодо несприятливих побутових умов помешкання, зокрема поганої вентиляції та впливу забруднюючих речовин (ВШ 2,53; 95% ДІ 1,45—4,40). Хронічні респіраторні захворювання, зокрема туберкульоз та хронічна обструктивна хвороба легень, були більш поширеними в групі хворих на рак легень в порівнянні з контрольною групою і сприяли підвищенню ризику. Висновки. Паління, професійні ризики, нездорове середовище в приміщенні та хронічні захворювання легень є важливими детермінантами раку легені у Північній Суматрі. Стратегії громадського здоров’я, зосереджені на обмеженні тютюнопаління, покращенні безпеки на робочому місці та зменшенні забруднення повітря в помешканнях, можуть суттєво зменшити поширення раку легені у цьому регіоні. PH Akademperiodyka 2026-08-21 Article Article application/pdf https://exp-oncology.com.ua/index.php/Exp/article/view/650 10.15407/exp-oncology.2026.02.152 Experimental Oncology; Vol. 48 No. 2 (2026): Experimental Oncology; 152-160 Експериментальна онкологія; Том 48 № 2 (2026): Експериментальна онкологія; 152-160 2312-8852 1812-9269 10.15407/exp-oncology.2026.02 en https://exp-oncology.com.ua/index.php/Exp/article/view/650/476 Copyright (c) 2026 Experimental Oncology https://creativecommons.org/licenses/by-nc-nd/4.0/ |
| spellingShingle | рак легені тютюнопаління професійні шкідливі фактори забруднення повітря в помешканнях туберкульоз Aulia Anwar, Putri Novisari Soeroso, Noni Putra Tarigan, Setia Chairani Eyanoer, Putri ПАЛІННЯ, ФАКТОРИ ДОВКІЛЛЯ ТА ХРОНІЧНІ ЛЕГЕНЕВІ ХВОРОБИ ЯК КЛЮЧОВІ ФАКТОРИ РИЗИКУ РАКУ ЛЕГЕНІ У ПІВНІЧНІЙ СУМАТРІ |
| title | ПАЛІННЯ, ФАКТОРИ ДОВКІЛЛЯ ТА ХРОНІЧНІ ЛЕГЕНЕВІ ХВОРОБИ ЯК КЛЮЧОВІ ФАКТОРИ РИЗИКУ РАКУ ЛЕГЕНІ У ПІВНІЧНІЙ СУМАТРІ |
| title_alt | SMOKING, ENVIRONMENTAL EXPOSURES, AND CHRONIC LUNG DISEASE AS KEY RISK FACTORS FOR LUNG CANCER IN NORTH SUMATRA |
| title_full | ПАЛІННЯ, ФАКТОРИ ДОВКІЛЛЯ ТА ХРОНІЧНІ ЛЕГЕНЕВІ ХВОРОБИ ЯК КЛЮЧОВІ ФАКТОРИ РИЗИКУ РАКУ ЛЕГЕНІ У ПІВНІЧНІЙ СУМАТРІ |
| title_fullStr | ПАЛІННЯ, ФАКТОРИ ДОВКІЛЛЯ ТА ХРОНІЧНІ ЛЕГЕНЕВІ ХВОРОБИ ЯК КЛЮЧОВІ ФАКТОРИ РИЗИКУ РАКУ ЛЕГЕНІ У ПІВНІЧНІЙ СУМАТРІ |
| title_full_unstemmed | ПАЛІННЯ, ФАКТОРИ ДОВКІЛЛЯ ТА ХРОНІЧНІ ЛЕГЕНЕВІ ХВОРОБИ ЯК КЛЮЧОВІ ФАКТОРИ РИЗИКУ РАКУ ЛЕГЕНІ У ПІВНІЧНІЙ СУМАТРІ |
| title_short | ПАЛІННЯ, ФАКТОРИ ДОВКІЛЛЯ ТА ХРОНІЧНІ ЛЕГЕНЕВІ ХВОРОБИ ЯК КЛЮЧОВІ ФАКТОРИ РИЗИКУ РАКУ ЛЕГЕНІ У ПІВНІЧНІЙ СУМАТРІ |
| title_sort | паління, фактори довкілля та хронічні легеневі хвороби як ключові фактори ризику раку легені у північній суматрі |
| topic | рак легені тютюнопаління професійні шкідливі фактори забруднення повітря в помешканнях туберкульоз |
| topic_facet | рак легені тютюнопаління професійні шкідливі фактори забруднення повітря в помешканнях туберкульоз lung cancer smoking occupational exposure indoor air pollution tuberculosis |
| url | https://exp-oncology.com.ua/index.php/Exp/article/view/650 |
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