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Wildfire Smoke Exposure and Cancer-Related Outcomes in the NLST Cohort

Principal Investigator

Name
Shuguang Leng

Degrees
MBBS PhD

Institution
University of New Mexico

Position Title
Associate Professor

Email
sleng@salud.unm.edu

About this CDAS Project

Study
NLST (Learn more about this study)

Project ID
NLST-1518

Initial CDAS Request Approval
Jul 14, 2026

Title
Wildfire Smoke Exposure and Cancer-Related Outcomes in the NLST Cohort

Summary
Wildfires have increased dramatically in frequency, duration, and intensity across the western United States and globally. Recent evidence indicates that wildfire smoke has stalled or reversed decades of progress in reducing ambient fine particulate matter (PM2.5) across much of the contiguous United States (CONUS). Since 2016, wildfire smoke has contributed approximately 1 µg/m³ to annual PM2.5 concentrations in the most affected regions. Wildfire emissions contain a complex mixture of fine particles, toxicants, and carcinogens that can adversely affect populations both near and far from fire sources. Despite strong biological plausibility linking wildfire smoke exposure to carcinogenesis and disease progression, its impact on cancer incidence, survival, and mortality remains poorly understood. This knowledge gap is particularly important given the growing population of cancer survivors who may experience repeated wildfire smoke exposure over time. We propose to leverage data from the National Lung Screening Trial (NLST) to evaluate the effects of long-term wildfire smoke exposure on cancer incidence, cancer mortality, and survival. We will include both lung cancer and non-lung cancers in analyses. This study will generate critical epidemiologic evidence on the long-term health impacts of wildfire smoke and inform public health strategies in an era of increasing wildfire activity.

Aims

Aim 1: Evaluate the associations between wildfire smoke exposure and cancer-related outcomes, including cancer incidence, mortality, and survival and determine whether associations vary by wildfire smoke composition.
Aim 2: Evaluate the associations between wildfire smoke exposure and cross-sectional and longitudinal features of lung nodules and determine whether associations vary by wildfire smoke composition.
Aim 3: Evaluate the associations between wildfire smoke exposure and digital pathology measures based on H&E stained images of tumors and determine whether associations vary by wildfire smoke composition.
Aim 4: Evaluate the associations between wildfire smoke exposure and CT features of COPD (emphysema, air trapping, airway thickening) and coronary artery calcium and determine whether associations vary by wildfire smoke composition.

Collaborators

Shuguang Leng University of New Mexico