Impact of cooking-related household air pollution (HAP) on never-smoker NSCLC risk in women: Systematic review and meta-analysis.

Abstract

e20690 Background: Among pollutants, exposure to cooking-related household air pollution (HAP) is a significant environmental health concern, particularly problematic for women who are non-smokers but still face a rising incidence of non-small cell lung cancer (NSCLC). However, globally, tobacco is the leading cause of cancers, but a substantial number of lung cancer cases have been reported among women, especially from low-income countries, who never smoked. Ultimately, our systematic review and meta-analysis focus on investigating the association between various cooking-related pollutants, such as cooking oil fumes and biomass fuel combustion, and risk for the development of NSCLC among these women. The pooled data will provide clarification of the impact of indoor smoking environmental pollutants on lung cancer etiology in never-smoking women. Methods: This systematic review and meta-analysis followed PRISMA guidelines and registered with PROSPERO. A total of 1901 articles were retrieved using databases including PubMed, Scopus, and EMBASE from inception to January 2026. Eligible studies evaluating the impact of exposure to cooking-related household air pollution (HAP) on the occurrence of non-small cell lung carcinoma among non-smoking adult women ≥18 years, compared with women unexposed to HAP were included. Data were analyzed using RevMan version 5.4 with a random-effects model to estimate pooled odd ratios (ORs) with 95% confidence intervals. A p-value < 0.05 was considered statistically significant. Results: Our systematic review and meta-analysis pooled results demonstrated a visible link between indoor pollution exposure and lung cancer. HAP exposure showed no significant association with lung cancer vs. healthy controls (OR: 0.66; 95% CI: 0.25-1.76, P = 0.41). Although limited by high heterogeneity (I2 = 99%), these results reflect variation in individuals across the globe. From the structural analysis of event sizes, we deduced that HAP exposure led to 1.51 times more chance of acquiring lung cancer (OR: 1.51; 95% CI: 1.25, 1.81; I2 = 20%; P < 0.0001). Our findings were verified from the reported HR: 2.04 (95% CI: 1.47, 2.82; I2 = 0%; P < 0.0001), indicating that exposed individuals had twice the chance of lung cancer being diagnosed. Conclusions: This systematic review and meta-analysis substantiates cooking-related household air pollution as an important etiologic factor in lung cancer among never-smoking women, implicating indoor combustion byproducts and supporting targeted public health interventions.