RE: Proportion of Never-Smoker Non–Small Cell Lung Cancer Patients at Three Diverse Institutions

We read with interest the report from Pelosof et al. (1) of an increasing proportion of never-smoker non–small cell lung cancer (NSCLC) patients in a population of more than 10 000 cases from three registries between 1990 and 2013, and note the conclusion that the incidence of lung cancer in never-smokers is increasing. These data, however, may be explained by alternative factors such as referral, misclassification, and other biases. Nonetheless, this is a major issue for public health because residential and occupational radon exposure, ambient air quality, and exposure to asbestos, pesticides, diesel, beryllium, and other heavy metals also contribute to lung cancer risk (2).

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