Figure 4|. The lung exposome.

The exposome of the lung comprises a diverse array of molecules and events (including carcinogens from tobacco, asbestos and radon) that come from the external and internal lung environment. These external and internal influences interact with each other and host’omes’to alter the lung cell environment (including inflammation and the microbiome) and may promote or protect against the development of the hallmarks of cancer⁷². Smoking is estimated to cause 90% of lung cancers. Occupational exposures to carcinogens and radon exposure are estimated to cause 9–15% and 10% of lung cancer cases, respectively¹⁷⁴. Measurement of the exposome, in addition to other host ‘omics’, has led to the development of precise biomarkers of risk, diagnosis, treatment response and prognosis by which patients can be classified into new taxa. These new taxa then require different standards of care for cancer screening, diagnosis, prevention and therapy.