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Although multiple risk factors, including environmental, hormonal, genetic and viral factors, have been implicated in the pathogenesis of lung cancer in never smokers, no clear-cut dominant factor has emerged that can explain the relatively high incidence of lung cancer in never smokers and the marked geographic differences in gender proportions

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What this paper adds What is already known on this subject Philip Morris International (PMI) claims that IQOS reduces users risk by reducing their exposure to harmful and potentially harmful constituents

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Socioeconomic status (SES) also plays a key role, as lower SES is linked to a higher risk of lung cancer, even after accounting for smoking habits