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The Advarra Institutional Review Board approved the study and participants provided written informed consent

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Human lung organoids recapitulated these adaptations, showing enlarged morphology, reduced apoptosis and nuclear NRF2 accumulation, consistent with a stress-tolerant, clonally persistent phenotype

Lung cancers were among those with the highest numbers of somatic mutations (4.21 per megabase) and this was attributed to recurrent exogenous mutagen exposure