Urinary Biomarkers of Carcinogenic Exposure Among Cigarette, Waterpipe, and Smokeless Tobacco Users and Never Users of Tobacco in the Golestan Cohort Study

Overview

Journal Cancer Epidemiol Biomarkers Prev

Specialties Biochemistry
Oncology
Public Health

Date 2019 Jan 10

PMID 30622099

Citations 27

Authors

Arash Etemadi

Hossein Poustchi

Cindy M Chang

Benjamin C Blount

Antonia M Calafat

Lanqing Wang

Victor R De Jesus

Akram Pourshams

Ramin Shakeri

Meredith S Shiels

Maki Inoue-Choi

Bridget K Ambrose

Carol H Christensen

Baoguang Wang

Gwen Murphy

Xiaoyun Ye

Deepak Bhandari

Jun Feng

Baoyun Xia

Connie S Sosnoff

Farin Kamangar

Paul Brennan

Paolo Boffetta

Sanford M Dawsey

Christian C Abnet

Reza Malekzadeh

Neal D Freedman

Affiliations

Soon will be listed here.

Abstract

Background: How carcinogen exposure varies across users of different, particularly noncigarette, tobacco products remains poorly understood.

Methods: We randomly selected 165 participants of the Golestan Cohort Study from northeastern Iran: 60 never users of any tobacco, 35 exclusive cigarette, 40 exclusive (78% daily) waterpipe, and 30 exclusive smokeless tobacco (nass) users. We measured concentrations of 39 biomarkers of exposure in 4 chemical classes in baseline urine samples: tobacco alkaloids, tobacco-specific nitrosamines (TSNA), polycyclic aromatic hydrocarbons (PAH), and volatile organic compounds (VOC). We also quantified the same biomarkers in a second urine sample, obtained 5 years later, among continuing cigarette smokers and never tobacco users.

Results: Nass users had the highest concentrations of tobacco alkaloids. All tobacco users had elevated TSNA concentrations, which correlated with nicotine dose. In both cigarette and waterpipe smokers, PAH and VOC biomarkers were higher than never tobacco users and nass users, and highly correlated with nicotine dose. PAH biomarkers of phenanthrene and pyrene and two VOC metabolites (phenylmercapturic acid and phenylglyoxylic acid) were higher in waterpipe smokers than in all other groups. PAH biomarkers among Golestan never tobacco users were comparable to those in U.S. cigarette smokers. All biomarkers had moderate to good correlations over 5 years, particularly in continuing cigarette smokers.

Conclusions: We observed two patterns of exposure biomarkers that differentiated the use of the combustible products (cigarettes and waterpipe) from the smokeless product. Environmental exposure from nontobacco sources appeared to contribute to the presence of high levels of PAH metabolites in the Golestan Cohort.

Impact: Most of these biomarkers would be useful for exposure assessment in a longitudinal study.

Citing Articles

Exposure to volatile organic compounds and chronic respiratory disease mortality, a case-cohort study.

Nalini M, Poustchi H, Bhandari D, Blount B, Kenwood B, Chang C Respir Res. 2025; 26(1):88.

PMID: 40045272 PMC: 11884121. DOI: 10.1186/s12931-025-03165-1.

Human Exposure Levels of Volatile Organic Compounds in E-waste Recycling Area: Get Insight into Impacts of Manipulation Mode and Associations with Oxidative Stress Markers.

Yan M, Cheng Z, Zou Q, Zhao H, Yang L, Zhu H Environ Health (Wash). 2024; 1(6):405-415.

PMID: 39474053 PMC: 11503962. DOI: 10.1021/envhealth.3c00131.

Volatile organic compounds and mortality from ischemic heart disease: A case-cohort study.

Nalini M, Poustchi H, Bhandari D, Chang C, Blount B, Wang L Am J Prev Cardiol. 2024; 19:100700.

PMID: 39100747 PMC: 11296009. DOI: 10.1016/j.ajpc.2024.100700.

Prevalence and Incidence of Metabolic Syndrome and Its Components Among Waterpipe Users.

Sadeghi Y, Naghash M, Poustchi H, Alvand S, Gandomkar A, Molavi Vardanjani H Int J Public Health. 2024; 69:1607156.

PMID: 39056061 PMC: 11269743. DOI: 10.3389/ijph.2024.1607156.

Toxicity of waterpipe tobacco smoking: the role of flavors, sweeteners, humectants, and charcoal.

Kassem N, Strongin R, Stroup A, Brinkman M, El-Hellani A, Erythropel H Toxicol Sci. 2024; 201(2):159-173.

PMID: 39037923 PMC: 11424890. DOI: 10.1093/toxsci/kfae095.

References

Kim S . Overview of Cotinine Cutoff Values for Smoking Status Classification. Int J Environ Res Public Health. 2016; 13(12). PMC: 5201377. DOI: 10.3390/ijerph13121236. View

Bilano V, Gilmour S, Moffiet T, Tursan dEspaignet E, Stevens G, Commar A . Global trends and projections for tobacco use, 1990-2025: an analysis of smoking indicators from the WHO Comprehensive Information Systems for Tobacco Control. Lancet. 2015; 385(9972):966-76. DOI: 10.1016/S0140-6736(15)60264-1. View

Hecht S . Tobacco carcinogens, their biomarkers and tobacco-induced cancer. Nat Rev Cancer. 2003; 3(10):733-44. DOI: 10.1038/nrc1190. View

Olsson M, Petersson G . Benzene emitted from glowing charcoal. Sci Total Environ. 2003; 303(3):215-20. DOI: 10.1016/S0048-9697(02)00403-5. View

Sepetdjian E, Saliba N, Shihadeh A . Carcinogenic PAH in waterpipe charcoal products. Food Chem Toxicol. 2010; 48(11):3242-5. PMC: 3008425. DOI: 10.1016/j.fct.2010.08.033. View

Baan R, Grosse Y, Straif K, Secretan B, El Ghissassi F, Bouvard V . A review of human carcinogens--Part F: chemical agents and related occupations. Lancet Oncol. 2009; 10(12):1143-4. DOI: 10.1016/s1470-2045(09)70358-4. View

Boffetta P, Hecht S, Gray N, Gupta P, Straif K . Smokeless tobacco and cancer. Lancet Oncol. 2008; 9(7):667-75. DOI: 10.1016/S1470-2045(08)70173-6. View

Pourshams A, Khademi H, Malekshah A, Islami F, Nouraei M, Sadjadi A . Cohort Profile: The Golestan Cohort Study--a prospective study of oesophageal cancer in northern Iran. Int J Epidemiol. 2009; 39(1):52-9. PMC: 3709199. DOI: 10.1093/ije/dyp161. View

Etemadi A, Khademi H, Kamangar F, Freedman N, Abnet C, Brennan P . Hazards of cigarettes, smokeless tobacco and waterpipe in a Middle Eastern Population: a Cohort Study of 50 000 individuals from Iran. Tob Control. 2016; 26(6):674-682. PMC: 5767941. DOI: 10.1136/tobaccocontrol-2016-053245. View

10.

Giovino G, Mirza S, Samet J, Gupta P, Jarvis M, Bhala N . Tobacco use in 3 billion individuals from 16 countries: an analysis of nationally representative cross-sectional household surveys. Lancet. 2012; 380(9842):668-79. DOI: 10.1016/S0140-6736(12)61085-X. View

11.

Hecht S . Research opportunities related to establishing standards for tobacco products under the Family Smoking Prevention and Tobacco Control Act. Nicotine Tob Res. 2011; 14(1):18-28. PMC: 3242967. DOI: 10.1093/ntr/ntq216. View

12.

Hatsukami D, Stepanov I, Severson H, Jensen J, Lindgren B, Horn K . Evidence supporting product standards for carcinogens in smokeless tobacco products. Cancer Prev Res (Phila). 2014; 8(1):20-6. PMC: 4299753. DOI: 10.1158/1940-6207.CAPR-14-0250. View

13.

Schubert J, Muller F, Schmidt R, Luch A, Schulz T . Waterpipe smoke: source of toxic and carcinogenic VOCs, phenols and heavy metals?. Arch Toxicol. 2014; 89(11):2129-39. DOI: 10.1007/s00204-014-1372-x. View

14.

Nasrollahzadeh D, Kamangar F, Aghcheli K, Sotoudeh M, Islami F, Abnet C . Opium, tobacco, and alcohol use in relation to oesophageal squamous cell carcinoma in a high-risk area of Iran. Br J Cancer. 2008; 98(11):1857-63. PMC: 2410115. DOI: 10.1038/sj.bjc.6604369. View

15.

Maroni M, Colosio C, Ferioli A, Fait A . Biological Monitoring of Pesticide Exposure: a review. Introduction. Toxicology. 2000; 143(1):1-118. DOI: 10.1016/s0300-483x(99)00152-3. View

16.

M J Roth Y-L Qiao N Rothman J A Tangrea S M Dawsey G-Q Wang S-H Cho D Kang P R Taylor P T Strickland . High urine 1-hydroxypyrene glucuronide concentrations in Linxian, China, an area of high risk for squamous oesophageal cancer. Biomarkers. 2013; 6(5):381-6. DOI: 10.1080/13547500110044780. View

17.

Abedi-Ardekani B, Kamangar F, Hewitt S, Hainaut P, Sotoudeh M, Abnet C . Polycyclic aromatic hydrocarbon exposure in oesophageal tissue and risk of oesophageal squamous cell carcinoma in north-eastern Iran. Gut. 2010; 59(9):1178-83. PMC: 3505022. DOI: 10.1136/gut.2010.210609. View

18.

Yuan J, Butler L, Stepanov I, Hecht S . Urinary tobacco smoke-constituent biomarkers for assessing risk of lung cancer. Cancer Res. 2014; 74(2):401-11. PMC: 4066207. DOI: 10.1158/0008-5472.CAN-13-3178. View

19.

Etemadi A, Islami F, Phillips D, Godschalk R, Golozar A, Kamangar F . Variation in PAH-related DNA adduct levels among non-smokers: the role of multiple genetic polymorphisms and nucleotide excision repair phenotype. Int J Cancer. 2012; 132(12):2738-47. PMC: 3597757. DOI: 10.1002/ijc.27953. View

20.

Sepetdjian E, Shihadeh A, Saliba N . Measurement of 16 polycyclic aromatic hydrocarbons in narghile waterpipe tobacco smoke. Food Chem Toxicol. 2008; 46(5):1582-90. DOI: 10.1016/j.fct.2007.12.028. View