• 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, and Neal D Freedman.
• Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, Bethesda, Maryland. arash.etemadi@nih.gov malek@ams.ac.ir.
• Cancer Epidemiol. Biomarkers Prev. 2019 Feb 1; 28 (2): 337-347.

BackgroundHow carcinogen exposure varies across users of different, particularly noncigarette, tobacco products remains poorly understood.MethodsWe 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.ResultsNass 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.ConclusionsWe 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.ImpactMost of these biomarkers would be useful for exposure assessment in a longitudinal study.©2019 American Association for Cancer Research.

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