ArticleNicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco2026
Biomarkers of Exposure to Tobacco-Related Toxicants and Oxidative Stress Among Cancer Survivors.
Article in Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionCancer survivors who continue to use tobacco products may have negative impacts on their long-term health outcomes. AIMS AND
methodsData were drawn from the Population Assessment of Tobacco and Health Study Wave 5 (n = 6946). Geometric mean concentrations of biomarkers from four classes of harmful and potentially harmful constituents, along with a biomarker of oxidative stress, were compared between cancer survivors and non-cancer adults using weighted linear regressions adjusted for demographic factors. Among cancer survivors, comparisons were also made across current cigarette smoking and e-cigarette use statuses.
resultsCompared to non-cancer adults (n = 6441), cancer survivors (n = 505) exhibited higher mean concentrations of 4-(methylnitrosoamino)-1-(3-pyridyl)-1-butanol (NNAL, 10.9 vs. 6.7 pg/mg creatinine), cadmium (0.3 vs. 0.2 ng/mg creatinine), lead (0.4 vs. 0.3 ng/mg creatinine), n-Acetyl-s-(2-carboxyethyl)-l-cysteine (CEMA, 156.6 vs. 128.3 ng/mg creatinine), and 8-isoprostane (521.6 vs. 441.5 pg/mg creatinine) in the unadjusted analyses. Among cancer survivors, both exclusive cigarette smokers and dual users had higher mean concentrations of urine nicotine metabolites (ie, nicotine equivalents [TNE2], and cotinine), NNAL, cadmium, volatile organic compounds, and 8-isoprostane than non-tobacco users. Exclusive e-cigarette users also had higher mean concentrations of nicotine metabolites (TNE2, 4.1 vs. 0.01, p < .0001; cotinine, 288.1 vs. 0.4, p < .0001), NNAL (5.6 vs. 1.7, p = .03), cadmium (0.4 vs. 0.3, p = .01), and 8-isoprostane (594.2 vs. 482.5, p = .03) than non-tobacco users.
conclusionsBoth exclusive smoking and dual-use pose elevated risks of exposure to tobacco-related toxicants to cancer survivors. Exclusive e-cigarette use also increases the risk of nicotine addiction and oxidative stress. Abstinence from all tobacco use among cancer survivors is needed to improve health outcomes. IMPLICATIONS: Cancer survivors represent a high-risk group for tobacco use. This study offers important insights into differences in biomarkers of tobacco-related toxicant exposure between cancer survivors and non-cancer adults and provides evidence of the health impacts associated with cigarette smoking and e-cigarette use. The findings emphasize the need for clinical monitoring and targeted public health interventions to encourage tobacco cessation, including addressing dual-use of cigarettes and e-cigarettes, in order to enhance long-term health outcomes and quality of life for cancer survivors.
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