Biomarkers of Exposure to Tobacco-Related Toxicants and Oxidative Stress among Cancer Survivors.

Abstract

Introduction: Cancer survivors who continue to use tobacco products may have negative impacts on their long-term health outcomes.

Methods: Data 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.

Results: Compared 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 (i.e., nicotine equivalents [TNE2], and cotinine), NNAL, cadmium, volatile organic compounds (VOCs), 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.

Conclusions: Both 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 of 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.