title: Serum cotinine level as predictor of lung cancer risk.
abstract: BACKGROUND
  No prospective studies are available on serum cotinine level as a marker of lung cancer risk.
  
  
  METHODS
  We analyzed serum cotinine level among 1,741 individuals enrolled since the 1970s in a prospective study of Norwegian volunteers who developed lung cancer during the follow-up and 1,741 matched controls free from lung cancer. Serum cotinine was measured with a competitive immunoassay. Regression dilution was corrected for based on repeated measures on samples from 747 subjects.
  
  
  RESULTS
  Mean serum cotinine level was higher in cases than in controls. Compared with subjects with a cotinine level of < or = 5 ng/mL, the odds ratio of lung cancer was increasing linearly, reaching 55.1 (95% confidence interval, 35.7-85.0) among individuals with a serum cotinine level of > 378 ng/mL. There was no clear suggestion of a plateau in risk at high exposure levels. Odds ratios were very similar in men and women. We found no association between serum cotinine level (range, 0.1-9.9 ng/mL) and lung cancer risk among self-reported nonsmokers and long-term quitters (79 cases and 350 controls).
  
  
  CONCLUSIONS
  The association between tobacco smoking and lung cancer risk might be stronger than is estimated from questionnaire-based studies. Serum cotinine level is a predictor of risk of lung cancer among smokers. The reported plateau in risk at high doses is likely due mainly to artifacts. There is no difference between men and women in the carcinogenicity of tobacco smoking.
authors.affiliation: IARC, 150 cours Albert Thomas, 69008 Lyon, France. boffetta@iarc.fr
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
authors.forename: Sarah
authors.initials: S
authors.lastname: Clark
authors.forename: Min
authors.initials: M
authors.lastname: Shen
authors.forename: Randi
authors.initials: R
authors.lastname: Gislefoss
authors.forename: Richard
authors.initials: R
authors.lastname: Peto
authors.forename: Aage
authors.initials: A
authors.lastname: Andersen
mesh_terms: D015415:Biomarkers / Q000097:blood*; D016022:Case-Control Studies; D003367:Cotinine / Q000097:blood*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000097:blood* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012650:Self Disclosure; D012907:Smoking / Q000378:metabolism; D011795:Surveys and Questionnaires
chemical_list: D015415:Biomarkers; D003367:Cotinine