Circulating cotinine concentrations and lung cancer risk in the Lung Cancer Cohort Consortium (LC3)

Tricia L. Larose, Florence Guida, Anouar Fanidi, Arnulf Langhammer, Kristian Kveem, Victoria L. Stevens, Eric J. Jacobs, Stephanie A. Smith-Warner, Edward Giovannucci, Demetrius Albanes, Stephanie J. Weinstein, Neal D. Freedman, Ross Prentice, Mary Pettinger, Cynthia A. Thomson, Qiuyin Cai, Jie Wu, William J. Blot, Alan A. Arslan, Anne Zeleniuch-JacquotteLoic Le Marchand, Lynne R. Wilkens, Christopher A. Haiman, Xuehong Zhang, Meir J. Stampfer, Allison M. Hodge, Graham G. Giles, Gianluca Severi, Mikael Johansson, Kjell Grankvist, Renwei Wang, Jian Min Yuan, Yu Tang Gao, Woon Puay Koh, Xiao Ou Shu, Wei Zheng, Yong Bing Xiang, Honglan Li, Qing Lan, Kala Visvanathan, Judith Hoffman Bolton, Per Magne Ueland, Øivind Midttun, Neil Caporaso, Mark Purdue, Howard D. Sesso, Julie E. Buring, I. Min Lee, J. Michael Gaziano, Jonas Manjer, Hans Brunnström, Paul Brennan, Mattias Johansson

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background: Self-reported smoking is the principal measure used to assess lung cancer risk in epidemiological studies. We evaluated if circulating cotinine—a nicotine metabolite and biomarker of recent tobacco exposure—provides additional information on lung cancer risk. Methods: The study was conducted in the Lung Cancer Cohort Consortium (LC3) involving 20 prospective cohort studies. Pre-diagnostic serum cotinine concentrations were measured in one laboratory on 5364 lung cancer cases and 5364 individually matched controls. We used conditional logistic regression to evaluate the association between circulating cotinine and lung cancer, and assessed if cotinine provided additional risk-discriminative information compared with self-reported smoking (smoking status, smoking intensity, smoking duration), using receiver-operating characteristic (ROC) curve analysis. Results: We observed a strong positive association between cotinine and lung cancer risk for current smokers [odds ratio (OR) per 500 nmol/L increase in cotinine (OR500): 1.39, 95% confidence interval (CI): 1.32–1.47]. Cotinine concentrations consistent with active smoking (115 nmol/L) were common in former smokers (cases: 14.6%; controls: 9.2%) and rare in never smokers (cases: 2.7%; controls: 0.8%). Former and never smokers with cotinine concentrations indicative of active smoking (115 nmol/L) also showed increased lung cancer risk. For current smokers, the risk-discriminative performance of cotinine combined with self-reported smoking (AUCintegrated: 0.69, 95% CI: 0.68–0.71) yielded a small improvement over self-reported smoking alone (AUCsmoke: 0.66, 95% CI: 0.64–0.68) (P ¼ 1.5x10–9). Conclusions: Circulating cotinine concentrations are consistently associated with lung cancer risk for current smokers and provide additional risk-discriminative information compared with self-report smoking alone.

Original languageEnglish (US)
Pages (from-to)1760-1771
Number of pages12
JournalInternational Journal of Epidemiology
Issue number6
StatePublished - Dec 1 2018


  • Biomarker
  • Case-control
  • Consortium
  • Cotinine
  • Lung cancer
  • Prospective

ASJC Scopus subject areas

  • Epidemiology


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