Different profiles of carcinogen exposure in Chinese compared with US cigarette smokers

Tob Control. 2015 Dec;24(e4):e258-63. doi: 10.1136/tobaccocontrol-2014-051945. Epub 2014 Dec 22.


Background: Differences in carcinogen exposure from different cigarette products could contribute to differences in smoking-associated cancer incidence among Chinese compared with US smokers.

Methods: Urine concentrations of metabolites of nicotine, the tobacco-specific nitrosamine (TSNA) 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and polycyclic aromatic hydrocarbon metabolites (PAHs) were compared in 238 Chinese and 203 US daily smokers.

Results: Comparing Chinese versus US smokers, daily nicotine intake and nicotine intake per cigarette smoked were found to be similar. When normalised for cigarettes per day, urine NNAL excretion was fourfold higher in US smokers, while the excretion of urine metabolites of the PAHs fluorene, phenanthrene and pyrene metabolites was 50% to fourfold higher in Chinese smokers (all, p<0.0001). Similar results were seen when NNAL and PAHs excretion was normalised for daily nicotine intake.

Conclusions: Patterns of carcinogen exposure differ, with lower exposure to TSNA and higher exposure to PAHs in Chinese compared with US smokers. These results most likely reflect country differences in cigarette tobacco blends and manufacturing processes, as well as different environmental exposures.

Trial registration number: NCT00264342.

Keywords: Carcinogens; Global health; Nicotine.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biomarkers / urine
  • Carcinogens / analysis*
  • China
  • Consumer Product Safety
  • Female
  • Humans
  • Male
  • Nitrosamines / urine*
  • Pyrenes / urine*
  • Smoking / adverse effects
  • Smoking / urine*
  • United States


  • Biomarkers
  • Carcinogens
  • Nitrosamines
  • Pyrenes
  • 4-(N-methyl-N-nitrosamino)-1-(3-pyridyl)-1-butanone
  • pyrene

Associated data

  • ClinicalTrials.gov/NCT00264342