Cancer Causes & Control

, Volume 24, Issue 6, pp 1223–1230 | Cite as

Accuracy of self-reported tobacco use in newly diagnosed cancer patients

  • Nelson A. Morales
  • Michelle A. Romano
  • K. Michael Cummings
  • James R. Marshall
  • Andrew J. Hyland
  • Alan Hutson
  • Graham W. Warren
Original paper



Accurate identification of tobacco use is critical to implement evidence-based cessation treatments in cancer patients. The purpose of this study is to evaluate the accuracy of self-reported tobacco use in newly diagnosed cancer patients.


Tobacco use questionnaires and blood samples were collected from 233 newly diagnosed cancer patients (77 lung, 77 breast, and 79 prostate cancer). Blood was analyzed for cotinine levels using a commercially available enzyme-linked immunosorbent assay. Patients with cotinine measurements exceeding 10 ng/mL were categorized as current smokers. Smoking status based upon cotinine levels was contrasted with self-report in current smokers, recent quitters (1 or less year since quit), non-recent quitters (>1 year since quit), and never smokers. Multivariate analyses were used to identify potential predictors of discordance between self-reported and biochemically confirmed smoking.


Cotinine confirmed 100 % accuracy in self-reporting of current and never smokers. Discordance in cotinine and smoking status was observed in 26 patients (15.0 %) reporting former tobacco use. Discordance in self-reported smoking was 12 times higher in recent (35.4 %) as compared with non-recent quitters (2.8 %). Combining disease site, pack-year history, and employment status predicted misrepresentation of tobacco use in 82.4 % of recent quitters.


Self-reported tobacco use may not accurately assess smoking status in newly diagnosed cancer patients. Patients who claim to have recently stopped smoking within the year prior to a cancer diagnosis and lung cancer patients may have a higher propensity to misrepresent tobacco use and may benefit from biochemical confirmation.


Tobacco Smoking Cotinine Accuracy Self report (self-report) Cancer Nicotine 



The authors wish to thank Cheryl Rivard and Jennifer Graf for their assistance with data analysis and comments on earlier drafts of this paper. This work was supported in part by Roswell Park Cancer Institute, National Cancer Institute (NCI) grant #P30 CA016056, an American Cancer Society Mentored Research Scholar Grant (MRSG-11-031-01-CCE), and an American Cancer Society Institutional Research Grant.

Conflict of interest

Dr Cummings provides expert testimony against the tobacco industry.


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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Nelson A. Morales
    • 1
  • Michelle A. Romano
    • 2
  • K. Michael Cummings
    • 3
  • James R. Marshall
    • 4
  • Andrew J. Hyland
    • 5
  • Alan Hutson
    • 6
  • Graham W. Warren
    • 2
    • 7
  1. 1.Department of Natural SciencesRoswell Park Cancer InstituteBuffaloUSA
  2. 2.Department of Radiation OncologyMedical University of South CarolinaCharlestonUSA
  3. 3.Department of Psychiatry and Behavioral SciencesMedical University of South CarolinaCharlestonUSA
  4. 4.Department of Cancer PreventionRoswell Park Cancer InstituteBuffaloUSA
  5. 5.Department of Health BehaviorRoswell Park Cancer InstituteBuffaloUSA
  6. 6.Department of BiostatisticsRoswell Park Cancer InstituteBuffaloUSA
  7. 7.Department of Cell and Molecular Pharmacology and Experimental TherapeuticsMedical University of South CarolinaCharlestonUSA

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