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In support of this approach, prospective studies of smokers in the Shanghai and Singapore cohorts have found that the major nicotine metabolite, cotinine, and total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), an established biomarker of the tobacco specific lung carcinogen, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), are significantly associated with lung cancer risk after adjustment for self-reported smoking history

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