A diet high in linoleic acid (an x-6 PUFA) increased the formation of miscoding etheno (e) -DNA adducts in WBC-DNA of women, but not in men (Nair et al., Cancer Epidemiol Biomark Prev 1997;6:597-601). This gender specificity could result from an interaction between x-6 PUFA intake and estrogen catabolism, via redox-cycling of 4-hydroxyestradiol (4-OH-E 2 ) and subsequent lipid peroxidation (LPO). In this study, we investigated whether in premenopausal women LPO-derived adducts in WBC-DNA are affected by serum concentration of 2-and 4-hydroxyestradiol metabolites and by fatty acid intake. DNA extracted from buffy coat and plasma samples, both blindly coded from healthy women (N 5 124, median age 40 year) participating in the EPIC-Heidelberg cohort study were analyzed. Three LPO-derived exocyclic DNA adducts, edA, edC and M 1 dG were quantified by immuno-enriched 32 P-postlabelling and estradiol metabolites by ultra-sensitive GC-mass spectrometry. Mean M 1 dG levels in WBC-DNA were distinctly higher than those of edA and edC, and all were positively and significantly interrelated. Serum levels of 4-OH-E 2 , but not of 2-OH-E 2 , metabolites were positively related to etheno DNA adduct formation. Positive correlations existed between M 1 dG levels and linoleic acid intake or the ratios of dietary linoleic acid/oleic acid and PUFA/MUFA. Aerobic incubation of 4-OH-E 2 , arachidonic acid and calf thymus DNA yielded two to threefold higher etheno DNA adduct levels when compared with assays containing 2-OH-E 2 instead. In conclusion, this study is the first to compare M 1 dG and etheno-DNA adducts and serum estradiol metabolites in human samples in the same subjects. Our results support a novel mechanistic link between estradiol catabolism, dietary x-6 fatty acid intake and LPO-induced DNA damage supported by an in vitro model. Similar studies in human breast epithelial tissue and on amplification of DNA-damage in breast cancer patients are in progress.Persistent cellular oxidative stress and enhanced lipid peroxidation (LPO), leading to macromolecular damage and disruption of signaling pathways are implicated in the development of human malignancies.