Nitrosamines are mainly mutagenic through methylation of DNA. 7-Methylguanine (m 7 Gua) is a product of base excision repair and spontaneous depurination of such lesions in DNA and a metabolite from RNA. Associations between urinary excretion of m 7 Gua and risk of lung cancer were examined in a population-based cohort of 25,717 men and 27,972 women aged 50-64 years. During 3-7 years follow-up 260 cases with lung cancer were identified and a subcohort of 263 individuals matched on sex, age and smoking duration was selected for comparison. Urine collected at entry was analyzed for m 7 Gua by HPLC. Effect modification by glutathione-S-transferases GSTM1, GSTM3, GSTT1 and GSTP1 was investigated. We found higher excretion of m 7 Gua among current smokers than among former smokers. The IRR (incidence rate ratio) of lung cancer was 1.20 (95% CI: 1.00-1.43) per doubling of m 7 Gua excretion in unadjusted analysis and 1.12 (95% CI: 0.93-1.35) after adjustment for smoking status, intensity and duration at entry. This association was mainly present among current smokers. Comparing the highest with the lowest tertile of m 7 Gua excretion the IRR of lung cancer was 1.75 (95% CI: 1.04-2.95) irrespective of genotype and 2.75 (95% CI: 1.33-5.81) in subjects with GSTM1 null genotype. If not caused by residual confounding by smoking a possible association between m 7 Gua excretion and lung cancer supports the importance of methylation of guanine. The finding of an association between m 7 Gua excretion and lung cancer risk mainly among current smokers and subjects with GSTM1 null genotype supports causality in this respect. ' 2007 Wiley-Liss, Inc.Key words: lung cancer; smoking; cohort study; biomarkers; 7-methylguanine; glutathione-S-transferasesThe causal factors of lung cancer include active smoking, environmental tobacco smoke, various occupational exposures and probably ambient air pollution. 1-4 Tobacco smoke contain more than 50 known carcinogens including polycyclic aromatic hydrocarbons, aromatic amines and tobacco-specific nitrosamines (TSNA), such as 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). TSNA are formed by nitrosation of nicotine and secondary amines during curing and smoking of tobacco. 5 Upon metabolic activation TSNA can form DNA adducts of which N 7 -methylguanine (m 7 Gua) is by far the most abundant, representing 70-90% of methylation products. 6-10 Whereas m 7 Gua is innocuous in DNA, the levels increase dose-dependently in DNA upon administration of methylating agents, correlating with pro-mutagenic and carcinogenic methyl-adducts, such as O 6 -methylguanine and methyladenine, 11-13 and may thus serve as biomarker of exposure to methylating agents. Indeed, a physiologically based pharmacokinetic model for interspecies dose extrapolation of dimethyl sulphate has been based on m 7 Gua adducts in the nasal cavity. 14 Glutathione-S-transferases (GST) are a superfamily of genetically polymorphic enzymes detoxifying carcinogens, including many of those from tobacco smoke. The mu class of GSTs include...