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DNA hypomethylation in certain genes is associated with tobacco exposure but it is unknown whether these methylation changes translate into increased lung cancer risk. In an epigenome-wide study of DNA from pre-diagnostic blood samples from 132 case–control pairs in the NOWAC cohort, we observe that the most significant associations with lung cancer risk are for cg05575921 in  AHRR  (OR for 1 s.d.=0.37, 95% CI: 0.31–0.54,  P -value=3.3 × 10 −11 ) and cg03636183 in  F2RL3  (OR for 1 s.d.=0.40, 95% CI: 0.31–0.56,  P -value=3.9 × 10 −10 ), previously shown to be strongly hypomethylated in smokers. These associations remain significant after adjustment for smoking and are confirmed in additional 664 case–control pairs tightly matched for smoking from the MCCS, NSHDS and EPIC HD cohorts. The replication and mediation analyses suggest that residual confounding is unlikely to explain the observed associations and that hypomethylation of these CpG sites may mediate the effect of tobacco on lung cancer risk.

Hypomethylation of smoking-related genes is associated with future lung cancer in four prospective cohorts