Background Urinary volatile organic compounds can accurately reflect individual exposure levels. This study investigated the association between urinary volatile organic compounds and cancer from both single- and combined-exposure perspectives and identified the volatile organic compounds most strongly associated with cancer. Methods This cross-sectional study analyzed data from 6056 US adults from the National Health and Nutrition Examination Survey 2011–2018 cycles, including 546 individuals with cancer. Logistic regression and restricted cubic spline models were used to evaluate associations for individual volatile organic compound exposures. Subgroup and interaction analyses were conducted to assess differences among populations. Least absolute shrinkage and selection operator, weighted quantile sum, and Bayesian kernel machine regression models were applied to evaluate mixture associations and to identify volatile organic compounds most strongly associated with cancer. Results Nine urinary volatile organic compound metabolites were significantly associated with cancer. Among them, N-acetyl-S-(3,4-dihydroxybutyl)-L-cysteine, a metabolite of 1,3-butadiene, and 2-aminothiazoline-4-carboxylic acid, a metabolite of cyanide, exhibited nonlinear dose–response relationships. Subgroup and interaction analyses indicated that age and body mass index were important effect modifiers of these associations. Mixture exposure analyses revealed that higher overall volatile organic compounds exposure levels were associated with a higher prevalence of cancer, with N-acetyl-S-(3,4-dihydroxybutyl)-L-cysteine contributing most strongly to the observed association. Conclusion This study provides epidemiological evidence of an association between urinary volatile organic compounds and cancer, with N-acetyl-S-(3,4-dihydroxybutyl)-L-cysteine consistently showing the strongest association. These findings highlight the potential public health relevance of exposure to specific volatile organic compounds.
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