Do E-Cigarettes Cause Cancer?

SEPTEMBER 6, 2018 / IN QUITTING SMOKING / 6 MIN READ

Written by OLIVIA MOHTADY
Medically reviewed by Dr. Maroof Ahmed, MD on September 6, 2018

The growing trend for using electronic cigarettes has caused quite a stir among medical experts. Initially, e-cigarettes (also known as “vapes”) were developed by Chinese pharmacist Hon Lik as an aid for individuals attempting to quit smoking. These novel technologies were designed to replenish the nicotine craved by quitters and enable them to leave behind toxic tobacco cigarettes. Randomised control trials show that this purpose has been somewhat fulfilled, with e-cigarette users showing modest reports of continued abstinence from smoking following quit attempts.

However, “vaping” has become a habit of smokers and non-smokers alike. In particular, the popularity of e-cigarettes among young adults and even high school students is staggering. And is this really surprising? Not only do e-cigarettes cost half as much as traditional cigarettes, but they also have a far more pleasing aesthetic: they produce colourful smoke, a variety of 7,000 flavours of vapor and some of them ever-so-slightly resemble that magical lamp from Aladdin’s cave of wonders. More importantly, they do not come encased in threatening packets warning of lung cancer and death.

However, it is important to wonder whether electronic cigarettes are as harmless as the bubble-gum flavouring would suggest. Since e-cigarettes contain nicotine, many users worry about their addictive effects. And it’s not just nicotine that can be found in e-liquids – the ambiguous content of the chemicals used to flavour e-cigarette vapor has raised concerns.

We’ve trawled through some of the conflicting literature, so that we can give our readers an idea of the health risks of vaping.

What we know (and what we don’t know)

Since e-cigarettes have only been around since the early noughties, researchers do not know an awful lot about their long-term consequences to our health. As time goes by, who knows what the evidence will reveal? Take traditional cigarettes – doctors originally prescribed smoking before the extremely harmful health effects began to show up in research.

Therefore, it’s important to stay updated with the latest research, especially when making crucial health decisions like whether to use e-cigarettes as a method of smoking cessation (or otherwise).

So far, research suggests e-cigarettes are less risky than traditional cigarettes because they do not contain tobacco. As most of us know, tobacco cigarettes carry high risks of lung cancer, heart disease and a multitude of other adverse health effects.

The higher risk implicated by tobacco smoke means doctors and oncologists tend to agree that e-cigarettes are a far safer method of nicotine delivery than cigarette smoking. Indeed, a report published by Public Health England suggests vaping may be 95% safer than smoking. E-cigarettes have therefore been highly praised for helping many individuals quit smoking tobacco.

However, it is important to be aware of the controversies here. For instance, in the United States, both the US Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) issue explicit health warnings about the use of e-cigarettes, especially recreationally. They strongly recommend e-cigarettes should be avoided by those who are not currently trying to quit tobacco smoking. Conversely, in Europe, there are a lack of public health messages of this nature – regulations have been more focused in the marketing sector, with emphasis placed on thorough labelling of products so that users are aware of their chemical content.

The differences between messages about e-cigarettes in these different parts of the world could reflect the greater push for tobacco-free nations in Europe. The potential health risks of using e-cigarettes as a means to achieve this are therefore reported differently.

Tobacco-control researchers have specific intentions to expose the dangers of tobacco and remove tobacco-related risk for patients. This is a noble agenda, but an agenda nonetheless: the potential for bias cannot be ignored and the other sides of the argument for the health dangers of e-cigarettes should be considered.

So, do e-cigarettes really cause cancer?

Currently, there are no established links between e-cigarettes and cancer. A study has shown that the levels of carbon monoxide and cancer-causing chemicals found in the body after using e-cigarettes are not comparable to those found after using regular cigarettes.

However, despite the absence of carbon monoxide, a study in 2016 discovered some concerning chemical content to the e-liquid used to flavour e-cigarette vapor. For instance, diacetyl is used to flavour some e-cigarettes. Diacetyl is associated with bronchiolitis obliterans – a condition also known as the ‘popcorn lung’ (high rates of it were once found in factory workers breathing in the diacetyl that flavours microwave popcorn).

A popcorn lung is not a form of cancer, but it is a very serious condition that involves damage and scarring to the small airways in the lungs, causing shortness of breath and pervasive coughing in those afflicted with it. It can even lead to the need for a lung transplant, especially if the inflammation is not treated promptly. And yet we do not see vaping may cause serious damage to the lungs scrawled on the packaging of e-cigarettes!

Since 2016, measures have been put in place to alleviate the potential risks e-cigarettes pose to the lungs, including health warnings and manufacturing regulations by the American FDA. Diacetyl was actually banned in e-cigarettes sold in the United Kingdom, under the EU Tobacco Products Directive.

We do not yet know the other potential health effects of e-cigarettes, but fortunately, the ‘popcorn lung’ risk has been identified and organisations are becoming more stringent about the way e-cigarettes are developed and distributed.

What about nicotine?

Regardless of the other chemicals in e-liquids, it is important to consider that e-cigarettes, by their very function, contain highly addictive nicotine. There is even evidence that e-cigarettes have become a gateway to smoking tobacco cigarettes in some young people. This is a disturbing finding considering that the initial intent of e-cigarettes was to help people quit smoking.

Nicotine in itself is not necessarily harmful and may even have some benefits to brain functioning in adults (this is another controversial topic that you can read about here), but nicotine addiction is no joke! Cravings are nasty, with side effects like exhaustion, impaired concentration and a general depletion of mood and enjoyment. Should experts be advocating a world resting on a nicotine crutch, even if the dangers of tobacco are removed?

Take home message

International oncology journals suggest there is currently little evidence of vaping being a completely safe alternative to smoking. Even though e-cigarettes have not yet been implicated in causing cancer (and attempts have been made to regulate potentially lung-harming e-liquids), there simply has not been adequate time to establish the exact health risks. Vaping therefore cannot be recommended in evidence-based guidelines.

There is a strong case for using electronic cigarettes as a lesser of two evils, if the alternative is tobacco use. However, the addictive effects of nicotine and the general uncertainty surrounding e-cigarettes leads us to recommend that non-smokers do not take up vaping as a recreational activity.

Quitters might do well to consider alternative routes to smoking cessation. Nicotine-replacement therapy alone may not be as effective as vaping, but in conjunction with cognitive-behavioural therapy, it has a strong evidence base for its efficacy in helping individuals stop smoking.

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