E-cigarette use among teens and young people has been a medical concern ever since the product hit the market. By 2018, the US Surgeon General had referred to vaping as an “epidemic,” and the US Food and Drug Administration has spent years working to regulate the e-cigarette industry to try and curtail use. Even still, teenagers continue to use vaping devices at increasing rates.
E-cigs and vapes remain in their infancy relative to cigarettes. But as cigarettes and lung cancer are inextricably linked, many in the medical field have wondered if there will be a similar connection with e-cigarettes. Is there data yet identifying a correlation between the two?
The Rise of Teen Vaping
First, let’s examine the increase in vaping tobacco among young people. A study in the New England Journal of Medicine published in October 2019 claimed that from 2017 to 2019, teen use of e-cigarettes more than doubled. Over 25% of 12th graders in the study had reported using nicotine vapes in the past 30 days in 2019 compared with 11% in 2017, while 9% of 8th graders had reported using the product in the past 30 days in 2019 compared with 3.5% in 2017.¹
The prevalence of these products among young Americans has caused an increase in what the Centers for Disease Control and Prevention (CDC) refers to as e-cigarette, or vaping, product use-associated lung injury (EVALI). Per the CDC, there were 2668 hospitalization cases or deaths attributed to EVALI as of January 14, 2020; 15% of those patients were aged <18 years, while 37% were aged 18 to 24. The median age of all patients was 24.²
EVALI can be difficult to diagnose, and the CDC attributes many cases to vapes that contained tetrahydrocannabinol. The medical field is seeing a general correlation between a rise in vaping and a rise in lung-related illnesses in teenagers and young adults. Has this resulted in a similar correlation with regard to lung cancer?
Are Lung Cancer Rates Rising in Young Adults?
Thus far, any peculiarities in lung cancer rates have yet to be attributed to e-cigarette use and may remain inconclusive altogether. A February 2020 study in the International Journal of Cancer analyzed the incidence of lung cancer in young men and young women in 40 countries across 5 continents and found an increased rate of lung adenocarcinoma in young women. But the countries with historical smoking data did not show the smoking prevalence in women consistently surpassing that of men, and thus researchers said future studies were required to identify why this rate was rising.³
It is possible that not enough time has elapsed since the emergence of e-cigarettes for there to be conclusive evidence relating it to lung cancer rates and diagnoses. Of course, this has not and should not stop medical professionals from being concerned with how tobacco products that have not been consistently regulated can affect consumers. Proceedings of the National Academy of Sciences published a study in 2019 that exposed mice to short-term e-cigarette smoke and found that they sustained lung, heart, and bladder damage, including lung adenocarcinoma.⁴ Time will tell if similar damage occurs in humans.
What to Tell Your Patients
If you have young patients or patients with teenagers who use e-cigarettes, there is plenty to warn them about when it comes to tobacco products. As it turns out, teenagers may be more open to these suggestions than you might anticipate; research in JAMA Pediatrics found that 44.5% of the nearly 15,000 children aged 12 to 17 surveyed reported that they were seriously considering quitting.⁵
You don’t need studies correlating vaping and lung cancer to explain your concerns. As mentioned, there is evidence of e-cigarettes causing other forms of lung damage and putting users at significant risk for other complications. A recent study from the Journal of Adolescent Medicine suggested that adolescents and young adults who smoke cigarettes and/or e-cigarettes are far more likely to be diagnosed with COVID-19; those who smoked only e-cigarettes were 5 times more likely, while those who used both were 7 times more likely.⁶
So while some physicians may still be waiting for conclusive evidence supporting the risk of lung cancer with e-cigarettes, there is no shortage of other risks to explain in the interim.
- Miech R, Johnston L, O’Malley P, Bachman J, Patrick M. Trends in adolescent vaping, 2017–2019. N Engl J Med. 2019;381(15):1490-1491. doi:10.1056/nejmc1910739
- Outbreak of lung injury associated with the use of e-cigarette, or vaping, products. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html. Published 2020. Accessed September 8, 2020.
- Fidler‐Benaoudia M, Torre L, Bray F, Ferlay J, Jemal A. Lung cancer incidence in young women vs young men: a systematic analysis in 40 countries. Int J Cancer. 2020;147(3):811-819. doi:10.1002/ijc.32809
- Tang M, Wu X, Lee H et al. Electronic-cigarette smoke induces lung adenocarcinoma and bladder urothelial hyperplasia in mice. Proce Natl Acad Sci U S A. 2019;116(43):21727-21731. doi:10.1073/pnas.1911321116
- Smith TT, Nahhas GJ, Carpenter MJ, et al. Intention to quit vaping among United States adolescents. JAMA Pediatr. Published online August 17, 2020. doi:10.1001/jamapediatrics.2020.2348
- Gaiha S, Cheng J, Halpern-Felsher B. Association between youth smoking, electronic cigarette use, and coronavirus disease 2019. J Adolesc Health. 2020. doi:10.1016/j.jadohealth.2020.07.002