‘We were shocked’: Vaping considerably increases lung cancer risk among people who smoke
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People who vaped and smoked cigarettes appeared four times more likely to develop lung cancer compared with those who only smoked, according to study results presented at American Association for Cancer Research Annual Meeting.
Marisa A. Bittoni, PhD, MS, research assistant professor at The Ohio State University Comprehensive Cancer Center — Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, and colleagues conducted a case-control study to evaluate links between vaping, smoking and lung cancer.
Data drived from Bittoni MA, et al. Abstract 2213. Presented at: American Association for Cancer Research Annual Meeting; April 5-10, 2024; San Diego.
The researchers — who included Randall Harris, MD, PhD, and David P. Carbone, MD, PhD — evaluated medical records of 4,975 individuals newly diagnosed with lung cancer between 2013 and 2021. The control group included 27,294 cancer-free individuals matched for age, sex, race and year of ascertainment.
The analysis revealed significantly higher likelihoods for combined vaping/cigarette smoking (OR = 57.8; 95% CI, 47.4-70.5) and cigarette smoking only (OR = 13.9; 95% CI, 12.7-15.3) among those with lung cancer than controls.
Results showed a fourfold higher risk for lung cancer among those who vaped and smoked cigarettes (OR = 38.7) compared with those who only smoked cigarettes (OR = 9.6).
The elevated lung cancer risk associated with combined vaping/smoking persisted when investigators conducted analyses limited to men (OR for vaping/cigarette smoking = 69.8; 95% CI, 53.2-91.7; OR for cigarette smoking only = 14.7; 95% CI, 12.8-16.9) and women (OR for vaping/cigarette smoking = 46.6; 95% CI, 34.9-62.3; OR for cigarette smoking only = 13.5; 95% CI, 11.8-153), as well as analyses based on histologic types of lung cancer.
The elevated lung cancer risk among those who vaped and smoked remained consistent after adjustments for comorbidities, chronic obstructive pulmonary disease and cardiovascular disease.
“Until now, I think a lot of physicians have fallen into a harm-reduction approach that implies vaping may be safer, but that’s only because we don’t have any evidence,” Bittoni told Healio. “With vaping, the product is aerosolized right into the lungs. We don’t know if that’s any better than burning tobacco. I think we need to reconsider the way we discuss this with patients.”
Healio spoke with Bittoni about the study rationale, the implications of the results and plans for further research in this area.
Healio: Why did you conduct this study?
Bittoni: We wanted to learn more about vaping and lung cancer, because a lot of young people vape and it has gotten more popular. There is also the perception that it is safer, but it takes years — sometimes decades — for lung cancer to develop, so it is too early for us to really know the potential long-term associations.
Healio: How did you conduct the study?
Bittoni: We conducted a case-control study looking at existing cases and their risk factors. We pulled about 5,000 lung cancer cases from the electronic health records, as well as five controls per case. We looked at their reported vaping and smoking habits and found huge risks for lung cancer for combined vaping and smoking. We’re talking ORs of 50 to 60 compared with 14 or 15 for smoking only. Those are huge ORs — it’s almost like a synergistic effect. It’s the kind of thing you see with radon or asbestos. We were shocked.
Healio: What might explain this difference?
Bittoni: We had some limitations, and that’s why we need to investigate this further. We used medical record intake data. We didn’t have a vaping-only group, and that was a limitation, because about 97% of the people who said they vaped also reported smoking. When we compared vaping and smoking with those who never reported vaping and only smoked, there still were huge risks. It is hard to say what could explain that but, in the vaping process, the liquid is heated by a battery in the vape pen that converts it to an aerosol. It’s a mixture of water, flavorings, nicotine and other chemicals. When it’s aerosolized, it has additionally harmful ingredients besides nicotine, including diacetyl, diethylene glycol, cadmium and benzene, and heavy metals such as nickel, tin and lead. So, there’s a lot of nasty stuff in there that people aren’t aware of.
Healio: How may these findings affect messaging about smoking cessation strategies?
Bittoni: The problem is there hasn’t been any evidence to show that vaping is safer. It’s too early to know, especially with younger vapers. We won’t see the impact on lung cancer for 10 to 20 years. However, in this type of case-control study, we can look at the existing cases. Our population wasn’t primarily younger people — there were some, but our average age was the 60s. I can’t say that this is representative of everybody or that everybody who vapes is going to get lung cancer, but it was quite shocking to see the difference. We also didn’t have temporal information about how long they smoked compared with how long they vaped. We did have some information on pack-years and, obviously the higher the pack-years, the greater the risk for lung cancer, whether there was vaping or not. Yet, every way we looked at this, there was a fourfold difference.
Healio: What are the key implications of these findings?
Bittoni: We will need to do more research. These are preliminary, exploratory findings because we didn’t have great quantification of the amount smoked and vaped. However, when you look at the whole picture, it definitely tells a story of harm. I think physicians should be taking a different approach in talking about vaping with their patients if they are promoting harm reduction. They should be cautioning people that vaping, in fact, may not be safer.
References:
- AACR 2024: Ohio State experts share new findings at annual meeting (press release). Available at: https://cancer.osu.edu/news/aacr-2024-ohio-state-experts-share-new-findings. Posted April 5,2024. Accessed May 3, 2024.
- Bittoni MA, et al. Abstract 2213. Presented at: American Association for Cancer Research Annual Meeting; April 5-10, 2024; San Diego.
For more information:
Marisa Bittoni, PhD, MS, can be reached at marisa.bittoni@osumc.edu.
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