Current e-cigarette users less likely to get screened for lung cancer

Key takeaways:

• A greater proportion of individuals who underwent vs. did not undergo lung cancer screening never used e-cigarettes.
• Current vs. never e-cigarette users had reduced odds for screening within the past year.

The likelihood for lung cancer screening uptake was reduced among current vs. never e-cigarette users, according to results published in JAMA Network Open.

Qian Wang

“It is crucial for clinicians to screen for both e-cigarette and traditional combustible cigarette use among patients,” Qian Wang, MD, MPH, assistant professor in the School of Medicine at Case Western Reserve University, told Healio. “Patients should be educated about emerging evidence suggesting that e-cigarettes may have carcinogenic effects similar to combustible cigarettes.

“It remains important for patients eligible for lung cancer screening to comply with screening recommendations, even if they have quit smoking and now use e-cigarettes,” Wang continued.

Using data from the 2022 Behavioral Risk Factor Surveillance System, Wang and colleagues conducted a cross-sectional study analyzing 22,713 individuals (median age, 62 years; 56.4% men; 77.7% non-Hispanic white; 8.6% non-Hispanic Black) eligible for lung cancer screening based on the U.S. Preventative Services Task Force 2021 recommendation to determine how e-cigarette use is related to lung cancer screening uptake.

In this population, 6,122 individuals (median age, 64 years; 58% men; 77.1% non-Hispanic white; 9.7% non-Hispanic Black) underwent lung cancer screening, whereas the remaining 16,591 individuals (median age, 61 years; 55.8% men; 77.9% non-Hispanic white; 8.2% non-Hispanic Black) did not get screened.

Researchers noted several significant differences between those screened vs. not screened in demographics, including:

• annual household income (< $50,000, 54.3% vs. 48.6%);
• insurance type (uninsured, 2.1% vs. 7.4%);
• number of comorbidities (three or more, 31.2% vs. 18.5%);
• routine check-up last year (yes response, 90.4% vs. 77.8%);
• self-reported general health (poor, 39.1% vs. 33%); and
• geographic region residence (Northeast, 19.5% vs. 15.3%).

In terms of lung cancer risk factors, the number of smoking pack-years was greater among individuals in the screened vs. not screened group (median, 43 vs. 38 pack-years), and these individuals had a shorter time since quitting (median, 6 years vs. 7 years).

Further, a greater proportion of individuals who underwent screening attempted to quit smoking in the past year (17.5% vs. 14%) and never used e-cigarettes (57.2% vs. 54.7%).

Following adjustment for potential confounders, researchers observed a significant reduced likelihood for lung cancer screening among current vs. never e-cigarette users (aOR = 0.79; 95% CI, 0.62-1).

In a subgroup of only those who previously smoked cigarettes, current vs. never e-cigarette use again significantly decreased the odds for lung cancer screening (aOR = 0.73; 95% CI, 0.52-1.04).

“Although e-cigarettes are increasingly used as a tool to help individuals quit smoking tobacco, aiming to reduce cancer risks, including lung cancer, we found that individuals who are current e-cigarette users and meet the criteria for lung cancer screening are surprisingly less likely to undergo lung cancer screening,” Wang said.

“This suggests a prevalent misconception: substituting traditional combustible cigarettes with e-cigarettes does not significantly lower lung cancer risk for those already eligible for screening,” she added.

Only 3,472 individuals (14.6%) underwent lung cancer screening within the past year, signaling up-to-date screening.

Parallel to the above findings, researchers observed a significant decreased likelihood for up-to-date lung cancer screening among current vs. never e-cigarette users (aOR = 0.67; 95% CI, 0.51-0.88), and the same was true in the subgroup of previous cigarette smokers (aOR = 0.54; 95% CI, 0.37-0.8).

“We need epidemiological studies to investigate the associations between e-cigarette use and lung cancer risks,” Wang told Healio. “Future studies in evaluating lung cancer screening recommendations may need to consider e-cigarette use history as well.”

For more information:

Qian Wang, MD, MPH, can be reached at qian.wang@uhhospitals.org.