Are e-Cigarettes Really a Safer Alternative for Smokers?

While lung cancer remains the leading cause of cancer-related deaths globally, with tobacco use as its primary driver, concerns are mounting over the role of vaping and e-cigarette use in increasing lung cancer risks.

Karl Sayegh, M.D., is a diagnostic radiologist and director of thoracic imaging with Baptist Health Miami Cancer Institute, which he says offers one of the top lung cancer screening programs in the nation. Dr. Sayegh spoke with Resource editors spoke about the dangers of vaping. Although still developing, current research suggests a potential increase in lung cancer risk associated with these newer forms of smoking, he says.

Karl Sayegh, M.D., is a diagnostic radiologist and director of thoracic imaging with Baptist Health Miami Cancer Institute

“Vaping is linked to various lung injuries, whose patterns and effects are actively being studied as usage rates continue to climb,” Dr. Sayegh says. “Although there is no established percentage of lung cancer cases that can be definitively attributed to vaping, there is increasing concern about the potential for vaping to increase lung cancer risk. Notably, we are observing a rising trend among our patients, particularly those who are current or former smokers, who are now turning to vaping.”

The American Cancer Society (ACS) recently reported on a study published in the Journal of Oncology Research and Therapy which showed that people who both smoke cigarettes and use electronic cigarettes (e-cigarettes, e-cigs or vapes) are four times more likely to develop lung cancer than people who only smoke cigarettes.

“The study found that combining both cigarette smoking and vaping is much more common in people with lung cancer,” the ACS states. “In fact, people with lung cancer were eight times more likely to both smoke and vape than people without lung cancer. The researchers also found that both men and women who smoked and vaped had an increased risk of lung cancer.”

Current guidelines do not recommend lung cancer screenings for adolescents who vape, because the risk of developing lung cancer at such a young age remains low. Even so, researchers at Miami Cancer Institute are working to make such screenings available to anyone who is at risk for lung cancer – especially if they have a history of smoking.

Manmeet Ahluwalia, M.D., MBA, FASCO, chief of medical oncology, chief scientific officer, deputy director and Fernandez Family Foundation Chair in Research at Baptist Health Miami Cancer Institute

Manmeet Ahluwalia, M.D., MBA, FASCO, chief of medical oncology, chief scientific officer, deputy director and Fernandez Family Foundation Chair in Research at Miami Cancer Institute, says that thanks to a partnership with Lungevity that established the nation’s first Hispanic lung cancer screening program, screenings have nearly doubled over the last three to four years. “Several years ago, fewer than 2,000 of our patients were screened for lung cancer screening. This year, we’re hoping to screen anywhere from 3,800 to 4,000 patients,” Dr. Ahluwalia says.

Dr. Sayegh adds that while immediate screening is not advised for young people who use e-cigarettes, ongoing monitoring of health effects from vaping is recommended.

Resource: The overall numbers of teens who smoke tobacco products has dropped in recent years. Does the same hold true for vaping?

Dr. Sayegh: The most recent findings from the 2024 National Youth Tobacco Survey, released by the FDA and the CDC, indicate a significant decline in e-cigarette usage among U.S. middle and high school students. From 2023 to 2024, reported use of e-cigarettes in the past 30 days decreased from 2.13 million (7.7% of youth) to 1.63 million (5.9%). This reduction was primarily observed among high school students, with numbers dropping from 1.56 million to 1.21 million. Meanwhile, e-cigarette usage among middle school students remained statistically unchanged. At its peak in 2019, over five million youths reported using e-cigarettes, contrasting sharply with the figures from 2024, which represent approximately one-third of that peak usage. Additionally, conventional cigarette smoking among teens has fallen to an all-time low, with only 1.4% reporting current use in 2024.

Resource: What specific ingredients are in e-cigarettes that users should be concerned about?

Dr. Sayegh: Most e-cigarettes contain nicotine, a highly addictive substance that can damage the developing adolescent brain and potentially lead to future addiction to other, more harmful substances. E-cigarette devices and vaping fluids are known to contain a range of definite and probable carcinogenic substances, including nicotine derivatives, polycyclic aromatic hydrocarbons, heavy metals, and aldehydes. These carcinogens can originate from the e-liquid itself—where aldehydes and other complex organic compounds are often used as flavorings—or from pyrolysis and other complex chemical reactions within the device, which can produce known carcinogens such as formaldehyde.

Resource: What do you say to people who regard vaping as a safer alternative to smoking tobacco?

Dr. Sayegh: Vaping is often considered less harmful than smoking but it is not without risk and has been associated with various types of lung injuries. Traditional cigarettes contain approximately 7,000 chemicals, many of which are toxic. While vaping involves exposure to fewer chemicals, many of these are potentially or definitively harmful carcinogens. While the long-term effects of smoking, including cancer, are extensively documented, the long-term impacts of vaping still require further investigation and research.

Resource: Are lung cancer screenings recommended for adolescents who vape?

Dr. Sayegh: Current guidelines do not recommend lung cancer screenings for adolescents who vape, as the risk of developing lung cancer at such a young age remains low. However, it is crucial to consider potential long-term risks associated with vaping. Studies on tobacco use suggest significant health implications could manifest after prolonged exposure periods, potentially around 20 years. Therefore, while immediate screening is not advised, ongoing monitoring of health effects from vaping is recommended.

Resource: Who should be getting lung cancer screenings?

Dr. Sayegh: Lung cancer screening should be considered in patients with substantial and prolonged exposure to smoke inhalants. For instance, the American Cancer Society's lung cancer screening guidelines specify that screenings are appropriate under the following conditions:

• Individuals aged 50-80 years old
• Current or former smokers
• Smoking history of 20 pack-years or more (a pack-year is defined as smoking one pack of cigarettes per day for a year, or an equivalent amount over a longer period)

It is crucial to highlight that quitting smoking at any stage can dramatically reduce the risk of developing lung cancer. Lung cancer screenings are not just a precaution; they are a potentially life-saving measure. Studies show that lung cancer screening can lead to a 20% reduction in lung cancer mortality within five years.

Resource: Is there a typical lung cancer patient?

Dr. Sayegh: Lung cancer predominantly affects older individuals, with most diagnoses occurring in those aged 65 and older. It is less common for people under 45 to be diagnosed with this disease. The average age at diagnosis is approximately 70. The likelihood of developing lung cancer escalates with both the intensity and duration of cigarette smoking. Lung cancer is exceptionally rare among young adults, with less than 2% of cases diagnosed in individuals under the age of 35. At Miami Cancer Institute, we see young patients who often present with distinctive features; a high proportion of them present with adenocarcinoma and advanced (stage 4) cancer. Lung cancer in this age group can affect both smokers and non-smokers. Given the increased likelihood of encountering driver gene alterations, genetic mutation assessments are crucial and routinely performed at our facility to tailor and optimize treatment strategies.

Resource: What are the symptoms of lung cancer one should watch out for?

Dr. Sayegh: Symptoms of lung cancer are consistent regardless of the cause. While these symptoms are more likely to be linked to conditions other than lung cancer, their presence warrants medical attention to determine and address the underlying cause. Vapers, in particular, should be vigilant about the following symptoms, as they might sometimes overlook these due to their association with vaping:

• Persistent or worsening cough
• Coughing up blood or rust-colored sputum
• Chest pain worsening with deep breathing, coughing, or laughing
• Hoarseness
• Loss of appetite
• Unexplained weight loss
• Shortness of breath
• Chronic fatigue or weakness
• Recurrent respiratory infections
• Newly developed wheezing

If you experience any of these symptoms, it is important to consult your healthcare provider to rule out lung cancer or address other potential health issues.