Vaping, Smoking and Lung Cancer Risk

Abstract

Nicotine exposure through the use of electronic delivery systems (vaping) has been found to elevate the risk of certain conditions of the lungs, e.g., vaping associated lung injury, EVALI). However, the potential impact of vaping on lung cancer risk remains unexplored. We, therefore, examined the association of vaping and cigarette smoking with lung cancer risk in a case control study conducted in central Ohio. The study design compared 4,975 individuals with recently diagnosed pathologically confirmed carcinoma of the lung to 27,294 controls without cancer that were group matched at a 5:1 ratio to the cases by age, gender, race and location of residence. Odds ratios (OR) adjusted for gender, age and race revealed a fourfold higher risk of lung cancer among individuals who vaped in combination with chronic smoking (OR=58.9, 95% CI=47.3-70.5) versus individuals who only smoked cigarettes (OR=13.9, 95% CI=12.7-15.3, P<0.001). Further adjustment for prevalent comorbidities, chronic obstructive pulmonary disease and coronary artery disease, reduced the magnitude of the OR, but the risk for vaping and smoking (OR=38.7, 95% CI =31.5-47.6) remained fourfold higher than for smoking alone (OR=9.6, 95% CI=8.7-10.6, P<0.001). This finding was consistent for men and women, with adjustment for pack-years of smoking, and for the main histological cell types of lung cancer. Our results suggest that the addition of vaping to smoking accelerates the risk of developing lung cancer.

Keywords: Electronic Cigarettes; Lung Cancer; Smoking; Vaping.

Figure 1:

Odds Ratios (OR) of lung cancer in chronic smokers who vaped versus chronic smokers who did not vape by gender, histologic cell type (SCC: Squamous Cell Carcinoma, AC: Adenocarcinoma) and pack-years (PY) of cigarette smoking. ORs and 95% confidence intervals are adjusted for matched variables: age, gender and race; and comorbid conditions: Chronic Obstructive Pulmonary Disease (COPD) and Coronary Artery Disease (CAD).