Vaping and Lung Cancer Screening: Reduced Rates Among Vapers Revealed

Former smokers using e-cigarettes may face a higher risk of lung cancer and are less likely to undergo recommended screening, a study revealed.¹ The cross-sectional analysis was published in JAMA Network Open.

Only 26.7% of individuals had undergone lung cancer screening (LCS), and only 14.6% of individuals were up-to-date with LCS testing.

"Emerging research suggests that e-cigarettes contain definite and probable carcinogens and cause similar cancer-associated gene deregulations as combustible tobacco," the researchers wrote. "However, it has been shown that two-thirds of individuals currently using e-cigarettes consider e-cigarettes to be less harmful than combustible cigarettes. Thus, individuals who use e-cigarettes may have lower awareness of lung cancer risks."

Since gaining popularity in 2007, e-cigarettes have become the second most used tobacco product among US adults in 2021, despite concerns about potential long-term cancer risks. Moreover, adult e-cigarette use has been associated with substantially increased health care utilization and expenses, totaling $15.1 billion or $2024 per person in 2018.²

The new study encompassed more than 20,000 individuals who met the current criteria for lung cancer screening set by the US Preventative Services Task Force, which first recommended low-dose computed tomography screening in 2013 but expanded its eligibility criteria in 2021 to include current and former heavy smokers at age 50 years with a 20 pack-year smoking history.¹

A total of 22,713 individuals from the 2022 Behavioral Risk Factor Surveillance System who met the current guidelines for lung cancer screening were included in the study. Among these individuals, the median (IQR) age was 62 (56-76) years, 56.4% were males, 77.7% were non-Hispanic White, and 8.6% were non-Hispanic Black.

These individuals had a median 39 pack-year history of cigarette smoking, 59% still smokers, and the rest (41%) were former smokers. Most (55%) individuals had never used e-cigarettes, while 35% were former users, and 9% were current users. Most individuals also had a routine checkup in the prior year, with nearly two-thirds believing they were in good general health.

However, only 26.7% of these individuals had undergone lung cancer screening (LCS), and only 14.6% of individuals were up-to-date with LCS testing.

Individuals who underwent screening tended to be older (64 vs 61 years), had lower income, poorer health, more comorbidities, and had a greater smoking history (43 vs 38 pack-years). Additionally, these individuals were more likely to have attempted to quit smoking in the prior year (18% vs 14%) and live in the Northeast. Furthermore, individuals who underwent screening were more likely to have reported never using e-cigarettes (57% vs 55%) and were less likely to be uninsured (2% vs 7%).

However, the researchers acknowledged some limitations to the study, including its cross-sectional design and not accounting for switching between traditional cigarettes and e-cigarettes.

Despite these limitations, the researchers believe the study identified an independent association between e-cigarette use and lower use of LCS, particularly among individuals had who had quit smoking traditional cigarettes.

"Our results highlighted the importance of raising awareness and rectifying misconceptions of e-cigarette use," the authors concluded. "Former smokers who use e-cigarettes remain at increased risk of lung cancer and should be targeted by interventions to improve adherence to LCS."

References

1. Wang Q, Jiang C, Hsu ML, et al. e-Cigarette use and lung cancer screening uptake. JAMA Network Open. 2024;7(7). doi:10.1001/jamanetworkopen.2024.19648

2. Klein EH. e-Cigarette use linked to $15 billion in health care expenses in 2018. May 26, 2022. https://www.ajmc.com/view/e-cigarette-use-linked-to-15-billion-in-health-care-expenses-in-2018