While e-cigarettes have often been touted as a safer alternative to traditional tobacco products, a groundbreaking study from South Korea suggests that vaping may still pose a significant lung cancer threat, especially for former smokers.
The findings challenge the belief that e-cigarettes are a risk-free smoking cessation tool and underscore the need for caution when it comes to these increasingly popular devices.
In the first study of its kind, researchers from Seoul National University Hospital analyzed data from over 4 million ex-smokers. They discovered that those who switched to vaping were twice as likely to die from lung cancer compared to those who quit smoking altogether.
The study’s lead author is Dr. Yeon Wook Kim, a professor of pulmonary and critical care medicine.
It highlights the potential risks associated with e-cigarette use that both doctors and patients should carefully consider. Recently, a first death was announced linked to vaping.
Research Links Toxic Compounds
While e-cigarettes typically contain fewer toxic chemicals than traditional cigarettes, they still produce harmful substances.
Prior research has linked the metals released from e-cigarette heating coils, such as nickel and chromium, to lung inflammation, chronic cough, shortness of breath, and conditions like popcorn lung. Studies have also found toxic compounds like formaldehyde and acrolein in e-cigarette aerosols.
The new South Korean study builds upon this existing evidence by directly examining the link between vaping and lung cancer mortality in a large population of former smokers.
Even those who had quit smoking five or more years prior saw a doubling of the lung cancer death risk if they took up vaping.
E-Cigarettes May Not Be harm-free
The researchers stress that their findings do not mean vaping is more dangerous than smoking. Cigarettes remain the leading cause of preventable death, responsible for 90% of lung cancer fatalities.
However, the study does suggest that e-cigarettes may not be the harm-free alternative many believe them to be, especially for ex-smokers.
More research is needed to understand the long-term effects of vaping fully. E-cigarettes are still a relatively new technology, and their impact on health over years or decades remains unknown.
Additionally, the wide variety of e-cigarette devices, e-liquids, and vaping habits among users makes it challenging to draw broad conclusions yet.
This study serves as an important warning that vaping is not without risks, particularly when it comes to lung cancer. As Dr. Kim notes, clinicians must be proactive in highlighting these potential dangers to patients who are trying to quit smoking or may be considering e-cigarettes.
The findings also have implications for public health policy, as many anti-smoking initiatives have embraced vaping as a cessation aid. Regulators and health officials may need to reevaluate their approach in light of this new evidence.
Ultimately, the safest path for smokers trying to quit is likely to avoid both tobacco products and e-cigarettes entirely. For those who do choose to vape, using the lowest possible levels of nicotine and limiting daily intake may help reduce risk, although more research is required.
E-Cigarette Studies
As the science behind vaping continues to evolve, studies like this one underscore the critical importance of caution, science-based policy, and frank discussions between doctors and patients about the potential dangers of e-cigarettes.
While they may be less harmful than traditional cigarettes, vaping appears far from risk-free when it comes to lung health.
- 1. Xie, W., Kathuria, H., Galiatsatos, P., Blaha, M. J., Hamburg, N. M., Robertson, R. M., Bhatnagar, A., Benjamin, E. J., & Stokes, A. C. (2022). Association of Electronic Cigarette Use With Incident Respiratory Conditions Among US Adults From 2013 to 2018. JAMA Network Open, 5(11), e2242212. https://doi.org/10.1001/jamanetworkopen.2022.42212. This study found that e-cigarette use was associated with an increased risk of developing respiratory diseases like COPD, chronic bronchitis, emphysema, and asthma compared to people who never used e-cigarettes.
- 2. Caporale, A., Langham, M. C., Guo, W., Johncola, A., Chatterjee, S., & Wehrli, F. W. (2019). Acute Effects of Electronic Cigarette Aerosol Inhalation on Vascular Function Detected at Quantitative MRI. Radiology, 293(1), 97–106. https://doi.org/10.1148/radiol.2019190562. This study used MRI scans to show that vaping temporarily impacted vascular function, reducing blood flow and the reactivity of blood vessels after inhaling e-cigarette aerosol.
- 3. Lin, C., Baiocchi, M., Halpern-Felsher, B. (2020). Longitudinal trends in e-cigarette devices used by Californian youth, 2014–2018. Addictive Behaviors, 108, 106459. https://doi.org/10.1016/j.addbeh.2020.106459. This analysis of survey data from over 150,000 California youth found increasing rates of e-cigarette usage from 2014 to 2018, with most youth vapers using high-nicotine, pod-based devices like JUUL by the end of the study period.
- 4. Perez, M. F., Atuegwu, N. C., Oncken, C., Mead, E. L., & Mortensen, E. M. (2019). Association between Electronic Cigarette Use and Asthma in Never-Smokers. Annals of the American Thoracic Society, 16(11), 1453–1456. https://doi.org/10.1513/AnnalsATS.201904-338RL. This study found that e-cigarette use was associated with increased odds of asthma among non-smokers, suggesting that vaping alone may increase the risk of developing the respiratory condition.
- 5. Tang, M. S., Wu, X. R., Lee, H. W., Xia, Y., Deng, F. M., Moreira, A. L., Chen, L. C., Huang, W. C., & Lepor, H. (2019). Electronic cigarette smoke induces lung adenocarcinoma and bladder urothelial hyperplasia in mice. Proceedings of the National Academy of Sciences of the United States of America, 116(43), 21727–21731. https://doi.org/10.1073/pnas.1911321116. In this mouse model study, exposure to e-cigarette smoke was found to induce lung adenocarcinoma and urothelial hyperplasia, indicating the carcinogenic potential of vaping.
The US Government’s Stance on Vaping and E-Cigs
The FDA regulates the manufacture, import, packaging, labeling, advertising, promotion, sale, and distribution of vape and e-cig products, including components and parts.
As of 2024, the US government’s stance on vaping and e-cigarette use is evolving. The FDA receives and investigates reports of safety problems associated with vaping products, such as overheating, fires, explosions, lung injuries, seizures, and other neurological symptoms.
The FDA conducts ongoing research on potentially less harmful forms of nicotine delivery for adults, including studies on e-cigarettes and vaping products.
1. FDA regulation: In 2016, the FDA gained regulatory authority over e-cigarettes, vape pens, and other electronic nicotine delivery systems (ENDS). Manufacturers must submit premarket tobacco applications (PMTAs) to demonstrate that their products are appropriate for public health protection.
2. Youth prevention: The government has taken steps to prevent youth access to e-cigarettes, such as raising the minimum purchase age to 21 and banning certain flavored e-cigarette cartridges that appeal to minors.
3. Health concerns: The CDC and other health agencies have investigated cases of lung injury associated with vaping (EVALI) and continue to research the long-term health effects of e-cigarette use.
4. Potential for harm reduction: Some government agencies, like the FDA, have acknowledged that e-cigarettes may have the potential to help adult smokers transition away from combustible cigarettes, but more research is needed.
5. Ongoing research: The government supports and conducts research to better understand the health effects of e-cigarettes and their effectiveness as a smoking cessation tool.
