Does Vaping Cause Cancer?

She heard the stories on her social media feed. The ones about kids just a couple years older than her getting really sick, and some even dying, because they vaped. She thinks about how long she’s been vaping — two years almost since she started when she was just 14 years old. Her friends told her vaping e-cigarettes was safer than smoking the real things. She had been smoking cigarettes for months by that time. Now she knows she’s addicted to nicotine — she gets anxious and jittery if she goes too long between vapes.

It scares her to think about teenagers and young adults — hundreds of them — suffering serious lung damage and other dangerous health effects from vaping. She wonders, Can vaping make me sick, even kill me? Does vaping cause cancer or other serious diseases?

Millions of teenagers and young adults are having an internal dialogue along these lines. Electronic cigarettes such as Juul are marketed as a “healthy” alternative to smoking cigarettes and as a way to help cigarette smokers quit smoking. Yet, presenting the vapor inhaled from e-cigarettes as healthier than breathing the smoke from a tobacco cigarette is like saying you’re safer playing Russian roulette with two bullets than you are with three bullets loaded.

Between 2017 and 2018, use of e-cigarettes among high school students increased by 78%, according to the 2018 National Youth Tobacco Survey from the U.S. Food and Drug Administration (FDA). In 2018, 20.8% of high school students reported using an e-cigarette at least once in the previous 30 days, compared with 11.7% who reported doing so in the 2017 survey. The increase in 2018 followed a general decline in e-cigarette use by high school students in 2015 and 2016.

Equally alarming is the steep rise in use of e-cigarettes by middle school students. In 2018, 4.5% of all middle school students were current e-cigarette users, which means they had used an e-cigarette in the previous 30 days. That represents an increase of 48% from the 3.2% of middle school students who used e-cigarettes in 2017. A total of 3.6 million children used e-cigarettes in 2018, including 570,000 middle school students.

Perhaps the most insidious aspect of this new, potentially devastating threat to public health is the time bomb it represents for these children, their families and their communities long into the future. An example of the hidden threat of e-cigarettes is a finding reported by the National Academy of Medicine in 2018 that young people who use e-cigarettes will smoke more cigarettes and will smoke more often in the future. The U.S. Centers for Disease Control and Prevention (CDC) reports on the research findings.

The enormity of the threat posed by the skyrocketing rates of vaping among young people is just coming into focus, and much research remains to be done to discover the source of the rise of vape-related illnesses. Yet, when it comes to protecting our children, time is of the essence. Limiting the use of e-cigarettes and nicotine products is a public health necessity.

It usually takes years of extensive research before scientists can conclude that a particular substance or product “causes cancer.” However, it’s easier for researchers to determine that a specific product contains chemicals that are known to increase the risk of cancer in people who are exposed to them.

For example, the National Cancer Institute notes that asbestos is classified as a “known human carcinogen (a substance that causes cancer)” by the U.S. Department of Health and Human Services (HHS), the Environmental Protection Agency (EPA) and the International Agency for Research on Cancer (IARC). That conclusion was reached only after decades of research into the matter. E-cigarettes are so new that it will take researchers many years to state definitively that the products contain known carcinogens. What we know today is that e-cigarette vapor contains chemicals that increase a user’s cancer risk.

Perhaps the greatest misconception about vaping is that the heated gases users are inhaling from their e-cigarettes are as harmless as water vapor. Many chemicals known to cause cancer are found in the vapor that e-cigarette users inhale, particularly cartridges that are loaded with flavored liquid that the vaping device heats up to create the gases that users inhale. These carcinogenic substances include propylene oxide and acrylamide, as Healthline reports.

The American Cancer Society describes formaldehyde as a known carcinogen that may be present in e-cigarette vapor when the liquid in the e-cigarette cartridge overheats or when not enough liquid reaches the e-cigarette’s heating element, which is called a dry puff. The organization notes that there’s less potentially carcinogenic material in e-cigarette vapor than in smoked tobacco, and yet any level of exposure to such products increases a user’s cancer risk.

Scientific Research on the Potential Carcinogenic Effects of Vaping

As stated above, e-cigarettes are a recent phenomenon, so all of their health risks haven’t yet been identified by researchers. However, early research into the cancer-related dangers of vaping has raised many red flags.

The heating coils present in most e-cigarette devices use alloys of nickel, chromium and iron (Nichrome), chromium and aluminum (Kanthal), as well as traces of copper, tin, silver and zinc. Microparticles of these metals can leak into the e-cigarette vapor, which “may … increase the risk of lung cancer” and also increase the frequency of respiratory tract infections. (American Journal of Physiology: Lung Cellular and Molecular Physiology)
Teenage users of e-cigarettes (average age of 16.4 years) were found to have higher levels of volatile organic compounds (VOCs) in their bloodstreams than teenage nonusers. VOCs present in e-cigarette vapor that have been identified as carcinogenic include benzene, ethylene oxide, acrolein and propylene oxide. (Pediatrics)
E-cigarettes have a “powerful booster effect on phase-I carcinogen-bioactivating enzymes” in laboratory mice. They’re also shown to increase the production of oxygen-free radicals and damage DNA at both the molecular and genetic levels, all of which heighten the risk of cancer and other serious health problems, particularly for young people. (Scientific Reports)

Does Vaping Hurt Your Health?

Nicotine is present in nearly all e-cigarettes. This poisonous drug may pose the greatest risk to all users — but young ones in particular — although it hasn’t been shown to cause cancer. However, nicotine is highly addictive, and the chemical is proven to have a negative effect on brain development in adolescents and young adults, according to the surgeon general’s office — which notes that the brain continues to develop until age 25.

The CDC reports that nicotine can impair areas of the brain associated with attention, learning, mood and impulse control. It also affects the way synapses form when people create memories, and young people generally create synapses much faster than adults. Last but not least, adolescents who become addicted to nicotine are more likely to become addicted to other dangerous substances in the future, according to statistics compiled by the CDC.

The American Cancer Society describes several other health-damaging substances found in the aerosol that e-cigarette users breathe deep into their lungs:

VOCs can irritate the eyes, nose and throat of users; cause nausea and headaches; and damage their liver, kidneys and nervous system.
Flavoring chemicals, especially those that contain diacetyl, are associated with the lung disease bronchiolitis obliterans, also known as popcorn lung.
Propylene glycol and vegetable glycerin, which are also used to create “theatrical fog” effects, can irritate the lungs and airways.

Vaping’s link to the occurrence of popcorn lung in users is well established, as Health reports. The disease is caused by diacetyl, which in the past was used to make popcorn — hence the name. The chemical has been removed from popcorn, but it’s still found in many of the flavorings used in e-cigarettes. Popcorn lung scars the small air sacs in the lungs, which thickens and narrows the organ’s airways.

In addition to the damage nicotine can do to a vaper’s cardiovascular system, e-cigarettes pose many other risks to heart health. Vox reports that the heating elements in e-cigarettes release microparticles of metals and other substances into the lungs, which damages the circulatory system and has been associated with increased risk of heart attacks, high blood pressure and coronary artery disease.

How Does Vaping Affect Students in Middle School and High School?

Children and young adults are at greater risk from using e-cigarettes than older adults for many reasons. For example, the HHS lists the serious health risks of e-cigarette use by young people:

They face a greater probability of smoking cigarettes and facing other addictions in the future.
They may suffer long-lasting effects, such as increased impulsivity and mood disorders.
Exposure to nicotine can interfere with proper brain development.
They’re more likely to suffer respiratory problems, such as those now being investigated by the CDC.

The “mysterious illness” that has affected hundreds of e-cigarette users in the U.S. and has killed seven of them as of September 2019, according to CNBC, is much like lipoid pneumonia, which occurs when oil is present in the lungs. Health officials have determined that many of the victims of the disease are young people: the New England Journal of Medicine reports that the median age of the 53 patients studied in Illinois and Wisconsin was 19.

Students in middle school and high school who use vaping products increase their susceptibility to mood disorders, memory problems and behavioral/cognitive impairment, according to the surgeon general’s office. Evidence also suggests that teens and young adults who vape are more likely to use alcohol, cannabis and other intoxicating substances. They’re also more likely to smoke tobacco cigarettes, which the FDA identifies as the single greatest cause of preventable deaths.

Tools and Resources to Help Students (and Others) Quit Vaping

While much uncertainty remains concerning the potential health risks of vaping to children and young adults, all the experts and researchers agree that the safest approach to e-cigarettes for young and old is to avoid them entirely. In fact, the FDA has proposed a complete ban on the manufacture and sale of flavored e-cigarettes in the U.S., as the Washington Post reports. The city of San Francisco banned the products in the summer of 2019, and Michigan and New York have passed a law prohibiting the sale of flavored e-cigarettes. More states are also expected to further regulate e-cigarettes.

Teens and young adults addicted to e-cigarettes (or any form of tobacco) face unique challenges in their attempts to overcome the addiction. Johns Hopkins Medicine cites three reasons that it’s so difficult for young people to stop vaping:

They’ve been told, incorrectly, that vaping is either harmless or is much less harmful than smoking tobacco.
E-cigarettes are far cheaper than conventional cigarettes, which makes them more accessible to teens.
Young people are attracted by the flavorings e-cigarette makers add to the liquid.

Combating the epidemic of youth vaping starts by educating young people about the imminent health risks posed by their use of e-cigarettes. In 2017, the FDA launched a “comprehensive plan … to make tobacco products less toxic, appealing, and addictive with an intense focus on youth.” Part of the plan is an expansion of the agency’s public education program called “The Real Cost.”

The CDC’s advice to parents who want to prevent their children from using e-cigarettes or any other tobacco is to set a good example by refraining from the products themselves. To help anyone break their addiction to nicotine, the National Cancer Institute (NCI) created Smokefree.gov, which offers tobacco users, their families and health care providers several tools and techniques for quitting. There’s also a version of the service geared specifically to teens: Smokefree Teens. Both sites provide information on smoke-free texting programs; 24/7 support lines for people kicking the tobacco habit; and use of nicotine replacement therapies, such as “the patch.” They also feature an interactive tool that lets you build your own quit plan.

To help parents start the discussion with their children about the dangers of e-cigarettes and other forms of smoking, the surgeon general has created a tip sheet, Talk with Your Teen About E-cigarettes, that emphasizes the need to be patient, to listen without criticizing, and to engage in a discussion with teens rather than a lecture. The tip sheet prepares parents to answer questions such as “Why don’t you want me to use e-cigarettes?” “What’s the big deal about vaping?” and “Aren’t e-cigarettes safer than conventional cigarettes?”

As the CDC reports, efforts are underway to prohibit the use of e-cigarettes in areas designated as smoke-free, to ban or restrict advertising of vaping products, to require childproof packaging of e-cigarettes, and to greatly expand research efforts to determine the nature of e-cigarette health risks and the best ways to counteract them.

When their teens ask, “Does vaping cause cancer?” parents can respond with a firm “Probably,” followed by a quick recap of the information presented above on the dangerous chemicals present in the aerosol of an e-cigarette. Teens and their parents looking for help to quit e-cigarettes will find free assistance from the Truth Initiative in the form of text messages offering support based on feedback received from other teens and young people who have succeeded in quitting or are in the process of becoming vape-free.

The battle to protect children from the health risks of e-cigarettes and other harmful smoking products is just revving up, and much work must be done by parents, public health agencies and the health care industry to counteract the growing epidemic of youth vaping. Degree programs such as the University of Nevada, Reno’s online Master of Public Health in Public Health Practice prepare health care professionals to lead the effort to protect vulnerable young people from the dangers of e-cigarettes.

Suggested Readings

Childhood Obesity as an Epidemic

Chemical Exposure Risks: Trends in Environmental Health

University of Nevada, Reno Online Master of Public Health

Sources

CNBC, “CDC Narrows Investigation of Mysterious Vaping-Related Lung Disease to 388 Cases”

CNBC, “Seventh Person Dies from Vaping-Associated Lung Disease”

Dana-Farber Cancer Institute, Does Nicotine Cause Cancer?

Drexel University, “A Call to Action!! Why Policy, Regulation, and DNP Leaders Are Requisites to Influencing the E-cigarette Epidemic”

Frontiers in Physiology, “Inflammatory and Oxidative Responses Induced by Exposure to Commonly Used e-Cigarette Flavoring Chemicals and Flavored e-Liquids Without Nicotine”

Johns Hopkins University, 5 Vaping Facts You Need to Know

Proceedings of the National Academy of Sciences, “E-cigarette Smoke Damages DNA and Reduces Repair Activity in Mouse Lung, Heart and Bladder as Well as in Human Lung and Bladder Cells”