Patients with lung cancer: Are electronic cigarettes harmful or useful?

Bertrand Dautzenberg, Daniel Garelik
Published online: 01 Mar 2016

Based on current knowledge, for patients with lung or other forms of cancer who would otherwise continue to smoke, e-cigarettes offer an alternative way to quit smoking while they undergo medical treatment. The option to switch to e-cigarettes should be considered by healthcare practitioners with patients with cancer who would otherwise continue to smoke. 


Comparing the cancer potencies of emissions from vapourised nicotine products including e-cigarettes with those of tobacco smoke

William E Stephens
Published online: 4 Aug 2017

“Most e-cigarette analyses indicate cancer potencies <1% that of tobacco smoke and <10% that of a heat-not-burn prototype, although a minority of analyses indicate higher potencies.”

Optimal combinations of device settings, liquid formulation and vaping behaviour normally result in e-cigarette emissions with much less carcinogenic potency than tobacco smoke.

Article in Lung Disease News: E-Cigarettes Carry Much Less Risk of Lung Cancer Than Cigarette Smoke, Study Finds

Comparative tumor promotion assessment of e‐cigarette and cigarettes using the in vitro Bhas 42 cell transformation assay

Damien Breheny, Oluwatobiloba Oke, Kamala Pant, Marianna Gaça
Published online: 26 Apr 2017

Results from this study suggest that e‐cigarettes may have reduced tumour promoter activity compared to conventional cigarettes and therefore may provide a safer alternative to cigarettes.

Have combustible cigarettes met their match? The nicotine delivery profiles and harmful constituent exposures of second-generation and third-generation electronic cigarette users

Theodore L Wagener, Evan L Floyd, Irina Stepanov, Leslie M Driskill, Summer G Frank, Ellen Meier, Eleanor L Leavens, Alayna P Tackett, Neil Molina, Lurdes Queimado
Published online: 21 Mar 2017

While not harmless, electronic cigarettes (e-cigarettes) have demonstrated a much more favourable toxicological profile than combustible cigarettes—the worldwide leading cause of preventable death. Average eCO levels (ppm) were significantly higher in smokers than in e-cigarette users. Compared with cigarettes, G2 and G3 e-cigarettes resulted in significantly lower levels of exposure to a potent lung carcinogen and cardiovascular toxicant.

Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users

Lion Shahab, Maciej L. Goniewicz, Benjamin C. Blount, Jamie Brown, Ann McNeill, K. Udeni Alwis, June Feng, Lanqing Wang, Robert West
Published online: 21 Mar 2017

Conclusion: “Former smokers with long-term e-cigarette–only or NRT-only use may obtain roughly similar levels of nicotine compared with smokers of combustible cigarettes only, but results varied. Long-term NRT-only and e-cigarette–only use, but not dual use of NRTs or e-cigarettes with combustible cigarettes, is associated with substantially reduced levels of measured carcinogens and toxins relative to smoking only combustible cigarettes.” 


Electronic cigarette use among patients with cancer: Reasons for use, beliefs, and patient-provider communication

John B. Correa, Karen O. Brandon, Lauren R. Meltzer, Hannah J. Hoehn, Bárbara Piñeiro, Thomas H. Brandon, Vani N. Simmons
Published online: 19 Apr 2018

Smoking tobacco cigarettes after a cancer diagnosis increases risk for several serious adverse outcomes. Thus, patients can significantly benefit from quitting smoking. Electronic cigarettes are an increasingly popular cessation method.

Patients with cancer who use e-cigarettes have positive attitudes toward these devices and use them to aid in smoking cessation. Most participants identified smoking cessation as the reason for initiating (81%) and continuing (60%) e-cigarette use.

Patients characterized e-cigarettes as more satisfying, more useful for quitting smoking, and more effective at reducing cancer-related stress than nicotine replacement therapies


Cancer potencies and margin of exposure used for comparative risk assessment of heated tobacco products and electronic cigarettes aerosols with cigarette smoke

Gregory Rodrigo, Guy Jaccard, Donatien Tafin Djoko, Alexandra Korneliou, Marco Esposito, Maxim Belushkin
Published online: 6 Oct 2020

Even if they should not be considered as risk-free products, however, HTPs and ECs lead to an appreciable risk reduction in comparison to cigarettes, both for cancer and non-cancer diseases. According to the current knowledge, and more specifically to the data presented here, HTPs and ECs might be considered as an acceptable reduced risk substitute for cigarettes for legal-age smokers who would otherwise continue smoking cigarettes.

A more pronounced cancer risk reduction was observed when comparing the mean lifetime cancer risk for the considered ECs with that for cigarette smoke. This reduction was about two orders of magnitude (ratio of 0.009 and 0.014) with 2.42·10–4 and 3.95·10–4 for ECs compared to 2.73·10–2 for cigarettes. In terms of consumers, this would mean that 1 out of 36 cigarette smokers vs. 1 out of 4132 or 1 out of 2531 EC consumers may develop a cancer if the cancer root cause would be only associated with exposure to the considered HPHCs.