Does Vaping Cause Lung Cancer?

Traditional tobacco smoke contains more than 7,000 chemicals that increase smokers' chances of developing cancer. In fact, smoking is tied to 80 to 90 percent of lung cancer cases, according to the Centers for Disease Control and Prevention.

As an alternative to smoking, many people have turned to e-cigarettes to vape, including teens and young adults (read our blog on how e-cigarette use is on the rise among teens in Oklahoma). But is inhaling liquid nicotine any safer and is there any risk of cancer associated with vaping? Laila Babar, M.D., an oncologist with the INTEGRIS Health Cancer Institute at INTEGRIS Health Southwest Medical Center, helps answer these questions and provides more context on the health risks.

What is an e-cigarette?

E-cigarettes, which are also called e-cigs, vape pens, vaporizers, vapes, mods, pod-mods and tank systems, are the most recent alternatives to traditional cigarettes used by teens, young adults and older adults. These electronic devices use a heat source to turn a liquid into a vapor that is then inhaled by the user.

The look and feel of e-cigarettes can vary by brand – some resemble pipes, pens or USB flash drives – but the parts used to construct the device are the same. They include:

• A power source (usually a lithium battery) that can produce 400 F temperatures in seconds.
• A cartridge or tank to hold the liquid solution (known as e-juice or e-liquid).
• A coiled heating element (called an atomizer) that heats the e-liquid to turn it into a vapor.
• A mouthpiece or opening to inhale the vapor.

The e-cigarette was developed in 2003 in China as a way to deliver nicotine without using tobacco. It has now become a trendy alternative to cigarettes, especially among younger people.

What chemicals are in vapes?

There is currently no oversight over vaping and e-cigarettes, so the ingredients used by manufacturers aren’t regulated. In other words, the ingredients used can vary from nicotine to THC and cannabinoid (CBD) oils.

Typically, though, the e-liquid is a mixture of water, nicotine, flavorings, additives such as propylene glycol or vegetable glycerin and other chemicals. There are thousands of flavors available for purchase at local vape shops or online, many of which tap into childhood nostalgia such as cotton candy, bubble gum or popular cereal flavors.

In addition to chemicals in the e-liquid, the heating element in e-cigarettes can also produce harmful chemicals and trace elements that enter the lungs. These include:

• Nicotine: Nicotine is a stimulant extracted from tobacco. Some e-cigarettes, such as pod-mods (a prefilled or refillable pod or a pod cartridge with a modifiable system), use nicotine salts rather than freebase nicotine. Nicotine salts have a lower pH level (meaning it’s less acidic) due to the addition of an acid (usually benzoic acid), which allows for higher levels of nicotine to be inhaled with less irritation.
• Propylene glycol: This common food additive helps suspend and deliver flavors and nicotine for a smoother inhalation.
• Vegetable glycerin: Like propylene glycol, this additive helps aerosolize flavors and nicotine during the heating process.
• Acetaldehyde: This chemical compound is used to make flavors, perfumes, dyes and polyester resins. It is a known carcinogen.
• Formaldehyde: This toxic chemical is used to make fertilizer, paper, plywood and some resins. It is a known carcinogen.
• Acrolein: This liquid chemical can be used as a weed killer and to control algae growth.
• Diacetyl: This chemical compound is a flavoring agent often found in microwave popcorn.
• Diethylene glycol: This chemical solvent is used to dissolve or suspend chemicals. Diethylene glycol can be found in antifreeze.
• Vitamin E acetate: This synthetic form of vitamin E is added as a thickening agent.
• Heavy metals: Chromium, aluminum, arsenic, copper, lead, nickel and tin may be found in e-cigarettes.
• Volatile organic compounds: VOCs are compounds that have a high vapor pressure and low water solubility. Common VOCs include acrylamide, benzene and propylene oxide. Acrylamide is used to make industrial products, benzene is found in car exhaust and propylene oxide is used to make detergents, lubricants and other chemicals.
• 2-chlorophenol: This liquid is used to make dyes, disinfectants and other chemicals.
• Flavoring chemicals: To create unique flavor combinations, e-cigarettes use hundreds of artificial chemicals, some of which have been found to be highly toxic like vanillin and cinnamaldehyde. 

How many cigarettes are in a vape?

A single cigarette contains anywhere from eight milligrams (mg) to 20 mg of nicotine, although the body absorbs only one to two mg due to the nicotine burning off or being filtered out. However, liquid nicotine found in e-cigarettes is much more potent. 

E-cigarettes range from zero mg/mL of nicotine to 50 mg/mL. For six mg/mL of e-juice, this means there are six mg of nicotine per every mL.

So if the body absorbs one mg of nicotine for each cigarette, smoking a pack of traditional cigarettes equals about 20 mg of nicotine. By comparison, a single one mL e-cigarette with a concentration of 20 mg/mL of nicotine is the equivalent of smoking an entire pack of cigarettes. One brand, called the Puff Bar, contains 50 mg of nicotine, or the equivalent of smoking two-and-a-half packs of cigarettes. 

Can vaping cause lung cancer?

In short, it’s unclear if the use of e-cigarettes to vape can cause lung cancer, primarily because researchers need years of information and data to study before making a concrete determination on the exact risk factors. 

"Since vaping is a relatively new trend, it’s hard to directly link e-cigarettes to cancer,” says Babar. “But there are still chemicals found in e-cigarettes that are known to increase the risk of cancer. That’s why we recommend against smoking or vaping of any kind.”

But while vaping isn’t as bad as cigarette smoke, that doesn’t mean it’s a safe alternative to smoking. Why? Because there are still chemicals found in e-cigarettes that are known to increase the risk of cancer.

For example, acetaldehyde and formaldehyde are known carcinogens – substances capable of causing cancer. To be clear, exposure to carcinogens doesn’t mean you will develop cancer. Instead, it means there is an increased cancer risk when consuming those chemicals. Vaping can create formaldehyde if the vape juice overheats or when a dry puff occurs (when not enough liquid reaches the heating element).

Heavy metals, including cadmium, lead and arsenic, are carcinogenic and can increase the risk of lung cancer if inhaled repeatedly. E-cigarettes also contain acrylamide, a volatile organic compound that has been deemed “probably carcinogenic” by the National Toxicology Program. Likewise, the herbicide acrolein is also considered “probably carcinogenic.”

The concern with these substances is that, although they contain lower amounts than in cigarette smoke, there still isn’t a way for e-cigarettes to filter out tiny particles that may cause damage to the lungs.

How does vaping affect your lungs?

Repeatedly inhaling any type of chemical can cause problems to the lungs by coating them with harmful particles.

Vaping can impact your lungs by causing lung damage, chronic bronchitis and asthma. Most notably, though, is a specific vaping-related lung disease called EVALI (e-cigarette- or vaping-use-associated lung injury). This inflammatory response causes widespread damage to the lungs and symptomatic changes such as shortness of breath, chest pain, rapid heartbeat and rapid breathing.

Several years ago, a breakout of EVALI cases became severe with a reported total of 2,807 hospitalizations or deaths. Many of these complications were caused by e-cigarettes that contained vitamin E acetate, a synthetic version of vitamin E. Once inhaled, vitamin E acetate adheres to the lungs and blocks the transfer of oxygen, which damages lung cells and causes an inflammatory reaction.

In addition to lung damage from vitamin E acetate, there have also been issues of lung scarring caused by diacetyl, a common chemical flavoring in vapes. Diacetyl can cause bronchiolitis obliterans, the medical term for popcorn lung. This condition occurs when tiny air sacs called alveoli become thick and narrow due to scarring.

What are the additional health concerns with vaping?

Aside from cancer and lung damage concerns, vaping also poses health concerns that affect the entire body.

For starters, nicotine is a highly addictive stimulant. The liquid used in e-cigarette cartridges rapidly enters the bloodstream upon inhalation and stimulates the release of the neurotransmitter epinephrine (also called adrenaline). This reaction increases your heart rate, blood pressure and breathing. Nicotine also triggers the release of dopamine, a neurotransmitter that controls the reward center of your brain.

In younger adults, the impact on the brain can make it harder to pay attention, learn, control impulses and regulate moods. Their brains are rapidly changing, and the addition of nicotine impacts development.

When nicotine use becomes chronic, people can chase the high by transitioning to cigarette smoking, which is worse on the body. It can also lead to sleep problems, make anxiety and depression worse and cause a condition called vaper’s tongue. Constant vaping can lead to dehydration and dry mouth, which then causes partial or full loss of taste.

If you or a loved one uses e-cigarettes and is struggling to quit, contact your doctor and ask how to construct an action plan. The National Cancer Institute also has a hotline to contact for help – call 1-800-QUIT-NOW or 1-877-44U-QUIT to talk with a smoking cessation counselor.

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If you or a loved one uses e-cigarettes and is struggling to quit, contact your doctor and ask how to construct an action plan. Make an appointment today.

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