Evidence update on the cancer risk of vaping e-cigarettes: A systematic review

There is substantial interest in the association of vaping e-cigarettes with the risk of cancer. We analyzed this risk in different populations by updating the Kings College London (KCL) review to include the period between July 2021 and December 2023.

We searched six databases and included peer-reviewed human, animal, and cell/in vitro original studies examining the association between e-cigarettes and cancer risk, but we excluded qualitative studies. We summarized findings on three types of e-cigarette exposure: acute, short- to medium-term, and long-term. Additionally, we assessed whether the health effects differ between subgroup populations based on various sociodemographic factors, for which we also screened the previously included studies in the KCL review. Different risk-of-bias tools were used to assess the quality of the included human studies.

We included 39 studies in the main analysis and 12 in the subgroup analysis. Of these, 2 were longitudinal observational studies, 9 were cross-sectional studies, 1 case report and 27 were cell/in vitro and animal studies. All human studies were conducted in adults, and about half of them had a low risk of bias. No significant incident or prevalent risk of lung cancer or other types of cancer was found in the never smoker current vapers population. However, there was substantial biomarker-based evidence of a significant association between e-cigarette exposure and oxidative stress, cellular apoptosis, DNA damage, genotoxicity, and tumor growth, particularly following acute exposure. We did not find any age or sex-based differences in cancer risk, and findings on race and education-based differences were insufficient.

There is substantial evidence that e-cigarette exposure is associated with biomarkers reflective of cancer disease risk. However, the overall evidence on cancer risk is still limited and should be further investigated by future research, particularly rigorously designed clinical trials and population-based research.