Is there an association between electronic cigarette (e-cigarette) use and the development of cancer?

From the Guidelines

Vaping is associated with an increased risk of cancer and should be avoided, especially by individuals with diabetes, as it can exacerbate health risks, including cardiovascular and respiratory problems, as suggested by the 2025 study published in Diabetes Care 1. The evidence regarding the effect of vaping on cancer risk is still emerging, but it is clear that e-cigarettes contain harmful chemicals, including nicotine, formaldehyde, acrolein, and toxic metal particles, which can damage DNA and potentially lead to cancer. Some key points to consider include:

• Vaping is not a safe alternative to smoking traditional cigarettes, and individuals with diabetes should be advised to avoid vaping and using e-cigarettes, either as an approach to stop smoking combustible cigarettes or as a recreational drug, as stated in the 2025 study 1.
• The aerosol from e-cigarettes contains fewer carcinogens than cigarette smoke, but still exposes users to cancer-causing substances, and long-term studies are limited since vaping is relatively new, but preliminary research suggests connections to lung, bladder, and oral cancers.
• For those using vaping as a smoking cessation tool, it should be viewed as a temporary step toward complete nicotine cessation rather than a permanent substitute, and non-smokers, pregnant women, and young people should avoid vaping entirely, as recommended by the American Thoracic Society 2020 guideline 1.
• If you're trying to quit smoking, consider FDA-approved cessation methods like nicotine replacement therapy, prescription medications (bupropion or varenicline), or behavioral counseling alongside or instead of vaping, as these methods have been shown to be effective in helping individuals quit smoking, as found in the Evaluating Adverse Events in a Global Smoking Cessation Study (EAGLES) 1.

From the Research

Vaping and Cancer Risk

• The relationship between vaping and cancer risk is a significant concern, with studies suggesting that e-cigarette use may increase the risk of lung cancer and other types of cancer 2, 3, 4.
• E-cigarette devices and vaping fluids contain various toxic substances, including nicotine derivatives, polycyclic aromatic hydrocarbons, heavy metals, and aldehydes, which have been shown to have oncogenic effects 2.
• The use of e-cigarettes has been increasing, particularly among younger populations, which may have significant future public health implications 2, 3.

Mechanisms of Cancer Risk

• The mechanisms of cancer risk associated with vaping are not fully understood, but studies suggest that e-cigarette exposure can lead to oxidative stress, cellular apoptosis, DNA damage, genotoxicity, and tumor growth 4.
• The toxic effects of e-cigarettes may be dose-dependent, and public health efforts are needed to decrease or eliminate new e-cigarette initiation and support cessation among current users 3.

Comparison with Traditional Smoking Cessation Methods

• Varenicline, a partial agonist at nicotinic alpha4beta2 receptors, has been shown to be effective for smoking cessation and may be more effective than bupropion or nicotine replacement therapy 5, 6.
• The combination of varenicline and bupropion may be a superior treatment for smoking cessation, with a higher probability of achieving abstinence compared to other interventions 6.

Limitations and Future Research

• The evidence on the cancer risk associated with vaping is still limited, and further research is needed to fully understand the relationship between e-cigarette use and cancer risk 4.
• More studies are needed to investigate the effects of vaping on different populations, including adolescents and young adults, and to develop effective strategies for preventing and treating e-cigarette addiction 3, 4.