Is vaping nicotine carcinogenic?

From the Guidelines

Vaping nicotine is not definitively proven to be carcinogenic, but it's not risk-free, and the most recent evidence suggests that e-cigarette aerosols contain potentially harmful substances that may damage DNA and potentially lead to cancer. While nicotine itself is not classified as a carcinogen, the aerosols produced by e-cigarettes contain toxic and carcinogenic substances in addition to nicotine, such as formaldehyde, acrolein, and metal particles, as reported in a study published in Pediatrics in 2015 1. The long-term cancer risk of vaping remains uncertain because e-cigarettes are relatively new, and cancer typically develops over decades of exposure.

Some key points to consider include:

• Vaping appears to be less harmful than smoking traditional cigarettes, which contain thousands of chemicals including many known carcinogens.
• Nicotine is highly addictive regardless of delivery method, and vaping can cause respiratory issues, cardiovascular problems, and other health concerns.
• For those trying to quit smoking, FDA-approved nicotine replacement therapies like patches, gum, or prescription medications such as varenicline (Chantix) or bupropion (Zyban) are generally considered safer options than vaping, as suggested by a study published in JAMA in 2021 1.
• The adverse effects of long-term inhalation of the flavoring agents used in e-cigarettes are not yet known, and some commonly used agents are known respiratory irritants, as noted in a study published in Pediatrics in 2015 1.

Overall, while the evidence is not yet conclusive, it is recommended to exercise caution when it comes to vaping nicotine, and to consider alternative methods for quitting smoking or managing nicotine addiction, such as telephonic tobacco dependence treatment, which has been shown to be beneficial in studies 1.

From the FDA Drug Label

Nicotine itself does not appear to be a carcinogen in laboratory animals However, nicotine and its metabolites increased the incidences of tumors in the cheek pouches of hamsters and forestomach of F344 rats, respectively when given in combination with tumor-initiators.

Vaping nicotine is not directly stated to be carcinogenic in the provided drug label. However, nicotine itself does not appear to be a carcinogen in laboratory animals. But, nicotine and its metabolites can increase the incidence of tumors when given in combination with tumor-initiators. 2

From the Research

Vaping Nicotine and Carcinogenicity

• The relationship between vaping nicotine and carcinogenicity is a complex one, with various studies suggesting that while e-cigarettes may be less harmful than traditional tobacco products, they still pose a potential cancer risk 3, 4, 5, 6, 7.
• Research has shown that e-cigarette emissions can contain carcinogenic chemicals, including polycyclic aromatic hydrocarbons, heavy metals, and aldehydes, which can damage DNA and lead to cancer 4, 5, 7.
• The cancer potencies of e-cigarette emissions have been found to span a wide range, with some products having potencies less than 1% of tobacco smoke, while others have much higher potencies 4.
• Nicotine, although not a carcinogen itself, can be metabolized to nitrosamines, which are known carcinogens and have been found in the saliva of e-cigarette users 5.
• The long-term cancer risk associated with e-cigarette use remains uncertain, and more research is needed to fully understand the potential risks and benefits of e-cigarettes 6.

Key Findings

• E-cigarette devices and vaping fluids contain definite and probable oncogens, including nicotine derivatives, polycyclic aromatic hydrocarbons, heavy metals, and aldehydes 7.
• The use of e-cigarettes has been increasing, particularly among younger cohorts and non-smokers, which is a significant concern for future public health implications 7.
• Research has demonstrated in vitro transforming and cytotoxic activity of e-cigarette derivatives, suggesting a potential oncogenic effect 7.
• The authors of various studies recommend further research and consideration of tighter control and regulation of e-cigarettes and e-liquids due to the potential oncogenicity of these products 4, 5, 6, 7.