Lung Cancer Screening for Electronic Cigarette Users
Electronic cigarette users do not currently qualify for lung cancer screening under established guidelines, as eligibility criteria are specifically based on combustible cigarette smoking history rather than e-cigarette use. 1, 2
Current Lung Cancer Screening Eligibility Criteria
The most recent NCCN Guidelines (Version 1.2025) clearly define eligibility for lung cancer screening based on:
- Group 1: Individuals aged 50-80 years with a ≥20 pack-year history of combustible cigarette smoking who currently smoke or have quit within the past 15 years 1, 2
- Group 2: Individuals aged ≥50 years with a ≥20 pack-year history of combustible cigarette smoking plus at least one additional risk factor (such as occupational exposure to lung carcinogens, radon exposure, personal cancer history, family history of lung cancer, or lung disease) 1
Why E-Cigarette Users Don't Currently Qualify
Several important points explain why e-cigarette users don't qualify:
- Cigarette-specific criteria: All major guidelines (NCCN, USPSTF, American Cancer Society) specifically define eligibility based on combustible cigarette smoking history measured in pack-years 1, 2
- Evidence gap: The landmark National Lung Screening Trial (NLST) and other studies that established the mortality benefit of screening were conducted in combustible cigarette smokers, not e-cigarette users 1
- Pack-year calculation: The definition of pack-years is explicitly tied to cigarettes: "number of packs of cigarettes smoked every day multiplied by the number of years of smoking" 1
E-Cigarette Use in Lung Cancer Screening Populations
Research shows that:
- Approximately 39.8% of individuals eligible for lung cancer screening report ever using e-cigarettes, while 8.9% report current e-cigarette use 3
- Some patients attending lung cancer screening who smoke combustible cigarettes express interest in switching to e-cigarettes for harm reduction 4
- However, this data reflects e-cigarette use among those who already qualify for screening based on their combustible cigarette smoking history
Clinical Implications and Recommendations
Screening eligibility assessment: When evaluating patients for lung cancer screening eligibility, focus specifically on combustible cigarette smoking history, not e-cigarette use 1, 2
Documentation: Document e-cigarette use separately from combustible cigarette smoking history, as they are not equivalent for screening eligibility purposes
Patient education: Inform e-cigarette users that:
- Current screening guidelines do not include e-cigarette use in eligibility criteria
- The long-term health effects of e-cigarettes are still being studied
- Screening may be recommended in the future as evidence evolves
Smoking cessation opportunity: Lung cancer screening represents a "teachable moment" for smoking cessation interventions 5, which could include discussions about both combustible cigarettes and e-cigarettes
Future Considerations
As research on e-cigarettes evolves, screening guidelines may be updated to address this population. Currently, there is insufficient evidence to recommend lung cancer screening based on e-cigarette use alone.
For patients who use both combustible cigarettes and e-cigarettes, eligibility should be determined based solely on their combustible cigarette smoking history according to established criteria 1, 2.