The growing popularity of vaping may come with a significant, previously underestimated risk: cancer. A comprehensive review of existing research, led by scientists at UNSW Sydney, suggests that e-cigarettes likely cause both lung and oral cancers, even in individuals who have never smoked traditional cigarettes. Whereas definitive long-term data is still years away, researchers are urging regulators to act now, citing concerning biological changes linked to cancer development observed in vapers.
The study, published Tuesday in the journal Carcinogenesis, doesn’t quantify the exact increased risk of cancer from vaping. Instead, it focuses on the evidence demonstrating that vaping induces pre-cancerous changes within the body. These include DNA damage and inflammation – hallmarks of cancer development – in the cells of the mouth and lungs. This assessment is particularly crucial given the relatively recent emergence of modern e-cigarettes in the early 2000s, which limits the availability of decades-long studies tracking cancer rates in vapers.
“There is no doubt that the cells and tissues of the oral cavity, the mouth and the lungs are altered by inhalation from e-cigarettes,” said Adjunct Professor Bernard Stewart, a co-author of the study. The research team analyzed data from animal studies, human case reports and laboratory investigations conducted between 2017 and 2025, representing one of the most detailed assessments to date of the potential carcinogenic effects of nicotine e-cigarettes.
Early Warning Signs and the Challenge of Long-Term Data
One of the key challenges in determining the full extent of vaping’s cancer risk is the overlap between vaping and smoking. Many individuals who vape likewise have a history of traditional cigarette utilize, making it difficult to isolate the effects of vaping alone. But, the review included case reports from dentists who have observed oral cancers in patients who exclusively vaped and had never smoked, offering a concerning signal. Researchers also pointed to animal studies, including one published in 2018, which found that mice exposed to e-cigarette vapor developed lung tumors at a higher rate than unexposed mice. The study, published in Toxicological Sciences, provides a potential biological mechanism for cancer development, though researchers caution that findings in mice don’t automatically translate to humans.
The researchers acknowledge the difficulty in establishing definitive proof of a causal link between vaping and cancer without decades of longitudinal data. Lead author Associate Professor Freddy Sitas drew a parallel to the history of smoking research, noting it took nearly 100 years of accumulating evidence before the US Surgeon General officially recognized smoking as a cause of lung cancer in 1964. “We risk repeating that same fate with vaping if we don’t accept emerging research and warning signs seriously,” said Calvin Cochran, a research fellow at the University of Otago’s department of public health in New Zealand.
A Shift in Perspective: Assessing Cancer Risk Independently
Traditionally, vaping has been assessed primarily in comparison to the known harms of smoking. However, researchers argue that it’s crucial to evaluate whether e-cigarettes can cause cancer “in their own right,” regardless of their relative safety compared to traditional cigarettes. “We’ve always assumed that vapes are safer than cigarettes, but you recognize, what we’re showing is that they might not be safe after all,” Sitas explained.
Professor Stephen Duffy, from Queen Mary University London, offered a nuanced perspective, stating that it would be an “overinterpretation” to claim vaping is as harmful as smoking based solely on this research. He emphasized that smoking involves exposure to combustion products with “massive carcinogenic effects,” which are absent in vaping. However, the core concern remains: the potential for vaping to initiate cancer development through other mechanisms.
Implications for Regulation and Public Health
The findings have significant implications for public health policy, particularly regarding youth vaping. Professor Becky Freeman, a tobacco control researcher with the University of Sydney, emphasized that this study is the first to directly assert an increased cancer risk associated with vaping, even for those who have never smoked. “This information is particularly important for young people who have never smoked,” she said. “Vaping is not a safe alternative to smoking for nonsmokers.”
The study reinforces the rationale behind current Australian regulations that restrict vape access to pharmacies for individuals using them to quit smoking. These regulations aim to prevent youth access while providing a controlled pathway for smokers seeking to transition away from traditional cigarettes. However, researchers stress the demand for continued vigilance and proactive regulation as more data emerges.
Currently, there is no conclusive way to assist people stop vaping, a critical gap in public health resources. While nicotine replacement therapies and medications exist for smoking cessation, evidence supporting their effectiveness for vaping cessation remains limited. Regulators are urged to consider the full spectrum of evidence when developing policies to protect public health, particularly vulnerable populations like young people.
The researchers emphasize that this is not simply a matter of comparing risks; it’s about recognizing that vaping introduces new and potentially dangerous health hazards. As Professor Sitas stated, “It’s not an alternative to smoking… It’s not an alternative to anything in the context of being safer, it is dangerous, and that’s the message.”
Disclaimer: This article provides information for general knowledge and informational purposes only, and does not constitute medical advice. It is essential to consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.
The scientific community will continue to monitor the long-term health effects of vaping. The next key development is expected in late 2026, when preliminary data from several ongoing cohort studies tracking long-term vapers will commence to be released. These studies will provide crucial insights into the actual incidence of cancer and other health outcomes among vapers.
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