Clearing the air about lung cancer and vaping

Lung cancer is by far the deadliest cancer in the U.S. More Americans die of lung cancer than colon, breast and prostate cancers combined. Nevertheless, despite its high occurrence, questions and myths surround the disease.

What we know is that smoking cigarettes is the number one lung cancer risk factor. But can people who don't smoke get lung cancer? Can e-cigarettes and vaping lead to lung cancer? What about smoking cigars or a hookah?

According to Dr. Igor Medic, a board-certified medical oncologist affiliated with Sharp Grossmont Hospital, cigarette smoking accounts for about 85% of all lung cancer diagnoses. "But it’s not the only risk factor,” he says.

Dr. Medic says it’s important to clear the air about common lung cancer myths, including mistruths about vaping. The most important myth he’d like to bust: Occasional smoking won’t hurt you or cause lung cancer.

“There’s no safe level of smoking,” he says. “Any level of smoking contributes to the development of lung cancer.”

Myth #1: Only smokers get lung cancer.

"Unfortunately, smoking is not the sole cause of lung cancer," says Dr. Medic. "Approximately 15% of patients with lung cancer never smoked."

Exposure to radon gas is the second most common cause. "There's also secondhand smoke; and patients who've had radiation therapy while being treated for previous malignancies are also at risk," he says.

To a lesser degree, environmental toxins, including asbestos; metals, such as chromium and nickel; and air pollution are associated with the disease. And family members of someone who is diagnosed with lung cancer are also at increased risk of developing lung cancer.

Myth #2: Vaping isn’t addictive and doesn’t cause lung cancer.

Vaping is performed using an e-cigarette, Dr. Medic explains, An e-cigarette is a battery-operated device that heats a liquid containing nicotine, as well as flavorings and other chemicals, to produce a vapor the user inhales.

"The devices are still largely unregulated by government," he says. "And in my opinion, they represent a public health concern."

E-cigarettes have risen in popularity, not only among adults but also among teens. Their small size makes them unnoticeable in school settings, and fun flavors like candy, fruit or chocolate make them appealing. In 2018, one survey indicated that 21% of high school students reported the use of e-cigarettes. 

“Vaping is very addictive because nicotine is an addictive substance," Dr. Medic says. "That said, there is no firm link yet between vaping and lung cancer. However, there have been multiple occasions when various e-liquids used in e-cigarettes were found to contain carcinogenic substances."

In 2020, the Centers for Disease Control and Prevention (CDC) reported over 2,800 cases of severe lung illness were linked to the use of e-cigarette devices that aerosolized substances for inhalation. Additionally, many people also refill the cartridge with various substances that increase risk of harm when heated for inhalation, such as tetrahydrocannabinol (THC) or cannabidiol (CBD) oils. The exact reasons for the illnesses are still under investigation.

Besides lung illness, there is evidence that e-cigarettes can cause increased coughing, bronchitis symptoms and asthma exacerbations. There are also concerns the habit could lead to the development of nicotine addiction, particularly for teens. Such use could be a potential gateway to using conventional cigarettes, or perhaps, using other substances.

Myth #3: Smoking cigars or a hookah is not harmful to your body or lungs.

Smoking cigars or a hookah is no safer than smoking cigarettes and can cause lung cancer.

A single large cigar can contain more than a half ounce of tobacco — as much tobacco as an entire pack of cigarettes. A single cigar also has 100 to 200 milligrams of nicotine versus a cigarette, which has 8 milligrams.

A hookah is a water pipe with a smoke chamber, water bowl, pipe and hose. Specially made tobacco that comes in different flavors is heated and used. The smoke passes through water and is then drawn through the hose to a mouthpiece.

Some smokers claim the water filters out any toxic ingredients. But according to the CDC, the charcoal used to heat the tobacco can raise health risks by producing high levels of carbon monoxide, metals and other cancer-causing chemicals, even after passing through water.

Myth #5: I’ve smoked all my life. Quitting now isn’t going to prevent me from getting lung cancer.

Quitting smoking is one of the best health decisions you can make. According to a 2013 study in the New England Journal of Medicine, quitting before age 40 reduces your chance of dying prematurely from a smoking-related disease by 90%. Quitting by age 54 reduces your chance by 66%. And quitting after age 54 still improves survival and should be the goal at any age.

“It’s very hard to quit smoking,” says Dr. Medic. "It’s one of the toughest habits to kick, but in doing so, you significantly reduce your risk of lung cancer."

If you want to quit smoking, immediately talk with your primary care doctor. There are also smoking cessation classes to help guide you through the process.

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