Vaping and lung cancer - A review of current data and recommendations.

Introduction:
This text provides an in-depth analysis of the potential oncogenic risks of electronic cigarettes (ECs) and electronic cigarette smoke (ECS)/electronic cigarette liquid (EL) on lung cancer (LCa). The study design includes a review of current data, scholarship, and active foci of research regarding potential cancer risk and oncogenic mechanisms of vaping and lung cancer. The authors aim to discuss the current evidence and ongoing investigations for the oncogenic potential of vaping and vaping products.

Key Points:

* E-cigarette devices and vaping fluids demonstrably contain a series of both definite and probable oncogens including nicotine derivatives, polycyclic aromatic hydrocarbons, heavy metals, and aldehydes/other complex organic compounds.
* The aerosolized EL/VL acts as both the nicotine source and the delivery vehicle, with submicron aerosols capable of penetration to the alveolar level.
* The most harmful component of TS are its aldehyde components, which demonstrate potent inflammatory and toxic activity and are also found in ECS.
* The heating element in ECS can be modified to increase coil temperatures, resulting in a greater potential for pyrolysis, oxidation, and thermal decomposition of these organics.
* ECs demonstrate both mitogenic and cocarcinogen activity to existing (pre-)malignant lesions and impair pulmonary clearance of particulates and some toxins.
* The oncogenic potential of cannabis and its derivatives remains somewhat equivocal, but the constituents of cannabis ELs are prone to undergo pyrolysis and thermal decomposition yielding various volatile and potentially toxic organic species.
* Heavy metals such as cadmium, arsenic, mercury, and nickel are proven oncogenic agents, and there is significant potential for the mobilization of heavy metal ions from the heating element of an EC.
* Vaping has been shown to induce DNA damage, inflammation, and genotoxicity, and prolonged use of ECs may lead to progressive rounds of DNA damage followed by dysfunctional repair and the acquisition of mutations and other genomic aberrations.

Main Message:
The text highlights the potential oncogenic risks of vaping and vaping products, particularly in relation to lung cancer. The authors emphasize the need for further research and scholarship in this area, given the increasing popularity of ECs, especially among younger demographics. They also advocate for greater public awareness regarding the health risks of vaping and tighter regulation of vaping products, including appropriate labelling and AYA cohort-directed advertising. The main message is that while vaping may be marketed as a less harmful alternative to smoking, it is far from benign and poses significant health risks.

Bracken-Clarke D, Kapoor D, Baird AM, et al. Vaping and lung cancer - A review of current data and recommendations. Lung cancer (Amsterdam, Netherlands). 2021;153:11-20. doi:10.1016/j.lungcan.2020.12.030