E-cigarettes may shift future cancer burden as cigarette use falls
A U.S. study finds younger adults are moving from cigarettes to e-cigarettes, a trend researchers say could affect future cancer rates.
By Tom Brennan · Health & Medicine Correspondent
3 min read
A shift toward e-cigarettes could change the future cancer burden in the United States as cigarette smoking falls to historic lows, according to researchers at MUSC Hollings Cancer Center. The study matters because burned tobacco remains a major driver of cancer deaths, while younger adults are increasingly using nicotine products that do not burn tobacco.
The findings, published in JNCI Cancer Spectrum, examined how adult tobacco use changed from 2015 through 2023. Lead author K. Michael Cummings, a tobacco control researcher at MUSC Hollings, said the data show exclusive cigarette use giving way to exclusive use of noncombustible products, mainly e-cigarettes, especially among younger adults.
The researchers used the National Health Interview Survey, a nationally representative survey of U.S. adults. They chose 2015 as the starting point because e-cigarettes were becoming more common then, according to Cummings.
How could e-cigarettes affect cancer burden?
Combustible tobacco products are products that are burned, including cigarettes, cigars, pipes and hookahs. Noncombustible products include e-cigarettes, smokeless tobacco and nicotine pouches; they still deliver nicotine but do not expose users to smoke from burning tobacco.
The cancer question turns on the type of product being used. The researchers said combustible tobacco products account for nearly one-third of cancer deaths and 90% of lung cancer deaths, so a broad move away from smoked tobacco could reduce smoking-related cancers over time.
That effect would take years to show up. Cummings said the full cancer impact of today’s tobacco-use changes may not be visible for decades.
What the study found
National surveys cited by the researchers show cigarette smoking is below 2% among youth and is continuing to decline among adults. At the same time, overall tobacco use has stayed relatively steady, prompting the research team to separate tobacco users by product type rather than treating all tobacco use as one category.
Across nearly every age group, exclusive use of combustible tobacco fell during the study period. The largest declines appeared among adults ages 18 to 34.
Exclusive use of noncombustible products rose, mostly because of e-cigarettes, according to the analysis. Dual use of combustible and noncombustible products was uncommon, at 2% to 3% of adults, and did not increase during the period studied.
The age pattern was uneven. Younger adults were more likely to move away from cigarettes, while adults 55 and older continued to smoke cigarettes and adopted noncombustible products at lower rates, the researchers reported.
Cummings said that older smokers may have the most immediate health benefit to gain from ending smoked tobacco use because many have smoked for decades. The study did not say that noncombustible products are risk-free.
Researchers propose a harm-reduction measure
To measure the shift, the team created a population harm-reduction index. The index compares exclusive noncombustible tobacco use with any combustible tobacco use, giving researchers a way to track whether users are replacing smoked products with alternatives that expose them to fewer cancer-causing chemicals.
The strongest shift appeared among adults ages 18 to 24. In that group, exclusive noncombustible tobacco use was higher than use of any combustible tobacco product, according to the study.
Cummings stressed that the healthiest choice is to avoid tobacco and nicotine or to quit using them. The researchers said the findings show why public health tracking should focus on what products people use, not only whether they use tobacco at all.
This story draws on original reporting from Medical Xpress.