E-Cigarettes and Cancer Patients

Are E-Cigs Better Than Combustible Cigarettes for People with Cancer?

Man using e-cigarette
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Are e-cigarettes safe for people with cancer? What if they are being used to help a person quit smoking? The research on e-cigarettes is still young, but what do we know about the nicotine and toxins in this smoking alternative?

Let's start by talking about how cigarette smoking can affect people who already have cancer, how nicotine alone may affect people with cancer (since nicotine is in both e-cigarettes and regular cigarettes), and whether e-cigarettes may play a role in quitting during treatment.

In other words, may e-cigarettes be a safer alternative for someone with cancer who smokes but is having difficulty quitting?

What Are the Risks of Smoking When a Person Has Cancer?

We know that cigarette smoking can cause many diseases including cancer, but in what ways does it affect somebody who already has cancer? There are actually many ways in which cigarettes may be detrimental including:

  • Cancer survival - Smoking may reduce survival with lung cancer and prostate cancer. Smoking both reduces survival and increases the risk of recurrence with colon cancer.
  • Overall survival - Smoking among people with cancer increases the risk of death from non-cancer related causes.
  • Surgery - Smoking increases the risk of complications from surgery, such as leading to delayed healing and an increased risk of blood clots.
  • Radiation therapy - Radiation therapy does not appear to be as effective for those who smoke. Smoking can also increase the risk of radiation-induced side effects (such as radiation pneumonitis) and may work together with radiation to increase the risk of a secondary cancer.
  • Chemotherapy - Smoking can reduce the effectiveness of chemotherapy and can also increase the risk of chemotherapy-related side effects and complications. As with radiation, chemotherapy may have an additive risk with smoking, such as with chemotherapy drugs which affect the heart.
  • Targeted therapy - People who smoke may have poorer responses to treatment with targeted therapy drugs such as Tarceva (erlotinib) used for some people with lung cancer.
  • Quality of life - Smoking can result in increased pain, worsened breathing, and greater fatigue for people with cancer.
  • Relationships - Smoking increases the chance that a person with cancer will expose their loved ones to second-hand smoke.
  • Financial - Smoking isn't cheap, and adds to the significant costs already associated with cancer.

Learn more about the important reasons to quit smoking if you have cancer.

Are E-Cigarettes Safer Than Cigarettes for People With Cancer?

It seems pretty clear that smoking is a bad idea for people with cancer, but a few questions remain. Are e-cigarettes safer than regular cigarettes for people with cancer, and can the use of e-cigarettes help people give up smoking?

Certainly, e-cigarettes might spare people the exposure to tar and some of the multitude of chemicals in cigarette smoke (some e-cigarettes have been found to have formaldehyde as well as heavy metals) but they usually contain nicotine. So what do we know about nicotine in people with cancer?

What Is the Effect of Nicotine on People With Cancer?

There has been a debate on whether nicotine can cause cancer, but there is evidence that nicotine may be involved in the progression of cancer. Findings with different cancers looking at this question from different angles have found that:

It's thought that nicotine may promote cancer due to its ability to damage DNA, disrupt metabolic processes in the cell, and by fueling the growth and spread of cancer cells.

Nicotine may not only influence the growth of cancer but interfere with the treatments of cancer as well. For example, nicotine was found to promote resistance to the chemotherapy drug Platinol (cisplatin) in lung cancer cells, a treatment which is part of most chemotherapy regimens for the disease.

Nicotine and Toxins in E-Cigarettes vs. Nicotine Replacement Therapy

If we were able to compare the amount of nicotine in cigarettes with that in e-cigarettes and nicotine replacement therapy products, we may have some idea on how this risk would compare.

Unfortunately, since e-cigarettes were not regulated by the FDA until August 8, 2016, we have not known about the amount of nicotine present in these products. In contrast, pharmaceutical grade nicotine is used in all nicotine replacement therapy products in the United States such as nicotine patches, gum, inhalers, lozenges, or nasal spray.

A 2017 study in the Annals of Internal Medicine found that long-term use of e-cigarettes and nicotine replacement therapy resulted in nicotine levels similar to those of people who smoke combustible cigarettes. Both long-term users of e-cigarettes and long-term users of nicotine replacement products had substantially reduced levels of carcinogens and toxins that can be measured than those who smoked regular cigarettes. Those who combined e-cigarettes with nicotine replacement therapy, and those who smoked regular cigarettes along with e-cigs or NRP, however, had levels of these toxins similar to those of people who smoked regular cigarettes. Again, since e-cigarettes haven't been regulated, we can't know if the nicotine level in the e-cigarettes used in this study or the levels of toxins or carcinogens would be the same for another type or brand of e-cigarettes.

Other concerns remain. For example, one study found that a particular type of e-cigarette increased carbon monoxide levels in the blood. Whether this is common, how it compares to carbon monoxide from combustible cigarettes, and what this may mean for people with cancer isn't yet known.

Do E-Cigarettes Help People Quit Smoking?

The jury is out as well on the role e-cigarettes may have as a smoking cessation product but at the current time, many experts believe that e-cigarettes should be considered a tobacco substitute and not a quit aid.

Learn more about what studies are telling us regarding the role of e-cigarettes in smoking cessation.

Do E-Cigarettes Cause Cancer?

A question that many people may be asking at this point is whether e-cigarettes can cause cancer. If you are living with cancer, the first concern is the role that e-cigs may play in the progression of cancer. As noted with nicotine above, we are still uncertain whether it can cause cancer to begin, but many studies tell us that it may contribute to the progression of a cancer already present.

At the current time, we don't know exactly what effect e-cigarettes may have on the causation of cancer. it is simply too early to know. We do know that some e-cigarettes contain chemicals known to cause cancer.

Unfortunately, it took far too many years until the public was aware that there was a relationship between cigarette smoking and cancer. Part of the reason for this, as well as the reason we cannot yet know about the risk of e-cigarettes, comes down to the latency period. The latency period is defined as the amount of time between exposure to a substance and the development of cancer. With cigarette smoking, the average minimal latency period is usually around 30 years. For some substances (for example, the radiation exposure in Hiroshima) the latency period is shorter. For other substances, the latency period is longer. and for some substances, it is longer. Since e-cigarettes have only been available in the United States since 2006, we may have to wait a long time for this data.

Bottom Line on E-Cigarettes for People With Cancer

E-cigarettes may be somewhat safer than regular cigarettes for people with cancer, but still, carry risks due to the presence of nicotine. Several studies have found that nicotine alone may contribute to the progression of cancer.

If you or a loved one are seriously motivated to give up smoking due to having cancer, the best choice would be to use a quit aid combined with counseling and support. Unfortunately, far too many people transfer their addiction from regular cigarettes to e-cigarettes and never truly give up the habit.

It could be argued that e-cigarettes might be better from someone who would otherwise continue to smoke, but even the fact that you are reading this page shows that you have some motivation to improve your health, and response to cancer treatment.

In the near future, we are likely to learn more about the effectiveness of e-cigarettes in smoking cessation, and whether e-cigarettes should be contenders along with nicotine replacement products to assist with smoking cessation.

Quitting Smoking If You Have Cancer

There are clearly many benefits to quitting smoking if you have cancer, not just with regard to survival or quality of life, but concerning your response to nearly every type of cancer treatment. It could easily be argued that smoking cessation should be considered an integral part of your treatment, no less important than treatments such as chemotherapy or radiation.

There are few things less important than taking an honest and heartfelt look at how you can quit. Begin by learning the steps to take to ensure success when you quit. Then consider the wide range of quit aids available which can sometimes ease the discomfort of quitting. Then set your quit date.

Quitting is most successful when you don't have to do it alone. Consider the people in your life who could be your cheerleaders. Is there someone you can be accountable to who you respect, perhaps even a friend or family member who has kicked the habit in the past? Foster a mindset that will help you quit for good.

Sources:

Barraza, L., Weidenaar, K., Cook, L., Logue, A., and M. Halpern. Regulations and Policies Regarding E-Cigarettes. Cancer. 2017 Apr 25. (Epub ahead of print).

Canistro, D., Vivarelli, F., Cirillo, S. et al. E-Cigarettes Induce Toxicological Effects That Can Raise the Cancer Risk. Science Reports. 2017. 7(1):2028.

Shahab, L., Goniewicz, M., Blount, B. et al. Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users: A Cross-Sectional Study. Annals of Internal Medicine. 2017. 166(6):390-400.

Wagener, T., Floyd, E., Stepanov, I. et al. Have Combustible Cigarettes Met Their Match? The Nicotine Delivery Profiles and Harmful Constituent Exposures of Second-Generation and Third-Generation Electronic Cigarette Users. Tobacco Control. 2017. 26(e1):e23-e28.

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