Researchers have warned that nicotine-based e-cigarettes are likely to cause lung and oral cancers, raising fresh concerns over the safety of vaping and challenging claims that it is a harmless alternative to smoking.
The findings, published in the journal Carcinogenesis, are based on a major review led by the University of New South Wales, Sydney, which examined evidence from human studies, laboratory research and animal experiments.
The review brought together experts from several Australian institutions, including The University of Queensland, Flinders University, The University of Sydney, Royal North Shore Hospital, The Prince Charles Hospital and Sunshine Coast University Hospital.
According to the researchers, the evidence consistently points to vaping as a likely cause of cancer, particularly cancers of the lungs and oral cavity.
Lead author, Prof. Brian Stewart, said the review provides the strongest evidence to date that people who vape face a higher cancer risk than those who do not.
“To our knowledge, this review is the most definitive determination that those who vape are at increased risk of cancer compared to those who don’t,” he said.
While vaping has often been studied as a gateway to cigarette smoking, the researchers noted that less attention has been given to whether e-cigarettes can directly cause cancer.
The review identified several cancer-causing substances in e-cigarette aerosols, including volatile organic compounds and metals released from heating coils. It also found evidence of DNA damage, inflammation, oxidative stress and other biological changes associated with cancer development.
Animal studies reviewed by the researchers also linked vaping exposure to lung tumours, while laboratory experiments showed damage to cells and tissues.
Although the exact number of cancer cases linked to vaping remains unknown, Stewart said the overall evidence was compelling.
“Our assessment is qualitative and does not involve a numerical estimate of cancer risk. We will only know the precise risk when longer-term studies become available,” he said.
The researchers also expressed concern over the growing popularity of vaping, particularly among young people.
E-cigarettes were introduced in the early 2000s and were initially promoted as a safer alternative to traditional cigarettes and a tool to help smokers quit. However, brightly coloured and flavoured products have since gained widespread appeal among teenagers and young adults.
Co-author, Associate Prof. Freddy Sitas, said evidence suggests many smokers who switch to vaping continue to use conventional cigarettes.
“Most of those who use e-cigarettes to quit smoking end up in dual-use limbo, unable to shake off either habit,” he said.
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He added that recent studies from the United States found that people who both smoke and vape face a fourfold higher risk of developing lung cancer.
The researchers said the current debate around vaping mirrors the early years of tobacco research, when warning signs about smoking-related diseases were often ignored.
Sitas noted that it took decades before smoking was officially recognised as a cause of lung cancer, despite mounting evidence.
“E-cigarettes were introduced about 20 years ago. We should not wait another 80 years to decide what to do,” he warned.
The researchers called for greater attention to the long-term health effects of vaping, arguing that existing evidence is strong enough to justify public health action while further studies continue.
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