For many years, e-cigarettes and vapes have been promoted as a safer alternative to traditional cigarettes.
Because they do not burn tobacco, many people assumed they were far less harmful than smoking.
Their fruity flavors, modern designs, and marketing campaigns reinforced the idea that vaping was a cleaner and healthier choice.
Some health experts even suggested that e-cigarettes could help smokers quit and reduce their risk of smoking-related diseases.
There is no doubt that quitting smoking is one of the best things a person can do for their health. Stopping smoking lowers the risk of heart disease, stroke, and many types of cancer.
The longer a person stays away from cigarettes, the more their health improves. However, scientists have become increasingly concerned that replacing cigarettes with e-cigarettes may not be as safe as many people believe.
A new study published in Nature Medicine has added to these concerns. Researchers analyzed health information from more than 4.5 million people in South Korea to investigate whether using e-cigarettes after quitting smoking affected the risk of developing lung cancer and dying from the disease.
Lung cancer is one of the deadliest forms of cancer in the world. According to global estimates, there were about 2.5 million new cases of lung cancer and 1.8 million deaths from the disease in 2022 alone.
Smoking is by far the biggest preventable risk factor for lung cancer. Scientists have long known that the more cigarettes a person smokes and the longer they smoke, the greater their risk becomes.
Because lung cancer often takes many years or even decades to develop, it has been difficult to understand the long-term effects of vaping.
Most previous studies focused on short-term problems such as coughing, throat irritation, and breathing difficulties. Researchers needed large studies that followed people over many years to better understand whether vaping changes the risk of serious diseases like cancer.
To answer this question, the researchers used information from South Korea’s National Health Screening Program. The study included 4,524,895 participants.
The researchers examined smoking and vaping habits over several years and divided participants into groups such as current smokers, short-term quitters, and long-term quitters. They also paid special attention to adults aged between 50 and 80 years, who face a particularly high risk of lung cancer.
The findings were striking. People who completely quit smoking had the lowest risk of lung cancer and lung cancer death. However, among former smokers who switched to e-cigarettes, the risk was significantly higher.
Compared with people who quit smoking entirely, those who switched to e-cigarettes had a 56 percent higher risk of developing lung cancer and were twice as likely to die from it.
The study also showed that vaping appeared to interfere with the health benefits gained from quitting smoking. Long-term quitters who had stayed away from cigarettes for at least five years still faced a significantly higher lung cancer risk if they used e-cigarettes.
Even among people who had quit smoking for less than five years, switching to vaping reduced some of the benefits of quitting.
The findings were particularly concerning among adults aged 50 to 80 years. In this high-risk group, people who switched to e-cigarettes had a 91 percent higher risk of developing lung cancer and a 92 percent higher risk of dying from the disease compared with those who completely stopped using nicotine products.
Scientists point out that e-cigarettes are not harmless. Although they do not contain burning tobacco, they can expose users to harmful substances.
Studies have detected cancer-causing chemicals such as formaldehyde as well as toxic metals including lead, nickel, and chromium in some vaping products. These substances may contribute to long-term damage to the lungs and other organs.
The researchers emphasize that the study does not prove that vaping directly causes lung cancer. However, the results strongly suggest that using e-cigarettes after quitting smoking may reduce some of the major health benefits of quitting altogether.
In reviewing these findings, the study challenges the widespread belief that e-cigarettes are a harmless long-term substitute for cigarettes. Although switching to vaping appears to be less harmful than continuing to smoke traditional cigarettes, the best outcomes were seen among people who stopped smoking completely and did not use e-cigarettes.
The enormous size of the study and its long-term follow-up provide important evidence that vaping may carry serious risks that are only beginning to become clear.
The findings suggest that doctors and public health experts may need to rethink how they discuss e-cigarettes with smokers and former smokers who are trying to protect their long-term health.
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