JAMA Study Links E-Cigarette Use to Lower Lung Cancer Screening Rates

Current vapers had lower odds of ever undergoing lung cancer screening (OR 0.79) and of being up to date on screening (OR 0.67) compared with those who never used e-cigarettes, the researchers reported. The relationships were more noticeable among individuals who were former smokers of traditional cigarettes rather than current smokers.

E-cigarettes, touted by some as a safer alternative to traditional smoking, have surged in popularity in recent years, particularly among younger demographics. Concerns persist, however, regarding their long-term health effects, including potential implications for lung health and cancer risk.

Since the US Preventive Services Task Force (USPSTF) endorsed lung cancer screening in 2013 (revised in 2021), there has been an increase in uptake, although it remains modest. The impact of e-cigarette use on LCS uptake remains uncertain. Considering this, Qian Wang, University Hospitals Seidman Cancer Center, Cleveland, Ohio, and colleagues conducted a cross-sectional study following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline and was exempt for human participants review from the institutional review board at University Hospitals.

Informed consent was waived as the data were deidentified. Participants meeting US Preventive Services Task Force 2021 criteria for lung cancer screening (age 50-80 years, ≥20 pack-years smoking history, current smokers or quit ≤15 years ago) were selected from the 2022 Behavioral Risk Factor Surveillance System (BRFSS).

Baseline demographic characteristics were compared using χ2 tests for categorical variables and Kruskal-Wallis tests for continuous variables between those who underwent LCS and those who did not. Logistic regression adjusted for potential confounders examined the association between LCS uptake and e-cigarette use. LCS uptake was stratified by time since the last screening (ever vs up-to-date within the past year).

The study led to the following findings:

• Of 22 713 eligible individuals, the median age was 62 years, and the sample included 56.4% males, 6122 individuals who underwent LCS, and 3472 individuals who were up-to-date with LCS testing.
• Individuals who underwent LCS were older, more likely to have lower income, and comorbidities, had a routine check-up last year, reported poor general health, resided in the Northeast region of the US, and were less likely to be uninsured.
• They also had a higher pack-year of smoking, had recently quit smoking (individuals who previously used cigarettes), had attempted to quit in the past year (individuals who currently use cigarettes), and were more likely to report never using e-cigarettes compared with those who did not undergo LCS.
• Individuals currently using e-cigarettes had 21% lower odds of having undergone LCS (odds ratio [OR], 0.79) compared with individuals who never used e-cigarettes after adjusting for confounders, with similar trends found in individuals who previously used combustible cigarettes (OR, 0.73).
• After stratifying by time since the last LCS, individuals currently using e-cigarettes had 33% lower odds of being up-to-date with LCS (OR, 0.67) than individuals who never use e-cigarettes.
• Similar findings were among individuals who previously used combustible cigarettes and currently use e-cigarettes; they had 46% lower odds of being up-to-date with LCS (OR, 0.54).

"Our findings underscore the critical need to increase awareness and correct misunderstandings about e-cigarette use," the researchers concluded. "It's crucial to note that former smokers who use e-cigarettes still face heightened risks of lung cancer, emphasizing the importance of targeted interventions to enhance adherence to lung cancer screening. "

Reference:

Wang Q, Jiang C, Hsu ML, et al. E-Cigarette Use and Lung Cancer Screening Uptake. JAMA Netw Open. 2024;7(7):e2419648. doi:10.1001/jamanetworkopen.2024.19648