Since their introduction in 2007, electronic cigarettes (e-cigarettes) have surged in popularity and become the second most commonly used tobacco product among U.S. adults by 2021. E-cigarettes are widely marketed as aids for tobacco cessation. However, concerns about their potential long-term cancer risks persist. Despite increased recommendations from the U.S. Preventive Services Task Force (USPSTF) to improve lung cancer screening (LCS) uptake, it remains low. The association between e-cigarette use and LCS uptake has not been well studied until now.

Methods

This cross-sectional study adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines and was exempt from human participants review by the institutional review board at University Hospitals. Data were deidentified, so informed consent was not required. Participants were selected from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) and included individuals who ever smoked cigarettes and met the USPSTF 2021 recommendations for LCS eligibility:

• Age 50 to 80 years
• 20 pack-years or more smoking history
• Currently smoking or quit within the past 15 years

The χ² test (for categorical variables) and Kruskal-Wallis test (for continuous variables) were used to compare demographic characteristics between individuals who underwent LCS and those who did not. Logistic regression calculated the association between LCS uptake and e-cigarette use after adjusting for potential confounders. LCS uptake was also stratified by time since last LCS—ever having an LCS vs having an up-to-date LCS (within the past year). Data analysis was conducted using SAS version 9.4 and R version 2024.04.1, with significance set at 2-sided α < 0.05.

Results

Of the 22,713 eligible individuals:

• Median age was 62 years (IQR, 56-67 years)
• 56.4% were male
• 77.7% were non-Hispanic White
• 8.6% were non-Hispanic Black

Demographically, individuals who underwent LCS were typically older, had lower income, more comorbidities, a routine check-up in the past year, and reported poorer general health. They were more likely to reside in the Northeast region of the U.S., be insured, and have a higher pack-year smoking history. They also recently quit smoking, attempted to quit in the past year, and were more likely to report never using e-cigarettes compared to those who did not undergo LCS.

Overall, individuals currently using e-cigarettes had 21% lower odds of having undergone LCS (odds ratio [OR], 0.79; 95% CI, 0.62-1.00) compared with individuals who never used e-cigarettes after adjusting for confounders. Similar trends were observed in individuals who previously used combustible cigarettes (OR, 0.73; 95% CI, 0.52-1.04).

When stratifying by time since last LCS, individuals who currently use e-cigarettes had 33% lower odds of being up-to-date with LCS (OR, 0.67; 95% CI, 0.51-0.88) than individuals who never used e-cigarettes.

Conclusion

The study highlights a significant association between e-cigarette use and lower uptake of lung cancer screening. Individuals who currently use e-cigarettes are less likely to undergo LCS or be up-to-date with LCS compared to those who never used e-cigarettes. These findings underscore the need for targeted interventions to improve LCS uptake among e-cigarette users.

Source: JAMA Network