The Impact of E-Cigarette Use on Lung Cancer Screening Uptake

The Impact of E-Cigarette Use on Lung Cancer Screening Uptake

Electronic cigarettes (e-cigarettes) have surged in popularity since their introduction in 2007, becoming the second most commonly used tobacco product among US adults by 2021. Although e-cigarettes are increasingly used as aids for tobacco cessation, concerns about their long-term cancer risks persist. Since the US Preventive Services Task Force (USPSTF) recommended lung cancer screening (LCS) in 2013, and revised these recommendations in 2021, the uptake of LCS has risen but remains relatively low. This article explores the association between e-cigarette use and the uptake of LCS.

Study Methods

The study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline and was exempt from human participants review by the institutional review board at University Hospitals. Due to the unidentified nature of the data, informed consent was not required. Participants were selected from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) who had ever smoked cigarettes and were eligible for LCS based on the USPSTF 2021 recommendations.

Participants included those aged 50 to 80 years, with a smoking history of 20 pack-years or more, currently smoking or having quit within the last 15 years. Baseline demographic characteristics were compared using the χ2 test for categorical variables and the Kruskal-Wallis test for continuous variables. Logistic regression was employed to calculate the association between LCS uptake and e-cigarette use, adjusting for potential confounders. LCS uptake was also stratified by the time since the last screening—whether participants had ever undergone LCS versus having an up-to-date LCS within the past year. Statistical analyses were conducted using SAS version 9.4 and R version 2024.04.1, with a significance level set at 2-sided α < 0.05.

Study Results

Among the 22,713 eligible individuals, the median age was 62 years, and the sample included:

  • 12,198 males: 56.4%
  • 19,136 non-Hispanic White individuals: 77.7%
  • 1,239 non-Hispanic Black individuals: 8.6%
  • 6,122 individuals who underwent LCS: 26.7%
  • 3,472 individuals who were up-to-date with LCS testing: 14.6%

Participants who underwent LCS were typically older, had lower income, more comorbidities, and reported worse general health. They were also more likely to have had a routine check-up in the past year, reside in the Northeast region, and be insured. These individuals had a higher pack-year of smoking, had recently quit smoking, attempted to quit in the past year, and were less likely to have used 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 to those who never used e-cigarettes after adjusting for confounding factors.

Source: Practice Update

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