1698MO - E-cigarette use among us ever-smoking cancer survivors and its implications on lung cancer screening

Background

E-cigarettes are increasingly used as a perceived safe alternative for smoking cessation, despite evidence of increased lung cancer risk. Young cancer survivors (<40 years old) use e-cigarettes 1.5 times more than their non-cancer survivor peers. Long-term cancer survivors have a higher risk of developing second primary lung cancer than the general population. However, lung cancer screening (LCS) guidelines that focus on cigarette smoking may overlook the cancer risk of using e-cigarettes. We aimed to study e-cigarette use in LCS-ineligible long-term cancer survivors.

Methods

Smokers aged 50-79 years were obtained from the 2017-2018 & 2020-2021 US Behavioral Risk Factor Surveillance System Ineligibility for LCS was defined using the US Preventive Service Task Force (USPSTF) 2021 criteria: smokers with <20 pack-year smoking history or former smokers quit >15 years. The prevalence of current e-cigarette use in LCS-ineligible smokers was calculated and compared between long-term cancer survivors (cancer diagnosed > 5 years ago) and non-cancer survivors. All calculations were weighted.

Results

Out of 11,431,095 smokers, 62.6% were ineligible for LCS. Ineligible cancer survivors had a significantly lower prevalence of e-cigarette use than their peers without a history of cancer (p<0.01) (Table). E-cigarette use was comparable between cancer survivors and non-cancer survivors who were current, heavy, or recently quit smokers (p>0.05).

Table: 1698MO

Conclusions

Nearly 0.8 million LCS-ineligible long-term cancer survivors currently use e-cigarettes in the US. While the overall prevalence of e-cigarette use among cancer survivors was relatively low, current/heavy smokers use e-cigarettes at rates comparable to non-cancer survivors. Given that cancer survivors already face an increased risk of lung cancer, the use of e-cigarettes may further heighten this risk. Future lung cancer risk assessment and screening studies may need to take e-cigarette use into consideration.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

M.L. Hsu: Financial Interests, Institutional, Advisory Board: Regeneron, MJH Life Sciences. A. Dowlati: Financial Interests, Institutional, Research Grant: EMD Serono, Tesaro, Roche, Regeneron, Vertex, Eli Lilly, Bayer, Takeda, Ipsen, United Therapeutics, Mirati, Bristol Myers Squibb, Incuron; Financial Interests, Personal and Institutional, Research Grant: AbbVie, AstraZeneca, Millenium, Seattle Genetics; Financial Interests, Personal, Financially compensated role: Ariad. All other authors have declared no conflicts of interest.