A link between e-cigarettes and oral cancer

Tobacco has long been the leading cause of oral cancer.

Estimates range from smokers being six to ten times more likely to develop oral cancer than non-smokers.

The introduction of e-cigarettes provided a method of consuming nicotine with health effects that are not as well understood. A review from the University of New South Wales in Sydney, Australia, however, has linked vaping to both oral and lung cancer.

Marisa Buchakjian, MD, Ph.D., surgical oncology and microvascular surgeon in the Division of Otolaryngology in Head & Neck Surgery at Michigan Medicine, answered questions about oral cancer risk factors after this latest study.

What are the implications of this latest study?

This most recent study from Australia compiled all available data on e-cigarettes and vaping and their association with head and neck cancer.

And what this study showed is that if you look at the case reports and then the clinical data as well as the mouse data, there is actually a very convincing relationship between the use of vaping and e-cigarettes and the risk of oral cavity and other cancers of the upper digestive tract.

This suggests that we may see an increase in oral cavity and head and neck cancers in the near future in our younger populations.

How does vaping cause head and neck cancer?

Vaping or e-cigarettes can cause head and neck cancer by exposing the lining of the mouth and the upper air of the digestive tract to different carcinogens.

These would be things like the nicotine itself, as well as some of the solvents in which the nicotine is stored.

Once aerosolized, they are exposed in the mouth and can cause changes in cells that can then become cancer.

Where does tobacco rank among the causes of oral cancer?

Tobacco is the number one cause of oral and head and neck cancer, and it can be in any form: cigarettes, cigars, e-cigarettes, chewing tobacco and nicotine patches.

This is the number one cause and certainly other factors are cumulative. These would be things like alcohol, dental hygiene and possibly HPV.

But tobacco remains the number one cause of head and neck cancer.

What is the role of the HPV virus in causing head and neck cancer?

HPV, or human papillomavirus, can also cause head and neck cancer, specifically cancer of the tonsils at the back of the tongue.

The majority of adults are exposed to HPV when they are younger. In a small percentage of people, this can cause some changes in the cells over time that can lead to cancer.

What is important to know is that the HPV vaccine, when people are children and then younger, has the potential to prevent this type of cancer from developing in adults.

There is actually a blood test offered here at Michigan Medicine that can detect circulating tumor DNA in a patient’s blood. This is called My HPVscore.

We use this test to help with diagnosis, to help look at the results of treatment, and to help with surveillance and in the long term, making sure that patients stay cancer-free.

How can patients reduce their risk of head and neck cancer?

To reduce your risk of head and neck cancer, it’s important to consider quitting smoking and avoiding excessive alcohol consumption — which would be no more than one drink a day for women and two a day for men.

Also, consider HPV vaccination follow-up if appropriate.

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