Dual use of vaping and smoking quadruples lung cancer risk, Ohio State study finds

People who both vape and smoke are four times more likely to develop lung cancer than people who just smoke, according to new study published by The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) and College of Public Health. These findings were consistent across gender and race.

This is the first study to provide evidence that smoking in combination with vaping increases the risk for cancer compared to smoking alone. Researchers reported their findings in the Journal of Oncology Research and Therapy.

Study design and methods

Lung cancer is the leading cause of cancer-related deaths worldwide, resulting in 1.8 million deaths in 2020 alone. The American Thoracic Society has found that about 87% of these cancers can be directly linked to persistent tobacco smoking. 

For this case-control study, researchers analyzed cigarette smoking and use of electronic cigarettes (also known as vaping) in 4,975 people with lung cancer compared to a control group of 27,294 people without cancer. All study subjects were from the same general geographic location (treated in Columbus, Ohio) and had the same distribution of age, gender and race.

Researchers found that vaping combined with cigarette smoking was eight times more common in people with lung cancer compared to the control group of people without lung cancer. In addition, the data showed that the risk of developing lung cancer was four times higher among people who combined vaping and smoking compared to those who only smoked.

Our findings provide the first evidence that smoking in combination with vaping significantly increases the risk of lung cancer compared to smoking alone. Most people know that tobacco smoke contains cancer-causing chemicals but, overall, there is less knowledge about the chemicals that are inhaled through vape vapors."

Randall Harris, MD, PhD, corresponding author of the study and professor of epidemiology, College of Public Health, Ohio State

Researchers say it is critical that regulators consider these additional health exposures in their regulation of the tobacco product industry to further protect public health, particularly when it comes to inhaled flavorings and nicotine dose concentrations.

"From a public health perspective, we have always been concerned about dual-use of both traditional and e-cig products. This study presents clear evidence showing that vaping in addition to smoking can increase your risk for lung cancer. This is especially concerning given the rate of youth and young adults using these products," said lead author Marisa Bittoni, PhD, a researcher in the medical oncology division in the College of Medicine. "More research about the health effects of alternative tobacco products is critically needed to put science behind the regulation of the tobacco industry."

This study was supported by a grant from the National Cancer Institute and the Richard B. Early Cancer Research Fund at The Ohio State University College of Public Health. David Carbone, MD, PhD, professor and director of the Thoracic Oncology Center at the OSUCCC – James, is also a coauthor.

Tobacco research at Ohio State

The OSUCCC – James is home to the Center for Tobacco Research, which brings together tobacco researchers from across the colleges of medicine, public health, law and nursing as well as the Ohio State Wexner Medical Center and the Comprehensive Cancer Center to conduct research on tobacco product use, regulation and health impact. The center is funded by the National Institutes of Health to provide critical research to inform the U.S. Food and Drug Administration's evidence-based regulation of tobacco products through a Tobacco Center of Regulatory Science (TCORS) grant.