Professor Claudia Andl, an associate professor of medicine at the Burnett School of Biomedical Science at the University of Central Florida, talks about how vaping can potentially cause oral cancer.
Interview conducted by Ivanhoe Broadcast News in 2023.
Could you describe how vaping can lead to cancer?
Andl: Yes, currently there are only experimental models to show that there is an increased risk with vaping for cancers. The cancers that have been identified to be associated with e-cigarettes in these experimental models. And mostly the lung and the bladder. So there’s not really much known yet about oral cancers and specifically like the test. Our experimental approach is mostly relying on cell culture. And in this, we have seen that with exposure of e-cigarette vapes, specific bio-markers that can identify cancerous cells are definitely upregulated. And that maybe an indication that e-cigarette vaping predisposes people to develop cancer, even of the oral cavity later on.
How often would someone need to vape for cancer to be a possible consequence?
Andl: There have been three cases described in the literature for which patients that were very heavy vapors. So they vape multiple times a day with lots of hits actually developed cancer. So these are the only current case reports that would have identified somebody developing cancer after e-cigarette vaping usage, and they were heavy users. For the general public, I don’t think we know yet, given that the e-cigarettes has been around for about 10-15 years and cancer, of course, usually takes much longer to develop. That I think we will see that in the future. But there are definitely again, from research that is done in the laboratory, there are definitely studies that show that this is probably a dose-dependent effects, that the more you vape, the more the effect.
How would this new information impact the medical field?
Andl: I believe that hopefully with some of the recent research that we have published and others, overall, it will lead to more awareness. And hopefully, it will change some of the policy-making. Given that originally introduced as a smoking cessation tool, the assumption was there would be mostly adults using it. But now we see this epidemic of high schoolers and even middle schoolers using e-cigarettes. I feel that better policies should be in place to protect the use, especially since they have a whole lifetime ahead of them before they may develop any negative consequences. Not just cancer, but also cardiovascular disease, lung disease. And so I do believe that the first step would be awareness. That kids realize that what is packaged as looking very sleek and has names like pink lush, and things that seem to be very tempting are not harmless. And that they actually do carry an increased risk for poor health, but also for potentially cancer and for other serious consequences. So I think awareness is key, but I do hope that ultimately that will also lead to changes in policy making.
What are the known dangers of vaping?
Andl: So the known dangerous right now are mostly related to changes in the oral health. So the health of the mouth. Most of the bacteria that inhabit the mouth or that live in the mouth, a good bacteria that prevent others that are disease-causing from taking hold. But we have shown in our research, for example, and others have to that after exposure to e-cigarette vape, and that was independent of nicotine or nicotine content. A lot of the bacteria, the good bacteria die. So now you leave space for other bacteria, pathogens disease-causing bacteria to take hold. And they can automatically lead to inflammation of the gums. The gums can recede. And the final outcome would be that you lose your teeth. And I think you’ve seen that in some of the tobacco advertisement. Well, actually the opposite, not advertisement. I think just making aware that tobacco is bad, that this same outcome happens for cigarettes. So e-cigarettes are actually very similar to cigarettes in many regards. Although they have been promised to be a healthier alternative. Other consequences or other symptoms that e-cigarette vapor is described by, that they very frequently have a dry mouth, that they feel a burning sensation. So there’s almost like a burn injury because the temperatures of the vape are actually very high. So it really causes a lot of damage not only to the mouth, but probably also then therefore to the lungs, and they definitely with the nicotine have an effect on cardiovascular health as well.
What is your research based on and what does it consist of?
Andl: Our research initially had started by focusing on some of these good and the bad bacteria and looking at their growth, but also of how well they can attach and therefore colonize in different surfaces, like the tooth or the inside of the mouth. And so in our experimental models, we use e-cigarette vape that we aerosolize. So it’s just like somebody vaping and we use just plain e-cigarette liquid. So without any nicotine added, but we also have the same comparison with e-cigarette liquid that do have nicotine in them. And we compare the effects of both because nicotine, of course, is known to generate carcinogens based on the high temperatures that it is metabolized at. And so the products that are generated from that can be carcinogenic or can induce tumors. So we use the same approaches in a laboratory to see if it affects cell growth. We look at the attachment to cell surfaces. But then we also have different three-dimensional models of growth that will allow our students to study different maker expressions like markers that could be associated with cancer.
How has your research helped?
Andl: I do hope that our research help create awareness. I think currently the data are not fully developed in terms of predicting that somebody will develop cancer. I also don’t think that we’ve studied the markers that we’ve identified enough that they could say that these could be used for diagnostics. I think all these such as preliminary data that you’re currently exploring. But we do hope that ultimately it will lead to possibly better screening methods. Especially since many of these oral lesions, things that happen in the mouth injury or inflammation can also be tested and usually are screened for at a dental office. So we believe that hopefully if you’re a heavy vaper and you go see the dentist and they do identify that there is a lesion in your mouth that they could possibly take a sample or even just maybe a little swap. And then this could be a samples that could be tested if there is an increased risk for cancer. But I think that is sadly still a little bit in the future, but that is what we’re aiming for in the future for sure.
Is there anything else that you’d like to add?
Andl: There’s a point I want to make. The problem is that nowadays, a lot of these middle school and high schoolers start vaping so young. That, of course, the effects will be very different than, for example, for somebody that was a regular smoker and develops cancer later on or any other disease. One of the problems that you have noticed with the e-cigarette vaping instead, it also induces genetic defects. So it’s an alteration to our genetic material, very similar to what cigarettes do. So they ultimately will induce mutation and a mutation which is a fault or a defect in your DNA and your material, is what ultimately could potentially predispose you for cancer. So you can imagine that there are many ways how this could be repaired at first. But if you start smoking very young and it does not get repaired properly, then of course, there’s a very long period that could aid in developing any negative consequences, such as cancer. So the early vaping in the middle schoolers and the high schoolers, especially if they would continue to vape is definitely something that will have more serious and severe negative consequences than if you’re an adult that starts vaping or cigarette smoking for that matter.
END OF INTERVIEW
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