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Vapers May Be Less Likely To Undergo Lung Cancer Screening

E-cigarette use among individuals eligible for lung cancer screening was independently associated with a reduced likelihood of screening, a cross-sectional study of U.S. Adults revealed.

Compared with those who never used e-cigarettes, current vapers had a lower odds of ever undergoing lung cancer screening (OR 0.79, 95% CI 0.62-1.00) and of being up to date on screening (OR 0.67, 95% CI 0.51-0.88), reported researchers led by Qian Wang, MD, MPH, of Case Western Reserve University in Cleveland.

The associations were more apparent for former (rather than current) smokers of traditional cigarettes. For individuals who previously smoked, those who used e-cigarettes appeared less likely to have undergone lung cancer screening (OR 0.73, 95% CI 0.52-1.04) and had a 46% lower chance of being up to date on screening (OR 0.54, 95% CI 0.37-0.80) compared with those who never used e-cigarettes.

No associations were seen between past e-cigarette use and lung cancer screening use, according to the findings in JAMA Network Open.

"Former smokers who use e-cigarettes remain at increased risk of lung cancer and should be targeted by interventions to improve adherence to LCS [lung cancer screening]," Wang and co-authors concluded.

E-cigarettes are increasingly being used as cessation aids for smokers seeking to quit traditional cigarettes, the research team explained in their introduction, but there have been growing concerns about the potential for lung cancer risk with long-term use, among other concerns.

"Emerging research suggests that e-cigarettes contain definite and probable carcinogens and cause similar cancer-associated gene deregulations as combustible tobacco," wrote Wang and co-authors. "However, it has been shown that two-thirds of individuals currently using e-cigarettes consider e-cigarettes to be less harmful than combustible cigarettes. Thus, individuals who use e-cigarettes may have lower awareness of lung cancer risks."

Their study included more than 20,000 individuals who met the current criteria for lung cancer screening set by the U.S. Preventive Services Task Force (USPSTF). The task force first recommended screening via low-dose CT in 2013, but broadened its criteria for eligibility in 2021.

"I would not see this as 'Well, you shouldn't be smoking an e-cigarette,'" said Nancy Rigotti, MD, of Massachusetts General Hospital in Boston, of the findings from Wang's group. "If you're smoking an e-cigarette and you used to smoke, you still need lung cancer screening."

"It's a reminder for us that we need to make sure that everybody who has recently or are currently smoking cigarettes and fits the eligibility criteria for lung cancer screening gets lung cancer screening," said Rigotti, who was not involved in the study.

Current USPSTF guidelines recommend annual screening via low-dose CT for adults ages 50 to 80 years who have at least a 20 pack-year smoking history and who either currently smoke or have quit in the past 15 years.

But in clinical practice, uptake of the screening recommendations has been "woefully low," noted Ashley Prosper, MD, of the University of California Los Angeles, who also was not involved in the study.

In the current sample, just 27% of the individuals had undergone lung cancer screening.

"Barriers to lung cancer screening adherence are myriad," Prosper told MedPage Today via email. These include "factors such as participant characteristics (insurance status, income, race, education), healthcare provider factors (whether or not a recommendation for lung screening is made by a provider to an eligible patient), and a number of psychological variables that are unique to lung screening as compared to other cancer screenings -- such as the fear of discovering a lung cancer and stigma associated with smoking."

Wang and colleagues' study included 22,713 individuals from within the 2022 Behavioral Risk Factor Surveillance System who met current USPSTF guidelines for lung cancer screening.

Median age was 62 years and 56% were men. Most were white (77%), while 9% were Black, 7% were Hispanic, and 7% were of another race. Individuals had a median 39 pack-year history of cigarette smoking: a majority still smoked (59%) while the rest were former smokers (41%; median 6 years since quitting).

With regard to e-cigarette use, a majority (55%) had never used them, while 35% were former users and 9% were current users. The vast majority (81%) of the sample had had a routine checkup in the prior year, and nearly two-thirds said they were in good general health.

Overall, 5,885 individuals had undergone screening, with 3,472 (14.6%) up to date on screening and 2,513 (11.4%) no longer up to date.

People who underwent screening tended to be older (64 vs 61 years for those never screened); have lower income, poorer health, more comorbidities, and a greater smoking history (43 vs 38 pack-years); and they were more likely to have attempted quitting in the prior year (18% vs 14%) and live in the Northeast. Individuals in the screening group were also more likely to have reported never using e-cigarettes (57% vs 55%) and were less likely to be uninsured (2% vs 7%).

Study limitations cited by Wang and colleagues included the cross-sectional design, use of self-reported screening and smoking information, and the fact that the study could not account for switching between traditional cigarettes and e-cigarettes and the impact of that on screening uptake.

Elizabeth Short is a staff writer for MedPage Today. She often covers pulmonology and allergy & immunology. Follow

Disclosures

Wang reported no disclosures. Co-authors reported relationships with Regeneron, Mirati, AstraZeneca, Amgen, Sanofi, Pharmaceutical Product Development, and Axella.

Prosper is a member of the American College of Radiology's Lung CT Screening Reporting & Data System (Lung-RADS), is co-director of UCLA's Lung Screening Program, and reported a relationship with the National Institutes of Health.

Rigotti reported a relationship with Achieve Life Sciences.

Primary Source

JAMA Network Open

Source Reference: Wang Q, et al "E-cigarette use and lung cancer screening uptake" JAMA Netw Open 2024; DOI: 10.1001/jamanetworkopen.2024.19648.

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Cancer Screening And Medicare: Are You Covered?

It's important to talk with your doctor about your individual cancer risk and any screening tests you may need. Your doctor can let you know if Medicare covers the specific tests recommended.

Medicare covers many screening tests that are used to help diagnose cancer, including:

If you're 40 years old or older, one mammogram screening is covered every 12 months under Medicare Part B. If you're between 35 and 39 years old and on Medicare, one baseline mammogram is covered.

If your doctor accepts the assignment, these tests will not cost you anything. Accepting the assignment means that your doctor agrees they will accept the Medicare-approved amount for the test as full payment.

Medicare Part B covers diagnostic mammograms if your doctor determines they are medically necessary. The Part B deductible applies, and Medicare will pay 80% of the approved amount.

With specific guidelines, Medicare covers:

Keep reading for more information on each screening.

Screening colonoscopy

If you're at high risk of colorectal cancer and have Medicare, you're covered for a screening colonoscopy once every 24 months.

If you're not at high risk of colorectal cancer, the test is covered once every 120 months, or every 10 years.

There's no minimum age requirement. If your doctor accepts the assignment, these tests will not cost you anything.

Fecal occult blood tests

If you're 45 years old or older and have Medicare, a fecal occult blood test to screen for colorectal cancer is covered once every 12 months.

If your doctor accepts the assignment, these tests will not cost you anything.

Multi-target stool DNA lab tests

If you're 45 to 85 years old and have Medicare, a multi-target stool DNA lab test is covered once every 3 years. You must meet certain conditions, including:

you're at average risk of colorectal cancer

you don't have symptoms of colorectal disease

If your doctor accepts the assignment, these tests will not cost you anything.

If you have Medicare, a Pap test and pelvic exam are covered every 24 months by Medicare Part B. A clinical breast exam to check for breast cancer is included as part of the pelvic exam.

You may be covered for a screening test every 12 months if:

you're at high risk of vaginal or cervical cancer

you're of reproductive age and have had an abnormal Pap test in the past 36 months

If you're 30 to 65 years old, a human papillomavirus (HPV) test is included as part of a Pap test every 5 years, too.

If your doctor accepts the assignment, these tests will not cost you anything.

Prostate-specific antigen (PSA) blood tests and digital rectal exams (DRE) are covered by Medicare Part B once every 12 months if you're 50 years old or older.

If your doctor accepts the assignment, the yearly PSA tests will not cost you anything. For the DRE, the Part B deductible applies, and Medicare will pay 80% of the approved amount.

If you're 50 to 77 years old, low dose CT lung cancer screening is covered by Medicare Part B once every year. You must meet certain conditions, including:

you're asymptomatic (no lung cancer symptoms)

you currently smoke tobacco or have quit within the last 15 years

your tobacco use history includes an average of one pack of cigarettes per day for 20 years

If your doctor accepts the assignment, these tests will not cost you anything.

Medicare covers a number of tests that screen for various types of cancer, including:

breast cancer

colorectal cancer

cervical cancer

prostate cancer

lung cancer

Talk with your doctor about cancer screening and whether it's recommended based on your medical history or symptoms.

It's important to understand why your doctor feels these tests are necessary. Ask them about their recommendations and how much the screening will cost, and if there are other equally effective screenings that may be more affordable. It's also a good idea to ask how long it will take to get your results.

When weighing your options, consider:

if the test is covered by Medicare

how much you'll need to pay toward deductibles and copays

whether a Medicare Advantage plan might be your best option for comprehensive coverage

other insurance you may have, such as Medigap (Medicare supplement insurance)

if your doctor accepts the assignment

the type of facility where the test takes place

The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. Jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.

JAMA Study Links E-Cigarette Use To Lower Lung Cancer Screening Rates

USA: A cross-sectional study published in JAMA Network Open revealed that e-cigarette use is independently associated with lower use of lung cancer screening (LCS), specifically among individuals who had quit smoking combustible cigarettes.

Current vapers had lower odds of ever undergoing lung cancer screening (OR 0.79) and of being up to date on screening (OR 0.67) compared with those who never used e-cigarettes, the researchers reported. The relationships were more noticeable among individuals who were former smokers of traditional cigarettes rather than current smokers.

E-cigarettes, touted by some as a safer alternative to traditional smoking, have surged in popularity in recent years, particularly among younger demographics. Concerns persist, however, regarding their long-term health effects, including potential implications for lung health and cancer risk.

Since the US Preventive Services Task Force (USPSTF) endorsed lung cancer screening in 2013 (revised in 2021), there has been an increase in uptake, although it remains modest. The impact of e-cigarette use on LCS uptake remains uncertain. Considering this, Qian Wang, University Hospitals Seidman Cancer Center, Cleveland, Ohio, and colleagues conducted a cross-sectional study following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline and was exempt for human participants review from the institutional review board at University Hospitals.

Informed consent was waived as the data were deidentified. Participants meeting US Preventive Services Task Force 2021 criteria for lung cancer screening (age 50-80 years, ≥20 pack-years smoking history, current smokers or quit ≤15 years ago) were selected from the 2022 Behavioral Risk Factor Surveillance System (BRFSS).

Baseline demographic characteristics were compared using χ2 tests for categorical variables and Kruskal-Wallis tests for continuous variables between those who underwent LCS and those who did not. Logistic regression adjusted for potential confounders examined the association between LCS uptake and e-cigarette use. LCS uptake was stratified by time since the last screening (ever vs up-to-date within the past year).

The study led to the following findings:

Of 22 713 eligible individuals, the median age was 62 years, and the sample included 56.4% males, 6122 individuals who underwent LCS, and 3472 individuals who were up-to-date with LCS testing.

Individuals who underwent LCS were older, more likely to have lower income, and comorbidities, had a routine check-up last year, reported poor general health, resided in the Northeast region of the US, and were less likely to be uninsured.

They also had a higher pack-year of smoking, had recently quit smoking (individuals who previously used cigarettes), had attempted to quit in the past year (individuals who currently use cigarettes), and were more likely to report never using e-cigarettes compared with those who did not undergo LCS.

Individuals currently using e-cigarettes had 21% lower odds of having undergone LCS (odds ratio [OR], 0.79) compared with individuals who never used e-cigarettes after adjusting for confounders, with similar trends found in individuals who previously used combustible cigarettes (OR, 0.73).

After stratifying by time since the last LCS, individuals currently using e-cigarettes had 33% lower odds of being up-to-date with LCS (OR, 0.67) than individuals who never use e-cigarettes.

Similar findings were among individuals who previously used combustible cigarettes and currently use e-cigarettes; they had 46% lower odds of being up-to-date with LCS (OR, 0.54).

"Our findings underscore the critical need to increase awareness and correct misunderstandings about e-cigarette use," the researchers concluded. "It's crucial to note that former smokers who use e-cigarettes still face heightened risks of lung cancer, emphasizing the importance of targeted interventions to enhance adherence to lung cancer screening. "

Reference:

Wang Q, Jiang C, Hsu ML, et al. E-Cigarette Use and Lung Cancer Screening Uptake. JAMA Netw Open. 2024;7(7):e2419648. Doi:10.1001/jamanetworkopen.2024.19648

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