A recent Daily Mail article suggested vaping could cause cancer, citing a recent study and claiming in the headline ‘e-cigs damage DNA just like smoking’. In other articles, we have talked about the attention-grabbing headlines that often surround E-Cigarette and vaping news and looked at the problems with such headlines.

Frustratingly, the Daily Mail article on vaping potentially causing cancer is another example of this. Not only does it reduce the results of the study to a frightening assumption, but the study itself has significant issues when it comes to the E-Cigarette details contained within.

The headline of the article is as follows: ‘Fears vaping could cause cancer: Shock study reveals e-cigs damage DNA just like smoking as top experts warn £5 gadgets loved by teens are ‘not as harmless as originally thought’.

There is a lot to unpack just in that headline. Firstly, it is known that damage to DNA can lead to cancer, however the study did not look at damage to DNA but a natural process called ‘methylation’ which is when a methyl group attaches itself to DNA, changing the way it functions in that given cell. This process of methylation is natural and plays a role in gene expression (how the gene functions) so could not be considered, necessarily, as damage to DNA.

Secondly, that ‘e-cigs damage DNA just like smoking’ is also misleading. The article is referring to methylation changes observed in smokers that can indicate cancer progression, potentially years ahead of diagnosis. What was actually observed was some overlap in the E-Cigarette group of the study and the tobacco-using group where similar changes in methylation were observed in a number of cell types.

Next is the ‘£5 gadgets loved by teens’ – it is a fact that under 18’s have been getting their hands on disposable vapes such as the Elf Bar, however the actual type of E-Cigarette and type of e-liquid are not indicated in the study, highlighting issues about consistency across the E-Cigarette group. We have other articles highlighting the differences between e-liquids made in the UK and those produced elsewhere in environments with little-to-no regulation, as well as the different types of nicotine used and the amount of flavourings included in the e-liquid. The power of the vape device impacts the products from the vaping process, and none of this is addressed in the study.

Finally, we have the claim that E-Cigarettes are ‘not as harmless as originally thought’. The article itself mentions the position of Public Health England that ‘E-Cigarettes are at least 95% less harmful than traditional cigarettes’ highlighting the use of E-Cigarettes as a harm reduction tool for smokers. In the UK, E-Cigarettes and e-liquids are regulated by the MHRA for the utmost safety, however liquids contained in the disposable vapes mentioned are manufactured in Asia and were circumventing the regulation as they are contained in a sealed unit. You only need to look at why disposable vapes are being banned here in the UK to learn that many of these disposable vapes contained illegal levels of e-liquid. What other UK regulations were being ignored by these manufacturers? Can their e-liquids be considered as safe as those made in the UK?

These problems are just in the headline and are expanded upon in the article itself.

The study which the Daily Mail article is talking about noted similar changes in methylation in some areas in the E-Cigarette users that are also observed in the smokers, but not in the non-smoking control group . The study looked at hypermethylation (increased methylation), and hypomethylation (reduced methylation). None of this equates to DNA damage.

Importantly, the study itself found ‘a partial but not complete overlap between smokers in the discovery set and e-cigarette users’ and goes on to say ‘smoking associated methylation alterations are associated with cancer and carcinoma in situ progression’ when talking about the tobacco-using group. This is likely where the Daily Mail headline gets its ‘juice’, highlighting this overlap in methylation changes as almost-certain indicators of cancer.

Interestingly enough, this study has a basis in a previous study published in 2021 that looked at methylation changes in E-Cigarette users, even deriving the E-Cigarette data from this 2021 study. The 2021 study concluded ‘the DNA methylation profile for e-cigarette use is largely distinct from that of cigarette smoking, did not replicate in independent samples, and was unable to discriminate lung cancer from normal tissue.’

This conclusion is very different from the Daily Mail headline, as well as the conclusion of the recent study that states ‘our data provide a first insight into cell type-specific epigenetic changes in response to cigarette smoking, and highlight certain epigenetic responses are shared by e-cigarette use and cancer’. Epigenetics is how your behaviours and environment can change the way your genes work, and the study’s conclusion states the overlap in methylation changes across smoking and E-Cigarette use and how some of these changes are observed in cancer, but does little to state anything further.

The reality is there isn’t a huge amount of data on long-term E-Cigarette use. Public Health England do publish evidence reviews, however the stance on E-Cigarette use has not changed. It is sensible with any novel product to be cautious, so highlighting indicators of potential damage from any new product is a good thing, however it is likely down to the nature of advertising revenue on websites that lead them to concocting outrageous headlines that garner clicks to drive traffic to their site.

Sadly, this headline fits into that category, bending the truth of the study to exaggerate the risks of vaping. It is worth noting that the article disappeared the following day after publication from the Daily Mail’s ‘front page’ of the website.

As the study states, the information is an insight into possible harms along the line of smoking. The 2021 study concluded that the changes were distinct from smoking (this explains the lack of complete overlap in the recent study) and weren’t replicated in independent samples, which is significant as there are many things that impact these ‘epigenetic’ changes. Other environmental factors like age and genetics play a part, and failure to replicate in independent samples suggests that these factors are more significant than E-Cigarette use.

Realistically, some overlap is to be expected between smoking and E-Cigarette use. At the end of the day, both require inhaling a substance which contains at least some volatile organic compounds - these chemicals cause stress, which creates a response by cells exposed to the smoke itself and other harmful chemicals that get into the bloodstream, which explains why methylation changes are observed in both tobacco smoking and E-Cigarette use.

However, the amount of volatile organic compounds produced by E-Cigarettes is a fraction of those produced by tobacco combustion, and E-Cigarettes avoid the production of things like tar that we know are harmful to the smoker. This is why Public Health England’s claim is that E-Cigarettes are 95% less harmful than smoking, not that they are risk-or-harm-free. This would explain why some of these methylation changes occur in E-Cigarette use and smoking, but also why there is not complete overlap between the two.

One of the more obvious issues with the recent study is the lack of detail with regard to E-Cigarette use, and the E-Cig users. It appears the only variable accounted for is the volume of e-liquid used, not the type of device, balance of e-liquid as well as the level and type of nicotine used by the E-Cig users in the study.

These details are significant, especially given the headline from the Daily Mail. The headline mentions ‘£5 gadgets’ which implies disposable E-Cigarettes, which largely come from China and use a type of nicotine called ‘protonated nicotine’ or more commonly ‘nic salt’. Immediately this is different from e-liquids using freebase nicotine, which is nicotine in its purest form, and this difference is significant due to the amount of flavourings used.

Typically, e-liquids using nic salt contain 3 to 4 times the amount of flavouring used in e-liquids that use freebase nicotine, and it is the flavourings that produce the volatile organic compounds that stress the cells. This means nic salt e-liquids are likely more harmful than those using freebase nicotine, which would suggest that more methylation changes would occur in vapers who use nic salt e-liquids in response to a larger number of volatile organic compounds. The study provides no information relating to the e-liquid used by vapers in the study.

Higher powered devices also produce more volatile organic compounds, so for the same reason it is likely that an increase in the number of volatile organic compounds causes more stress, resulting in the epigenetic changes associated with this stress. The study provides no information on the type or power levels of the devices used by the vapers.

The study provides insight into possible harms from E-Cigarette use but, as described above, there are serious limitations to the information we can learn from the study. Not only does it have a differing conclusion from the older study examining the same effect (methylation in E-Cigarette use) which suggests there is information missing or confounding variables not accounted for, but the degree of the effect in E-Cigarettes compared with smoking is the key issue here.

E-Cigarettes were designed as a harm reduction tool, and so relating the degree of potential damage back to tobacco use is essential. All indicators show that vaping is much less harmful than smoking and the degree of potential damage may be sufficiently low that the body’s defences are capable of managing the issue, like the growth of cancers found that doctors choose to observe for a while as the body is often capable of dealing with it without outside help.

Overall, this is something to take note of moving forward for those studying E-Cigarettes, however smokers will still benefit from switching to E-Cigarettes in every observable metric, from cardiovascular improvements to recovered lung function. Don’t just take our word for it – check out the article put forward by Cancer Research UK for the UK’s leading authority on cancer’s overview of the study mentioned by the Daily Mail!

There is still no question that E-Cigarettes are a better choice for smokers, and the largest review of evidence to-date, conducted by Cochrane, found ‘high-certainty evidence’ that E-Cigarettes are more effective for quitting smoking than traditional forms of nicotine replacement therapy, like nicotine patches or nicotine gum. 

I think we can all agree that the world would be a better place without scaremongering headlines, especially when they are riding a wave of happenstance, like the Government’s Smokefree 2030 plan or the ban on disposable vapes. Proper information on vaping has never been more needed, but Daily Mail headlines scaring smokers away from vaping is a genuine disservice to the actual information contained in the studies they use to prop up the headline.

If you are not a smoker, you shouldn’t take up vaping. Full-stop. The headline may help prevent some youths from starting without a history of smoking, however it undermines trust when they discover they have been lied to, which can have far-reaching consequences.