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Do JUULs Cause Cancer?

By Dr. Annie Macpherson
Updated: 2019-09-17

Introduction

E-cigarettes like juul are devices that provide a hit of nicotine which result in a flavored vapour when inhaled. Generally considered safer than smoking, e-cigarettes are fast becoming an established device that people use to quit smoking.

JUUL are pod-loading e-cigarettes, that use nicotine salts which result to deliver a stronger nicotine hit than is possible with most other e-cigarettes.

One of the biggest concerns to smokers is the increased risk of cancer or causing/trigger cancer. Many people start vaping to reduce their risk of smoking-related diseases like cancer or causing health accidents. But, are there any links between e-cigarettes, JUUL and cancer, or any health accidents caused cancer?

In this article,

We’ll discuss any links between JUUL and cancer. So if you are considering using a JUUL, you can make your decision an informed one about cancer and health accidents.

How is Using a JUUL Different to Smoking?

There is a big difference between using a JUUL and smoking.

The cancer effects of smoking are not because the smoker inhales tobacco, but because the smoker is inhaling smoke that cause health accidents.

The carcinogens found in tobacco smoke are generated through combustion, the burning of tobacco.

Using a JUUL is different because you inhale vapour. The components of vapour are the same as those found in JUUL e-liquid. Vaping requires no combustion and no smoke, dramatically reducing can trigger the volume of carcinogenic substances you inhale.

What is in JUUL e-liquid?

JUUL are slightly different to standard e-cigarettes. One of the key differences is their use of nicotine salts. Nicotine salts provide a stronger, faster hit, as your body absorbs them more quickly than nicotine.

E-juice is the fluid used in e-cigarettes to create vapour. It comes in a variety of flavours. JUUL e-juice is composed of:

Nicotine salt-based e-liquids, like those used by JUUL, contain high levels of benzoic acid. Benzoic acid is necessary to keep the nicotine in salt form.

Cancer Cause From JUULs?

So, could using a JUUL cause cancer? Research is limited into the risks of cancer if you use JUUL excessively, or long term. We don’t know at the moment if the flavourings in JUUL cause cancer after long-term exposure, mainly because JUUL technology (an e-cigarettes in general) is so new. 

Let’s take a look at the evidence for each ingredient:

  • Propylene Glycol (PG) and Vegetable Glycerol (VG)

  • Nicotine salts, flavourings and benzoic acid are diluted in PG and VG to create the e-liquid. How are PG and VG linked to cause of cancer?

  • The good news is, little to no research that suggests either of these compounds for cancer. Used in many medical and industrial products like toothpaste, makeup, paint and theatrical smoke, there is absolutely no evidence to suggest either of these compounds have any links to
    cause of cancer.

  • PGhas been shown to reduce lung function in entertainment industry workers chronically exposed to PG-based theatrical smoke [2]. We don’t know if this cause and effect is permanent, or if it improves after a break from PG exposure. We know that PG inhalation probably doesn’t cause cancer, because that result would have come up in an investigation like this one.

  • Nicotine

  • The US Department of Health and Human Services agrees that nicotine, in the absence of tobacco smoke, does not cause cancer [3]. They concluded in a 2014 report that there was no direct evidence for any carcinogenicity of nicotine replacement therapies, like nicotine patches and gum.
  • However, studies done on healthy and cancerous lung cells show that nicotine could have the potential to act and cause as a tumorpromoter [4]. This means nicotine could potentially encourage the cause of growth of an existing cancer. This work is controversial though, contradicted by similar work done in more reliable mouse models of lung cancer [5]. If you have cancer, or a history of cancer, it is probably best to avoid using a JUUL, or nicotine altogether. 

  • Benzoic Acid

  • The World Health Organisation (WHO) classifies benzoic acid as safe to consume [6]. But, does this mean it’s safe to inhale? 
  • Research suggests that consuming benzoic acid does not lead or cause to cancer [6]. However, a recent study published the cause and effects of chronic benzoic acid exposure on industrial workers. They demonstrated a link between chronic benzoic acid inhalation and asthma [7]. Whether the quantities of benzoic acid found in JUUL could similarly cause asthma after chronic use, is still uncertain.
  • Flavourings

    E-cigarette flavourings are generally considered the singular component of JUUL that could have risks. Flavourings need to be approved as safe to eat, to be used in an e-liquid. 

    However, eating something is a very different process to inhaling it – when you inhale something, it directly enters your bloodstream, undigested, through sensitive lung tissue, at very high doses. For example, FDA-approved butter popcorn-flavouring diacetyl, harmless when eaten, can cause a serious and destructive lung disease when inhaled [8]. JUUL use diacetyl-free flavourings.

    There is very limited research on the cause and effects of food flavourings when inhaled [9,10]. Most e-juice flavours do not have supporting evidence to demonstrate safety, asides from the knowledge that they can cause harmless when eaten. This means that some flavourings will be more harmful than others.

    Simply put, we don’t know if there are any links between e-cigarette flavourings and cancer. It is down to the user to decide if the potential risks of e-juice flavourings are of more concern than the proven and established dangers of tobacco.

Conclusion

Therefore I conclude:

  • Your risk of cancer is very low, particularly if you choose to use JUUL only in the short term. It is important however to remember that safer than smoking, does not equal safe, particularly if you are using JUUL long term or in excess.
  • Unlike tobacco smoke, where more cause of harmful components are being characterised every day, current research suggests the individual components of JUUL have a limited potential to cause cancer [9,10,11]. If you are worried about your risk of cancer from smoking, and are looking for a high-nicotine alternative, it’s worth considering JUUL as an aid to help you quit.

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Dr. Annie Macpherson
Dr. Annie Macpherson

Annie has a PhD in Genome Stability from the University of Sussex. She has first-hand experience in cancer and human disease research. This allows her to provide us with new and unbiased insights into the ongoing research of the public and health effects of vaping. She loves an adventure, and has travelled through South East Asia and Australia working for Vaping Insider.