Juul Lung Cancer – What Are The Causes?

By Dr. Annie Macpherson
Updated: 2019-09-19

Why is a JUUL Different to E-cigarettes?

JUULs are different to most e-cigarette devices. Most importantly, this is because they use nicotine salts within their e-liquids, as opposed to standard nicotine.

Nicotine salts are structurally similar to nicotine, but more closely resemble the nicotine found in tobacco leaves, that you might inhale from a cigarette. They provide the user with a faster, stronger hit than standard nicotine-based e-cigarettes, as your body can absorb nicotine salts more quickly than nicotine alone. This means, when you use a JUUL, you can expect to inhale more nicotine than if you vaped with a regular e-cigarette.

We’ll discuss how the increased nicotine you consume with a JUUL might lead to cancer, a little later on in this article.

Effects of JUUL on Your Lungs

There are a lot of common, short-term effects JUULs can cause you to experience when you vape. These include:

– Mouth and throat irritation [1]
– Dry mouth
– A dry cough [2]
– Reduced cough reflex [3]

These symptoms do not last long, and will normally resolve after you stop vaping. So far, research suggests that using a JUUL appears to have almost no long-term effects on lung function. This includes having no effect on lung carbon monoxide levels, forced vital capacity, and cough reflexivity – all problem areas for smokers [3, 4].

Could Using a JUUL Cause Cancers?
Researchers announced in early 2018 that mice exposed to e-cigarette vapour displayed increased DNA damage, a known precursor to cancer, in their lungs. This fueled concerns about e-cigarettes and JUULs causing cancer [5]. However, this work has been dismissed by members of scientific and vaping communities alike. Mice in this study were exposed to 3000 times more vapour than the average vaper, resulting in complete intoxication and aerosol overdose [6]. There is currently no evidence linking vaping to lung cancer, although more long-term research is definitely required.

The only link that current research can provide between JUULs and lung cancer is down to the high concentrations of nicotine found in JUUL. Studies done on healthy and cancerous lung cells show that nicotine could have the potential to act as a tumor promoter [7]. This means that although it won’t cause cancer, nicotine could potentially encourage the growth of an existing tumor. This work is controversial, contradicted by similar work done in more reliable mouse models of lung cancer [8]. If you have cancer, or a history of cancer, it is probably best to avoid using a JUUL, or nicotine altogether.

lungs
Lung Cancer shown in an X-ray. Arrows denote the tumor mass.

Can Using JUUL Lead to Other Lung and Respiratory Diseases?

Current research suggests that using JUUL has limited cancer-causing effects, unlike smoking, which encourages cancer formation and can cause lung diseases like COPD. Could JUUL cause other lung diseases, similarly to smoking?

Popcorn Lung
Popcorn lung is a vicious, incurable disease, caused by scarring of the lung tissue. It is caused by chronically inhaling high levels of toxic and industrial powders such as diacetyl, a food grade flavouring. Popcorn lung has been linked to vaping due to the early use of diacetyl as an e-juice flavouring. At the moment, research suggests the risks of getting popcorn lung, or any lung tissue scarring from using JUUL is highly unlikely, although more research is required. Fortunately, all JUUL flavours are diacetyl-free, so you are at no risk of popcorn lung using a JUUL.

COPD
COPD is a deadly lung disease caused by tobacco smoke, that will affect 20-30% of smokers [9]. Research from clinical trials and patient surveys shows that the majority of patients with COPD who switch from smoking to vaping will see a positive impact on their symptoms, including improved quality of life and reduced requirement for oxygen [10, 11].

However, research from 2016 showed that mice exposed to e-cigarette vapour for extended periods of time developed markers of COPD in their lungs, including lung tissue destruction. This effect seemed to be entirely dependent on nicotine – found in high concentrations in JUUL. The study did not investigate how quickly cigarette smoke would induce a similar effect, so we are not able to compare the significance of this damage to smoking tobacco [12].

Conclusion

Current research suggests vaping has limited and short-term effects on lung function, and the majority of experts tell us vaping could be 95% less damaging than smoking [13]. At the moment, there is no evidence linking JUULs to lung cancer. JUUL’s high nicotine content, achieved through using nicotine salts, may promote tumour development if you already have cancer, however this effect is still unclear.

More research is required before using a JUUL, or vaping in general can be considered entirely safe, and e-cigarettes are never advised for use by non-smokers. However, these effects pale in comparison to the toxic and damaging effects of smoking. A stark reminder comes from FDA Commissioner Scott Gottlieb, in a 2017 press release on the known dangers of smoking. “Cigarettes – the only legal consumer product that, when used as intended, will kill half of all long-term users,” [14].

Image

Sources

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https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0066317

2. Characteristics, perceived side effects and benefits of electronic cigarette use: a worldwide survey of more than 19,000 consumers. Farsalinos KE, Romagna G, Tsiapras D, Kyrzopoulos S, Voudris V
Int J Environ Res Public Health. 2014 Apr 22; 11(4):4356-73.
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3. Chest. 2016 Jan;149(1):161-5.Effect of e-Cigarette Use on Cough Reflex Sensitivity.
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4. Ferrari M, Zanasi A, Nardi E, et al. Short-term effects of a nicotine-free e-cigarette compared to a traditional cigarette in smokers and non-smokers. BMC Pulm Med. 2015;15:120.
https://www.ncbi.nlm.nih.gov/pubmed/26459355

5. E-cig damages DNA in lung, heart, and bladder. Hyun-Wook Lee, Sung-Hyun Park, Mao-wen Weng, Hsiang-Tsui Wang, William C. Huang, Herbert Lepor, Xue-Ru Wu, Lung-Chi Chen, Moon-shong Tang. Proceedings of the National Academy of Sciences Jan 2018, 201718185
http://www.pnas.org/content/early/2018/01/25/1718185115

6. Assessment of E-cigarette impact on smokers: The importance of experimental conditions relevant to human consumption. Giovanni Li Volti, Riccardo Polosa, Massimo Caruso
Proceedings of the National Academy of Sciences Apr 2018, 115 (14) E3073-E3074
http://www.pnas.org/content/115/14/E3073

7. Chernyavsky, Alex I et al. “Mechanisms of tumor-promoting activities of nicotine in lung cancer: synergistic effects of cell membrane and mitochondrial nicotinic acetylcholine receptors” BMC cancer vol. 15 152. 19 Mar. 2015, doi:10.1186/s12885-015-1158-4
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4369089/

8. Long-term nicotine replacement therapy: cancer risk in context. Shields PG Cancer Prev Res (Phila). 2011 Nov; 4(11):1719-23.
https://www.ncbi.nlm.nih.gov/pubmed/22052338/

9. Institute of Medicine. Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence. Washington: National Academy of Sciences, Institute of Medicine, 2009 [accessed 2018 October 28]
https://www.ncbi.nlm.nih.gov/m/pubmed/25032340/

10. Centers for Disease Control and Prevention. Chronic Obstructive Pulmonary Disease Among Adults—United States, 2011. Morbidity and Mortality Weekly Report 2012;61(46):938–43 [accessed 2018 October 28].
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11. Polosa R, Morjaria JB, Caponnetto P, et al. Evidence for harm reduction in COPD smokers who switch to electronic cigarettes. Respir Res. 2016;17(1):166.
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12. Garcia-Arcos I, Geraghty P, Baumlin N, et al Chronic electronic cigarette exposure in mice induces features of COPD in a nicotine-dependent manner Thorax 2016;71:1119-1129.
https://thorax.bmj.com/content/71/12/1119

13. Public Health England E-cigarettes: an evidence update A report commissioned by Public Health England (accessed 27/10/18)
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14. FDA News Release – FDA announces comprehensive regulatory plan to shift trajectory of tobacco-related disease, death. [Accessed 27/10/18]
https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm568923.htm

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.