A link between e-cigarettes and oral cancer

Tobacco has long been the leading cause of oral cancer.

Estimates range that smokers are six to ten times more likely to develop oral cancer than nonsmokers.

The introduction of e-cigarettes has provided a method of nicotine consumption with health implications that are not as well understood. A review from the University of New South Wales in Sydney, Australia, however, has linked vaping to both oral and lung cancers.

Marisa Buchakjian, M.D., Ph.D., surgical oncology and microvascular surgeon in the Department of Otolaryngology in Head & Neck Surgery at Michigan Medicine, answered questions about risk factors for oral cancer following this latest study.

What are the implications of this latest study?

This most recent study out of Australia pulled together all of the available data about e-cigarettes and vaping and its correlation to head and neck cancer.

And what this study showed is that if you look at patient case reports and then clinical data as well as mouse data, there really is a very convincing link between the use of vaping and -e-cigarettes and the risk of oral cavity and other upper aero digestive tract cancers.

This suggests that we might see a rise in oral cavity and head and neck cancers in the near future in our younger populations.

How does vaping cause head and neck cancer?

Vaping or e-cigarettes can cause head and neck cancer by exposing the lining of the mouth and the upper air digestive tract to different carcinogens.

Those would be things like the nicotine itself, as well as some of the solvents that the nicotine is stored in.

Once those are aerosolized, they are exposed into the mouth and can cause changes to the cells that can then later become a cancer.

Where does tobacco rank among causes of oral cancer?

Tobacco is the number one causative factor for oral cavity and head and neck cancer, and this can be in any form: cigarettes, cigars, e-cigarettes, chewing tobacco and nicotine patches.

This is the number one cause, and certainly other factors are additive. Those would be things like alcohol, dental hygiene and potentially the HPV virus.

But tobacco remains the number one cause of head and neck cancers.

What is the role of HPV virus in causing head and neck cancers?

The HPV virus, or human papilloma virus, can also cause head and neck cancer, specifically cancer of the tonsils in the back of the tongue.

The majority of adults are exposed to HPV when they're younger. In a small percentage of people, this can cause some changes in cells over time that can lead to a cancer.

What’s important to know is that the HPV vaccine, when people are children and then younger has the potential to prevent this kind of cancer from growing in adults.

There’s actually a blood test offered here at Michigan Medicine that can detect circulating tumor DNA in a patient's blood. This is called My HPVscore.

We use this test to help with diagnosis, to help examine effects of treatment and to help surveillance and long term while we make sure that patients remain cancer-free.

How can patients reduce their risk of head and neck cancer? 

To reduce your risk of head and neck cancer, it's important to consider smoking cessation and to avoid excessive alcohol consumption — that would be at most one drink per day for women and two per day for men.

Also consider following up on HPV vaccination if eligible.

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