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Daily Bulletin

Former Smokers Who Use E-Cigarettes Present Lung Cancer Screening Challenge

Tuesday, Nov. 30, 2021

By Nick Klenske

According to the CDC, cigarette smoking is responsible for as much as 90% of lung cancer deaths in the U.S. As such, it should come as no surprise that the best way to prevent lung cancer is to not smoke or, if you do, to quit.

But what about the use of e-cigarettes, or vaping — particularly by former smokers?

“Many of the nearly 14 million U.S. adults who use e-cigarettes classify themselves as former smokers, suggesting that most don’t view vaping as a form of tobacco use,” said Karim Oueidat, MD, a research assistant in the department of diagnostic radiology at Rhode Island Hospital. “On top of this, a good portion of former smokers use e-cigarettes as a means of not smoking tobacco cigarettes.”

Dr. Oueidat conducted an assessment of the smoking behaviors of former smokers. Among the 1,085 patients who completed the survey, 378 provided open-ended responses on how they stopped smoking. 27% reported using e-cigs or an over-the-counter (OTC) nicotine replacement product (by comparison, 12.7% reported using medication). Of these, 34.3% vaped e-cigarettes.

Likewise, of the 354 participants who provided an open-ended response to how they avoid smoking during a craving or urge, 10.2% reported using e-cigs or an OTC nicotine replacement product (by comparison, 0.6% reported using medication). Among these 36 patients, 12 (33.0%) vaped e-cigarettes.

“These numbers show that the vast majority of patients are interested and willing to quit smoking,” said Dr. Oueidat. “But the fact that many are doing so by using e-cigarettes suggest that there’s a lack of understanding on how to best achieve this.”

The assessment was conducted on self-described former smokers attending an annual lung cancer screening. Eligibility for screening was based on having smoked at least 30 packs a year and being between the ages of 55 and 80.

An Opportunity for Radiology

While more research is needed as to the efficacy and safety of using e-cigarettes as a smoking cessation tool, Dr. Oueidat said health care providers — including radiologists — should already be counseling patients on the topic. “Unfortunately, many don’t feel competent enough to provide such counseling,” he said.

According to a survey that Dr. Oueidat administered to medical students at Brown University, there is a clear lack of education about e-cigarettes in the current medical curriculum. “As a result, there’s a relative lack of confidence when it comes to counseling patients on the use of e-cigarettes,” he added.

Dr. Oueidat sees an opportunity for radiologists to help fill this knowledge gap, both in terms of the medical curriculum and in the design of tailored smoking cessation programs. “In order to implement change at the medical curriculum level, one first needs to know how patients perceive e-cigarettes — which is where radiology can play an important role,” he said.

As Dr. Oueidat explained, radiologists and imaging centers can administer thorough questionnaires and surveys during screening encounters to identify smoking habits and perceptions of self-identified current and former smokers. “This data will contribute to the development of tailored counseling and education methods and will provide information about the long-term safety of e-cigarette use,” he said.

Such data could also impact who is being screened for lung cancer. “If former traditional cigarette smokers use e-cigarettes as a smoking cessation tool and self-identify as former smokers, there’s a risk of excluding them as potential lung cancer screening candidates,” Dr. Oueidat noted. “This can be problematic, especially if the proportion of those patients grows.”

View the digital poster “E-cigarette Use Among Self-described Former Smokers Undergoing Lung Cancer Screening,” (SDP-CH-40) at