Measuring the Cancer Risk of Different Nicotine Products Via Biomarkers

While the media is saturated with conflicting messages about the risks and benefits of different tobacco and nicotine products, biomarker studies on such products are setting the record straight.

Biomarkers are measurable substances in our bodies that show up or increase as a result of exposure to certain compounds, and have specific effects on our body. A simple example of these are elevated cholesterol levels, which are considered a biomarker for heart disease risk.

A recent article by tobacco harm reduction expert Dr. Colin Mendelsohn said that cigarette smoke is known to contain at least 69 known carcinogens, most of which are found in high doses. He explained that by comparing the levels of cancer biomarkers from smoking and vaping, we can compare the cancer risk from smoking versus vaping.

Referring to countless studies (Holt 2023; Scherer 2022; Scherer 2022; Anic 2022; Taylor 2023; Soulet 2022; Hartmann-Boyce 2022; Smith 2020; Xia 2020; Goniewicz 2018; Dai 2022; Shahab 2017;  Office of Health Improvement and Disparities 2022.), Dr. Mendelsohn highlighted that most of the cancer biomarkers found in people who smoke, are not detected in people who vape. Moreover, he added, those which are actually found in both, are found in significantly lower doses in vapers than they are in smokers.

Biomarkers can deliver less speculative and more definitive conclusions
Most of the cancer biomarkers found in people who smoke, are not detected in people who vape. While those which are actually found in both, occur in significantly lower doses in vapers than in smokers.

In line with this, a recent article on The Daily Pouch added that using biomarkers to determine the risks of any product, also serves to speed up the research in that area. In fact, biomarker studies have been used in the US to help authorize some vaping products, however they have yet to be used to study other alternative products such as nicotine pouches.

Meanwhile, a recent study by a UCF researcher reported that vaping can increase one’s chances for oral cancer, while another study from Sweden claimed there is a link between snus consumption and cancers of the esophagus and of the pancreas. These studies are a clear example of how biomarkers could be used to derive more definitive conclusions.

Studies linking nicotine products to cancer
In her study, Dr. Claudia Andl, at the University of Central Florida (UCF) explained that vapour, irrespective of whether it contains nicotine or not, causes an unbalance in oral microbiome (good bacteria) causing large bacterial communities to die. She said that the combination of high heat and certain chemicals in vapour have a negative impact on this bacteria.

“In our research, we focused on a specific bacterium, Streptococcus mutans, commonly associated with tooth decay. Then we looked at how e-cigarette vape affects that bacterium and others common to the environment in the mouth,” Dr. Andl explained. “It turns out the antimicrobial effect of the e-cigarette liquid creates an environment where the healthy bacteria have trouble growing, but the bad bacteria are not affected and are left with more room to take over.”

She went on to explain that an imbalance in the oral microbiome can lead to tooth decay, which in turn can cause inflammation and gum disease, and also increase the risk for cancer.

Similarly, the study “A systematic review of cancer risk among users of smokeless tobacco (Swedish snus) exclusively, compared with no use of tobacco,” looked into the cancer risk, and resulting mortality in exclusive users of Swedish snus, compared with non-users of tobacco.

By looking into 14 cohort-studies and one case-control study, out of 2450 articles, the research team found moderate to low evidence that there was an increased risk of cancer of the esophagus, pancreas, stomach and rectum, as well as an association between use of snus and increased mortality in exclusive snus users. Discussing the study, NIPH researcher Tord Vedøy said that the snus report uses old numbers and that the numbers are small. However, he added of course it’s best not to use snus.

In contrast countless studies, such as observational study carried out at the Unit of Periodontology and Oral Hygiene of Calabrodental Clinic in Crotone, highlighted the relative safety of vaping on oral health. The current study analyzed the oral health of 110 smokers who had just switched to vaping. At the start of the study, 61% in group 1 and 65% in group 2, experienced gum bleeding. When re-examined at the end of the study, 92% and 98% respectively, experienced no bleeding.

An accurate measure of the relative risks and benefits of different products
Meanwhile, tobacco harm reduction and public health experts have always underlined that both snus and vapes, as well as any other alternative product, should be used solely as an NRT (nicotine replacement therapy), with the aim to quit or reduce smoking. Sadly, the above studies failed to compare the risks and benefits for users when they switch to using vapes or snus from smoking cigarettes, and once again, an effective way of doing this would be by carrying out biomarker studies.