The tradition is that tobacco was introduced into English society in 1586 when Sir Walter Raleigh brought if from Roanoke Island, Virginia.  Stories abound about Spanish and Portuguese sailors smoking long before its introduction to England.

Not only was it fashionable to smoke, but it was also presumed to be good for your health.  It was felt tobacco could alleviate pain, worms, and ward off the effects of the bubonic plague.  Demand for tobacco continued to increase over the centuries.  In the early twentieth century cigarettes were implicated as causing cancer and by the 1950s were positively linked to cancer.  It was a slow acceptance in the general public and even in the professional world that tobacco causes cancer.  In the late 1960s only one-third of physicians believed that the evidence was sufficient to establish its causative effect.

Tobacco is addictive and many people struggle to stop smoking even when they know it is bad for their health.  Many struggle to stop even when they are diagnosed with cancer.  Today, smoking is mostly considered unfashionable, expensive and inconvenient, as you cannot smoke in public.  The rising generation was smoking in much smaller numbers.

E-Cigarettes and Vaping
Introduce electronic cigarettes or e-cigarettes.  This device uses a battery-powered vaporizer that aerosolizes the liquid solution.  Using this device is called “vaping”.   Over the years different devices have been constructed and different liquid solutions have been formulated with propylene glycol, nicotine, and flavorings.  Many of my patients converted to vaping from cigarettes to see if the e-cigarette could help them stop tobacco smoking.  The electronic cigarette companies championed their products for smoking cessation – although no studies have shown it is any more effective than other non-smoking techniques or medicines.

The use of e-cigarettes has grown exponentially in the last few years.  Almost 15% of American high school students report using them.  It is reported that nearly 10 million people vape daily.  The long-term health effects of vaping were unknown, so many felt it can’t be any worse than regular cigarette smoking … so go ahead.  Recently vaping has gotten a lot of bad press as there has been an outbreak of severe lung illnesses in many patients across many states with a direct link to their use of e-cigarettes.

E-Cigarettes May Cause Cancer
We learned the toxic effects of cigarette smoking only after a long period of time.  And now we have some data that suggests nicotine in e-cigarettes may cause cancer.   Just published in the journal Proceedings of the National Academy of Sciences of the United States of America, a study showed that 22.5% of mice who were exposed to nicotine-containing e-cigarette vapor developed lung cancer.  Fifty-seven percent of the mice developed abnormal growth of cells in the bladder seen in bladder cancer.

So this is perhaps an early cautionary tale of what may happen in humans with long-term vaping.  These devices are so new that we will have to probably wait decades to get a definitive answer on whether they cause cancer.

Are e-cigarettes safer than combustible cigarettes?  I don’t know.  We know that tobacco is not safe.  This study certainly throws doubt on my previous premonitions of its safety.  The safest approach is not to smoke or vape at all.