A new qualitative, multidisciplinary risk assessment conducted at UNSW Sydney has found a definitive link between nicotine-based vaping and cancers of the lung and oral cavity—a significant shift from decades of the risk of vaping being largely undefined.
The study was led by UNSW cancer researcher Adjunct Professor Bernard Stewart, whose research focused on cancer causes that are from either environmental pollutants and lifestyle factors, with investigators from The University of Queensland, Flinders University, The University of Sydney, as well as Royal North Shore, The Prince Charles and Sunshine Coast University hospitals and was published in Carcinogenesis.
“Considering all the findings—from clinical monitoring, animal studies and mechanistic data—e-cigarettes are likely to cause lung cancer and oral cancer,” said UNSW cancer researcher Adjunct Professor Bernard Stewart AM.
The study uses experts from multiple fields including pharmacists, epidemiologist, thoracic surgeons and public health researches and draws on existing clinical studies, animal experiments, and laboratory research to evaluate whether vaping leads to oral cancer.1
Vaping has only been available for about 20 years, so, long-term epidemiological data is not available; comparatively, smoking has been studied for about a century now. Because of a lack of real understanding of harms, advising patients on risks of vaping was often a “gray area” for clinicians; something that was often further complicated by the fact that many people claimed vaping was a smoking cessation strategy.
“To our knowledge, this review is the most definitive determination that those who vape are at increased risk of cancer compared to those who don’t,” Prof. Stewart said.
As a result, the study’s current conclusion relies on other forms of evidence, such as using knowledge of carcinogenic compounds in vapes. The compounds in e-cigarette aerosols include volatile organic chemicals and metals that are released from the heating coils. This can lead to DNA damage, oxidative stress and tissue inflammation.
The study performed experiments on mice, showing that the compounds leading to those damages led to cellular damage and disrupted biological pathways linked to cancer.1
Oral cancer symptoms clinicians should know
Symptoms of oral cancer can vary from person to person, but most patients experience ear or jaw pain, unexplained weight loss, persistent soreness or pain, fatigue, swollen lymph nodes, and difficulty swallowing and chewing.
There can also be symptoms in the throat area, including coughing, voice changes such as hoarseness, and numbness. Feeling any lump in the head or neck can be a sign of oral cancer, whether the lump is painful or not.
Susan Cotten, the CEO of Oral Cancer Consulting and creator of The Cotten Method2 said that nonpainful lumps may be more concerning, painful lump can be a sign of the immune system working to fight off infections.
Patients are advised to pay attention to how long these signs last. If a condition persists for longer than two weeks, further investigation by a specialist is recommended.
“They know to reach out to their dentist, or I really encourage making an appointment with an ENT, ear, nose, and throat, because they're the specialists of the head and neck,” Cotten said.
What the oral cancer screening process includes
The screening process starts with reviewing a patient’s health history, including dental history and any risk factors the patient might have, such as smoking, vaping or dip use.
“Offices that I work with and courses that I give, after we've gone through it do a separate oral cancer risk assessment form,” Cotten said. “I encourage that, because then we gather all of the information that we need from patients.”
After reviewing patient history, clinicians perform both extraoral and intraoral evaluations.
Evaluations of the temporomandibular joint and check for any abnormalities upon opening, any deviations or grinding are noted. Examiners will palpate the lymph nodes, salivary glands, posterior auricular nodes and the occipital nodes behind the ear and base of the skull.
Assessing the inside of the mouth involves examining all areas, including cheeks, back of the throat, tongue, tonsils and uvula. Examiners are looking for symmetry in size and color, as well as soreness.
References:
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“Vaping Likely to Cause Cancer, New Findings.” University of New South Wales (UNSW). March 2026. UNSW Newsroom. https://www.unsw.edu.au/newsroom/news/2026/03/vaping-likely-to-cause-cancer-new-findings
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Cotten S. “The Cotten Method of Screening.” RDH. April 22, 2024. https://www.rdhmag.com/resources/document/14271019/the-cotten-method-of-screening
