Evidence-based interventions at local, state, and federal levels, including tobacco price increases, public health campaigns, marketing restrictions, cessation counseling, FDA-approved medications, and smoke-free laws, must be utilized to continue the downward trend of tobacco use (134). Other combustible tobacco products (e.g., cigars), smokeless tobacco products (e.g., chewing tobacco and snuff), and water pipes (e.g., hookahs) are also associated with adverse health outcomes, including cancer (135-137). Electronic cigarettes (e-cigarettes) were first introduced into the U.S. market in 2006 and have gained popularity among those who smoke and those who have never smoked, especially among middle and high school students and young adults ages 18 to 24. The landscape of e-cigarette devices has evolved over the years to include different types of products, such as prefilled pods (e.g., JUUL) or cartridge-based devices, and disposable devices (e.g., Puff Bar), among others. E-cigarettes can deliver nicotine, an extremely addictive substance that is harmful to the developing brain, at similar levels as traditional cigarettes (138,139). While e-cigarettes emit fewer carcinogens than combustible tobacco, they still expose individuals to toxic chemicals that can damage DNA and trigger inflammation (140-143). Unlike combustible cigarettes, e-cigarettes come in flavors, such as cotton candy and bubblegum, that appeal to youth and are key drivers of e-cigarette use among youth and young adults (144). After years of increase, the use of e-cigarettes has started to decline among U.S. middle and high school students. Nearly 28 percent of high school students and 11 percent of middle school students reported using e-cigarettes in 2019. While these numbers have declined to 14.1 percent of high school students and 3.3 percent of middle school students in 2022, they are slightly higher than what was reported in 2021 (145,146). Beyond the Lungs: Cancers Caused by Smoking Tobacco Smoking tobacco increases an individual’s risk of developing not only lung cancer, but also 17 other types of cancer. No level of exposure to tobacco smoke is safe, including exposure to secondhand smoke. Use of smokeless tobacco (such as chewing tobacco and snuff) can cause oral, esophageal, and pancreatic cancer. Figure adapted from (1). Nasal Cavity Nasopharynx Oral Cavity Oropharynx Hypopharynx HEAD AND NECK Larynx LUNG AND BRONCHUS HEMATOPOIETIC SYSTEM Acute Myeloid Leukemia UROGENITAL SYSTEM Kidney Ureter Bladder Ovary* Uterine Cervix *Certain subtypes of ovarian cancer DIGESTIVE SYSTEM Esophagus Stomach Pancreas Liver Colon FIGURE 8 AACR Cancer Progress Report 2023 Reducing the Risk of Cancer Development 40
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