E-cigarettes and head and neck cancers: A systematic review of the current literature

Susanne Flach (Lead / Corresponding author), Pavithran Maniam, Jaiganesh Manickavasagam

    Research output: Contribution to journalReview articlepeer-review

    27 Citations (Scopus)
    641 Downloads (Pure)


    Background: Cigarette smoking is a well-established risk factor for head and neck (HN) cancers. Use of electronic cigarettes (e-cigarettes) is gaining popularity, being advertised as benign alternatives to tobacco. A wide variety of potentially harmful chemical components with variable quantity have been identified in e-liquids and aerosols of e-cigarettes. However, use of e-cigarettes remains controversial due to conflicting evidence.

    Objectives: We aimed to assess the association between e-cigarettes and HN cancers. We conducted a systematic review to evaluate the literature for evidence on carcinogenic effects of e-cigarettes in the pathogenesis of HN cancers.

    Type of review: Qualitative systematic review.

    Search strategy: A PubMed/MEDLINE, Cochrane, CINAHL Plus, Trip Medical Database and Web of Science search was done for studies on e-cigarettes and HN cancer.

    Evaluation method: Abstract review of all articles, full article revision of included studies, data extraction and quality assessment were performed by two independent assessors.

    Results: The literature search resulted in the identification of 359 articles. Eighteen articles were selected for inclusion into the systematic review. The majority were laboratory-based studies, followed by several cohort and case studies, representing low-level evidence. A few reports suggested DNA damage following exposure to e-cigarettes potentially due to increased oxidative stress. Flavoured e-liquids appear to be more harmful. There is variable evidence from clinical studies.

    Conclusions: Our review outlines potential dangers associated with the use of e-cigarettes and their role in HN cancers. More longitudinal and controlled studies are needed to assess the possible link between e-cigarettes and HN cancers.

    Original languageEnglish
    Pages (from-to)749-756
    Number of pages8
    JournalClinical Otolaryngology
    Issue number5
    Early online date30 May 2019
    Publication statusPublished - Sept 2019


    • e-cigarettes
    • electronic cigarettes
    • electronic nicotine-delivery system
    • head and neck cancer
    • head and neck neoplasm
    • oral cancer
    • smoking

    ASJC Scopus subject areas

    • Otorhinolaryngology


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