HJAR Nov/Dec 2024

HEALTHCARE JOURNAL OF ARKANSAS I  NOV / DEC 2024 43 Donald B. Norwood, MD Medical Director of Imaging Services CARTI WE ARE, thankfully, now decades past smoke-filled meals out, airplane trips, or even work meetings. With the enactment of health-related regulations, Arkansans who choose to abstain from the habit no longer must trudge through clouds of carcinogens and other chemicals in their daily lives. De- spite consistent progress in encouraging our residents to quit smoking, the pall of tobac- co-containing products — and their corre- sponding risk of lung cancer — still looms large in our state. Unfortunately, that is because as cigarette smoking has declined in Arkansas, the use of alternatives, often billed as cessation aids, has experienced a steady uptick in use. Re- search indicates these products may not be as harmful as traditional cigarettes, but vaping is not without risks. As healthcare providers, we must discuss the potential adverse effects with our patients, includ- ing how the habit may impact their need to receive annual low-dose CT scans (LDCTs) for lung cancer. E-cigarettes are relatively new products. The devices, more commonly known as vape pens, have been in the market for less than two decades. A lack of consumer education — intentional or not — about vaping has en- abledmisconceptions to flourish. One of the worst offenders is the pervasive claim that “E-cigarettes aren’t bad for our health.”That is simply not true. Johns Hopkins University (JHU) states that “vaping coats lungs with potentially harmful chemicals.” JHU also notes that “Electronic cigarettes are just as addictive as traditional ones,” with “many e-cigarette users [getting] even more nico- tine than they would from a combustible Network in July 2024 stated that nearly 70% of individuals using e-cigarettes believe they are less harmful than combustible cigarettes. The article goes further to say that these in- dividuals “may have [a] lower awareness of lung cancer risks”and, thus, a lower uptake of LDCTs. The Radiological Society of North America confirms this trend, indicating that individuals who used traditional cigarettes but now vape often self-identify as “former smokers,” potentially “excluding them as potential lung cancer screening candidates.” The signs and symptoms of lung cancer often don’t appear until the disease has ad- vanced. Unfortunately, the American Lung Association says this causes most cases to be diagnosed later when “treatment options are less likely to be curative, and survival is lower.” LDCT is an invaluable, noninvasive tool that allows us to find the disease when it’s smaller or localized, improving patients’ outcomes. For eligible patients, receiving yearly LDCTs can be lifesaving. Growing research indicates that this may include individuals who vape. JAMA reiterated, “Former smok- ers who use e-cigarettes remain at increased risk of lung cancer and should be targeted by interventions to improve adherence to LDCT.”As providers, we have a responsibil- ity to talk with our patients, including those who vape, about the risks of using tobacco- containing products and the potential ben- efits of lung cancer screening. n Donald B.Norwood,MD, is a board-certified diagnos- tic radiologist and themedical director of imaging ser- vices for CARTI,a not-for-profit,multidisciplinary can- cer care provider with 18 locations across Arkansas and the state’s first dedicated cancer surgery center. tobacco product,” particularly if they use extra-strength cartridges. To put it simply, vaping devices can cause individuals to pick up or maintain a hard- to-break habit that may put their long-term health in jeopardy. As part of its analysis of existing peer-reviewed research, Advances in Respiratory Medicine found that there is “evidence to suggest that e-cigarette use may increase the risk of cancer as well as other diseases.”TheAmerican Cancer Society also acknowledges the potential dangers, sharing that the vapor from e-cigarettes contains some cancer-causing chemicals, “although in significantly lower amounts than ciga- rette smoke.” According to theAmerican LungAssocia- tion, tobacco remains the leading cause of preventable death and disease in the U.S. To- day, the organization ranksArkansas 50 out of 51 for adults who smoke at 21%, compared to the national rate of 13.5%. As providers, we should encourage patients who meet the screening criteria to consider yearly LDCTs. At CARTI, we recommend scans for current or former smokers 50-80 years old or in- dividuals with a smoking history of at least 20 pack years who are in generally good health with no signs or history of lung can- cer. This guidance aligns with leading medi- cal organizations, including the American Cancer Society. Along with current and former smokers, doctors should also talk to those who use e-cigarettes about the potential benefits of lung cancer screening. Forbes recently noted that Arkansas is ranked third among U.S. states for the percentage of adults who vape daily. A research letter published by JAMA