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A paper released on 31 March 2026 in Carcinogenesis, [] by 91ɫ��Ƭ Professor Bernard Stewart AM, and ICFHS Adjunct Associate Professor Freddy Sitas, shows that e-cigarettes are likely to cause lung and oral cancer. When epidemiological studies take decades to provide data, WHO-International Agency for Research on Cancer relies on ten early key laboratory-based and clinical characteristics to determine causation.  The paper, co-authored by Australian experts including pharmacists, epidemiologists, toxicologists, thoracic surgeons and public health practitioners, summarised the laboratory, animal and mechanistic evidence from over 100 studies (these citing thousands of other studies). With all ten key characteristic criteria fulfilled, the group concluded that e-cigarettes are likely to cause lung cancer and oral cancer. The assessment is qualitative, so it did not calculate a numerical determination of risk.

In an accompanying commentary in Cancer Epidemiology, [] following the evolution of evidence between tobacco smoking and e-cigarettes, Sitas and Stewart argue that it took about 100 years of research to finally “prove” that smoking caused lung cancer (in 1964) and another 50 years thereafter to calculate the full hazard associated with tobacco smoking.  The historical parallels of diseases associated with smoking, first infectious respiratory disease, followed by cardiovascular, chronic lung disease and finally cancer, appear to be similar to those unfolding with e-cigarette use.  The review cites a USA epidemiological study showing that those who use e-cigarettes to quit smoking end up in dual-use-limbo, unable to shake off either habit.  Those people increase their lung cancer risk by a factor of four, that is, from the “text book” background risk of about13-fold for tobacco smoking to 38-fold for dual use. Only 3% of this cohort managed to replace tobacco with e-cigarettes. 

E-cigarettes were introduced about 20 years ago. “As evidence of carcinogenicity progressively accumulates, e-cigarettes should not be offered as a pathway to quit smoking without strict precautions around minimising dual use”. “We should not have to wait 100 years to decide on what to do.”