CRA50 MAKING THE CAUSATION CASE BETWEEN E-CIGRATTE USE AND LUNG CANCER

Vijayan Munusamy, Pathamanathan.R, Muralitharan.M,Kuan Woon Pang , Rushil Rajan
University of Malaya, Kuala Lumpur, Malaysia
Subang Jaya Medical Center, Malaysia
National Cancer Society of Malaysia
Hospital Columbia Asia Bukit Rimau, Malaysia

Introduction:

GLOBOCAN data shows, lung cancer ranks as the second most common type of cancer worldwide. The transition from conventional smoking to electronic cigarettes and other electronic vaping products (EVPs) has become popular as a smoking cessation method. Harmful components found in EVPs, such as organometallic compounds, nicotine and polycyclic aromatic hydrocarbons, are well-established factors contributing to lung cancer.

Objective:

This case likely represents the first reported instance of lung cancer associated with vaping in Malaysia.

Case History:

We present the case of a 61-year-old male with a history of smoking 29 pack-years, who switched to e-cigarettes in 2010 and had no prior medical conditions. He initially visited Klinik Kesihatan due to a persistent chesty cough since December 2023. A CXR at that time showed normal findings. Despite this, his cough persisted, and he subsequently sought care at a private hospital after experiencing hemoptysis and a weight loss of 5kg over four months.

Further investigations were conducted to evaluate the possibility of pulmonary tuberculosis based on his symptoms and chest X-ray findings. CT scan revealed consolidation and a mass-like lesion in the right lower lobe. Bronchoscopy revealed an endoluminal growth with mucosal infiltration. Additional imaging studies, including MRI brain and CT of the abdomen and pelvis, showed no evidence of distant metastases.

Results:

Endobronchial biopsy confirmed moderately differentiated squamous cell carcinoma.

Conclusion:

Studies suggestive of a causative relationship between EVPs and the onset of lung cancer, this has not been firmly established. This case may serve as one of the clear index cases for building the chain of evidence.