Megan Varlow

This review involves a qualitative carcinogenic risk assessment of nicotine-based e-cigarettes. Though direct epidemiological evidence of cancer causation takes time to accumulate, carcinogenicity of e-cigarettes is evident from different types of investigation including, with respect to studies in humans, some case reports but mainly involving monitoring of biomarkers of exposure and biomarkers of harm implicating tumorigenesis. Complementary laboratory investigations of e-cigarette aerosols and constituent chemicals include rodent bioassays and a range of approaches to elucidate mechanism(s). In respect of e-cigarettes, each of these types of investigation have been subject to successive reviews, sometimes more than once per year. Consequently, this over-arching review is restricted to publications since 2017 to avoid possible selection bias. Physiological evidence of exposure using biomarkers reveals DNA damage correlated with vape-derived metabolites attributable to carcinogens including nicotine-derived nitrosamines, volatile organic compounds, flavour-derived agents, and certain metals. Biomarkers also indicate vaping-attributable oxidative stress, epigenetic change and inflammation in oral and respiratory tissue often specified in comparison with smoking. Rodent bioassays include inhalation exposure of mice to e-cigarette aerosol described as causing lung adenocarcinomas. Mechanistic data are presented using the key characteristics of carcinogens and taken together implicate a complex mixture mediating carcinogenicity via genotoxic and other processes. From 2017 to 2025, the conclusions in e-cigarette reviews addressing different avenues of investigation moved from describing a need for more evidence to notifying concern about e-cigarette carcinogenicity. Nicotine-based e-cigarettes are likely to be carcinogenic to humans who use them causing an indeterminate burden of oral cancer and lung cancer.

Purpose: It is well established that people diagnosed with cancer often experience poor mental health, yet there are still inequities in access to appropriate care and support. This study set out to explore perceptions and experiences of mental health support, including facilitators and barriers, among people with cancer to help inform national cancer policy development in Australia. Methods: We conducted semi-structured interviews with nine people diagnosed with cancer who accessed mental health support services or resources during their cancer care. Qualitative analysis using a social-ecological framework identified key themes that shaped their experience. Results: Psychosocial distress screening was identified as an important facilitator to enable access to needs-based supportive care services. There was strong advocacy for the role of peer support in helping individuals cope with emotional and psychological stressors associated with cancer care. There was a perception that disparities exist in the availability and accessibility of psycho-oncology services outside of metropolitan areas in Australia. Participants acknowledged that even if they had identified unmet supportive care needs and were referred for support, it was not always available, and that inequity exists in the supportive care services available based on cancer type, disease stage, and geographic location. Conclusion: National policy levers aimed at improving the integration and implementation of psychosocial distress screening in cancer care and addressing inequities in access to supportive care services, such as peer support and psycho-oncologists, are needed to ensure adequate support for psychological wellbeing.

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Issue addressed: Knowledge, attitudes and beliefs about lung cancer among Chinese, Vietnamese and Arabic‐speaking communities in Sydney, New South Wales (NSW) are explored.Methods: Seven focus groups were completed with a total of 51 participants (smokers and non‐smokers) from three culturally and linguistically diverse communities (CALD). Five topics were discussed and translated summaries from focus groups were thematically analysed.Results: There were variations in perceived susceptibility to lung cancer between the CALD groups and between smokers and non‐smokers. Fatalistic views towards lung cancer were apparent across all three CALD communities. There were low levels of awareness of lung cancer signs and symptoms, with the exception of haemoptysis. Differences in help‐seeking behaviour and levels of trust of general practitioners (GP) were apparent.Conclusion: Limited awareness of the signs and symptoms of lung cancer, combined with cultural perceptions about cancer, impacted on attitudes towards help‐seeking behaviour in these three CALD communities.So what?: The prevalence of smoking among Chinese men, Vietnamese men and Arabic‐speaking communities in NSW puts them at increased risk of lung cancer. Health promotion initiatives for lung cancer should be tailored for CALD communities and could focus on increasing knowledge of key symptoms, awareness that ex‐smokers are at risk and awareness of the diagnostic pathway including the importance of avoiding delays in help‐seeking.