Comparison of carcinogenic potential of alternative tobacco products. A systematic review.
Level 5 - mechanism / opinion, no new human data
Systematic review of preclinical (in vitro and animal) and mechanistic toxicology studies
PubMed 40741827 · doi:10.1080/15376516.2025.2536664
What was done
A systematic review searching PubMed, Embase, and Scopus (through July 2025) evaluating the carcinogenic potential and epigenetic effects of alternative tobacco and nicotine products: electronic cigarettes (ECs), heat-not-burn (HnB) products, and snus/nicotine pouches (NPs). The review focused on DNA damage, repair mechanisms, and epigenetic alterations including miRNA expression, DNA methylation, and histone modifications.
What was found
The abstract reports no quantitative values, effect sizes, or study counts. Qualitatively, reviewed studies showed that ECs and HnB products induced DNA damage, reduced DNA repair capacity, and altered miRNA expression, global DNA methylation, and histone modifications. Snus and nicotine pouches induced DNA damage and changed expression of genes related to oxidative stress, cellular stress, cell growth, and proliferation. Data on epigenetic effects for snus/NPs were noted to be limited.
Why it matters
This synthesis summarizes mechanistic and preclinical evidence indicating that alternative nicotine and tobacco products induce biomolecular disruptions linked to cancer development.
Limits
The abstract provides no quantitative metrics or counts of included studies. The available evidence is derived primarily from cell-based and animal models rather than prospective clinical or epidemiological cancer outcome data in exclusive human users.
Cited by
- partial Oral nicotine products do not cause cancer.