- The review identifies tobacco smoke’s toxic chemicals as central to smoking-related cancer.
- It states that nicotine itself is not carcinogenic.
- Nicotine remains addictive and can affect cancer-related biological processes.
- The authors call for smoking cessation treatment within cancer care.
A cancer review has highlighted the role of tobacco smoke in causing cancer, challenging the belief that nicotine itself is responsible.
Published in Klinická onkologie, the review by Alexandra Pánková, Kamila Zvolská and Eva Králíková examines products including vapes, nicotine pouches and heated tobacco.
“Nicotine itself is not carcinogenic”, the authors write in the paper’s English abstract.
The paper reviews existing research rather than reporting new patient data.
Nicotine and cancer
The authors acknowledge that nicotine can interfere with programmed cell death and encourage blood-vessel formation, processes relevant to tumour growth. They also discuss potential DNA damage and oxidative stress.
The findings do not mean all nicotine products are harmless.
Cancer Research UK gives similar advice. The charity explains that nicotine makes cigarettes addictive, while the cancer risk comes from other substances in tobacco. Nicotine replacement therapy has been used safely for many years.
French oncologist Dr David Khayat, a former president of France’s National Cancer Institute, made the same distinction in April 2025. He explained that burning tobacco produces carcinogenic substances and argued for greater use of alternatives to cigarettes among smokers who struggle to quit.
Earlier that year, cardiologist Professor Reuven Zimlichman told a doctors’ convention that nicotine is addictive but is not carcinogenic. He urged healthcare professionals to discuss alternatives with patients who continue to smoke despite having cardiovascular disease.
Why smoke is key
The US National Cancer Institute says tobacco smoke contains more than 7,000 chemicals. At least 250 are known to be harmful, and at least 69 can cause cancer, including benzene, arsenic and formaldehyde.
The damage extends well beyond the lungs. Smoking causes cancers in organs including the bladder, kidneys, pancreas and liver, as well as the mouth and throat.
Why the type of product matters
The review separates nicotine products according to whether they contain tobacco and whether they involve heating.
The authors note that “some forms of nicotine replacement therapy are among the World Health Organization’s essential medicines”.
Patches and gum allow smokers to manage their dependence without continuing to inhale cigarette smoke.
The paper also distinguishes vapes, which heat liquid, from heated tobacco products, which contain tobacco leaf. It reports that heated tobacco aerosols contain more toxic substances than those from vapes.
Nicotine pouches contain no tobacco leaf and involve no heating. However, the authors acknowledge that evidence supporting their effectiveness as a smoking cessation aid remains insufficient.
Cancer Research UK says legal vapes are far less harmful than smoking, with potentially harmful chemicals generally present at much lower levels. However, their long-term effects remain uncertain, and the charity advises people who have never smoked against taking them up.
For people using vaping to quit, its advice is to stop smoking completely. Once they feel confident they can remain smokefree, they may choose to stop vaping too. Preventing a return to smoking remains the priority.
Quitting is crucial after diagnosis too
The review calls for accessible treatment of tobacco dependence to become part of routine cancer care.
The National Cancer Institute says stopping smoking after a cancer diagnosis can improve healing and the response to treatment. It may also reduce the likelihood of cancer returning or a second cancer developing.
For patients with some cancers, it reports that quitting at diagnosis may reduce the risk of dying by 30 to 40 per cent.
