e-Cigarettes Need Research and Regulation, Say AACR and ASCO

Roxanne Nelson

January 08, 2015

In the interest of public health, electronic cigarettes (e-cigarettes) and other electronic nicotine delivery systems (ENDS) need federal and state regulations, say two leading cancer organizations.

The American Association for Cancer Research (AACR) and the American Society of Clinical Oncology (ASCO) have jointly issued a statement with recommendations on how to ensure the safety of these products and minimize potential negative consequences.

The statement is published in the AACR's Clinical Cancer Research and ASCO's Journal of Clinical Oncology .

"We are concerned that e-cigarettes may encourage nonsmokers, particularly children, to start smoking and develop nicotine addiction. While e-cigarettes may reduce smoking rates and attendant adverse health risks, we will not know for sure until these products are researched and regulated," said ASCO President Peter Paul Yu, MD, in a statement.

"The FDA has signaled its willingness to regulate e-cigarettes and other electronic nicotine delivery systems, and we urge the agency to follow through on this intention," he added.

Even though some state and local governments have enacted policies regarding ENDS, such as restricting the sale of e-cigarette to minors and prohibiting their use in public places, there are no federal regulations to date. Unlike tobacco products, e-cigarettes and other ENDS are not currently regulated by the US Food and Drug Administration (FDA). Manufacturing standards and quality controls on e-cigarettes have also yet to be implemented.

The use of e-cigarettes in the United States has risen dramatically since e-cigarettes first became available in 2008. In fact, 8% of the general population and 30% of smokers reported trying them by 2012. And even though the use of regular cigarettes has declined among adolescents in the United States, e-cigarette use is growing; e-cigarettes are now considered to be the nicotine delivery device of choice in this population.

According to the authors of the policy statement, e-cigarettes and other ENDS could be beneficial if they reduce smoking rates or if they prevent or can reduce the known adverse health effects associated with tobacco use. However, they also point out that these products can also be harmful if they increase the likelihood of nonsmokers using combustible tobacco products or if they discourage smokers from quitting. Thus, one of their key recommendations is for additional research on these products, including assessing the health effects of ENDS, understanding patterns of use, and determining what role ENDS have in cessation.

"Further research and regulation are needed to determine if e-cigarettes can help people stop smoking combustible cigarettes," commented Roy S. Herbst, MD, PhD, Ensign Professor of Medicine, professor of pharmacology, and chief of medical oncology at Yale Cancer Center and Smilow Cancer Hospital, New Haven, Connecticut, in a statement. Dr. Herbst served as chair of the joint AACR/ASCO committee that developed the policy statement.

Key Recommendations

Given the potential risks and lack of known benefits of long-term e-cigarette use, AACR and ASCO "strongly encourage health care providers to refer patients who use tobacco — including cancer patients — to evidence-based cessation treatment and recommend the use of FDA-approved cessation methods."

In addition to emphasizing the need for research, key policy recommendations include the following:

  • The FDA should regulate all ENDS that meet the statutory definition of tobacco products.

  • Manufacturers should be required to register with the FDA and report all product and ingredient listings, as well as the nicotine concentration in the ENDS solution.

  • Packaging and advertising should be required to carry safety labels that include a warning about nicotine addiction.

  • All ENDS advertising and marketing targeted at youth should be prohibited.

  • Internet and other mail-order sellers of ENDS should be required to check the age and identification of customers at the point of purchase and delivery.

  • Childproof caps should be required for all e-liquid containers.

  • ENDS and ENDS liquid–containing candy, along with other products aimed at youth, should be banned, unless evidence is produced that they do not encourage use by this population.

  • Use should be prohibited in places where federal, state, or local law prohibit combustible tobacco products until the safety of secondhand aerosol exposure is established.

  • Funding generated through tobacco product taxes, including any potential taxes levied on ENDS, should be used to help support research on ENDS and other tobacco products.

  • All data related to ENDS composition, use, and health effects should be disclosed for dissemination and should inform policy decisions for ENDS product regulation.

  • State and local governments should implement ENDS regulations appropriate for public health safety.

Several of the authors report relationships with industry, as noted in the paper.

Clin Cancer Res. Published online January 8, 2015. Full text

J Clin Oncol. Published online January 7, 2015. Full text

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