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Arnold School of Public Health

Cancer experts issue urgent calls for action against e-cigarettes

October 28, 2022 | Erin Bluvas,

Anthony Alberg, chair for the Department of Epidemiology and Biostatistics and international leader in cancer epidemiology, has been called upon again to lead the development of a cancer-related policy statement. Most recently the senior author on a policy statement for skin cancer prevention, this time Alberg led a group of experts in the publication of a statement on electronic nicotine delivery systems (namely e-cigarettes) for both the American Association for Cancer Research and the American Society for Clinical Oncology. The special report simultaneously appeared in the organizations’ high-impact journals (Clinical Cancer Research and Journal of Clinical Oncology, respectively) yesterday. 

“Combustible tobacco use has reached historic lows, demonstrating the importance of proven strategies to reduce smoking since publication of the 1964 Surgeon General's report,” Alberg said in the statement. “In contrast, the use of electronic nicotine delivery systems (ENDS), specifically e-cigarettes, has grown to alarming rates and threatens to hinder progress against tobacco use.”

Marketed as a form of cessation against combustible tobacco cigarettes since its introduction to the U.S. in 2006, the long-term health risks of ENDS remain unclear. A 2015 joint policy statement by the same entities expressed alarm at the increasing numbers of youth using ENDS while keeping an open mind that these products could prove to be a less harmful alternative to combustible cigarettes. Research conducted in the years since then has yet to clearly establish ENDS as tobacco cessation aids, according to the U.S. Surgeon General, Academies of Sciences and more than 30 other leading cancer centers.

Meanwhile, ENDS use has increasingly attracted youth and adults who were not previous users of tobacco– concerning public health/medical researchers and clinicians that these products are serving to increase the risk of tobacco use rather than its hoped-for end. Thirty-six to 54 percent of these individuals use both types of products, and those who do transition entirely away from combustible tobacco to ENDS are still at risk for adverse health effects.

“While ENDS emit fewer carcinogens than combustible tobacco, preliminary evidence links ENDS use to DNA damage and inflammation, key steps in cancer development,” Alberg said. “Furthermore, high levels of nicotine can also increase addiction, raise blood pressure, interfere with brain development, and suppress the immune system.”

While additional research is still needed, an abundance of existing evidence has led Alberg and his co-authors to issue several calls to action in their newly released policy statement:

  • An immediate ban on all non–tobacco-flavored ENDS products that contain natural or synthetic nicotine to reduce ENDS use by youth and adults who never previously used tobacco.
  • Evidence-based treatments to promote smoking cessation and prevent smoking relapse to reduce cancer incidence and improve public health remain top priorities for our organizations.
  • Research to understand the relationship between ENDS and tobacco-related disparities.

“Carcinogens from combustible tobacco products are very harmful to health, contributing to nearly half a million deaths each year in the United States and more than eight million deaths per year globally … (and) results of ENDS use investigated to date clearly indicate that vaping exposes the user to carcinogens,” Alberg said. “This policy statement details advances in science related to ENDS and calls for urgent action to end predatory practices of the tobacco industry and protect public health.”


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