January 08, 2015
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AACR, ASCO recommend regulation of e-cigarettes, other electronic nicotine delivery systems

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A joint statement issued today by the American Association for Cancer Research and ASCO calls for the regulation of electronic cigarettes and other electronic nicotine delivery systems.

The statement — in which the organizations emphasize the need for additional research into the potential adverse health effects of the devices, as well as safety measures intended to protect minors — is intended to help policymakers as they consider ways to ensure public health while still acknowledging the potential roles of these devices in smoking cessation.

“Certainly, we agree that smoking [electronic cigarettes] is not the same as a tobacco cigarette, and that there are many more carcinogens in tobacco,” Roy S. Herbst, MD, PhD, Ensign professor of medicine at Yale Cancer Center, chief of medical oncology at Smilow Cancer Hospital at Yale-New Haven and chair of the AACR/ASCO committee that delivered the statement, told HemOnc Today. “But we don’t know about the long-term consequences that these vapors might have on the pulmonary epithelium and on patients’ lungs.”

E-cigarettes and other electronic nicotine delivery systems (ENDS), which deliver nicotine in an aerosol form, are used by some smokers as a smoking cessation tool. Although there are some restrictions on the sale of ENDS at the local and state levels, there is no federal regulation in place and no manufacturing or quality-control standards exist.

In addition, because use of ENDS is fairly new, safety data are limited and no information is available with regard to their long-term effects.

The use of ENDS is on the rise, especially among minors, and the statement’s authors expressed concern that use of ENDS could encourage minors to try other forms of tobacco.

This is particularly concerning given that tobacco is the top preventable cause of disease, disability and death in the United States. Smoking causes 18 forms of cancer and accounts for 30% of cancer deaths in the country, according to the AACR/ASCO statement.

“We are concerned that e-cigarettes may encourage non-smokers, particularly children, to start smoking and develop nicotine addiction,” Peter Paul Yu, MD, FACP, FASCO, president of ASCO, said in a press release. “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. 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.”

In an effort to deter minors from using ENDS, AACR and ASCO called for the FDA Center for Tobacco Products to regulate all ENDS that meet the statutory definition of tobacco products. Devices that do not meet that definition should be regulated by the FDA through “other appropriate authorities,” according to the organizations.

Other recommendations include:

  •            A requirement that all ENDS manufacturers register with the FDA and report all product and ingredient listings, as well as nicotine concentrations in the devices’ solutions.
  •            A requirement that packaging and advertising carry safety labels that include a warning about nicotine addiction.
  •            A ban on the sale of these devices to anyone aged younger than 18 years, as well as a ban on youth-oriented advertising and marketing.
  •            A requirement that online and mail-order sellers of these devices verify the identity and age of customers at the point of purchase and delivery.
  •            A ban on use of ENDS in areas where use of tobacco products is prohibited, at least until the safety of second-hand aerosol exposure is established.

AACR and ASCO recommend placement of child safety caps on ENDS liquids, as well as a ban on ENDS that contain candy or other youth-friendly/youth-oriented flavors.

The organizations also encourage oncologists to recommend FDA-approved smoking cessation methods to their patients.

“The effects of [electronic cigarettes] on the lungs are still unknown and the long-term effect of these high doses of nicotine are not known,” Herbst told HemOnc Today. “There aren’t data at this point to suggest that electronic cigarettes are an approved and legitimate form of smoking cessation.” – by Lauren Frisby