Cancer organizations seek tighter regulations on electronic nicotine delivery systems
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American Association for Cancer Research and ASCO have issued a joint policy statement delineating the latest scientific evidence on use of e-cigarettes and other electronic nicotine delivery systems.
The statement, published in Journal of Clinical Oncology and Clinical Cancer Research, includes recommendations to regulate these products for public safety.
“We worked on this for a while. We wanted to really point out that these are not benign devices — that even though there isn’t combustible tobacco in these products, they still can cause damage and inflammation to the lungs, especially if used early in development,” Roy S. Herbst, MD, PhD, chair of the electronic nicotine delivery system (ENDS) statement writing committee and AACR science policy and government affairs committee, and deputy director of Yale Cancer Center, told Healio. “We need to find ways for these products to be regulated among middle school and high school students. What we see is that the use of these then leads to dual usage, where people use these devices and smoke tobacco at the same time. These products are working against everything we’re trying to do.”
Assessing new evidence
The statement expands upon a 2015 joint AACR/ASCO statement on ENDS that urged the FDA to regulate the products due to the growing rate of use among youth and young adults, Herbst said.
This need for regulation has intensified, as ENDS use among youth and young adults, as well as among those who never smoked, has increased dramatically from 2015 to 2019, according to a release. A subsequent decrease in ENDS use during 2020 and 2021 was likely attributable to the COVID-19 pandemic, increased public awareness and laws raising the minimum age to buy tobacco products to age 21 years.
However, new results from the National Youth Tobacco Survey showed use of ENDS among high school students is again increasing — an estimated 2 million high school students used ENDS in 2022, a 24% increase from 2021, according to the release.
“New evidence has emerged, and when that happens, it’s very important that we take an unbiased look at the new evidence,” Herbst said. “We felt now was the perfect time to do this, that we could provide recommendations for politicians and regulatory authorities based on this new evidence.”
Restricting flavored ENDS
The two organizations reviewed and summarized the existing research on ENDS and recommended policies to minimize the possible harms they cause. Among the points summarized from the literature are:
- Although ENDS release fewer carcinogens than combustible tobacco products, preliminary evidence shows an association between ENDS use and DNA damage and inflammation, which are key factors in cancer development.
- Appealing flavors play a key role in driving ENDS use among youth; a 2020 survey reports that more than 82% of youth who use ENDS use products with flavors other than tobacco.
- Although the FDA has placed restrictions on flavors other than tobacco and menthol in pod- or cartridge-based ENDS, flavored open-tank and single-use products remain on the market and have seen an increase in popularity among middle school and high school students.
- Young people who use ENDS have an increased likelihood of later smoking combustible tobacco, with research reporting that people who use ENDS are between 2.9 and 4 times more likely to ever smoke a combustible cigarette vs. individuals who have never used ENDS.
Herbst expressed particular concern over flavored nicotine products, which he said are used to attract young consumers “like candy.”
“We’re very concerned about the appealing flavors,” Herbst told Healio. “We went back and forth on this, but we decided that since more than 82% of youth who use ENDS used the flavored products, this needed to be addressed. So, we recommended no flavored products.”
Need for regulation
In addition to summarizing the current evidence on ENDS, AACR and ASCO have called upon policymakers, regulatory authorities and the research community to be proactive in combating ENDS use, particularly among young people, and support evidence-based smoking cessation programs. Among the key recommendations in the policy statement are:
- ban all non-tobacco-flavored products containing nicotine;
- tax all products that contain natural or synthetic nicotine with a goal of reducing tobacco use and promoting public health;
- impose regulations on predatory tobacco advertising practices, particularly those that target youth and young adults;
- restrict the sale of tobacco products, including ENDS, to stores or store areas that require proof of age upon entrance, and increase enforcement of minimum age to legally purchase tobacco products; and
- promote and fund research to understand the long-term health impacts of ENDS use.
Herbst noted that ENDS could someday have value as a smoking cessation tool, but that this possibility must be explored only under full regulatory oversight.
“This would need to be done as a controlled trial, licensing the material and regulating its production,” he said. “It needs to be done with the approved mechanisms, not with devices like these, which are just increasing the number of people smoking.”
References :
- AACR and ASCO release joint policy statement on electronic nicotine delivery systems (press release). Available at: www.aacr.org/about-the-aacr/newsroom/news-releases/aacr-and-asco-release-joint-policy-statement-on-electronic-nicotine-delivery-systems. Published Oct. 26, 2022. Accessed Oct 27, 2022.
- Herbst RS et al. Clin Cancer Res. 2022;doi:10.1158/1078-0432.CCR-22-2429.
For more information :
Roy S. Herbst, MD, PhD, can be reached at Yale Cancer Center, Medical Oncology, Medical Oncology, P.O. Box 208028, New Haven, CT 06520-8028.
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