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Leading U.S. Cancer Organizations Call for Regulation of E-Cigarettes and Other Electronic Nicotine Delivery Systems

Recommendations focus on efforts to protect minors

The American Association for Cancer Research (AACR) and the American Society of Clinical Oncology (ASCO) have outlined steps in a joint statement to guide policymakers as they work to minimize the potential negative consequences of electronic cigarettes (e-cigarettes) and other electronic nicotine delivery systems (ENDS) without undermining their potential to reduce harm as a smoking-cessation tool. The two organizations’ recommendations were published in AACR’s Clinical Cancer Research and in ASCO’s Journal of Clinical Oncology.

According to the statement, tobacco use constitutes the largest preventable cause of death and disability in developed countries and is a rapidly growing health problem in developing nations. It is responsible for 30% of all cancer deaths and is associated with increased risk for at least 18 types of cancer. E-cigarettes and other ENDS, which are capable of delivering a nicotine solution in aerosolized form, have been promoted as potential tobacco-cessation products and as safer alternatives to combustible cigarettes. At the present time, however, insufficient data exist on the health consequences of ENDS use and their value as tobacco cessation aids, experts say.

Unlike combustible cigarettes and many other tobacco products, e-cigarettes and other ENDS are not currently regulated by the FDA. Some state and local governments have enacted e-cigarette regulations, including imposing restrictions on the sale of e-cigarettes to minors and prohibiting the use of e-cigarettes in public places. Federal regulations have yet to be adopted, and manufacturing standards and quality controls on e-cigarettes are also absent. The statement calls on federal policymakers to immediately implement these recommendations, most specifically the ones that are aimed at restricting the sale, distribution, marketing, and advertising of ENDS to youth.

Noting that additional research is needed to inform the regulation of e-cigarettes and other ENDS, the AACR and ASCO statement outlines steps that can be taken in the interest of public health. These policy recommendations include the following:

  • The FDA’s Center for Tobacco Products should regulate all ENDS that meet the statutory definition of tobacco products. ENDS that do not meet this definition should be regulated by the FDA through other appropriate authorities.
  • ENDS manufacturers should be required to register with the FDA and to report all product and ingredient listings, as well as the nicotine concentration in the ENDS solution.
  • ENDS packaging and advertising should be required to carry safety labels that include a warning regarding nicotine addiction.
  • All youth-oriented ENDS advertising and marketing 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 and other youth-friendly or youth-oriented flavors should be banned unless evidence demonstrates these products do not encourage youth uptake.
  • ENDS use should be prohibited in places where combustible tobacco product use is prohibited by federal, state, or local law until the safety of secondhand aerosol exposure has been 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, and should not preclude the allocation of federal funding for this research.
  • All data related to ENDS composition, use, and health effects should be disclosed for dissemination and should inform policy decisions for the regulation of ENDS products.
  • State and local governments should implement ENDS regulations appropriate for protecting the public’s health, including restricting the sale, distribution, marketing, and advertising of ENDS to youth.

“Further research and regulation are needed to determine if e-cigarettes can help people stop smoking combustible cigarettes,” said Roy S. Herbst, MD, PhD, who served as chair of the joint AACR/ASCO committee that developed the statement. “In the meantime, oncologists should encourage patients to use FDA-approved cessation medications, refer them for smoking- cessation counseling, and provide education about the potential risks and lack of known benefits of long-term e-cigarette use.”

Source: AACR; January 8, 2015.


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