Electronic cigarettes should be subject to the same taxes, marketing restrictions and limitations on public use as traditional tobacco products, according to new guidance from cancer experts.

In a joint policy statement issued Thursday, the American Assn. for Cancer Research and the American Society for Clinical Oncology acknowledged that e-cigarettes may improve public health by taking market share away from combustible tobacco products and helping smokers quit. But until the benefits are proved, the statement said, regulators shouldn’t distinguish between the two kinds of products.

“The public health impact of cigarette smoking is devastating, and policy recommendations should consider reduction of the health hazards of smoking as paramount,” the statement said.

The U.S. surgeon general’s office estimates that smoking-related conditions such as lung cancer and chronic obstructive pulmonary disease result in 484,000 premature deaths each year. If present trends continue, 5.6 million children alive today will wind up dying as a result of smoking.


Dr. Tom Frieden, director of the federal Centers for Disease Control and Prevention, and other health experts say they fear that e-cigarettes will entice more kids and teens to try smoking. If the devices get them hooked on nicotine, they could be more likely to graduate to traditional cigarettes, they say.

Advocates for e-cigarettes counter that the products can reduce tobacco use by helping smokers quit -- a contention backed by some research. However, the results of other studies are mixed.

With these issues in mind, the two cancer groups said they sought to learn everything they could about e-cigarettes and other electronic nicotine delivery systems, or ENDS. These were defined as battery-operated devices that allow users to vaporize a nicotine solution.

What the cancer experts found is that solid evidence on benefits and harms does not exist -- and likely won’t for several years. Among other things, the wide variation in the way the devices are designed and used makes it difficult for researchers to establish clear patterns.


The policy statement lists many unknowns about the health risks of e-cigarettes, including “second-hand” exposure to nicotine vapor and “third-hand” exposure to chemicals that fall out of that vapor and land on surfaces where they can be touched, ingested and inhaled.

Another big question is whether e-cigarettes have value as a smoking-cessation device. If patients seek advice about whether they should try e-cigarettes to help them quit smoking, doctors should steer them toward proven nicotine-replacement therapies such as patches, gum and nasal sprays, according to the policy statement.

Other recommendations include:

* Urging the Food and Drug Administration to regulate e-cigarettes in the same manner as combustible cigarettes.


* Requiring e-cigarettes to carry “health warning and safety labels.”

* Forbidding sales of e-cigarettes to minors and preventing e-cigarette brands from sponsoring “athletic, musical, or other social or cultural events.”

* Making e-cigarette users subject to the same public smoking restrictions as those who use traditional smokes.

* Banning the sale of nicotine solutions “containing candy and other youth-friendly flavors.” (More than 7,700 flavors are currently on the market, the statement noted.)


* Imposing taxes on e-cigarette products to discourage their use and pay for much-needed research.

The full policy statement appears in the journal Clinical Cancer Research and the Journal of Clinical Oncology.

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