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American Cancer Society: E-cigarettes better than combustible tobacco, but not harmless

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Jeffrey Drope

The American Cancer Society released a position statement that cautiously accepts electronic cigarettes as less harmful than combustible tobacco products for smokers who are unwilling or unable to quit using FDA-approved cessation aids.

“Based on currently available evidence, using current generation e-cigarettes is less harmful than smoking cigarettes, but the health effects of long-term use are not known,” the position statement reads. “The American Cancer Society recognizes our responsibility to closely monitor and synthesize scientific knowledge about the effects of all tobacco products, including e-cigarettes and any new products derived from tobacco. As new evidence emerges, the [society] will promptly report these findings to policy makers, the public and clinicians.”

HemOnc Today spoke with Jeffrey Drope, PhD, vice president of economic and health policy research at American Cancer Society, about what the position statement encompasses and how it relates to the society’s goal of reducing preventable cancer deaths.

Question: Can you summarize the key points in the position statement?

Answer: I want to emphasize that this really is about combustible tobacco use — specifically conventional cigarettes. What drives us to think about e-cigarettes is the broader situation in terms of tobacco use in the United States, as well as around the world. We know that, in the United States, combustible tobacco products are the single greatest cause of cancer. Tobacco kills more than 7 million people worldwide and nearly a half-million in the United States. This is a huge problem, and it frames our stance on tobacco products. In terms of science on e-cigarettes, we did a very deep research review and pooled data on hundreds of articles to evaluate the accuracy of the science, as well as the depth and sophistication of the science. We came to the conclusion, based upon the available evidence, that using current-generation e-cigarettes is somewhat less harmful than smoking traditional cigarettes. This comes with the major caveat that we do not know the long-term effects of e-cigarette use.

We want smokers to try to stop smoking with FDA-approved cessation aids — preferably with counseling, as most of the research suggest this is the best strategy for quitting. There are a lot of cessation techniques available; however, they are not being used as effectively as they could be used for a number of reasons. One reason is that people do not have access to them, as insurance coverage is not particularly great for cessation aids. Second, a lot of clinicians do not know how to counsel their patients on how to use them properly, and we have missed some incredible potential there.

This is the starting point but, for those patients who have made multiple attempts to stop smoking with FDA-approved cessation aids, those people should be encouraged to switch to the least harmful tobacco product possible. This means, based upon current evidence, we suggest moving exclusively to e-cigarettes with the goal of quitting all tobacco products as soon as possible.

Q: How and why does this policy stance differ from the society ’ s previous position?

A: We did not have an explicit policy on e-cigarette use prior to this. What is different is that, although we are still treating all tobacco products the same, we have changed the very specific conditions for which we would perhaps be a little bit open to e-cigarette use under very specific circumstances. I want to reiterate that we would never recommend e-cigarette use to never smokers or former smokers.

Q: Can you provide context for how this position statement relates to the society’s goal of reducing preventable cancer deaths?

A: Imagine that we have nearly 40 million people in the United States who smoke, and we know more than half of these people will die of tobacco-attributable disease. We also know that approximately 30% of cancers are attributable to tobacco. We are talking about millions of deaths over a period of time. In a perfect universe, everyone would quit smoking and no one would ever have tobacco-attributable cancer or any other disease. However, we are realistic. We also listen to our clinicians, and they tell us about their patients who have tried to quit smoking but cannot.

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Q: Can you address the known evidence and unanswered questions about the potential risks of e-cigarette use?

A: It is too early to tell the long-term risks of e-cigarettes, but we know the levels of carcinogens are lower and the levels of tobacco-specific nitrosamines are almost non-existent in most e-cigarette products. We have a lot of biomarker data telling us that, when we compare e-cigarette users with exclusive cigarette users, e-cigarette users appear to have far lower levels of these harmful ingredients in their bodies. Having said this, we do not think e-cigarettes are harmless. Any time anyone inhales heated aerosol, damage is done to the lungs. We are seeing the harms of cancer decrease, but the harms on lung disease do not decrease as much with e-cigarettes. We also are seeing mixed evidence on the harm on cardiovascular effects.

Q: Do you have anything else that you would like to mention ?

A: We truly do not want people to become distracted by e-cigarettes, because the huge problem in the United States today is regular cigarette use. This is something we are working hard to emphasize. We need to work harder on the issue of regular cigarette use. – by Jennifer Southall

For more information:

Jeffrey Drope, PhD, can be reached at American Cancer Society, 250 Williams St., Atlanta, GA 30303; email: jeffrey.drope@cancer.org.

Reference:

American Cancer Society. ACS position statement on electronic cigarettes. Available at: www.cancer.org/healthy/stay-away-from-tobacco/e-cigarette-position-statement.html. Accessed on May 11, 2018.

Disclosure: Drope reports no relevant financial disclosures.