The American Association for Cancer Research (AACR) and ASCO have released a joint policy statement outlining the latest research on the use of e-cigarettes and other electronic nicotine delivery systems (ENDS) and recommendations for regulating these products to protect public health. The statement was published by Herbst et al in both AACR’s journal Clinical Cancer Research and ASCO’s Journal of Clinical Oncology.
Lisa M. Coussens, PhD, FAACR
“The popularity of ENDS among young people and adults who do not smoke continues to be a significant public health problem that threatens to derail decades of progress against tobacco use,” said AACR President Lisa M. Coussens, PhD, FAACR. “Along with our colleagues at ASCO, we are alarmed by the rapid increase in the number of high schoolers using these products, as well as the growing body of evidence that suggests ENDS expose users to carcinogens while also increasing the likelihood that individuals will begin using other tobacco products. The policy statement… emphasizes the urgent need for bold regulatory action and more research so that we can mitigate the dangers of these devices and maintain the momentum against the many cancers caused by tobacco use.”
The statement builds on an earlier joint AACR/ASCO statement on ENDS, published in 2015, which called on the U.S. Food and Drug Administration (FDA) to regulate such products in order to address the growing rate of ENDS use among youth and young adults. The need for regulation is urgent, as ENDS use among youth and young adults—as well as people who have never smoked—rose dramatically from 2015 to 2019.
While the COVID-19 pandemic, along with increased public awareness about the risks of these products and laws raising the minimum age to buy tobacco products to 21 years, likely contributed to a drop in ENDS use during 2020 and 2021, these declines were temporary. Unfortunately, new results from the National Youth Tobacco Survey show that ENDS use among high school students is once again growing. An estimated 2 million high school students use ENDS in 2022—a 24% increase compared to 2021. This situation highlights the need for continued regulatory and scientific attention to the public health risks posed by ENDS.
New Statement
AACR and ASCO collaborated to summarize the existing research on ENDS and propose policies to mitigate the potential harms caused by these products. According to the statement:
- While ENDS emit fewer carcinogens than combustible tobacco, preliminary evidence nonetheless links ENDS use to DNA damage and inflammation, key steps in cancer development.
- Appealing flavors are key drivers of youth ENDS use, with a 2020 survey reporting that more than 82% of youth who use ENDS use non–tobacco-flavored products.
- Despite recent FDA restrictions on flavors other than tobacco and menthol in pod- or cartridge-based ENDS, flavored open-tank and single-use products are still on the market and have dramatically increased in popularity among middle and high school students.
- A young person who uses ENDS is more likely to later begin smoking combustible tobacco, with studies finding that people who use ENDS are between 2.9 and 4 times more likely to ever smoke a combustible cigarette than people who have never used ENDS.
“While more research is needed to fully understand the long-term health effects of ENDS use, the harms of nicotine addiction—especially for young people—are well-known,” said ASCO President Eric P. Winer, MD, FASCO. “Additionally, since it is increasingly clear that ENDS expose users to carcinogens and increase the odds that a young person will go on to smoke combustible tobacco, state and federal policymakers, along with other stakeholders, must advance policies that curb ENDS use in nonsmokers and advance research on the long-term health impacts of these products.”
Eric P. Winer, MD, FASCO
The AACR and ASCO call on policymakers, regulatory authorities, and the research community to take action to combat ENDS use, especially among young people, and support evidence-based smoking cessation therapies. Specific recommendations in the policy statement include:
- Ban all non–tobacco-flavored products that contain nicotine
- Tax all products that contain natural or synthetic nicotine in a manner that reduces tobacco use and promotes public health
- Regulate predatory tobacco advertising practices, especially those designed to appeal to youth
- Limit the sale of tobacco products, including ENDS, to stores or areas within stores that require age verification upon entrance, and increase enforcement of the minimum age to legally purchase tobacco products
- Support research to understand the long-term health impacts of ENDS use.
“I am proud to have chaired this effort to build consensus between the world’s two leading cancer organizations on such an important topic,” said Roy S. Herbst, MD, PhD, Chair of the ENDS Statement Writing Committee and the AACR Science Policy and Government Affairs Committee, and Deputy Director of Yale Cancer Center. “The science is clear that ENDS pose health risks, especially for youth and people who do not smoke. This statement will provide much-needed guidance and recent scientific research on the impact of ENDS and what policymakers can do to curtail nicotine addiction.”
Roy S. Herbst, MD, PhD
Disclosure: For full disclosures of the statement authors, visit ascopubs.org.
