Leading Cancer Research Groups Call for US Regulation of E-Cigarettes

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ASCO and AACR called on the FDA to regulate e-cigarettes and other electronic nicotine delivery systems and for more research to occur to find out how long-term use affects health. Leaders of these groups said that e-cigarettes could cause nicotine addiction among teens, and CDC data show rising use of the products among middle- and high-schoolers.

The American Society of Clinical Oncology (ASCO) and the American Association of Cancer Research (AACR) today called for US policymakers to regulate e-cigarettes and other electronic nicotine delivery systems, citing the need to limit potential harms from these products while keeping them available for those trying to quit smoking.

In their joint statement, ASCO and AACR expressed concern that e-cigarettes may promote nicotine consumption by non-smokers, especially children, who could develop nicotine addiction. Leaders of the 2 groups said too little is known about the long-term effects of these products. E-cigarettes are often advertised as a healthier alternative to traditional cigarettes, which were first publicly shown to cause cancer in a groundbreaking report to the US Surgeon General more than 50 years ago. Even though tobacco use is by far the largest preventable cause of death, the FDA did not gain its current regulatory powers over cigarettes until the Tobacco Control Act of 2009. At present, the agency is not regulating e-cigarette or other electronic nicotine delivery systems.

“While e-cigarettes may reduce smoking rates and attendant adverse health risks, we will not know for sure until these products are researched and regulated,” said Peter Paul Yu, MD, FACP, FASCO, president of ASCO. “The FDA has signaled its willingness to regulate e-cigarettes and other electronic nicotine delivery systems, and we urge the agency to follow through on this intention.”

Carlos L. Arteaga, MD, the president of AACR, express concern about the time it will take to know the long-term effects of electronic nicotine delivery. “Therefore, we call for additional research to determine with certainty the potential negative public health consequences of these products, particularly in youth. We cannot afford to wait to take prudent steps to stop those under 18 from using e-cigarettes,” he said.

Specifically, ASCO and AACR said:

· FDA’s Center for Tobacco Products should regulate all electronic nicotine delivery systems that meet the legal definition of “tobacco products.” Those that do not should be regulated through other means.


· Electronic nicotine products must register with the FDA, report ingredients and nicotine concentration.

· Packaging and advertising must include safety labels and nicotine addiction warnings.

· Nicotine “e-liquid” containers must have childproof caps.

· Electronic nicotine products that are flavored, targeted at youth, or look like candy must be banned.

· Wherever cigarettes are banned, e-cigarettes must be also until the safety of secondhand aerosol exposure is known.

· Funding through taxes, including any on e-cigarettes, should support research on these and other tobacco products, but should not limit other federal funds for tobacco research.

· State and local governments should be encouraged to regulate e-cigarettes and electronic nicotine systems.

The CDC has closely tracked e-cigarette use among teenagers. In September 2013, CDC Director Tom Frieden, MD, MPH, personally announced that their use among high school students had more than doubled among teens from 2011 to 2012, rising from 4.7% to 10% that year.

"The increased use of e-cigarettes by teens is deeply troubling," Dr Frieden said at that time. "Nicotine is a highly addictive drug. Many teens who start with e-cigarettes may be condemned to struggling with a lifelong addiction to nicotine and conventional cigarettes."

Advertising for e-cigarettes has drawn fire from some health advocates. One spoof ad by World Health Organization, “More Docs Vape,” conjures the highly inaccurate 1950s-era pitches made by tobacco companies, before the Surgeon General’s 1964 report led to advertising controls. (For a full discussion of the history of tobacco advertising, see “Surgeon General’s Smoking and Health Turns 50” in Evidence-Based Oncology, a publication of The American Journal of Managed Care.)

A December 12, 2014, international tobacco control treaty put forth by WHO calls on countries to regulate e-cigarettes. In the United States, some individual states have limited where e-cigarettes can be sold or cracked down on misleading advertising through consumer protection statutes.

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