In a policy shift, the American Cancer Society (ACS) this week endorsed e-cigarettes as a smoking cessation aid for smokers who won't use FDA-approved methods.
"Some smokers, despite firm clinician advice, will not attempt to quit smoking cigarettes and will not use FDA approved cessation medications," according to a . "These individuals should be encouraged to switch to the least harmful form of tobacco product possible; switching to the exclusive use of e-cigarettes is preferable to continuing to smoke combustible products."
The statement emphasized that giving up combustible cigarettes is the single most important thing that a smoker can do to improve their health and sought to "strongly" discourage concurrent use of regular cigarettes and nicotine vapor devices.
"Optimally, smokers who want to quit will see their doctor and take advantage of therapies that are proven to be successful for smoking cessation," said Richard Wender, MD, the ACS's chief cancer control officer.
"But we recognize that people quit smoking in many different ways, and most don't go to a doctor or go buy nicotine patches, as much as we would like them to. If a smoker who wants to quit chooses to try e-cigarettes to see if they will help, we support that effort."
Wender deviated slightly from the published statement on the topic of dual use, saying it's acceptable as long as the goal is to stop smoking cigarettes in a reasonable period of time.
In a report summarizing the available evidence on e-cigarette safety, published last month, the National Academies of Sciences, Engineering and Medicine (NASEM) concluded that replacing combustible cigarettes with e-cigarettes reduces exposure to many toxicants and carcinogens.
But Wender said the evidence also shows e-cigarette use to offer no health benefits to people who vape and continue to smoke combustible cigarettes.
The position statement makes clear that while e-cigarettes are less harmful than cigarettes, that does not mean they are harmless -- in particular, it said "the health effects of long-term use are not known." It also stressed the risks to young people who may initiate e-cigarette use.
Vaping has become far more popular among teens than smoking, with roughly 10% of high school students reporting current use of combustible cigarettes in , versus one-quarter reporting recent e-cigarette use.
Several recent studies suggest that teens who vape are more likely to take up combustible cigarettes, and other studies suggest that early exposure to nicotine can harm brain development.
With these studies in mind the ACS policy statement "strongly recommends that every effort be made to prevent the initiation of e-cigarettes by youth."
But Wender acknowledged that the position on youth vaping is nuanced, by necessity, given that the popularity of e-cigarettes among teens has coincided with record low use of combustible cigarettes.
"At the population level we have seen an overwhelming shift away from smoking cigarettes and toward vaping among this age group," he said. "Smoking levels among adults and youth are at an all time low, and we need to be very careful to avoid messaging and policies that end up driving adults and young people back to smoking."
The ACS position statement called on the FDA to regulate all tobacco products, including e-cigarettes, "to the full extend of its authority, and to determine the absolute and relative harms of each product."
"The FDA should assess whether e-cigarettes help to reduce tobacco-related morbidity and mortality, and the impact of marketing of e-cigarettes on consumer perceptions and behavior."
The group also called on federal health officials to use their authority to reduce the toxicity, addictiveness and appeal of all tobacco products.
Last summer, FDA Commissioner Scott Gottlieb, MD, announced that the agency was considering requiring that the nicotine in combustible cigarettes be reduced to non-addictive levels in an effort to further reduce cigarette smoking.
Nancy Rigotti, MD, of Massachusetts General Hospital, served on the NASEM committee that evaluated the scientific evidence regarding e-cigarette safety.
Rigotti told 鶹ý that while many safety questions remain, including the impact on long-term use on health, it is now clear that e-cigarettes are less harmful than continuing to smoke combustible cigarettes.
She said the jury is still out on whether e-cigarettes will be proven effective for helping large numbers of cigarette smokers quit.
"Our first recommendation is that smokers use existing, evidence-based, proven products that are safe and effective when they attempt to quit. It is clear that combining these medications with some sort of counseling support or coaching is the best way to quit."
Primary Source
American Cancer Society
ACS Position Statement on Electronic Cigarettes