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Regulation Is Required to Deter Potential Oncological Outcomes

Nolen, Lindsey

doi: 10.1097/01.COT.0000615188.31656.0c


Over the past several years, the act of vaping through the use of electronic cigarettes has become increasingly popular among general tobacco users and young adults. The allure of a convenient battery-operated device with various flavor options, without the smoke and tar of a regular cigarette, has led its popularity to skyrocket. This increased use across the population has left researchers wondering what the long-term effects of the vape pen are, and if cancer could arise as a result.

Despite falling lung cancer rates across the U.S. due to educational campaigns and awareness, the e-cigarette trend is bringing back the act of smoking in a redesigned way. Health care leaders worry that electronic cigarettes, through absorption of nicotine by vaping, may lead otherwise non-smokers to begin the practice and undermine the anti-tobacco movements in place.

“The fact that thousands and thousands of young kids are using these and becoming addicted to nicotine can even lead them to picking up a cigarette and then dual-use,” explained Roy Herbst, MD, PhD, Chair of the AACR's Tobacco Products and Cancer Subcommittee and Chief of Medical Oncology at Yale Cancer Center and Smilow Cancer Hospital. “Then they are exposed to more carcinogens and the potential for cancer becomes an even more likely reality.”

“I stress that vaping is still smoking. It may not be with a combustible cigarette, but it is still smoking,” stressed Panagis Galiatsatos, MD, MHS, a pulmonologist and tobacco treatment specialist at Johns Hopkins University. “When I work with patients, I make sure they have the proper information to recognize that they are still inhaling a product that has its own toxins and health risks. With that information, if they want to quit smoking altogether, I work fully to try to get them off of [either cigarettes or vape pens].”

Galiatsatos explained that patients typically come to see him regarding vaping for one of two reasons. First, patients who use the traditional combustible cigarettes inquire about trying to transition over to electronic cigarettes in an attempt to quit combustibles. Second, younger patients see him regarding the need to come off of electronic cigarettes after addiction has caused them lung or health issues. These issues stem from the chemicals contained within vape pens and their overall use as inhalants.

Often designed to look like real cigarettes, e-cigarettes are essentially cartridges containing nicotine liquid connected to a vaporization chamber (which is a hollow tube that contains electronic controls and an atomizer). Activated by inhalation and powered by a lithium battery, the atomizer heats the nicotine liquid and converts the liquid to a vapor, or mist, that the user then inhales.

Along with the nicotine liquid, cartridges usually contain propylene glycol, an additive that the FDA has approved for use in food. However, consumers can buy cartridges containing different amounts of nicotine or no nicotine at all. Manufacturers usually add flavorings to the liquid (such as menthol, mint, pineapple, etc.)

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The Need for Regulation

Even though these liquids are often regarded as being safer than tobacco, vape pens are not well-regulated across the market by the FDA, leading to their misuse. For this reason, sellers have succeeded in lacing them with chemicals such as THC, diacetyl, heavy metals, and other organic compounds or ultrafine particles which are known to be harmful to the lungs.

“Vaping risks in the acute sense pose the risk for a lot of lung-specific injuries that are related to a heterogeneous group called pneumonitis,” Galiatsatos said. “You can severely damage the lung tissue through the chemicals and biologicals found in e-cigarettes. This can come from a high utilization of lipids and oils to just the chemicals that they are using.”

In response to this realization, the CDC has become tasked with intervening and investigating how these contaminated products are making their way into the mouths of consumers. Even more recently, there has been speculation that their use is causing numerous cases of a pulmonary illness, and even death. As these various materials are absorbed into patient lungs, users have reported experiencing shortness of breath, gastrointestinal symptoms, chest pains, and other symptoms.

Health care providers have warned that the overall lack of regulation poses great risk to those who choose to vape, and they stress that adolescents should absolutely abstain from the activity. Aside from posing additional developmental risks, practitioners warn that by the time researchers are able to decipher the long-term effects of e-cigarettes, it may be too late to deter them. Included in these effects is undoubtedly the potential for cancer, they say.

“We need more data and research to look at the epidemiology. The problem with these [e-cigarettes] is that they are not regulated, so how does anyone know which nicotine dose they're using? If the dose is too high or too low, it's possible that there could be long-term consequences,” Herbst emphasized.

“The chronic outcomes of vaping we don't know,” Galiatsatos added. “They've only been sold in the American markets since 2007. We're still in its infancy in terms of impact on future health consequences, but there is good data to suggest a plausible risk for carcinogens or cancer to be created through these products.”

He further explained that a lot of these products through the EPA are listed under Generally Recognized as Safe (GRAS), which is misleading because this list only evaluates items through ingestion. So, these products have never been tested as inhalants. He shared that only time will show the direct consequences of their usage.

“This is unfortunate because I don't want my community members to feel like guinea pigs when they're out there testing these products,” Galiatsatos said. “We as scientists and physicians should combat the misinformation campaigns that exist and let people know that there is a plausible consideration that what you're breathing in could amount to cancer later.”

Providers stress that educating patients on the risks of vaping should remain a priority. For heavy cigarette smokers, vaping may in fact be a better solution to consuming the 65 carcinogens in the tobacco cigarette. Yet for others, regulation and research are the only ways to truly uncover the potential for vaping to cause oncological outcomes.

Galiatsatos believes that the next steps is to extrapolate what we know about the chemicals contained in e-cigarettes from other data that exists extensively. Toxicities from inhalants that e-cigarettes contain have been used since the 1940s.

“You take that information and lead a campaign discussing the potential risks, because if we don't do that we will find the limitations of science to impede us from delivering proper messages to this generation, just like the failure to warn people of the 1950s and 1960s about tobacco. Help patients make judgements based on the most proper information that exists.”

In the meantime, Galiatsatos suggests that all states ban electronic cigarettes until the government, researchers, and health care professionals can find a way to regulate them and “stop putting lives in danger of plausible cancerous outcomes.” Every death is a person the community failed to keep safe, Galiatsatos stated.

Lindsey Nolen is contributing writer.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
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