Herbst Roy S, Hatsukami Dorothy, Acton Dana, Giuliani Meredith, Moushey Allyn, Phillips Jonathan, Sherwood Shimere, Toll Benjamin A, Viswanath Kasisomayajula, Warren Nicholas J H, Warren Graham W, Alberg Anthony J
Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, CT.
Masonic Cancer Center, Minneapolis, MN.
J Clin Oncol. 2022 Dec 10;40(35):4144-4155. doi: 10.1200/JCO.22.01749. Epub 2022 Oct 26.
Combustible tobacco use has reached historic lows, demonstrating the importance of proven strategies to reduce smoking since publication of the 1964 Surgeon General's report. In contrast, the use of electronic nicotine delivery systems (ENDS), specifically e-cigarettes, has grown to alarming rates and threatens to hinder progress against tobacco use. A major concern is ENDS use by youth and adults who never previously used tobacco. While ENDS emit fewer carcinogens than combustible tobacco, preliminary evidence links ENDS use to DNA damage and inflammation, key steps in cancer development. Furthermore, high levels of nicotine can also increase addiction, raise blood pressure, interfere with brain development, and suppress the immune system. The magnitude of long-term health risks will remain unknown until longitudinal studies are completed. ENDS have been billed as a promising tool for combustible tobacco cessation, but further evidence is needed to assess their potential efficacy for adults who smoke. Of concern, epidemiological studies estimate that approximately 15%-42% of adults who use ENDS have never used another tobacco product, and another 36%-54% dual use both ENDS and combustible tobacco. This policy statement details advances in science related to ENDS and calls for urgent action to end predatory practices of the tobacco industry and protect public health. Importantly, we call for an immediate ban on all non-tobacco-flavored ENDS products that contain natural or synthetic nicotine to reduce ENDS use by youth and adults who never previously used tobacco. Concurrently, evidence-based treatments to promote smoking cessation and prevent smoking relapse to reduce cancer incidence and improve public health remain top priorities for our organizations. We also recognize there is an urgent need for research to understand the relationship between ENDS and tobacco-related disparities.
可燃烟草的使用已降至历史最低点，这表明自1964年美国卫生局局长报告发布以来，已证实的减少吸烟策略非常重要。相比之下，电子尼古丁传送系统（ENDS），特别是电子烟的使用已增长到惊人的速度，并有可能阻碍在控烟方面取得的进展。一个主要担忧是从未使用过烟草的青年和成年人使用ENDS。虽然ENDS释放的致癌物比可燃烟草少，但初步证据将ENDS的使用与DNA损伤和炎症联系起来，而这是癌症发展的关键步骤。此外，高含量的尼古丁还会增加成瘾性、升高血压、干扰大脑发育并抑制免疫系统。在完成纵向研究之前，长期健康风险的程度仍将未知。ENDS一直被宣传为帮助戒烟的有前景的工具，但需要更多证据来评估其对吸烟成年人的潜在功效。令人担忧的是，流行病学研究估计，约15%-42%使用ENDS的成年人从未使用过其他烟草产品，另有36%-54%的人同时使用ENDS和可燃烟草。本政策声明详细介绍了与ENDS相关的科学进展，并呼吁采取紧急行动，制止烟草行业的掠夺性行为，保护公众健康。重要的是，我们呼吁立即禁止所有含有天然或合成尼古丁的非烟草口味ENDS产品，以减少从未使用过烟草的青年和成年人对ENDS的使用。与此同时，促进戒烟和预防吸烟复发以降低癌症发病率和改善公众健康的循证治疗仍然是我们各组织的首要任务。我们也认识到迫切需要开展研究，以了解ENDS与烟草相关差异之间的关系。
