Yale Comprehensive Cancer Center, Yale School of Medicine, New Haven, Connecticut.
Masonic Cancer Center, Minneapolis, Minnesota.
Clin Cancer Res. 2022 Nov 14;28(22):4861-4870. doi: 10.1158/1078-0432.CCR-22-2429.
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% to 42% of adults who use ENDS have never used another tobacco product, and another 36% to 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低点，这表明自 1964 年《美国卫生总监报告》发布以来，减少吸烟的经过验证的策略非常重要。相比之下，电子尼古丁传送系统（ENDS），特别是电子烟的使用，已经以惊人的速度增长，并有可能阻碍反吸烟工作的进展。一个主要的担忧是，从未使用过烟草的青少年和成年人也在使用 ENDS。虽然 ENDS 释放的致癌物质比可燃烟草少，但初步证据表明，ENDS 的使用与 DNA 损伤和炎症有关，这是癌症发展的关键步骤。此外，高水平的尼古丁也会增加成瘾、升高血压、干扰大脑发育和抑制免疫系统。只有完成纵向研究，才能了解长期健康风险的严重程度。ENDS 被吹捧为可燃烟草戒烟的有希望的工具，但需要进一步的证据来评估它们对吸烟成年人的潜在效果。令人担忧的是，流行病学研究估计，大约 15%至 42%使用 ENDS 的成年人从未使用过另一种烟草产品，另有 36%至 54%的人“双重使用”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，制止烟草业的掠夺性做法，保护公共健康。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的 ENDS 产品，以减少从未使用过烟草的青少年和成年人对 ENDS 的使用。同时，促进戒烟和预防复吸以减少癌症发病率和改善公共健康的循证治疗仍然是我们组织的首要任务。我们还认识到，迫切需要研究了解 ENDS 与烟草相关差异之间的关系。
