AACR, ASCO Release Statement on Use of Electronic Nicotine Delivery Systems

By Leah Lawrence - January 18, 2023

The American Association for Cancer Research (AACR) and the American Society of Clinical Oncology (ASCO) released an updated policy statement on electronic nicotine delivery systems (ENDS). The statement outlines the latest research on the use of e-cigarettes and other ENDS.

In contrast to combustible tobacco use, which has reached historic lows, the use of ENDS had grown at an “alarming” rate, the statement said, and “threatens to hinder progress against tobacco use.”

The statement highlighted that the majority of ENDS use is by youth and adults who never previously used tobacco, and that ENDS use is linked to DNA damage and inflammation, both key steps in cancer development.

“A growing body of evidence points toward a biologically plausible role for ENDS use in contributing to human carcinogenesis, based on the presence of carcinogens in ENDS aerosols, metabolites of carcinogens in human urine samples, inflammation markers in human lung swabs and blood samples, and cell culture and mouse experiments exhibiting DNA damage and inflammation,” the statement said.

Other research has shown that the fact that ENDS often have appealing flavors appears to be a key driver of its use among youth. A 2020 survey showed that more than 82.9% of youth who use ENDS use flavored products rather than tobacco flavored products. Youth offered fruit-flavored ENDS are 6.5 times more likely to try compared with tobacco-flavored ENDS.

Despite recent FDA restrictions on flavors other than tobacco and menthol in pod- or cartridge-based ENDS, flavored open tank and single-use products are still on the market and have dramatically increased in popularity among middle and high school students.

Additionally, research has shown that a young person who uses ENDS is more likely to later begin smoking combustible tobacco, with studies finding that people who use ENDS are between 2.9 and 4 times more likely to ever smoke a combustible cigarette than people who have never used ENDS.

The policy statement called for specific action from policy makers, regulatory authorities, and the research community. These actions included a ban on all non-tobacco-flavored products that contain nicotine and a tax on all products that contain natural or synthetic nicotine in a manner that reduces tobacco use and promotes public health.

In addition, the statement called for the limitation of the sale of tobacco products, including ENDS, to stores or store areas that require age verification upon entrance.

There is also a great need for research to understand the long-term health impacts of ENDS use.

“The top tobacco control priorities for the AACR and ASCO continue to be preventing initiation of tobacco use (including ENDS), preventing smoking relapse, and promotion of evidence-based tobacco cessation treatment for all groups,” the statement said.


Electronic nicotine delivery systems: an updated policy statement from the American Association for Cancer Research and the American Society of Clinical Oncology.