IASLC Policy Statement - Electronic Cigarettes

The International Association for the Study of Lung Cancer (IASLC) is the world’s largest multidisciplinary lung cancer organization. Combating tobacco use is critical to reduce lung cancer incidence and to improve outcomes in patients already diagnosed with cancer. Electronic cigarettes have rapidly gained popularity under the premise that they may help people who smoke to quit, and that they may be less harmful than combustible tobacco. Some people have been able to quit smoking with the use of electronic cigarettes, but their use has expanded significantly to non-smokers, often youths and young adults. Data regarding cessation outcomes are inconsistent and long-term risks are unknown. The recent recognized and growing outbreak reported late 2019 in the United States of severe illness and deaths due to apparent pulmonary inflammation associated with electronic cigarettes have brought to light potential dangers of their use. Based on current evidence, the IASLC shares international concern and takes the following positions on electronic cigarettes and other heated tobacco product devices. We support the position of the American Thoracic Society on this issue² and make the following specific points:

• Cancer treatment outcomes are worse in patients who continue to smoke, and it is critical
  for all physicians to support patients through shared decision making to stop smoking. This issue has been addressed in the recent IASLC Declaration³.
• Individuals who smoke including those with cancer should quit smoking immediately by any means possible.
• Healthcare professionals should advise all patients to stop smoking and vaping with cessation aids that are evidence-based.
• Evidence-based cessation aids which are safe and effective include approved pharmacotherapy and counseling.
• Electronic cigarettes for smoking cessation have not been proven by systematic reviews at this time.
• A few studies suggest there could be a link between vaping and lung cancer in animal models; there are no studies that have shown a cancer risk in humans. It is expected that studies linking vaping to the development of cancer would take several years to mature. 
• Flavorings including other additives used in electronic cigarettes may contribute to vaping related illnesses. 
• Electronic cigarettes should never be used by youth or by adults who are not currently smoking.

References:

1. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html
2. https://www.thoracic.org/professionals/clinical-resources/disease-related-resources/vaping-the-threat-to-public-health-and-the-ats-response.php
3. https://www.iaslc.org/About-IASLC/News-Detail/declaration-from-iaslc-tobacco-cessation-after-cancer-diagnosis
4. IASLC Tobacco Brochure