Among all of the alternative tobacco products, e-cigarettes are the least regulated. They have no warning labels and can be sold to people of any age. The FDA has not approved e-cigarettes as a way to quit smoking. People with cancer who want to quit smoking should use the approved methods for quitting smoking.

Without FDA regulation and review, we simply don’t know what is in e-cigarettes. However, in initial lab tests conducted in 2009, the FDA found detectable levels of toxic cancer-causing chemicals—including an ingredient used in antifreeze—in two leading brands of e-cigarettes and 18 various cartridges. A review of studies found that levels of toxins in e-cigarette aerosol varied considerably within and between brands. A 2014 study found that aerosol from e-cigarettes with a higher voltage level contains more formaldehyde, another carcinogen with the potential to cause cancer. It is considered a Group 1 compound, carcinogenic to humans, by the International Agency for Research on Cancer, making it one of the 114 compounds that are known carcinogens. And remember, this formaldehyde is heading to one of the most environmentally sensitive organs in the body, the lungs, mouth and throat.

A study conducted by researchers from the University of Southern California found that the vapor produced by a popular brand of e-cigarette contained toxic levels of certain metals far greater than those found in the smoke of traditional cigarettes. “Our results demonstrate that overall, electronic cigarettes seem to be less harmful than regular cigarettes, but their elevated content of toxic metals such as nickel and chromium do raise concerns,” says Prof. Sioutas, coauthor of the study.

Aside from concerns about e-cigarette use and emissions alone, calls to the nation’s poison centers related to e-cigarette exposure poisonings are rapidly increasing, according to data released by the Centers for Disease Control and Prevention (CDC). One study found that while most calls involving e-cigarette liquid poisoning came from accidental ingestion of the e-cigarette or its liquid, about one-sixth of the calls related to someone inhaling these items. Exposure through the eye and the skin were also reported.

The most frequently reported less harmful effects of vaping compared to smoking were reduced shortness of breath, reduced cough, reduced spitting, and reduced sore throat.

Unregulated e-cigarettes can be a risk to young children. In the United States, a child died after ingesting liquid nicotine in 2014, as did another child in Israel in 2013. A 2014 editorial stated that e-cigarettes have concentrated liquids that are packed in colorful containers and combined with flavors that appear to be made to attract children. It was concluded that it is recommended that e-cigarettes be kept in a safe place, where children and pets do not have access them. Nicotine toxicity is a concern when e-cigarette solutions are swallowed intentionally by adults as a suicidal overdose. A man died in 2012 after injecting himself with nicotine liquid. An excessive amount of nicotine for an adult that is capable of being fatal is 0.5–1 mg/kg of body weight. A lethal dose for grownups is from 30 – 60 mg.

There is a possibility of high levels of nicotine exposure, in regard to e-cigarette cartridges, from inhalation, ingestion, or skin contact while replacing or handling of the e-cigarette cartridges. This may be especially risky to children, pregnant women, and nursing mothers.

The German Cancer Research Center in Germany released a report stating that e-cigarettes cannot be considered safe, in part due to technical flaws that have been found. This includes leaking cartridges, accidental contact with nicotine when changing cartridges, and potential of unintended overdose.

According to Dr. Farsalinos’ statements, “E-cigarettes are not a healthy habit, but they are a safer alternative to tobacco cigarettes.

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