E-Cigarettes and Toxin Exposure
Authors: Lion Shahab, Maciej L. Goniewicz, Benjamin C. Blount, Jamie Brown, Robert West
Journal: Annals of Internal Medicine (2017)

Letters3 October 2017E-Cigarettes and Toxin ExposureLion Shahab, PhD, Maciej L. Goniewicz, PhD, Benjamin C. Blount, PhD, Jamie Brown, PhD, and Robert West, PhDLion Shahab, PhDFrom University College London, London, United Kingdom; Roswell Park Cancer Institute, Buffalo, New York; and Centers for Disease Control and Prevention, Atlanta, Georgia., Maciej L. Goniewicz, PhDFrom University College London, London, United Kingdom; Roswell Park Cancer Institute, Buffalo, New York; and Centers for Disease Control and Prevention, Atlanta, Georgia., Benjamin C. Blount, PhDFrom University College London, London, United Kingdom; Roswell Park Cancer Institute, Buffalo, New York; and Centers for Disease Control and Prevention, Atlanta, Georgia., Jamie Brown, PhDFrom University College London, London, United Kingdom; Roswell Park Cancer Institute, Buffalo, New York; and Centers for Disease Control and Prevention, Atlanta, Georgia., and Robert West, PhDFrom University College London, London, United Kingdom; Roswell Park Cancer Institute, Buffalo, New York; and Centers for Disease Control and Prevention, Atlanta, Georgia.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0315 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Aubin and colleagues argue that we have produced misleading claims about estimated risk reduction from switching from conventional cigarettes to e-cigarettes because duration of exposure is more important than degree of exposure in increasing risk for cancer. We acknowledge that assessing whether e-cigarette use actually reduces harm among conventional cigarette smokers is challenging and that the adverse health effects of tobacco are related to duration of use, not just exposure. However, both are essential causal factors and, to the extent that risk is broadly proportional to either, reducing the degree or duration of exposure will proportionally reduce ...References1. Yuan JM, Gao YT, Murphy SE, Carmella SG, Wang R, Zhong Y, et al. Urinary levels of cigarette smoke constituent metabolites are prospectively associated with lung cancer development in smokers. Cancer Res. 2011;71:6749-57. [PMID: 22028322] doi:10.1158/0008-5472.CAN-11-0209 CrossrefMedlineGoogle Scholar2. Yuan JM, Butler LM, Gao YT, Murphy SE, Carmella SG, Wang R, et al. Urinary metabolites of a polycyclic aromatic hydrocarbon and volatile organic compounds in relation to lung cancer development in lifelong never smokers in the Shanghai Cohort Study. Carcinogenesis. 2014;35:339-45. [PMID: 24148823] doi:10.1093/carcin/bgt352 CrossrefMedlineGoogle Scholar3. Shields PG. Long-term nicotine replacement therapy: cancer risk in context. Cancer Prev Res (Phila). 2011;4:1719-23. [PMID: 22052338] doi:10.1158/1940-6207.CAPR-11-0453 CrossrefMedlineGoogle Scholar4. Cherng ST, Tam J, Christine PJ, Meza R. Modeling the effects of e-cigarettes on smoking behavior: implications for future adult smoking prevalence. Epidemiology. 2016;27:819-26. [PMID: 27093020] doi:10.1097/EDE.0000000000000497 CrossrefMedlineGoogle Scholar5. Beard E, West R, Michie S, Brown J. Association between electronic cigarette use and changes in quit attempts, success of quit attempts, use of smoking cessation pharmacotherapy, and use of stop smoking services in England: time series analysis of population trends. BMJ. 2016;354:i4645. [PMID: 27624188] doi:10.1136/bmj.i4645 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University College London, London, United Kingdom; Roswell Park Cancer Institute, Buffalo, New York; and Centers for Disease Control and Prevention, Atlanta, Georgia.Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health and the U.S. Food and Drug Administration.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1107. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoNicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users Lion Shahab , Maciej L. Goniewicz , Benjamin C. Blount , Jamie Brown , Ann McNeill , K. Udeni Alwis , June Feng , Lanqing Wang , and Robert West E-Cigarettes and Toxin Exposure Henri-Jean Aubin , Pascal Guénel , Marie-Christine Boutron-Ruault , Mireille Matrat , Amandine Luquiens , and Patrick Dupont Metrics Cited byA Decision-Theoretic Public Health Framework for Heated Tobacco and Nicotine Vaping ProductsPublic health implications of vaping in the USA: the smoking and vaping simulation modelPublic health impact of a US ban on menthol in cigarettes and cigars: a simulation studyAn Open-Label, Randomized, Controlled, Crossover Study to Assess Nicotine Pharmacokinetics and Subjective Effects of the JUUL System with Three Nicotine Concentrations Relative to Combustible Cigarettes in Adult SmokersA modeling approach to gauging the effects of nicotine vaping product use on cessation from cigarettes: what do we know, what do we need to know?E-cigarette Aerosol Condensate Enhances Metabolism of Benzo(a)pyrene to Genotoxic Products, and Induces CYP1A1 and CYP1B1, Likely by Activation of the Aryl Hydrocarbon Receptor 3 October 2017Volume 167, Issue 7Page: 525-526KeywordsCancer epidemiologyCarcinogensDisclosureEpidemiologyFood and Drug AdministrationNicotinePopulation statisticsPregnancyPrevention, policy, and public healthToxins ePublished: 3 October 2017 Issue Published: 3 October 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. 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