“Those are all aldehydes, ketones, and chemicals that are being inhaled into the lungs,” Dr. Jackler said. “They come from the food industry, where those flavorants are designed to be swallowed into the [gastrointestinal] tract, but nobody really knows if, over 10 or 20 years [of] inhaling all day long, that kind of vapor can be problematic to people and cause injury to the lungs, larynx, and voice.”
Explore This IssueDecember 2014
The lack of evidence-based data makes formulating recommendations on the use of e-cigarettes a thorny topic. Kristen Otto, MD, an otolaryngologist at the Moffitt Cancer Center in Tampa, Fla., can’t recommend the product to her patients. Dr. Otto’s clinical focus is head and neck surgical oncology and microvascular reconstructive surgery for head and neck cancer defects, and patients in those groups are at particular risk of problems associated with nicotine use. “These people are going to be at much higher risk of failure of their reconstruction with the high nicotine doses than just the standard cancer-causing agents in the tobacco and the tar,” she said. “So I’m definitely somebody who would tell patients that they can’t do e-cigarettes or nicotine patches before the big cancer reconstructive surgery, because of the nicotine effects on the cardiovascular system. But the direct association with oral or head and neck cancers, we can’t really make at this time.”
To underscore the nascent views on e-cigarettes, Dr. Otto noted that she has seen them used on her campus in Florida. “There’s this perception … that this is not really smoking,” she said. “I’ve actually seen people wandering around Moffitt Cancer Center—a cancer center, where you would think the last thing you would want to do is to pull out a cigarette or a cigarette-like device, and yet people have them. “I think we all have to be aware that it’s now more like a public health issue,” she said.
So what should an otolaryngologist say to a patient or a patient’s family member if the habit is one that people feel comfortable indulging in even in the halls of a cancer center?
“What I tell my patients, and I try to educate them as much as I can, is that, health-wise, e-cigarettes are probably more healthy for you than a [traditional] cigarette,” said Dr. DiNardo. “My advice overall, though, is to pursue a smoking cessation program, because as far as we know at the moment, e-cigarettes aren’t necessarily going to stop you from smoking or really curb your addiction to nicotine, so it’s not necessarily a way out.”
The discussion of e-cigarettes and their potential regulation, of course, hangs on the decision of the FDA, which accepted comments on its proposed rule through early August. “We cannot speculate on when FDA will issue a final rule,” a spokeswoman told ENTtoday. “However, the agency intends to work as quickly as possible to review comments.”