The letter encouraged the agency to ban activities that may promote use in children, such as e-cigarette flavors or flavor names that are brand and/trademarked names of candy, cookies, soda, and other products, and to prohibit e-cigarettes containing candy and other youth-friendly flavors, unless there is evidence demonstrating that they do not encourage young people to use these products.

Robert Tarran, PhD, an associate professor at the Department of Cell Biology and Physiology at the University of North Carolina (UNC) School of Medicine and a member the UNC Lineberger Comprehensive Cancer Center in Chapel Hill, NC, said an e-cigarette company can literally concoct an e-liquid and start selling it for inhalation without any testing or regulation.

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He said there is an urgent need to regulate all electronic nicotine delivery systems (ENDS). These systems include e-cigarettes, and all devices capable of delivering nicotine in an aerosolized form.

“There is serious because for concern here since many of the flavors used have not been tested for safety via inhalation and this can give different results to oral ingestion,” Tarran told Cancer Therapy Advisor.

“Little cigars and other unregulated tobacco products produce similar cancer-causing toxicants as regular cigarettes. Whilst the effects of e-cigarettes on the human body are still being investigated, it is known that e-liquids do contain a lot of nicotine, which is known to be carcinogenic and may also generate formaldehyde when they are heated/aerosolized as the liquid vehicle gets broken down.”

ASCO would like to see federal, state, and local regulation of ENDS. It would also like manufacturers to be required to register with the FDA and report all product ingredients. ASCO wants the FDA to require childproof caps on ENDS liquids, and include warning labels on products and their advertisements.2

Last year, the FDA proposed a rule to extend its authority over ENDS. ASCO and other groups requested that the FDA issue its final rule by April 25, 2015, which was 1 year from the date the agency issued the proposed rule. However, that deadline came and passed.

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The FDA said it regularly receives voluntary reports of adverse events involving e-cigarettes from consumers, clinicians, and concerned members of the public.

The adverse events described in these reports have included hospitalization for illnesses such as pneumonia, congestive heart failure, disorientation, seizure, hypotension, and other health problems.3


  1. American Society of Clinical Oncology. Published April 25, 2015. Accessed July 28, 2015.
  2. Brandon TH, Goniewicz ML, Hanna NH, et al. American Association for Cancer Research and American Society of Clinical Oncology. Electronic nicotine delivery systems: A policy statement from the American Association for Cancer Research and the American Society of Clinical Oncology. Clin Cancer Res. 2015;21(3):514–525.
  3. U.S. Food and Drug Administration. Electronic cigarettes (e-cigarettes). Updated July 7, 2015. Accessed July 28, 2015.