TUESDAY, Oct. 3, 2017 -- Millions of cigarette smokers could live substantially longer if electronic cigarettes are embraced as a replacement for tobacco during the next decade, a new study contends.
As many as 6.6 million cigarette smokers could live a combined 86.7 million more years under policies that encourage them to swap their smokes for e-cigarettes, according to "optimistic" projections from cancer researchers at Georgetown University in Washington, D.C.
Even a worst-case scenario involving e-cigarettes would still save lives, the researchers said.
Under a "pessimistic" projection, 1.6 million former cigarette smokers would have a combined 20.8 million more years of additional life, the research team found.
These numbers show that adopting e-cigarettes as an alternative to smoking could prove the easiest way to cause tobacco use to dwindle in the United States, said lead researcher David Levy, a professor of oncology at Georgetown's Lombardi Comprehensive Cancer Center.
"An e-cigarette strategy really could help us move towards the goal that we all have, to reduce cigarette use," Levy said. "Everybody agrees that cigarettes are really harmful, and population health could be dramatically improved."
People using e-cigarettes are not exposed to the carcinogens and chemicals produced by burning tobacco, although they still endure the addictive and systemic effects of nicotine, Levy said.
However, the vapor-emitting, battery-powered devices remain unregulated by the U.S. Food and Drug Administration. This makes it tough for tobacco control advocates to adopt a pragmatic strategy focused on the devices, said Dr. Louis DePalo, a professor of pulmonology with the Icahn School of Medicine at Mount Sinai in New York City.
FDA-approved nicotine replacement products such as gum or patches are considered safe and are used alongside counseling and therapy to help people kick their addiction, DePalo said. Gum and patches also aren't as pleasurable as using an e-cigarette, and that enjoyment might make it more difficult for someone to wean themselves off e-cigarettes.
"E-cigarettes in an unregulated environment just don't offer you the exit strategy of being part of a comprehensive smoking cessation strategy," said DePalo, who had no role in the new study.
For the study, Levy and his colleagues crafted optimistic and pessimistic scenarios under which smokers start adopting e-cigarettes, and then projected out how many lives would be saved and extended under those scenarios. The optimistic scenario assumes that:
- Cigarette smoking would decline to 5 percent of the U.S. population as e-cigarettes become the more popular option, down from the current 16 percent.
- New smokers would take up e-cigarettes rather than tobacco.
- People would quit e-cigarettes at about the same rate they quit tobacco.
- E-cigarettes carry 5 percent of the health risk of tobacco cigarettes.
The pessimistic scenario paints a somewhat darker picture, as expected. It assumes that:
- About 10 percent of Americans would still smoke tobacco; more never-smokers would take up e-cigarettes.
- Vapers would quit at half the rate of smokers.
- E-cigarettes carry about 40 percent of the risk of smoking.
This less-rosy outlook reflects some of the recent science regarding e-cigarettes.
For example, a September study in the Journal of the American Heart Association linked the nicotine in e-cigarettes to adrenaline level spikes that could increase the risk of heart attack. Also, a study in JAMA Pediatrics estimated that teens and young adults who use e-cigarettes are nearly four times more likely to graduate to full-fledged tobacco smoking.
Nevertheless, both scenarios predicted that millions of former smokers would live many more years thanks to e-cigarettes.
"What the scientists have discovered is it's not the nicotine that causes nearly all the deaths," Levy said. "It's all the other stuff in cigarettes that people inhale."
FDA regulation of e-cigarettes could pave the way to the devices becoming a more accepted form of nicotine replacement, Levy and DePalo said.
"The FDA has begun to look very seriously at an e-cigarette strategy," Levy said. "The FDA commissioner explicitly stated about two months ago that e-cigs will be a prime component of tobacco control strategies here on."
But DePalo worries that such a strategy might imply that continued nicotine addiction is acceptable compared to the hazards of smoking, unless more is done to help e-cigarette users eventually wean themselves off the devices.
"As a pulmonologist, the idea that tobacco could be outlawed is so appealing to me," DePalo said. "That's what we all want. The question is, would we be making a deal with the devil regarding e-cigarettes? If they were regulated by the FDA, maybe that deal is one we want to make."
The new study was published Oct. 2 in the journal Tobacco Control.More information
For more on quitting smoking, visit the U.S. Centers for Disease Control and Prevention.
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