Together we will beat cancer

An e-cigarette

An e-cigarette

Five years ago you’d probably never heard of electronic cigarettes, or e-cigarettes. Now it seems you can’t open a newspaper – or go into a newsagent, supermarket or pharmacist – without seeing them advertised or on sale.

For smokers concerned about the toxic cocktail of cancer-causing substances in tobacco smoke, e-cigarettes – sometimes touted as a safer alternative to smoking – might initially sound like a Holy Grail. We’re determined to reduce the number of smoking-related cancers. If e-cigarettes can help reduce this toll, it’s crucial to public health that this avenue is properly explored to fully understand the benefits and risks of these devices.

There are widely differing responses to the replication of the act of smoking offered by e-cigarettes use, known as vaping. Some people see a unique opportunity to promote a mass switch to vaping that would avoid the massive health toll of smoking tobacco on the 1 in 5 adults smoking in the UK today. Others see e-cigarette as posing a great risk that would keep people too close to their cigarette habit, making a lapse back to smoking more likely.

Currently e-cigarettes are not regulated in the way that approved nicotine replacement therapies (NRT) such as patches and gum are. This means they haven’t undergone all the rigorous tests needed to ensure their safety and effectiveness.

We want to see ‘light touch’ regulation brought in, to ensure the products contents and delivery is monitored and consistent, they are not sold to under 18’s and that their marketing does not promote smoking itself.

The increasing popularity of e-cigarettes makes it crucial to answer questions about their impact – not just on the health of smokers who use them, but on non-smokers, ex-smokers, children and society as a whole.

That’s why we commissioned researchers at the University of Stirling to identify the unanswered questions and concerns around e-cigarettes, and look at the broader issue of tobacco ‘harm reduction’ – measures to reduce illness and death caused by tobacco use.

We’ve just published their report (pdf), and a summary has been published in the journal Tobacco Control). In this post, we’ll look in more detail at the questions and issues it raises.

What are e-cigarettes?

E-cigarettes look like real cigarettes and usually consist of a battery, a cartridge containing nicotine (the addictive ingredient in tobacco), a solution of propylene glycol or glycerine mixed with water, and an atomiser (a device that turns the nicotine solution into a fine mist or vapour).

When someone inhales on the e-cigarette the nicotine solution is heated and evaporates. Research shows the e-cigarette user inhales a ‘hit’ of nicotine as they would when inhaling smoke from a cigarette (although other research has questioned how effective some e-cigarettes are at nicotine delivery).

Cartridges are available in different concentrations of nicotine, and in various flavours such as apple, chocolate, coffee and mint. Most e-cigarettes have an LED at the tip which lights up when someone inhales, in a similar way to the lit tip of a cigarette.

Are they really ‘safer than cigarettes’?

While it’s the highly addictive nicotine that keeps smokers hooked, it’s the toxic cocktail of chemicals in tobacco smoke that kills half of all long-term users. Traditional tobacco cigarettes contain around 4000 different chemicals, including toxins like arsenic and radioactive polonium-210. Tobacco smoke has long been recognised as a carcinogen responsible for more than one in four UK cancer deaths, and the biggest single cause of cancer in the world.

The lack of tobacco in e-cigarettes means they are almost certainly much safer way of getting a nicotine hit than smoking cigarettes.

But there are still some questions about the safety of the chemicals that are in e-cigarettes, and the current lack of regulation means there’s no way of verifying what’s actually in them, especially with so many different companies now entering the market.

For example, we know little about the safety of the propylene glycol in many e-cigarettes. And nicotine itself can be toxic in very high doses. So there are questions about the safety of leakage from cartridges and refill bottles.

Research has found that some e-cigarettes contain chemicals other than nicotine and propylene glycol or glycerin. Tests on some e-cigarettes have found small amounts of nitrosamines, formaldehyde (both cancer-causing chemicals), acetaldehyde and acrolein (toxins) in the vapour or liquid. These are all chemicals found in tobacco smoke, at far higher levels.

Given reports of malfunctions, we‘d like to see these products regulated to help ensure that the mechanical components in the device are safe and reliable, and deliver consistent doses of controlled chemical contents.

Who uses e-cigarettes and why?

E-cigarette manufacturers aren’t yet allowed to market their products as quitting aids, as they haven’t been through the strict tests needed to see how effective they are.

Some research suggests that smokers are already using them to help give up and we want to see much more research to be sure if e-cigarettes could be useful in helping smokers quit (or cut down) smoking.

So we need to know more about how people use e-cigarettes, and why. For example:

  • How many people are using them to cut down their cigarette consumption, or to try to quit entirely?
  • Are people using e-cigarettes in combination with smoking, for example to ‘get round’ smoke free laws?
  • If so, what impact does such ‘dual use’ mean for their future attempts to quit? Are they more or less likely?
  • Are smokers who may have otherwise successfully conquered their nicotine addiction more likely to stay on e-cigarettes (and thus addicted to nicotine) long term, if they start using them?

More research to answer such questions is needed to understand the long-term impacts of using e-cigarettes.

Effects on tobacco smoking?

One of the effects of decades of legislation against tobacco is to make smoking less socially acceptable, as more people are aware of the health risks and it has become more difficult to smoke in public. But the UK’s smoke free legislation doesn’t cover e-cigarettes. So we also need to consider whether using e-cigarettes in places where tobacco smoking is now banned might make smoking more acceptable again.

Likewise, e-cigarettes aren’t covered by the UK’s ban on tobacco advertising. So e-cigarettes are marketed all over the place, and even promoted by celebrities and at celebrity events – techniques barred to the tobacco industry since 2003. It’s important to look at whether e-cigarettes could serve as a ‘gateway’ to smoking traditional cigarettes – by ex-smokers, non-smokers and, most importantly, children.

More than 200,000 under 16s start smoking in the UK every year, so protecting children from the dangers of smoking is a top priority for us. We need to find out more about whether e-cigarettes are attractive to children (particularly given the appealing flavourings and heavy advertising involving celebrities), and whether this will affect the number of children who subsequently take up smoking.

Tobacco industry involvement

Over the last few years, the tobacco industry has become heavily involved in selling e-cigarettes – a move that is seen by some as an ‘insurance policy’ against future potential losses in cigarette sales. This raises many issues around conflicts of interest and the role, if any, of the tobacco industry in public health.

The World Health Organisation’s Framework Convention on Tobacco Control (FCTC) is a global public health treaty set up to provide a united response to the tobacco epidemic. Part of the FCTC aims to prevent tobacco industry interference and there are concerns this will be weakened by the industry’s entry into the e-cigarette market and that this may simply be another tactic to keep profits high.

Next steps

Today’s report by Stirling University will help guide future research and ultimately answer questions about potential benefits and harms of e-cigarettes. A comprehensive report by the French Office for Smoking Prevention (OFT) has also just been published (pdf), which recommends a strict approach to marketing among other proposals.

In 2010, the Medicines and Healthcare Products Regulatory Agency (MHRA), which regulates all medicines and medical devices in the UK, asked for feedback on how to regulate new nicotine-containing products (including e-cigarettes).

We told them (response 1015 in this pdf) that we think such regulation will help address questions around the safety and effectiveness of e-cigarettes. The MHRA response to this consultation is expected imminently, along with results of the research they undertook to inform their decision.

Similarly, the National Institute for Health and Care Excellence (NICE) is due to publish new guidelines on tobacco harm reduction approaches to smoking, which may have implications for e-cigarettes. (Update: these guidelines are now published and do not include e-cigarettes.)

Quitting smoking is still the single most important thing smokers can do to for their health. We hope that the NICE guidance and the upcoming MHRA announcement will help provide smokers with the information and advice that they need to achieve this. And Cancer Research UK looks forward to working with others to deliver the research needed to inform the development of effective policies to support them.

11/06/13: this post was updated in response to the publication of NICE guidelines on tobacco harm reduction


Rose Anderson November 24, 2013

I smoked for 40 years and tried inhalors, and patches in an attempt to give smoking up. They did not work for me. Pure desperation, drove me to try vaping 9 weeks ago. I have’nt had the urge to smoke since. My smokers cough and chestiness disappeared in a matter of days. My sense of smell and taste has improved dramatically and I can walk up the hill to my home, without stopping to catch my breath. I feel fitter than I have felt for years and vaping has saved my life. I have gradually lowered the nicotine strenght I’m using and intend to wean myself down to zero nicotine, then hopefully I can give up vaping, before our government tax it beyond my budget, as they are bound to do eventually. I will never go back to smoking as I’m enjoying being healthy for the first time, in a long time. I’m a 60 year old woman who is grateful that vaping has allowed me to get that cigarette monkey off ny back, when other methods failed. If vaping is banned, then many smokers who want to quit, won’t because something that does work, has been taken away from them. Smoking is a legal proven killer, the goverment should be banning them, but they won,t, because they want the huge taxes they pull in from tobacco products. Hippocrites, pure and simole.

troy McGinley November 12, 2013

I ve been a smoker for almost 20 years. Ecig helped me quit. I was able to ween myself off tobacco with the ability to select the nicotine doses . Now I just vape.. I m Nicotine free .
I ve tried to quit smoking many times. Nothing worked. Quiting with Ecig was very easy.

Alan Beard November 9, 2013

Positive news stories and research studies are now quite a common occurrence (although lots of negative press also), what has been absent though has been Parliamentary debate at Westminster . This may be about to change as a number of MP are raising the subject eg Dr Sarah Wollaston in the Plain Packaging debate on 7/9/13 her position is highlighted in this excellent blog .CR_UK we have repeatedly asked you to re-examine your position , are you going to attempt to lead or just merely follow ?
I am afraid goodwill towards your organisation has either disappeared or is severely compromised by your illogical stance on e-cigs

Chris Knight November 4, 2013

OK, just read all the posts here and heres my humble and knowledgeable opinion.

I am 71 and started smoking when i was 8 years old. Thats 63 years i have smoked. And yes i am still alive.

One month ago, i tried a e cigarette whilst i was buying my twice weekly packet of 50 gramme rolling tobacco. I still have that packet, unopened and sat on my computer desk. I now only smoke e cigs and what a difference they have made to me. I still cough a little but only a fraction of what i used to. I breath much easier and my very eratic heart beat is rapidly stabalising to a modest 65 beats a minute.

My sense of taste and smell has improved dramatically and i sleep much better. I feel so much better all round and have become more active. AND I NO LONGER CRAVE FOR TOBACCO SMOKE.

Will i give up e cigs. Probably not, because after 63 years my body accepts nicotine. But i have given up smoking tobacco.

So folks, for me E cigs are the bees knees. Hey, the way i am starting to feel health wise now i may even receive the queens ( or kings) telegram in 29 years time.

Mike Waxman (@MikeWaxman1) November 3, 2013

I’ll try again….

I smoked from the age of 13. I am now 51. I have tried periodically over the years to give up, going cold turkey, using patches, hypnotherapy and prescribed zyban among other things. None have significantly worked.

I came across e-cigarettes during an discussion on an online forum in July 2012. Based on the independent, unrequested info, I searched and was surprised to find a huge market out there.

To cut a long story short, I bought a starter kit in August last year and, without putting myself under pressure to give up, started using it. Very quickly I smoked less ordinary cigarettes and in a matter of max 4 weeks, I found my 40-a-day habit cut to 3. In October of that year I smoked my last cigarette. I no longer liked the taste.

It is now just over 12 months since I had a cigarette. And it’s all thanks to an electronic cigarette. My partner who smoked the same, if not more, than me is exactly the same.

Both hardened smokers, I never for one second thought we would stop smoking. How wrong could I be.

We now no longer have night-time or morning coughing fits (there is no doubt it is healthier!), we don’t stink …and we have more money in our pockets.

If we could give up, anyone can. And anybody who tries to put a spoke in the wheels of this phenomenal invention can only have a hidden agenda. Shame on them!

Mike Waxman (@MikeWaxman1) November 3, 2013

Interesting – above post got through immediately …. yet my post explaining how 35+ year smoker has successfully given up through using e-cigs has still not made it.

Mike Waxman (@MikeWaxman1) November 3, 2013

Are posts here moderated? I’ve tried, now 3 times within last 24 hours, to post ….and nothing.

brainyfurball November 2, 2013

Alan: “ASH UK and CR UK could and should sort this out if they are to retain any future credibility and support from e-cig users/Vapers.”

Now read… . Yes the tide is turning.. “The unanswered questions” – well ASH have answered one of them. Go to the factsheet everyone and you will get a very pleasant surprise.

I cannot fathom the reason behind this. Could it be that the charities are in breach of the law by preventing something that benefits health for reasons other than heath reasons?

brainyfurball November 2, 2013

Marcy. So what if we do not know “how much nicotine” goes into an e cigarette. You really must try to keep up with scientific developments. I am no scientist but the information is so very easy to access if you cared to try. Nicotine, it is now being proposed, is probably only mildly addictive, and it is not nearly as toxic as first thought. How many of the millions of vapors can you identify as having given themselves nicotine poisoning – and I will give you another 10 years to answer because it will still be none.

The nonsense you hear about ‘nicotine’ is as scary as an x rated horror movie, and just about as realistic.

p mccullagh October 27, 2013

the big man is just out for him self does not care how he tramps on now some one has took away his diner plate and he cant take it they have coned us for years hope ecigs take over they cant do as much harm as fags

Gordon Beard (@GordonAlanBeard) October 24, 2013


I looked through your link , it certainly looks a well organised campaign group you have there, however without my wishing to cause arguments are you a grassroots organisation or are you funded by a larger organisation?.Whatever, your so called “scary” concerns are totally unfounded , responsible sellers batch test their e-liquid to ensure quality and samples tested and recorded. To make a comment of” not knowing whats in them ” is total nonsense typically its 3 or 4 nicotine, flavouring, PG /VG nothing more ALL products are well known and proven to be safe .

You are erring on the side of caution , I wonder to what purpose and what are you actually advocating . I cannot speak for everyone who has contributed to this thread but we probably have ALL tried ineffective NRT and decided it’s not for us . What actually is the case is that we have discovered an enjoyable and relatively safe alternative to tobacco cigarettes that scaremongers,do-gooders cannot or will not recognise . Alternatively as is the case of some smoking cessation services they are starting to become concerned for their funding and ultimately employment. This is evidenced by the rate of increase in e-cig use( I quote UK only) Aug 2012 =700,000 April 2013 1.3 m Aug 2013 2m , ecig use has overtaken NRT recently .

The main point of the thread .”.the unanswered questions”
have been repeatedly answered by the users but still await the next response from CRUK.. I commend any reader to read this excellent article from a non-smoking(or vaping) government administrator who is involved in The Institute for Government

dave knox October 23, 2013

@ marcy458
marcy I know perfectly well whats in my e – liquid because I mix it myself, in the uk as stated these liquids are covered by several consumer licenses that protect people from the kind of issue you are talking about,so to state we don’t know what chemicals are in e-liquid is a completely false statement picked up or copied from a propaganda statement read elsewhere if you did proper research on this subject maybe you could give more of a educated comment on it instead and understand it offense meant..but just do more research before commenting it would do wonders for your credibility.

DAVE KNOX October 22, 2013

why don’t the so called medical professionals ask me and millions of others like me who used to smoke cigarettes and have switched over to a safer alternative for health reasons? the e-cigarette is a consumer led and consumer driven phenomenon and with no cost to government ? e-cigarettes are saving lives all around the world plus creating business and innovation at the same time. all the medical councils will do if they succeed in banning or making them require a medicinal license would be to force them underground and create the biggest black market the world has ever that is a very scary prospect and one the fake cloners and dubious make money quick merchants are closely monitoring. in the u.k as they stand e-cigarettes are covered by several consumer licenses that work very well in protecting the user of e-cigarettes and nothing more should be required. I agree slap a 18 certificate on them and deny them to teens of impressionable age but actually I would prefer my son or daughter to try one of these than actual cigarettes and I suppose in the real world I would prefer them to be saints and try nothing but that very rarely happens amongst the youth of today.
i’m 63 now and after smoking for 50 years I think I have the knowledge and experience to talk on this matter since I switched to e-cigarettes my clothes my car my house my hair and skin don’t smell terrible any more and I finally realise the misery I caused through second hand smoke to my wife and friends and I am truly sorry for my thoughtlessness since I switched to the e-cigarette my breathing has improved drastically my blood oxygen has gone back to normal my taste has returned no wheezing no heartburn or acid reflux after three short months I feel better sleep better hell even my golf handicap came down to twelve my friends and family are over the moon and I have the satisfaction of knowing I will never smoke again this is a personal experience and one I’m sure is being mimicked all over the world so why don’t the medical people ask us for our opinion its free and doesn’t cost anything is it because they really believe that they know better? I don’t think so not on this subject. its time people woke up and smelt the coffee ( a nice e-cigarette flavour by the way) the e cigarette is here to stay and neither doom merchants /pharmaceuticals /tobacco companies /governments/medical councils or anybody else having a go are going to stop it ..the truth will out it always does