Ask the Expert

On Cancer: Are Electronic Cigarettes Safer to Use than Conventional Cigarettes?

By Andrea Peirce, BA, Writer/Editor  |  Monday, October 28, 2013
Pictured: Electronic Cigarette Electronic cigarettes are battery-powered vaporizers that deliver nicotine and other additives in an aerosol format. An LED light at the tip simulates burning tobacco.

Many smokers around the world are choosing electronic cigarettes (also known as e-cigarettes) in the belief that they are less damaging to their health. Millions of Americans have joined the trend since the tobacco-free devices were introduced domestically in 2007, with sales estimated to reach $1 billion this year.

Although they differ in shape and size, e-cigarettes basically all function in the same way. The user inhales through a mouthpiece, triggering a sensor that turns on a battery-powered heater. This action vaporizes liquid nicotine and activates a light at the tip.

The heater also vaporizes substances such as propylene glycol and glycerol to produce theatrical smoke similar to the white puff produced when exhaling tobacco cigarettes. Flavorings such as mint, chocolate, and bubblegum are often added.

Among the new users are many young people. The number that have tried e-cigarettes doubled from 2011 to 2012, according to the Centers for Disease Control, which estimates that a total of 1.78 million middle and high school children have experimented with the devices.

As the assistant director of Memorial Sloan Kettering’s Tobacco Cessation Program, Jack E. Burkhalter hears questions and concerns about the safety of e-cigarettes every day.

We asked him to help us sort through the mixed safety messages.

Many Unknowns

Dr. Burkhalter says he often hears smokers claim e-cigarettes must be healthier than conventional cigarettes because they do not contain tobacco. But e-cigarettes do contain a liquid form of nicotine, a highly addictive tobacco component that may cause changes in the developing brains of young people. And the consequences of long-term nicotine use in adults have not even been fully studied, Dr. Burkhalter explains.

“Another problem is that we have no way of knowing what’s in a given product,” Dr. Burkhalter says, as manufacturers and types of e-cigarettes vary widely. “There is no one product — so it is impossible to determine whether any given e-cigarette is in fact safer than a conventional one, or safer than another brand of e-cigarette.”

Most electronic cigarettes sold in the United States are imported from China, which does not regulate or standardize the products. Domestic e-cigarettes are not government regulated, either. As a result, users are left in the dark regarding how much nicotine or other substances they are inhaling.  

What those other substances might be is yet to be determined. While more research on the topic is needed, some studies indicate that e-cigarettes may contain a variety of chemicals, from suspected carcinogens to heavy metals and airway irritants.

Nor has much research been done to determine the health impact of inhaling e-cigarette vapors into the lungs.

“So while they may seem to be safer compared to tobacco cigarettes because they don’t contain tobacco and tobacco smoke, we can’t really quantify if that is the case,” Dr. Burkhalter says. “Overall, I hope for the best—but fear the worst.”

Questions of Safety to Others, and to Youth

I hope for the best but fear the worst. The issue of whether e-cigarettes are safe and actually help smokers quit is a problem we will have to grapple with until we have more evidence.

-Jack Burkhalter, Assistant Director, Tobacco Cessation Program

The health risks of secondhand exposure to tobacco smoke are well established. Still unclear, however, is the impact of secondhand vapor from e-cigarettes, Dr. Burkhalter says. “E-cigarette users may feel more at ease in smoking around others, including children — a decision based on their perception of reduced harm. Unfortunately, this perception isn’t supported with sound scientific data.”   

He also finds the rising numbers of young people trying electronic cigarettes very concerning because the devices might serve as gateway products to tobacco use. According to the CDC report, of the nearly 1.8 million middle and high school children who have tried e-cigarettes, an estimated 160,000 of them have never used conventional cigarettes.

Any exposure to nicotine can have harmful effects on the development of the body and brain in a young person, Dr. Burkhalter notes.

Regulators and Options for People Trying to Quit

“E-cigarettes have an allure, and it’s difficult at times to convince people that instead of turning to products that we still don’t know a lot about, we have evidence-based ones that, unlike the e-cigarette, have been approved by the Food and Drug Administration and have proven track records for enabling many people to break their addition to nicotine,” Dr. Burkhalter explains. 

In addition to nicotine replacement products such as chewing gum, lozenges, and skin patches designed to ease cravings, there is the nicotine inhalation system (such as the Nicotrol® Inhaler) — which he says is the closest in look and feel to the e-cigarette.

But what this prescription-only product doesn’t have is the benefit of styling in appealing shapes and colors, or the illusion, complete with visible vapor puffs, of smoking a cigarette. “Many of my patients won’t be seen with the Nicotrol Inhaler; marketing of the Food and Drug Administration–approved cessation products has not been as sophisticated and aggressive as those for e-cigarettes,” Dr. Burkhalter says.

What these FDA-approved nicotine replacement products do provide is definitive information about their ingredients, including how much nicotine they deliver. They represent tools to use along what is known as the “harm-reduction continuum,” with total abstinence on one end of the spectrum, the use of conventional tobacco cigarettes on the other, and products that offer less damaging alternatives at various points along the middle.

“If the FDA decides that it will start regulating the e-cigarette industry – a ruling on this is expected in the fall of 2013 – we will soon learn a lot more about what is contained in these devices and where they might fit along this harm-reduction continuum,” Dr. Burkhalter explains. Many countries with tobacco control policies are struggling to shape policies regarding safety and the appropriate use of e-cigarettes.

Meanwhile, research about e-cigarette use is under way at Memorial Sloan Kettering and elsewhere to take stock of how cancer patients use e-cigarettes, whether users are more likely to quit smoking tobacco cigarettes, what sorts of substances the products contain, and what the health risks of inhaling vaporized chemicals might be.


I find it interesting that you think the deleterious health effects of second-hand smoke are "well established." I assume you are a scientist as well as a physician. If so, do you think the EPA report on second-hand smoke was capably done? Thirty one studies which had to not only be combined in a meta-analysis to show a statistical effect (at the 0.1 level, by the way), but also had to be scaled in terms of quality by EPA prior to data aggregation. The largest study of them all, Garfinkel's study of second hand smoke among a million people found no effect. Furthermore, cigar and pipe smokers are obviously heavy second-hand smokers. Yet the original Surgeon General's report recommended cigarette smokers switch to pipes and cigars because their data (those in the Surgeon General's report) showed that pipe and cigar smokers have the same mortality rate as non-smokers.

Alan, according to Dr. Burkhalter, the statement is supported by findings of the Surgeon General’s Report on Health Consequences of Involuntary Exposure to Tobacco Smoke published in 2004, and subsequent research since then, which found secondhand smoke causes premature death and disease in children and in adults who do not smoke. Thank you for your comment.

Been cigarette free since March 2013. Have had head and neck cancer(tonsils and lymph nodes)in 2008-cured. Have had prostate cancer since Dec.20012, in remission.Urologist told me smokers are prone to bladder cancer so I quit smoking and took up E-cigarettes. Feeling better but only hope what I'm doing with the electronic cigarettes are safe to a degree.

E-cigarettes are handy at public functions, but I don't kid myself that they are "healthy" or even a good way to quit smoking.

thanks for your exposing such dangerous e- cigrate.

It's up to each person to make their own health decisions, and helping them with those decisions is important. It seems the best thing about E-ciggs is there is, I suspect, no second hand smoke to injure others. A step in the right direction.

Every time I want to light up, I just eat a bag of potato chips instead...

I quit smoking 3 months ago and have been smoking a vapouriser ever since and I have never felt healthier (aopart from before I started smoking in the first place, obviously) I don't get out of breath climbing stairs, my clothes and breath don't smell, I've lost the morning hacking and coughing session (don't miss that one bit) Anything doing this much good can't be a bad thing.
@ Hamza, the article isn't "exposing" anything, it is hypothesising, there is no scientific evidence to vindicate any claims that these devices are detremental to health !!

U have no idea how popular vapes are in
Middle school these days.

I took on smoking when I was 14 and never quit. I got pregnant at 18 and still didnt quit I was smoking a pack 1/2 a day. I took on smoking cause of stress. Now 22 pregnant with my second. And decided to quit for the pregnancy. So I starting vaping 2 months ago. And havent had a cigarette since. I never felt healthier. Vaping was the best decision I ever made.

Thats all i here people complaining about kids smoking e cigs well i remember when i was i middle school and you'll be surprised of the actual real amount of kids that smoke (the ones that dont tell no one) you statistics show the ones the admit to it not a real number at all. At least e cigs are a lil better and a lil goes a long way the kids gonna try stuff and smoke anyways at least there trying something less harmfull any way you put it e cig are less harmful than real cigs and thays what we trying to accomplish here y'all just looking for a problem when theres non evident i can speak for myself and they have saved my life no more coughing all day no more smokey clothes its a good thing and y'all trying to ruin it. Let it go

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