BOSTON — The widely held belief that e-cigarettes do not pose a cancer threat may be wishful thinking, according to the results of a new pilot study that focuses on their potential impact on bladder cancer.

The small study showed that two known carcinogens, otoluidine and 2-naphthylamine, were found in the urine of e-cigarette users but not in nonusers.

"That's concerning because we know there are people who genetically susceptible to developing bladder cancer," said lead study author, Thomas Fuller, MD, a urologist at the University of Pittsburgh in Pennsylvania.

Traditional cigarette smoking is a major risk factor for bladder cancer. e-Cigarettes have gained popularity, in part because they are perceived as a safer alternative, he explained.

"No level of exposure to these carcinogens is without risk," Dr Fuller told Medscape Medical News after he discussed the study at press conference today at the American Urological Association (AUA) 2017 Annual Meeting. However, he also admitted that the clinical implication of the findings about otoluidine and 2-naphthylamine is unknown.

Previous studies of traditional cigarette smokers have identified otoluidine and 2-naphthylamine as the two most carcinogenic molecules for the bladder, Dr Fuller said.

In the new study, 12 of the 13 e-cigarette users whose urine was analyzed had both otoluidine and 2-naphthylamine detected (limits of detection were 100 ng/mL and 10 ng/mL, respectively). None of the 10 controls were positive for the compounds.

Specifically, among e-cigarette users, there were 2.3-fold mean concentration level increases for otoluidine (P = .0013) and a 1.3-fold increase for 2-naphthylamine (P = .014) compared with controls.

Notably, all study participants, when interviewed by investigators, said that e-cigarettes were "safe."

Dr Fuller also commented that, among traditional cigarette smokers, the urine levels of these molecules would be "greater."

The investigators examined study participants' urine for three other carcinogens — benz(a)anthracene, benzo(a)pyrene, and 1- hydroxypyrene — but found no significant findings for these molecules.

The study's e-cigarettes users were also ex-smokers of traditional cigarettes; they had a median of 20 years of use. Importantly, they had quit traditional cigarettes for a median of 15 months before the current study. And they had been using e-cigarettes for a median of 26 months. So, there was a period in the past in which most participants overlapped use of both forms of smoking.

Press conference moderator, Sam Chang, MD, a urologist from Vanderbilt University in Nashville, Tennessee, wondered whether there was a correlation between frequency of e-cigarette use and urine levels of the carcinogens.

Dr Fuller revealed that they could not assess that because most of the study participants (84.6%) used e-cigarettes more than 28 times a week (about four times a day). The study questionnaire had assumed that this four-times-a-day frequency would be the upper limit of use. But it turned out to be a lower limit. "We underestimated how often people are using these e-cigarettes," he said.

Bladder Cancer Research Is Just Starting

Dr Chang believes the study, despite its small size, is an important step in understanding e-cigarettes and their potential bladder cancer threat.

The new study reveals that problematic chemical molecules are "processed, end up in the urine, which end up sitting in the bladder, which inevitably will have some impact on the likelihood of the development of cancer," he said.

Dr Chang also repeated the importance of a slide shown by Dr Fuller depicting the skyrocketing e-cigarette use among middle school and high school students from 2013 to 2015, with a jump in users from about 8% to 25% of all students over that time.

As a father of three school-aged daughters, Dr Chang said the threat of e-cigarette use in their age groups is "scary, scary."

Dr Fuller acknowledged that research into e-cigarettes and their effect on the bladder lags behind research into their effect on the lungs.

"Maybe as a community, we [urologists] bought into the idea that this was going to be a much safer alternative because there is no combustion," he said.

Dr Fuller said that a next step for research is that the new results need confirmation in a larger study. And more carcinogens must be examined. The current study looked at only five molecules that are considered carcinogenic.

The new results conflict somewhat with the message from other recent research from the United Kingdom that suggests e-cigarettes are largely safe and certainly an improvement over traditional cigarettes.

As reported by Medscape Medical News, former smokers who only used e-cigarettes or nicotine replacement therapy were substantially less likely to be exposed to carcinogens and toxins than those who continue to smoke, according to a cross-sectional study that looked at urine and blood samples.

Dr Fuller and Dr Chang have disclosed no relevant financial relationships.

American Urological Association (AUA) 2017 Annual Meeting. Abstract MP88-14. Presented May 15, 2017.

Follow Medscape senior journalist Nick Mulcahy on Twitter: @MulcahyNick

For more from Medscape Oncology, follow us on Twitter: @MedscapeOnc</s>More than 15,000 cigarette butts have been collected from 23 cigarette waste recycling stations in downtown Oklahoma City. [Photo by Chris Landsberger, The Oklahoman] The Oklahoma House couldn't muster enough votes to raise the cigarette tax rate on Monday, potentially throwing budget talks into more of a tailspin.

Start the conversation, or Read more at NewsOK.com.</s>Youngstown City Council is being asked to approve an ordinance that would make the punishment for tossing a cigarette butt or spitting gum onto a city street or sidewalk the same as if you dump tires, or any other rubbish.

Council is being asked at this week's meeting to amend the city's litter ordinance, adding cigarette butts and gum to the list of items considered garbage, rubbish and junk.

Littering is considered a misdemeanor in Youngstown, punishable by up to six months incarceration and a fine of up to one thousand dollars or both.

Just last week the city announced that it intends to apply for a Keep America Beautiful Grant to fund the installation of cigarette disposal containers downtown.

The elongated box-shaped containers would be strapped to light poles around the city.

A portion of the grant application would include a list of downtown businesses, organizations, and residents who would support the concept.

Downtown Events and Citywide Special Projects Coordinator Michael McGiffin has emailed those entities asking them to pledge their support for the idea.</s>A firefighter in western Newfoundland says a grass fire in Little Rapids on Sunday evening was started by a cigarette butt thrown from a car driving on the Trans-Canada Highway.

Shawn Leamon, who's deputy fire chief with Steady Brook-Little Rapids fire department, got the call around 5 p.m. Sunday to tend to a fire in the small community. The fire was on a grass patch between the highway and Marble Drive, a main road in the community.

Leamon said after looking at the burn patterns, it's clear that the fire was started on the TCH side, and figures it came from a cigarette butt that was thrown from a vehicle on the highway.

"It's the only logical cause," said Leamon who adds that the weather had been extremely dry for a couple weeks before the day of the fire.

Leamon said he notices people throwing cigarette butts out of their vehicles quite often as a he drives from Little Rapids to Corner Brook.

"I see it quite regularly. People driving down the highway, and that lit cigarette butt."

He said thanks to quick reaction from someone driving by the scene, who called 911, the firefighters were able to handle the situation fast, but the wind was high, and the fire had already jumped over a small brook.

No butts about it

If the fire had spread across the street it could have threatened a local business, Rapid Power Motor Sports, and the merchandise parked outside, Leamon said.

"ATVs, snowmobiles, RVs, and campers and all kinds of different things — and they've all got gasoline and things into them."

Leamon said it was a senseless act of littering that caused the fire and people should think twice about throwing cigarette butts to the ground.

"We're only a year away from Fort McMurray fire — and, we don't need anything like that in our neighbourhood."</s>Farmers’ body FAIFA on Monday asked the government to have a taxation policy that disincentivises cigarette smuggling in India, ahead of a crucial meeting of the GST Council later this week. The Federation of All India Farmer Associations (FAIFA), a non-profit organisation representing farmers across states such as Andhra Pradesh, Telangana, Karnataka and Gujarat, said cigarette smuggling has hit tobacco farmers supplying to legitimate manufacturers in India. It urged Finance Minister Arun Jaitley “to protect the interests of Indian FCV tobacco farmers through balanced and uniform taxation under GST”. “We appeal to the government to have a taxation policy that disincentivises cigarette smuggling in India,” FAIFA General Secretary Murali Babu said in a statement.

He further said GST is an opportunity for the government to ensure illicit trade is eradicated from the country by removing distortions and address tobacco taxation in India.

It will bring back lost livelihood opportunities of the tobacco farmers, he added.

FAIFA said a steep increase in excise duty in the recent past has led to growth of smuggling of cigarettes in India due to the high tax arbitrage.

Illegal cigarette trade is more than 20 per cent of the cigarette industry in India, making the country the 4th largest and fastest growing illicit market in the world, it claimed.

It has resulted in revenue losses of approximately Rs 9,200 crore and is growing annually, it added.

A shift in consumption to smuggled cigarettes has affected Indian tobacco farmers adversely as the illegal cigarettes do not use Indian tobacco, FAIFA said.

The demand of the farmers’ body comes ahead of the meeting of the all-powerful GST Council to be held in Srinagar on May 18-19, where it is expected to give final nod to four rules and also fix GST rates for major commodities and services.

The four rules pertain to how input tax credit is to be calculated and claimed, valuation of supply of goods and services, method for intimation for opting for composition levy and transitional rules.

For all the latest India News, download Indian Express App now</s>Many smokers have turned to e-cigarettes and vapes as an alternative to traditional tobacco products.

A new study suggests that these products are not without risks of their own.

According to Dr. Donald Cross, Director of Cardiology of Baylor Scott & White Medical Center-Hillcrest, currently there is not much medical research on the effects.

"The e-cigarette is fairly new and scientifically we really don't know so we're starting to collect that data."

In a recent study from The Journal of the American Medical Association, they found habitual users of electronic cigarettes are more likely to show increased cardiovascular risks.

"The nicotine that's aerosolized in the e-cigarette may have some detrimental effects to the heart just like you get from the cigarette," Cross said. "If people are thinking the e-cigarette is something they are going to use lifelong because it's safe for them this research really brings this into question."

Many of the juices or liquids used in the e-cigarettes are offered with nicotine. The amount varies allowing users to cut down on their intake or eliminate it completely. Right now, Dr. Cross says that may be the most heart healthy choice.

"This study suggests more research needs to be done and we can't think that the e-cigarette is completely safe," he said.
A small study shows that two known carcinogens, o-toluidine and 2-naphthylamine, were found in greater amounts in the urine of e-cigarette users than in nonusers. Previous studies of traditional cigarette smokers have identified o-toluidine and 2-naphthylamine as the two most carcinogenic molecules for the bladder.