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E-cigarettes: an evidence update <br /> <br />76 <br />10. Safety of e-cigarettes in the light of new <br />evidence <br />Introduction <br />PHE commissioned a review of EC in 2014, which covered EC safety [131]. The review <br />found that the hazard associated with use of EC products currently on the market “is <br />likely to be extremely low, and certainly much lower than smoking” and “the health risks <br />of passive exposure to electronic cigarette vapour are likely to be extremely low”. <br /> <br />These conclusions tally with a review by an international team of experts, which <br />estimated the risks of vaping at less than 5% of the risks of smoking [10] and a <br />comprehensive review of relevant literature by another international team which <br />concluded that “EC aerosol can contain some of the toxicants present in tobacco <br />smoke, but at levels which are much lower. Long-term health effects of EC use are <br />unknown but compared with cigarettes, EC are likely to be much less, if at all, harmful to <br />users or bystanders” [132]. <br /> <br />Over the past few months, however, several reports have suggested that EC may pose <br />more risks than previously thought [133-137]. <br /> <br />We were asked to review these studies to see if in the light of this new evidence, the <br />conclusions of the PHE 2014 review need to be adjusted. We present below the details <br />of these studies together with any additional data that may assist with their <br />interpretation. <br /> <br />Aldehydes in vapour from e-cigarettes <br />Two recent reports raised a possibility that under certain conditions, EC may release <br />high levels of aldehydes. Aldehydes, including formaldehyde, acrolein and <br />acetaldehyde, are released in tobacco smoke and contribute to its toxicity. Aldehydes <br />are also released with thermal degradation of propylene glycol and glycerol in e -liquids. <br />Previous studies detected the presence of aldehydes, especially formaldehyde, in the <br />vapour from some EC, but at levels much lower than in cigarette smoke [138]. Across <br />brands, EC released 1/50th of the level of formaldehyde released by cigarettes. The <br />highest level detected was six times lower than the level in cigarette smoke [138]. <br /> <br />In November 2014, following a press release from Japan [136], major media around the <br />world reported variations of a headline: “E-cigarettes contain 10 times the carcinogens <br />of regular tobacco”. This was based on a Japanese researcher reporting at a press <br />conference that during tests on a number of EC brands, one product was identified