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That means we do not yet have the kind of long-term population data that definitively quantifies cancer risk the way we can for traditional cigarettes

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Airway inflammation The immune response to inhaled tobacco smoke leads to the recruitment of inflammatory cells, such as neutrophils, lymphocytes and alveolar macrophages [41]

Part of it is the product design

A potentially important factor is that case-control studies of association are susceptible to supporting associations based only on population stratification