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The mechanisms primarily include the activation of oxidative stress-related signalling pathways (such as NF-B and MAPK), oncogenes, inactivation of tumour suppressor genes, mutations in repair genes, and microsatellite instability [114,115,116]

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E-cigarette flavor restrictions have the opposite effect of pushing many people towards more harmful tobacco. In the study, Pesko also found that in Maryland, a state with a policy that exempted menthol-flavored e-cigarettes from a ban on other flavors, both vaping and smoking rates decreased, showing that a more nuanced approach to regulation might be the best way to tackle public health issues

For individuals smoking two packs or more daily, the risk rises dramatically, reaching 15 to 30 times higher