reuters: Puff-free tobacco raises cancer risk

[rr0]

[I am an enthusiastic snus user, and wanted to share this because the article explicitly mentioned that tobacco users in Sweden were among the highest users in the world, along with the US and India. They researched the risks of snuff and "chewing" tobacco, but it is not clear to me if snus is considered chewing tobacco in the analysis.]

01 Jul 2008:

LONDON - Chewing tobacco and snuff are less dangerous than cigarettes but the smokeless products still raise the risk of oral cancer by 80 percent, the World Health Organization's cancer agency said on Tuesday.

The review of 11 studies worldwide showed people who chewed tobacco and used snuff also had a 60 percent higher risk of esophagus and pancreatic cancer.

The researchers sought to quantify the risk of smokeless tobacco after a number of studies differed on just how dangerous the products were, said Paolo Boffetta, an epidemiologist at the WHO's International Agency for Research on Cancer.

"What we did was try to quantify the burden of smokeless cancer," he said in a telephone interview. "This has never been attempted in such a systematic way before."

The researchers, who published their findings in Lancet Oncology, did this by looking at population-wide studies and trials of both humans and animals.

They found frequency of use varies greatly both across and within countries, depending on sex, age, ethnic origin and economic background, and were highest in the United States, Sweden and India.

They also found that while snuff and chew were less dangerous than smoking because they were not linked to lung cancer, getting cigarette users to switch was not good public policy.

"If all smokers did this there would be a net benefit," Boffetta said. "The point is we don't know whether this would happen and there is no data to suggest these smokers would stop or switch."

[MN_Snuser]

I am not a medical professional in any way shape or form. With that said, I have been reading up on this subject alot, probably more than I should be. Anyways, there seems to be 3 factions when it comes to the smokeless arena that I can tell so far:

1. The total abstainence crowd ie. no nicotene in any form what so ever. All tobacco is deadly and should be avoided.

2. The only use "low nitrosamine (tsna)" crowd which contends that that Swedish snus is only acceptable when it comes to "reduced risk" tobacco.

3. The any kind of western smokeless crowd that says American style smokeless and Swedish snus should both be considered as "reduced risk" tobacco.

I can tell you that historically, TSNA in all American and Swedish smokeless tobacco are down significantly, with Swedish snus being the lowest. Some contend that the TSNA in both products have dropped so much over the past 50 years that there is little difference between them. The difference being anywhere from 5 to 10 parts per million between Swedish and American smokeless.

Also, some of the oral cancer studies include users of smokeless tobacco from non-western countries, India, middle east, Asia, etc. The types of smokeless in these countries are very toxic, and have very high levels of TSNA, not even in the ballpark of smokeless from America and Sweden. I think this may distort some of the studies.

I am going back and forth between using snus and dip. I like the "bite" of American dip (copenhagen mostly), and I upper lip it, and after a couple of spits, I just swallow the juice for the remainder of the time I am dippin.

I love snus because of the ease of use, not spitting required, and very low TSNA. But it seems to lack the bite of American dip.

The preceeding comments represent my opionion only, I encourge all of you to read the various studies and make your own conclusions.

[Azrsuperstar]

Not a fun subject, but an important one nonetheless. Each and every one us snus users takes a risk when we in indulge ourselves with our favorite brand. I used snus to quit smoking, I have now gone 5 weeks without smoking. That is something that I could not accomplish with the patch, gum, and or pills. Either way, glad to here this section of the forum is not dead. I will be sure to post anything and everything I hear about snus and it's potential side effects.

[lxskllr]

MN_Snuser made an important observation about the different country's smokeless types. Without seeing the data that was collected, one can only assume that the non-western countries drove the average up across the board. I'm more concerned about gum recession than any kind of cancer tbh.

[KarlvB]

I've been able to track down only a summary. Bits relating to Sweden highlighted.

For more in-depth reading I would suggest these:

http://nzhta.chmeds.ac.nz/publicatio...ss_tobacco.pdf

(pp23 - 37)

http://ec.europa.eu/health/ph_risk/c...nihr_o_009.pdf

(pp75-77)

and

http://www.medscape.com/viewarticle/556437

Smokeless Tobacco Can Also Increase Cancer Risk
03 Jul 2008

A review published in The Lancet Oncology finds that although users of smokeless tobacco products (STPs) likely have a lower cancer risk than smokers, they are still increasing their risk of developing several types of cancer.

In the USA and Sweden, a finely cut or powered, flavored tobacco called moist snuff is the most popular form of STP used. In places like India, there is a wide range of products that are regularly consumed. These STPs contain over 30 carcinogenic (cancer-promoting) compounds, such as nitrosamines and metals. To investigate STPs and cancer risk, Dr Paolo Boffetta (International Agency for Research on Cancer (IARC), Lyon, France) and colleagues studied global STP use - both oral and nasal varieties - and the risk of cancer associated with them.

Researchers still lack conclusive evidence as to the risk of individual cancers due to STPs. For example, American and Asian studies have found a 2.5 times increase in oral cancer for STP users, but similar European studies were unable to find a significant increase in risk. Boffetta and colleagues performed an assessment of all studies and concluded that STPs lead to an 80% increase in risk of oral cancer, a 60% increase in risk of esophageal cancer, and a 60% increase in risk of pancreatic cancer. There also seem to be geographic differences in how these specific cancers are related to STP use. More than 50% of oral cancers in India and Sudan can be attributed to STPs specific to those countries, compared to only 4% of oral cancers in the USA. Sweden can blame 20% of esophageal and pancreatic cancer on STPs that are consumed there.

Lung cancer research has also resulted in inconsistencies across geographical areas. Studies from northern Europe have not found an increased lung cancer risk due to STPS, but research from the USA suggests an 80% increase in lung cancer risk for STP users.

One study included in the analysis assesses the change in cancer risk for two groups of men: one that quit smoking and switched to spit tobacco (switchers) and another that quit smoking and any tobacco use completely (quitters). Those who continued using tobacco, the switchers, had about a 2.5 times increase in risk of death from oral cavity and pharynx cancers than those who stopped using tobacco. The relative risk of lung cancer, compared to quitters, was 50% higher for switchers who used chew only, 90% higher for switchers who used snuff only, and 100% higher for switchers who changed to chew and snuff. The study also revealed that the quitters were four times as likely, and the switchers more than 5.5 times as likely, to develop lung cancer compared to men who never used tobacco products.

According to the authors, there is strong support from animal studies and research on cancer mechanisms that indicates an increase in cancer risk due to STPs. "We do not intend to address explicitly the use of smokeless tobacco to reduce the risk from tobacco smoking - e.g., by promoting smokers to switch to smokeless products or by introducing these products in a population where the habit is not prevalent. Nevertheless, several conclusions can be reached based on the available data...the risk of cancer, especially that of oral and lung cancer, is probably lower in smokeless tobacco users in the USA and northern Europe than in smokers, and the risk of cancer is higher in smokeless tobacco users than in non-users of any form of tobacco. Available data for a possible benefit of switching from smoking to smokeless tobacco come from few studies and models from the USA and Sweden. Comparative risk estimates depend on many assumptions, including the expected effect of the introduction of new smokeless products in populations where the habit has not been common," they conclude.

Smokeless tobacco and cancer
Paolo Boffetta, Stephen Hecht, Nigel Gray, Prakash Gupta, Kurt Straif
The Lancet Oncology (2008). 9(7): pp. 667-675.

http://www.ecancermedicalscience.com...f/news-222.pdf

[MN_Snuser]

Well I think that Sweden is pushing the envelope when it comes to lowering TSNA levels in smokeles tobacco. In my research, I have found that the American smokeless makers are recognizing this fact, and are doing everything they can to match Sweden, and producing "dip" with lower TSNA. I would like to think that this will benefit every user of western smokeless tobacco. That said, no tobacco product is without risks.

KarlvP: Great articles, thank you for posting them.

If anyone eles has come across any articles on this subject (smokeless, TSNA, oral cancer, etc.) please post a link. I love reading them, and it may be very helpful for the old-timers, and the newbies alike.

[ace]

Smokeless Tobacco Can Also Increase Cancer Risk
03 Jul 2008

...

cancers are related to STP use. More than 50% of oral cancers in India and Sudan can be attributed to STPs specific to those countries, compared to only 4% of oral cancers in the USA. Sweden can blame 20% of esophageal and pancreatic cancer on STPs that are consumed there.

...

Isn't it true that about 20% of the adult population of Sweden uses snus? That would mean that even if snus usage and esophageal cancer were statistically independent, you would still find that 20% of the adults contracting esophageal cancer were snus users.

Interestingly, I read somewhere that 3.4% of the adult population of the US uses smokeless tobacco.

[IndyGuy]

Interesting

I found this in one of the articles

If snus or other STP can provide some of the smokers who will not otherwise quit
smoking with a less hazardous source of nicotine that is acceptable to them, then the use
of snus as a harm reduction option deserves consideration (Bates et al. 2003, Fagerstrom
and Schildt 2003, Foulds et al. 2003, Kozlowski 2002, Tobacco Advisory Group of the
Royal College of Physicians 2002). If, on the other hand, the availability of snus has little
impact on smoking prevalence but adds further tobacco users to the existing population,
as appears to have occurred in Norway (chapter 3.3.3.2), there would be no benefit, but
an adverse impact on public health from allowing snus use.

As a person that has smoked most of his life, I found Swedish snuff a great solution to not smoking. I have tried to quit smoking for a long time. I have spent tons of money on Patches, Gums and other nicotine replacement stuff. They all have lead to one thing, smoking again.

I have done a lot of different research on the health effects of snus. I think what it really comes down to is that all nicotine products are addictive and not the greatest for your health. However, even in the US as they raise prices and everyone is aware of the health effects of smoking, the amount of smokers has stayed almost the same. People are going to us nicotine products period.

I think is up to an individual to decide what risk they are going to except. I feel that using snuff is a lot less dangerous then going to McDonalds once a week.

Just my humble opinion.

[DraculaViktor]

Let's level the playing field too on that. Take two people who have the same lifestyle and one will take a pris of snus a day, and the other will eat one big mac a day. Both do the exact same routine per day as well. I am pretty sure the Big Mac per day eater will suffer consequences while the one pris a day person will not have an issue probably never. Forget McDonalds for that matter, and have that person eat one steak everyday. That affects the health in a greater way than one pris a day. Anyone else agree with me? Trick is, try to get someone to do JUST ONE pris a day

[ace]

Smokeless Tobacco Can Also Increase Cancer Risk
03 Jul 2008

...

cancers are related to STP use. More than 50% of oral cancers in India and Sudan can be attributed to STPs specific to those countries, compared to only 4% of oral cancers in the USA. Sweden can blame 20% of esophageal and pancreatic cancer on STPs that are consumed there.

...

Isn't it true that about 20% of the adult population of Sweden uses snus? That would mean that even if snus usage and esophageal cancer were statistically independent, you would still find that 20% of the adults contracting esophageal cancer were snus users.

Interestingly, I read somewhere that 3.4% of the adult population of the US uses smokeless tobacco.

My wife just read my post and didn't understand it. And she has a PhD in probability theory. So clearly I did not explain myself very well, and I would like to try again.

Suppose a Swede gets elbow cancer. What is the probability he is a snus user? Well, elbow cancer obviously has nothing to do with snus, so the question is the same as, what is the chance that a randomly chosen Swedish adult is a snus user? The answer: 20%.

So what percentage of Swedes with elbow cancer are snus users? 20%.

And what percentage of Swedes with throat cancer are snus users? 20%, according to the article.

So this section of the article is basically saying nothing.

Similarly, they are saying nothing about American smokeless tobacco, since about 4% of adult Americans use it. The author of the article is saying nothing, but saying it in a way that makes it seem like Swedish tobacco not only causes throat cancer, but in fact causes 5 times as much throat cancer as American tobacco.

The moral of the story: beware of laypeople wielding statistics. Especially laypeople with an agenda.

[DraculaViktor]

Ace, well said sir. I agree 100%

[velinn]

The moral of the story: beware of laypeople wielding statistics. Especially laypeople with an agenda.

Absolutely. I swear there must be a "statistics manipulation" class taught in journalism, because they're masters of it.

In the other much touted Swedish study where they followed 100 or so people around, the thing that everyone fails to even bring up is that 3 people who did not smoke or use snus got cancer. All they say is that there is 2x the chance if you snus.

The fact remains that people DID develop cancer, snus or not. What they should be saying is that there is increased risk but that there is plenty of risk even without using any tobacco products at all. It's certainly not as if quitting cigarettes/snus magically makes you not a candidate for cancer as they'd like you to believe.

[numerrik]

Well how many people get oral cancer out of the blue without using tobacco? less than 1%. but for this argument lets say 1% of people get oral cancer naturally. 80% more than 1% is still less than 2%. besides, oral cancer isn't anywhere near as deadly as lung cancer. At least that's my two cents. besides, you can have oral surgery easily to remove the cancerous cells, lung surgery isn't as easy. right?

[velinn]

Right. You screw up your lungs, you're.. well, screwed. My grandmother is 84 and has been smoking cigarettes since she was 15. She's currrently on oxygen, which means she has a huge tank in her living room and walks around attached to an O2 hose at all times. She also has to take treatments 4 times a day.

Oral surgery to fix your gums or teeth, or even remove cancerous cells is a walk in the park compared to what she's currently going through. Cancer is obviously a terrible thing in any form, but oral cancer, if you were going to get one, is perferable by a long shot.

Also in that study I don't think they specified which kind of cancer the nonsmokers/snusers got, they just said they got cancer. Is that correct, because that's how I read it. Which is to say, you're at risk of cancer anyway, regardless of tobacco use. Prostate and colon cancer are on the rise for most US males.. I mean, if I'm at risk anyway just living my life, at least I can snus and enjoy it, eh?

[darkwing]

Depends on the type of oral cancer - my brother in law died a horrific death from a mouth cancer that spread. And he never used any tobacco of any kind, BTW.