Summary of the epidemiological evidence relating snus to health

PN Lee Statistics and Computing Ltd., Sutton, Surrey, UK.
Regulatory Toxicology and Pharmacology (Impact Factor: 2.03). 12/2010; 59(2):197-214. DOI: 10.1016/j.yrtph.2010.12.002
Source: PubMed


Interest in snus (Swedish-type moist snuff) as a smoking alternative has increased. This wide-ranging review summarizes evidence relating snus to health and to initiation and cessation of smoking. Meta-analyses are included. After smoking adjustment, snus is unassociated with cancer of the oropharynx (meta-analysis RR 0.97, 95% CI 0.68-1.37), oesophagus (1.10, 0.92-1.33), stomach (0.98, 0.82-1.17), pancreas (1.20, 0.66-2.20), lung (0.71, 0.66-0.76) or other sites, or with heart disease (1.01, 0.91-1.12) or stroke (1.05, 0.95-1.15). No clear associations are evident in never smokers, any possible risk from snus being much less than from smoking. "Snuff-dipper's lesion" does not predict oral cancer. Snus users have increased weight, but diabetes and chronic hypertension seem unaffected. Notwithstanding unconfirmed reports of associations with reduced birthweight, and some other conditions, the evidence provides scant support for any major adverse health effect of snus. Although some claims that snus reduces initiation or encourages quitting are unsoundly based, snus seems not to increase initiation, as indicated by few smokers using snus before starting and current snus use being unassociated with smoking in adults (the association in children probably being due to uncontrolled confounding), and there are no reports that snus discourages quitting.

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    • "Products that deliver nicotine without the smoke carry no more than 1% of the health risks of smoking [Phillips et al. 2006]. Decades of research on Swedish smokers who switched to snus (a type of moist snuff) showed no increased risk of any type of cancer, cardiovascular disease or lung disease [Lee, 2011]. Similarly, a review of 120 studies on NRT products found that NRT is associated with adverse effects that may be discomforting for the patient but are not life threatening [Mills et al. 2010]. "
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    • "The earlier review [17] briefly summarized evidence related to various aspects of non-neoplastic oral disease. Though there were some reports of increased risks of gingival disease [47] or of dental caries [48], more studies showed no effects on such diseases [49-52] and it was evident that any association of snus use with periodontal and gingival disease or with dental caries was not established. "
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    ABSTRACT: An earlier review summarized evidence relating use of snus (Swedish-type moist snuff) to health and to initiation and cessation of smoking. This update considers the effect recent publications on snus use and health have on the overall evidence. The additional evidence extends the list of neoplastic conditions unassociated with snus use (oropharynx, oesophagus, stomach, lung) to include colorectal cancer and acoustic neuroma, and further undermines the weakly-based argument that snus use increases the risk of pancreatic cancer, although there is a report of poorer cancer survival in users. It remains undemonstrated that "snuff-dipper's lesion" increases risk of oral cancer, and recent publications add to the evidence that snus use has no effect on periodontitis or dental caries. Although onset of acute myocardial infarction is not adversely associated with snus use, there is some evidence of an association with reduced survival. Whether this is a direct effect of snus use or a result of confounding by socioeconomic status or other factors requires further investigation, as does a report of an increased risk of heart failure in snus users. Even if some adverse health effects of snus use do exist, it remains clear that they are far less than those of smoking.
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    • "Observations from long-term snus use show little evidence, or inconsistent results, of increased cancer risk compared with non-tobacco users (Lewin et al., 1998; Luo et al., 2007; Schildt, Eriksson, Hardell, & Magnuson, 1998). Furthermore, a recent meta-analysis found no association between snus and cancer of the oropharynx , esophagus, stomach, pancreas, lung or other sites (Lee, 2011). For methodological and ethical reasons, little research has been done on the long-term health effects (including cancer) of nicotine in humans. "
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