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

ABSTRACT 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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    ABSTRACT: A growing body of scientific studies show that e-cigarettes may serve as an acceptable substitute for smoking tobacco cigarettes, thereby reducing or eliminating exposure to harmful elements in smoke. The success of e-cigarettes is such that sales of these products are rapidly gaining on traditional cigarettes. The rapidly evolving phenomenon is raising concerns for the health community, pharmaceutical industry, health regulators and state governments. Obviously, these products need to be adequately regulated, primarily to protect users. Depending on the form and intended scope, certain regulatory decisions may have diverse unintended consequences on public health and may face many different challenges. Ideally, before any regulations are enacted, the regulatory body will require sufficient scientific research to verify that a problem does exist, quantify the problem, explore all potential solutions including making no change at all, determine the possible consequences of each, and then select the solution that is best for public health. Here we present an overview on the existing and deeming regulatory decisions for electronic cigarettes. We challenge them, based on the mounting scientific evidence with the ultimate goal of proposing appropriate recommendations while minimizing potential unintended consequences of ill-informed regulation.
    Therapeutic Advances in Chronic Disease 03/2014; 5(2):50-61. DOI:10.1177/2040622314521271
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    • "Since my comprehensive review [17] appeared I became aware of two more recent publications providing major new findings, one on pancreatic cancer [19], the other on AMI [20], diseases which are particularly relevant to the debate concerning the safety or otherwise of snus. It was therefore felt important to update my review, taking into account not only these two papers, but also other recent publications on snus use and health, in order to determine the effect they had on the overall conclusions. "
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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.
    Harm Reduction Journal 12/2013; 10(1):36. DOI:10.1186/1477-7517-10-36 · 1.26 Impact Factor
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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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    ABSTRACT: Over the last 50years, the concept of tobacco harm reduction has been well established. It is now understood that nicotine itself is not very harmful and nicotine replacement therapy products have been widely used as an aid to quit, reduce to quit or temporarily abstain from smoking for many years. The popularity of the unlicensed electronic cigarette has increased despite an unknown risk profile and snus use in Sweden provides strong evidence in support of a harm reduction strategy. The regulatory environment around harm reduction has changed in the UK and is continuing to evolve across the globe. The need for more appealing, licensed nicotine products capable of competing with cigarettes sensorially, pharmacologically and behaviourally is considered by many to be the way forward. The significant positive impact on public health that could be gained from encouraging people to switch from cigarettes to licensed medicinal nicotine products cannot be ignored.
    Addictive behaviors 11/2013; 39(3). DOI:10.1016/j.addbeh.2013.11.002 · 2.76 Impact Factor
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