The relative risks of a low-nitrosamine smokeless tobacco product compared with smoking cigarettes: Stimates of a panel of experts

Roswell Park Cancer Institute, Buffalo, New York, United States
Cancer Epidemiology Biomarkers & Prevention (Impact Factor: 4.13). 12/2004; 13(12):2035-42.
Source: PubMed


A nine-membered panel of experts was asked to determine expert opinions of mortality risks associated with use of low-nitrosamine smokeless tobacco (LN-SLT) marketed for oral use. A modified Delphi approach was employed. For total mortality, the estimated median relative risks for individual users of LN-SLT were 9% and 5% of the risk associated with smoking for those ages 35 to 49 and > or =50 years, respectively. Median mortality risks relative to smoking were estimated to be 2% to 3% for lung cancer, 10% for heart disease, and 15% to 30% for oral cancer. Although individual estimates often varied between 0% and 50%, most panel members were confident or very confident of their estimates by the last round of consultation. In comparison with smoking, experts perceive at least a 90% reduction in the relative risk of LN-SLT use. The risks of using LN-SLT products therefore should not be portrayed as comparable with those of smoking cigarettes as has been the practice of some governmental and public health authorities in the past. Importantly, the overall public health impact of LN-SLT will reflect use patterns, its marketing, and governmental regulation of tobacco products.

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    • "The low toxicity of Swedish snus is well recognized [7-9]. Consequently, there is general agreement that use of snus instead of cigarettes will be beneficial for the health of individual users. "
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    ABSTRACT: It is well known that Swedish men have lower tobacco-related mortality than men in other European countries, but there are questions that need further investigation to what extent this is related to the specific patterns of tobacco use in Sweden, where use of snus, the Swedish low-nitrosamine oral tobacco, dominates over smoking in men but not in women. The recent WHO Global Report: Mortality Attributable to Tobacco provides a unique set of estimates of the health burden of tobacco in all countries of the world in the year 2004, and these data can help elucidating the above-mentioned questions. For Sweden and all other European Union Member States mortality data for a number of tobacco-related causes of death were extracted from the WHO Report. The size of the mortality advantage for selected causes of death in different age groups of Swedish men compared to men of the same age in Europe as a whole was calculated in terms of ratios of death rates attributable to tobacco. Differences between age groups with respect to tobacco-related mortality were analyzed with respect to differences in terms of development and status of smoking and snus use. The analyses also paid attention to differences between countries regarding tobacco control regulations. Among men in the European Union Member States the lowest level of mortality attributable to tobacco was consistently found in Sweden, while Swedish women showed levels similar to European average. A strong co-variation was found between the mortality advantage and the degree of dominance of snus use in the different age groups of Swedish men. Among Swedish women there are no age groups with dominant use of snus, and similar observations were therefore not possible for women. The above findings support the assumption that the widespread use of snus instead of cigarettes among Swedish men may be a major part of the explanation behind their position with Europe’s lowest mortality attributable to tobacco.
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    • "In addition, use of snus in Sweden has been associated in some studies with the reduction in smoking and has been used for smoking cessation (Ramström & Foulds, 2006; Stegmayr, Eliasson, & Rodu, 2005; Stenbeck, Hagquist, & Rosen, 2009). Therefore, encouraging smokers to switch to these novel smokeless products is seen by some as a potential harm-reduction strategy (Bates et al., 2003; Levy et al., 2004; Savitz, Meyer, Tanzer, Mirvish, & Lewin, 2006). On the other hand, potential negative consequences include dual use of smokeless products and cigarettes, recruitment of new smokeless tobacco users, and maintenance of tobacco use in current smokers (Accortt, Waterbor, Beall, & Howard, 2002; Hatsukami, Lemmonds, & Tomar, 2004; Severson, Forrester, & Biglan, 2007; Teo et al., 2006; Tomar, 2003). "
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    ABSTRACT: Introduction: Analysis of novel smokeless tobacco products purchased in Round I of the New Product Watch (NPW)-a national tobacco monitoring network-demonstrated that some tobacco constituents vary not only across various brands but also regionally and over time within the same product. In this study, we analyzed snus and dissolvable tobacco products that were purchased in Round II of the NPW. Methods: We analyzed tobacco-specific N-nitrosamines (TSNA) and nicotine in snus and dissolvable tobacco products that were purchased in various regions of the country during the spring and summer of 2011. The results were compared against the Round I data, across different U.S. regions, and among products. Results: A total of 216 samples were received from different states representing 6 regions of the country. Compared with the previous analyses, TSNA levels increased significantly in Marlboro and Camel Snus and some dissolvable Camel products. The levels of unprotonated nicotine in Marlboro Snus and Camel Snus in this study were not different from Round I but varied significantly by regions; the differences between the highest and the lowest average regional levels were ~3.2-fold in Marlboro Snus ~1.7-fold in Camel Snus. Conclusions: Our results indicate that some novel smokeless tobacco products contain TSNA at the levels found in the conventional moist snuff. Observation of regional variations in unprotonated nicotine content in both Round I and Round II of NPW suggest that manufacturers may tailor the levels of this constituent consistently to different regions.
    Full-text · Article · Aug 2014 · Nicotine & Tobacco Research
    • "No risk increase for oral cancer was shown with smokeless tobacco use in the Nordic countries.[10] In the UK and Europe (with the notable exception of Sweden) the use of smokeless tobacco is rare except in minority ethnic groups.[11] In the USA, it is a major problem with 6% of the adult male population as regular users.[12] "
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    ABSTRACT: Snus (nass) is a form of snuff used in a similar manner to American dipping tobacco, but it does not typically result in a need for spitting. Possible hazards associated with this material include malignant and premalignant lesions in the oral cavity and gastrointestinal tract. The use of smokeless tobacco has increased in the Middle East in recent decades, particularly among teenagers and young adults. Therefore, practitioners must be able to recognize malignant and premalignant lesions. Although, an estimated 10-25% of the world's population uses smokeless tobacco, this practice is virtually unknown in Iran. The aim of this study is to report a series of cases of squamous cell carcinoma and verrucous carcinoma occurring in the users of snus, who referred to the Department of Oral Medicine in Kerman Dental School.
    No preview · Article · Apr 2013 · Dental research journal
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