Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study

Luo, Juhua; Ye, Weimin; Zendehdel, Kazem; Adami, Johanna; Adami, Hans‐Olov; Boffetta, Paolo; Nyrén, Olof

doi:10.1016/s0140-6736(07)60678-3

Cited by 200 publications

(229 citation statements)

References 34 publications

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“…For example, cigarette smoking delivers a mix of over 5,000 chemicals directly to the lung and is associated with the risk of developing a wide range of cancers, with lung cancer being the highest risk ( International Agency for Research on Cancer, 2004 ). On the other hand, oral use of some smokeless tobacco products that are free of the many combustion products present in cigarette smoke and also contain relatively lower levels of a major group of tobacco carcinogens, the tobacco-specifi c N -nitrosamines (TSNA s ), was reported to be associated with a much lower risk of developing cancer ( Greer, 2011 ;Luo et al, 2007 ). The importance of TSNA content is based on the existing strong evidence supporting their role in causation of cancers of the lung, pancreas, oral cavity, and esophagus in smokers and oral cavity and pancreas in smokeless tobacco users ( Bartsch & Spiegelhalder, 1996 ;Hecht, 1998 ;Hecht & Hoffmann, 1988 ;Magee, 1996 ;Preston-Martin & Correa, 1989 ) and the relationship between amount of exposure to TSNAs and cancer risk ( Church et al, 2009 ;Yuan et al, 2009 ).…”

Section: Nicotine and Tsna In Snus Pouchesmentioning

confidence: 99%

Increased Pouch Sizes and Resulting Changes in the Amounts of Nicotine and Tobacco-Specific N-Nitrosamines in Single Pouches of Camel Snus and Marlboro Snus

Stepanov

Jensen

Biener

et al. 2012

Nicotine & Tobacco Research

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Introduction: Initial analyses of the novel smokeless tobacco products Camel Snus and Marlboro Snus demonstrated that these products contain relatively low amounts of nicotine and the carcinogenic tobacco-specifi c nitrosamines N' -nitrosonornicotine (NNN) and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), as compared with traditional smokeless products. It is unknown whether the modifi cations in packaging, fl avors, and pouch sizes that occurred for both Camel Snus and Marlboro Snus since their fi rst introduction to the market were accompanied by any changes in nicotine or nitrosamine levels. Methods:We examined the available data on nicotine and NNN and NNK levels in 60 samples of Camel Snus and 87 samples of Marlboro Snus that were analyzed in our laboratory between 2006 and 2010.Results: Due to the increase in pouch size, the amounts of total nicotine, unprotonated nicotine, and the sum of NNN and NNK present in the large Camel Snus pouches released in 2010 are 1.9-fold, 2.4-fold, and 3.3-fold higher, respectively, than in the original smaller pouches that entered the market in 2006. Total and unprotonated nicotine content in the current version of Marlboro Snus pouches are 2.1-fold and 1.9-fold higher, respectively, and the sum of NNN and NNK is 1.5-fold lower than in the original version. Conclusions:We observed an increase in nicotine content in single portions of Camel Snus and Marlboro Snus, and an increase in tobacco-specific N -nitrosamine content in single portions of Camel Snus, due to the increases in pouch size that occurred between 2006 and 2010. This fi nding stresses the importance of tobacco product regulation and ingredient disclosures. Brief Report

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Section: Nicotine and Tsna In Snus Pouchesmentioning

confidence: 99%

Increased Pouch Sizes and Resulting Changes in the Amounts of Nicotine and Tobacco-Specific N-Nitrosamines in Single Pouches of Camel Snus and Marlboro Snus

Stepanov

Jensen

Biener

et al. 2012

Nicotine & Tobacco Research

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“…We could however not verify any premalignant mucosal changes in the stomach. A retrospective cohort study showed that snus use was associated with increased risk of pancreatic cancer as was also cigarette smoking [39]. A Swedish review on the possible harmful effects of snus use found that the carcinogenic effect is probably due to the content of tobacco specific nitrosamines [40].…”

Section: Helicobacter Pylori and Serology 16mentioning

confidence: 99%

Use of tobacco products and gastrointestinal morbidity: an endoscopic population-based study (the Kalixanda study)

et al. 2010

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There is little knowledge regarding the relationship between gastrointestinal symptoms and snus. The nicotine intake is usually higher than in smokers, and a great deal of tobacco juice contaminated saliva is swallowed during use. In a Swedish cross-sectional study of symptoms in 130,000 construction workers, smokers reported "ulcer-like" dyspepsia three times as often 5 as the non tobacco users, while snus users reported significantly fewer symptoms than both smokers and non tobacco users [10].It has been shown both in studies on patients and in population-based studies that smoking is a risk factor for peptic ulcer disease (PUD) [8,11], but there are no data concerning snus on this issue. Data from the US show that cigarette smokers have a markedly increased risk for gastric cancer and that use of more than one tobacco product increases the risk in men [12].Male users of smokeless or chewing tobacco have also been shown in US prospective studies to have higher death rates from all causes compared with non-users (CPS-I and II studies) and also higher death rates from cancer of the gastrointestinal tract overall (CPS-I study), but separate data on the upper gastrointestinal tract were not shown [13].Although there is extensive exposure to swallowed tobacco juice contaminated saliva, and high serum levels of nicotine and nitrites, there have been no studies in terms of oesophageal or gastric histology or Helicobacter pylori infection in snus users.The aim of the study was to investigate whether smoking cigarettes and snus use are associated with gastrointestinal symptomatology, macroscopic findings on endoscopy or histological signs of inflammation or cancer risk markers in the esophagus or stomach, including the prevalence of Helicobacter pylori. MATERIALS AND METHODS SettingThe Kalixanda study setting consisted of two neighbouring communities in Northern Sweden (Kalix and Haparanda) with 28,988 inhabitants (December 1998). The distribution of age and sex was similar to the national average in Sweden in both communities; although proportion of unemployment, income, and the proportion with a higher education were slightly lower [14]. ParticipantsBy using the computerized national population register, covering all citizens in the two communities by date of birth order, a representative stratified sample was generated. Every seventh adult (n=3,000) from the target population (18-80 years of age, n=21,610 in September 1998) was drawn. The sampled subjects were given an identification number (1-3,000) in a random order [14]. Study design and logisticsThe original study population (n=3,000) was invited by mail to take part. The invitation included information of the study design and of the aims of the study and a validated questionnaire, the Abdominal Symptom Questionnaire (ASQ) to be returned by mail [15]. Up to two remainders were sent when necessary; 140 subjects were unavailable at the time for invitation, thus 2,860 of the original study population were eligible for inclusion [14]. The overall response rate was 7...

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“…Several Swedish case-control studies concluded that there was no significant association between use of snus and head and neck cancer, [5][6][7] while a significant excess risk of pancreatic cancer was reported from 2 recent cohort studies. 8,9 Moreover a moderately increased all-cause mortality was observed among snus-using male construction workers. 10 We aimed to quantify cancer incidence among male snus users, and to shed light on the net health outcome by studying their overall and disease group-specific mortality.…”

mentioning

confidence: 96%

Cancer and mortality among users and nonusers of snus

Roosaar

Johansson

Sandborgh‐Englund

et al. 2008

Intl Journal of Cancer

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Scandinavian moist snuff (snus) is claimed to be a safer alternative to smoking. We aimed to quantify cancer incidence among male snus users and to shed light on the net health outcome by studying their overall mortality. A cohort, comprised of 9,976 men who participated in a population-based survey, was compiled in 1973-74. Follow-up until January 31, 2002, was accomplished through record-linkages with nation-wide and essentially complete registers of demographics, cancer and causes of deaths. Adjusted relative risks among exposed relative to unexposed men were estimated using Cox proportional hazards regression. The cohort members contributed more than 220,000 person-years at risk for cancer. A statistically significant increase in the incidence of the combined category of oral and pharyngeal cancer among daily users of snus (incidence rate ratio 3.1, 95% confidence interval 1.5-6.6) was found. Overall mortality was also slightly increased (hazard ratio 1.10, 95% confidence interval 1.01-1.21). Although the combined previous literature on snus and oral cancer weigh toward no association, this population-based prospective study provided suggestive evidence of snus-related risks that cannot be lightly ignored.

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Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study

Cited by 200 publications

References 34 publications

Increased Pouch Sizes and Resulting Changes in the Amounts of Nicotine and Tobacco-Specific N-Nitrosamines in Single Pouches of Camel Snus and Marlboro Snus

Increased Pouch Sizes and Resulting Changes in the Amounts of Nicotine and Tobacco-Specific N-Nitrosamines in Single Pouches of Camel Snus and Marlboro Snus

Use of tobacco products and gastrointestinal morbidity: an endoscopic population-based study (the Kalixanda study)

Cancer and mortality among users and nonusers of snus

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