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Published on: January 2, 2012
Smokeless tobacco and cancer
Paolo Boffetta1, Stephen Hecht, Nigel Gray
1International Agency for Research on Cancer, Lyon, France. boffetta@iarc.fr
The Lancet. Oncology
|July 5, 2008
Summary
Smokeless tobacco use is common globally and linked to increased oral, esophageal, and pancreatic cancer risks. While risks vary geographically, smokeless tobacco carcinogenicity is supported by animal studies.
Area of Science:
- Oncology
- Toxicology
- Epidemiology
Background:
- Smokeless tobacco product consumption is prevalent worldwide, with rising usage in numerous regions.
- Epidemiological studies indicate a significant association between smokeless tobacco use and elevated risks of certain cancers, though findings vary geographically.
- Smokeless tobacco contains carcinogenic nitrosamines, necessitating robust exposure assessment for understanding cancer development.
Purpose of the Study:
- To evaluate the global epidemiological evidence on the association between smokeless tobacco use and cancer.
- To quantify the attributable risk of smokeless tobacco use for specific cancers in different populations.
- To review the toxicological data and biomarker evidence supporting the carcinogenicity of smokeless tobacco products.
Main Methods:
- Systematic review and meta-analysis of epidemiological studies on smokeless tobacco and cancer.
- Analysis of cancer statistics to determine the proportion attributable to smokeless tobacco in specific countries.
- Review of animal carcinogenicity studies and biomarker data for exposure assessment.
Main Results:
- Epidemiological data from the USA and Asia show a 2.6-fold increased risk of oral cancer, but this is not confirmed in Northern European studies.
- Northern European studies indicate increased risks for esophageal (1.6-fold) and pancreatic cancers (1.6-fold).
- In India and Sudan, over 50% of oral cancers are linked to smokeless tobacco; in Swedish men, 20% of esophageal and pancreatic cancers are attributed to it.
Conclusions:
- Smokeless tobacco use is associated with increased risks of oral, esophageal, and pancreatic cancers, with significant geographical variations.
- While cancer risks for smokeless tobacco users are likely lower than for smokers, they are higher than for non-tobacco users.
- Biomarker development aids in quantifying exposure and modeling carcinogenesis, supported by strong animal carcinogenicity data.
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