Snus and the risk of cancer of the mouth, lung, and pancreas
2007; Elsevier BV; Volume: 370; Issue: 9594 Linguagem: Inglês
10.1016/s0140-6736(07)61533-5
ISSN1474-547X
Autores Tópico(s)Smoking Behavior and Cessation
ResumoJuhua Luo and colleagues (June 16, p 2015)1Luo J Ye W Zendehdel K et al.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.Lancet. 2007; 370: 2015-2020Summary Full Text Full Text PDF Scopus (184) Google Scholar state: “Our study is at odds with the perception that use of Swedish moist snus has no demonstrable carcinogenic risk.” This statement is attributed to a publication of which I was the first author.2Rodu B Jansson C Smokeless tobacco and oral cancer: a review of the risks and determinants.Crit Rev Oral Biol Med. 2004; 15: 252-263Crossref PubMed Scopus (172) Google Scholar However, I wrote in that article that Swedish moist snuff is associated with no demonstrable risk of oral cancer. I am delighted to learn that Luo and colleagues agree, since their study “did not detect any excess risk for cancer of the oral cavity” among Swedish snus users.Their current study has two important ramifications for tobacco users, neither of which was discussed. First, Luo and colleagues excluded Swedish construction workers enrolled in their cohort from 1971 to 1975 because of “ambiguities” in questionnaire coding. This presents a challenge to the credibility of an earlier report by Bolinder and colleagues,3Bolinder G Alfredsson L Englund A de Faire U Smokeless tobacco use and increased cardiovascular mortality among Swedish construction workers.Am J Public Health. 1994; 84: 399-405Crossref PubMed Scopus (232) Google Scholar which stands almost alone in linking snus use with cardiovascular diseases. The Bolinder study involved only workers enrolled in the years excluded by Luo and colleagues (1971–74), and questions about its findings were raised shortly after its publication.4Rodu B Cole P Excess mortality in smokeless tobacco users not meaningful.Am J Public Health. 1995; 85: 118Crossref PubMed Scopus (5) Google Scholar Luo and colleagues should disclose more information about deficiencies in this cohort, and about the decision to restrict their analysis to workers enrolled from 1978 to 1992.Second, the study by Luo and colleagues has implications for cancer mortality patterns not only in Sweden, but in smoking-dominated societies. The table shows mortality rates for cancers of the oral cavity, lung, and pancreas in Luo and colleagues' study population according to tobacco use. No tobacco product is demonstrably safe, but these data show that snus use is 97% less harmful than smoking with respect to cancers of the oral cavity, lung, and pancreas.TableMortality rate*Deaths per 100 000 human-years. Data based on incidence rates from Luo and others1 and 5-year case-fatality rates: oral cavity (41%), lung (85%), and pancreas (95%) from US National Cancer Institute Surveillance, Epidemiology and End Results Program.5 for cancers of oral cavity, lung, and pancreas in Swedish male construction workers, according to tobacco useOral cavityLungPancreasAllNever-users1·37·33·712·3Current smokers2·870·012·485·2Current snus users1·15·18·414·6* Deaths per 100 000 human-years. Data based on incidence rates from Luo and others1Luo J Ye W Zendehdel K et al.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.Lancet. 2007; 370: 2015-2020Summary Full Text Full Text PDF Scopus (184) Google Scholar and 5-year case-fatality rates: oral cavity (41%), lung (85%), and pancreas (95%) from US National Cancer Institute Surveillance, Epidemiology and End Results Program.5US National Cancer Institute Surveillance, Epidmiology and End Results ProgramCancer Stat Fact Sheets.http://seer.cancer.gov/statfacts/Google Scholar Open table in a new tab My research is supported by unrestricted grants from smokeless tobacco manufacturers (US Smokeless Tobacco Company and Swedish Match AB) to the University of Louisville. The sponsors are unaware of this letter and had no scientific input or other influence with respect to its design or preparation. Juhua Luo and colleagues (June 16, p 2015)1Luo J Ye W Zendehdel K et al.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.Lancet. 2007; 370: 2015-2020Summary Full Text Full Text PDF Scopus (184) Google Scholar state: “Our study is at odds with the perception that use of Swedish moist snus has no demonstrable carcinogenic risk.” This statement is attributed to a publication of which I was the first author.2Rodu B Jansson C Smokeless tobacco and oral cancer: a review of the risks and determinants.Crit Rev Oral Biol Med. 2004; 15: 252-263Crossref PubMed Scopus (172) Google Scholar However, I wrote in that article that Swedish moist snuff is associated with no demonstrable risk of oral cancer. I am delighted to learn that Luo and colleagues agree, since their study “did not detect any excess risk for cancer of the oral cavity” among Swedish snus users. Their current study has two important ramifications for tobacco users, neither of which was discussed. First, Luo and colleagues excluded Swedish construction workers enrolled in their cohort from 1971 to 1975 because of “ambiguities” in questionnaire coding. This presents a challenge to the credibility of an earlier report by Bolinder and colleagues,3Bolinder G Alfredsson L Englund A de Faire U Smokeless tobacco use and increased cardiovascular mortality among Swedish construction workers.Am J Public Health. 1994; 84: 399-405Crossref PubMed Scopus (232) Google Scholar which stands almost alone in linking snus use with cardiovascular diseases. The Bolinder study involved only workers enrolled in the years excluded by Luo and colleagues (1971–74), and questions about its findings were raised shortly after its publication.4Rodu B Cole P Excess mortality in smokeless tobacco users not meaningful.Am J Public Health. 1995; 85: 118Crossref PubMed Scopus (5) Google Scholar Luo and colleagues should disclose more information about deficiencies in this cohort, and about the decision to restrict their analysis to workers enrolled from 1978 to 1992. Second, the study by Luo and colleagues has implications for cancer mortality patterns not only in Sweden, but in smoking-dominated societies. The table shows mortality rates for cancers of the oral cavity, lung, and pancreas in Luo and colleagues' study population according to tobacco use. No tobacco product is demonstrably safe, but these data show that snus use is 97% less harmful than smoking with respect to cancers of the oral cavity, lung, and pancreas. My research is supported by unrestricted grants from smokeless tobacco manufacturers (US Smokeless Tobacco Company and Swedish Match AB) to the University of Louisville. The sponsors are unaware of this letter and had no scientific input or other influence with respect to its design or preparation. Snus and the risk of cancer of the mouth, lung, and pancreas – Authors' replyWe apologise for misinterpreting the conclusion of the review paper by Brad Rodu and his colleague.1 Our impression was based on Rodu's explicit suggestion that the International Agency for Research on Cancer's classification of all smokeless tobacco products as carcinogenic to human beings, and the requirement to place warning labels on such products, might have been too broad. We are glad to learn that Rodu's standpoint is more moderated. A report showing similar urinary excretion of a biomarker of exposure to the carcinogenic tobacco-specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone in smokeless tobacco users and cigarette smokers2 underscores the need for caution. Full-Text PDF
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