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Chewing Tobacco and Cancer

by | Mar 21, 2018

Chewing tobacco has been found to be linked with cancer, most commonly mouth cancer. There are two peer-reviewed primary research articles that support this health claim2,3. The first study collected data from The National Health and Nutrition Examination Survey (NHANES) from 1999-2012 about those using smokeless tobacco, cigarettes, or both2. Researchers analyzed the biomarkers of 23,684 NHANES participants, ages 20 and older2. The biomarkers were related to tobacco exposure and have health consequences, such as cancer2. These included cotinine, 4-(methylnitrosamino-1-(3-pyridyl-1-butanol (NNAL), N-Acetyl-S-(2-cyanoethyl)-L-cysteine (CYMA), lead, cadmium, mercury and arsenic2. Researchers concluded that concentrations of cotinine, lead, NNAL and CYMA were higher among smokeless tobacco users compared to cigarette smokers2. Researchers also concluded that concentrations of cotinine and NNAL increased over time with longer use2. Overall, this study concluded that smokeless tobacco contains cancer causing agents and users have significantly higher exposures to carcinogens and nicotine than cigarette smokers (p= 0.04)2.

The second study was a case-control study looking at the connection between long-term smokeless tobacco use and cancer3. There were 1,239 controls and 1,046 case subjects recruited from nine different medical facilities in the Greater Boston Metropolitan Area. Each subject was given a questionnaire and researchers analyzed the data. They found that subjects reporting ten or more years of smokeless tobacco use had a statistically significant increased risk of HNSCC compared to none users, with a 4.06 increased odds3. Additionally, researchers found that the increased risk of cancer was the same for the oral cavity, larynx and pharynx, and pharyngeal cancer risk increased with longer use3. Lastly, researchers concluded that when controlling for cigarette smoking, those who used smokeless tobacco as few as 20 times still had an increased risk of HNSCC, with 4.21 increased odds, and a statistically significant increased risk with increased duration (p=0.02)3.

References:

  1. Rostron, B. L., Chang, C. M., van Bemmel, D. M., Xia, Y., & Blount, B. C. (2015). Nicotine and Toxicant Exposure Among US Smokeless Tobacco Users: Results from 1999-2012 National Health and Nutrition Examination Survey Data. Cancer Epidemiology, Biomarkers & Prevention : A Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology, 24(12), 1829–1837. http://doi.org/10.1158/1055-9965.EPI-15-0376
  2. Zhou, J., Michaud, D. S., Langevin, S. M., McClean, M. D., Eliot, M., & Kelsey, K. T. (2013). SMOKELESS TOBACCO AND RISK OF HEAD AND NECK CANCER: EVIDENCE FROM A CASE-CONTROL STUDY IN NEW ENGLAND. International Journal of Cancer. Journal International Du Cancer, 132(8), 1911–1917. http://doi.org/10.1002/ijc.27839