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Smokeless tobacco and cancer

Preparing chewing tobacco‘Smokeless tobacco’ is a very broad term that refers to over 30 different types of products. Smokeless tobacco products include chewed tobacco (‘dry chewing tobacco’) and sucked tobacco (‘moist oral tobacco’), rather than smoked tobacco in the form of cigarettes. There are some inhaled tobacco products (‘nasal snuff’), but these are less common in the UK.

Some people believe that smokeless tobacco is a harmless alternative to smoking cigarettes. But scientists have shown that many forms of smokeless tobacco increase your risk of mouth cancer and oesophageal (food pipe) cancer. They could also increase your risk of pancreatic cancer, liver cancer, and other conditions including gum disease and heart disease.

Different types of smokeless tobacco

Almost all types of smokeless tobacco can cause mouth cancer. But some types or brands can be more dangerous than others. This is because different products can have very different levels of cancer-causing chemicals.

Most smokeless tobacco products in the UK are used by South Asian communities. In these communities, dry chewing tobacco is often used as part of a ‘betel quid’ or ‘paan’. These consist of a mixture of betel nut (or areca nut), slaked lime and various herbs and spices, wrapped in a betel leaf.

Betel nut itself can cause cancer, so chewing betel quids can cause mouth cancer even if no tobacco is added.

What’s in smokeless tobacco?

Most types of smokeless tobacco contains at least 28 different chemicals that can cause cancer.

The worst of these are a group of chemicals called tobacco-specific nitrosamines, or TSNAs for short. Some smokeless tobacco brands can contain up to 100 times more TSNAs than any other product including cigarettes. People who use these brands can expose themselves to up to a thousand times more TSNAs than non-smokers.

As addictive as smoking

Smokeless tobacco contains as much, if not more, nicotine than smoked tobacco products do. So like cigarettes, it is highly addictive.

People who use smokeless tobacco absorb 3-4 times as much nicotine as smokers do. The nicotine is also absorbed more slowly and stays in the blood for a longer time.

Newer brands can be just as dangerous

Some smokeless tobacco companies claim that their products are now less harmful because they have lowered the levels of TSNAs, the main cancer-causing chemicals in smokeless tobacco.

There is some evidence that levels are falling, but not in all brands. So we cannot say that modern smokeless tobacco brands are getting safer until clearer regulations are put into place.

Can smokeless tobacco help me quit smoking?

The current medical advice is that you should not use smokeless tobacco to help you quit smoking. Smokeless tobacco can also cause cancer and is highly addictive.

You can increase the chances of successfully quitting smoking by getting professional help. Have a look at our Giving Up page for more advice.

What is snus?

Snus is a special type of smokeless tobacco that is used in Sweden. It is banned in most other countries in the EU. Snus is manufactured using a special process that considerably lowers the levels of TSNAs in the finished product. Because of this, snus may be less dangerous other types of smokeless tobacco.

And it is not clear if snus has any other health risks. For example, one study found that snus increases the risk of pancreatic cancer, but not mouth cancer. And it still contains nicotine so, like all other tobacco products, it is highly addictive.

It is possible that ‘snus’ could be used specifically to help hardcore smokers, who are unlikely to quit through other means, to stop smoking altogether. But before we suggest introducing it in to the UK, more research is needed to see if it would help hardcore smokers to quit. And we must examine other potential intended and unintended effects of introducing it in to the UK.

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Updated: 25 September 2009