The potential impact of a low-nitrosamine smokeless tobacco product on cigarette smoking in the United States: Estimates of a panel of experts

Levy, David T.; Mumford, Elizabeth A.; Cummings, K. Michael; Gilpin, Elizabeth A.; Giovino, Gary A.; Hyland, Andrew; Sweanor, David; Warner, Kenneth E.; Compton, Christine

doi:10.1016/j.addbeh.2005.09.010

Cited by 161 publications

(198 citation statements)

References 15 publications

Supporting

Mentioning

191

Contrasting

Unclassified

Order By: Relevance

“…elevation among users exclusively of snus, with much fewer and weaker general health effects, 14 is noteworthy. The relative excesses of cancer-specific death among snus users were generally of a similar magnitude as among smokers, whereas the excesses of deaths due to other causes tended to be lower.…”

Section: Epidemiologymentioning

confidence: 96%

“…Although snus is harmful, 13 there is general consensus that its overall adverse health effects are only a fraction of those attributed to smoking. 14 Given that nicotine effects might influence tumor progression and possibly interfere with antitumor treatment, [5][6][7][15][16][17][18] our study aimed to investigate associations of tobacco use, divided into smoking and snus use, with cancer survival. Therefore, fatality according to self-reported tobacco use among new cases with any cancer was studied within a large cohort of male construction workers.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Tobacco use and cancer survival: A cohort study of 40,230 Swedish male construction workers with incident cancer

Nordenvall

Nilsson

et al. 2012

Intl Journal of Cancer

View full text Add to dashboard Cite

On theoretical grounds, nicotine has been implicated as a modifier of cancer progression. We investigated possible associations of smoking or use of Scandinavian moist snuff (snus) with survival after cancer among Swedish male construction workers. Snus use is associated with substantial exposure to nicotine but not to the combustion products in smoke. Among 336,381 workers with detailed information on tobacco use in 1971-1992, we observed 40,230 incident cancers. Complete follow-up through 2007 was accomplished through linkage to population and health registers. Hazard ratios (HRs) and 95% confidence intervals (CIs) for death from any cause, cancer-specific death and death from other causes were derived from Cox proportional hazards regression models adjusted for age at diagnosis, body mass index at study entry and period of diagnosis. Never users of any tobacco served as reference. Increased risks of cancer-specific death were observed both among exclusive smokers (HR all cancer 1.15, 95% CI: 1.10-1.21) and never-smoking snus users (1.15, 95% CI: 1.05-1.26). As regards deaths due to other causes, exclusive smokers had higher relative risks than exclusive snus users (p 5 0.03). A history of tobacco use, even exclusive use of the seemingly benign snus, is associated with moderately increased cancer-specific mortality. Although nicotine might play a role, the mechanisms warrant further investigation.

show abstract

Section: Epidemiologymentioning

confidence: 96%

mentioning

confidence: 99%

Tobacco use and cancer survival: A cohort study of 40,230 Swedish male construction workers with incident cancer

Nordenvall

Nilsson

et al. 2012

Intl Journal of Cancer

View full text Add to dashboard Cite

show abstract

“…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 ). Thus, completely switching to the use of lower-TSNA smokeless products instead of smoking is seen by some public health researchers as a potential strategy to reduce harm in those smokers who are unable or unwilling to quit tobacco use ( Bates et al, 2003 ;Levy et al, 2004 ).…”

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

View full text Add to dashboard Cite

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

show abstract

“…In the past several years, a new concept has emerged. Responsible members of the tobacco control community support the idea of using "low nitrosamine" moist snuff as a substitute for cigarette smoking (109,110). The rationale for this is that moist snuff is demonstrably less carcinogenic in humans, and less toxic in other ways, than cigarette smoking, because it lacks the combustion products.…”

Section: The Second Re-emergence Of Smokeless Tobaccomentioning

confidence: 99%

Progress and Challenges in Selected Areas of Tobacco Carcinogenesis

Hecht

2007

Chem. Res. Toxicol.

260

242

View full text Add to dashboard Cite

Tobacco use continues to be a major cause of cancer in the developed world, and despite significant progress in this country in tobacco control, which is driving a decrease in cancer mortality, there are still over 1 billion smokers in the world. This perspective discusses some selected issues in tobacco carcinogenesis focusing on progress during the 20 years of publication of Chemical Research in Toxicology. The topics covered include metabolism and DNA modification by tobacco-specific nitrosamines, tobacco carcinogen biomarkers, an unidentified DNA ethylating agent in cigarette smoke, mutations in the K-RAS and p53 gene in tobacco-induced lung cancer and their possible relationship to specific carcinogens, secondhand smoke and lung cancer, emerging issues in smokeless tobacco use, and a conceptual model for understanding tobacco carcinogenesis. It is hoped that a better understanding of mechanisms of tobaccoinduced cancer will lead to new and useful approaches for the prevention of lung cancer and other cancers caused by tobacco use.

show abstract

The potential impact of a low-nitrosamine smokeless tobacco product on cigarette smoking in the United States: Estimates of a panel of experts

Cited by 161 publications

References 15 publications

Tobacco use and cancer survival: A cohort study of 40,230 Swedish male construction workers with incident cancer

Tobacco use and cancer survival: A cohort study of 40,230 Swedish male construction workers with incident cancer

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

Progress and Challenges in Selected Areas of Tobacco Carcinogenesis

Contact Info

Product

Resources

About