Snus lies and exaggerations?

**Jason** · 04-08-08, 09:48 AM

The lies never end....do these people bother to do any real research at all? :roll:

**ponysoprano** · 04-08-08, 10:01 AM

**The Mad Celt** · 04-08-08, 11:33 AM

Snus Health

It is healthier not to use ANY tobacco product; nonetheless, the current research shows that using snus is far safer than smoking and has much lower TSNA (cancer causing agent) levels than American chewing/dipping tobaccos. I quit smoking (two packs a day) using snus.

Cited studies on snus and health can be found at the following sites:

*European Smokeless Tobacco Council (ESTOC)
(http://estoc.org/estoc.asp)

*HighBeam Research
(http://www.highbeam.com/search.aspx?...f_id=ency_MALT)

*ESTOC (PDF Document) (http://estoc.org/Archive/PDF/Fact%20...ets6-15-07.pdf)

SnusOn!

**KarlvB** · 04-08-08, 04:21 PM

Hyperbole = yes

We do have to admit though that snus, despite being much safer than cigarettes, does carry some risk.....but I think the majority of us are prepared to live with that risk if it stops us from smoking...

The most recent article on the link between oral cancer and snus is this one "Risk of gastroesophageal cancer among smokers and users of Scandinavian moist snuff" Int. J. Cancer: 122, 1095–1099 (2008)

Unfortunately I do not have a link to a publicly available copy.

Below is the summary and discussion:

Although Scandinavian moist snuff (‘‘snus’’), no doubt, is a safer alternative to smoking, there is limited evidence against an association with gastroesophageal cancers. In a retrospective cohort study, we investigated esophageal and stomach cancer incidence among 336,381 male Swedish construction workers who provided information on tobacco smoking and snus habits within a health surveillance program between 1971 and 1993. Essentially complete follow-up through 2004 was accomplished through linkage to several nationwide registers. Multivariable Cox proportional hazards regression models estimated relative risks (RR) and 95% confidence intervals (CIs). Compared to never-users of any tobacco, smokers had increased risks for adenocarcinoma (RR 5 2.3, 95% CI 1.4–3.7) and squamous cell carcinoma (RR 5 5.2,95% CI 3.1–8.6) of the esophagus, as well as cardia (RR 5 2.1,
95% CI 1.5–3.0) and noncardia stomach (RR 5 1.3, 95% CI 1.2– 1.6) cancers. We also observed excess risks for esophageal squamous cell carcinoma (RR 5 3.5, 95% CI 1.6–7.6) and noncardia stomach cancer (RR 5 1.4, 95% CI 1.1–1.9) among snus users who had never smoked. Although confounding by unmeasured exposures, and some differential misclassification of smoking, might have inflated the associations, our study provides suggestive evidence for an independent carcinogenic effect of snus. © 2007 Wiley-Liss, Inc.

Discussion

This large retrospective cohort study with long and essentially complete follow-up confirms the well-established link between smoking and all major types of gastroesophageal cancer. It also provides new data suggestive of snus-associated carcinogenic risks. Although effectively confined to septuagenarians or older, never-smoking snus users overall had a statistically significant 40% excess risk of N-CSC compared to never-users of any tobacco. Although our data indicated that some differential misclassification of smoking status may have occurred at entry or during follow-up, despite several reports suggesting that exclusive snus users rarely take up smoking, this misclassification is an unlikely explanation for our finding. We found little evidence of any net protective effect of snus use through its presumed reduction of smoking dose—neither in the mixed population of smoking and nonsmoking workers, nor among workers who were reportedly ever-smokers at entry into the cohort. Never-smoking snus users, further, had a substantially increased risk of ESCC when compared to never-users of any tobacco, again not likely explained by differential misclassification of smoking status. There was a nonsignificant tendency for a lower risk of ESCC among smokers who also used snus, but the purported harm reduction by snus use did not impress overall.

Generally, adjustments for smoking variables in analyses that also included smokers changed the unadjusted relative risk estimate surprisingly little. The main reason is that the proportions who reported being or having been smokers at entry were almost identical among users (56.8%) and nonusers (57.8%) of snus. Hence, based on the smoking information obtained at entry, the scope for confounding was limited to the observed variation among smokers in regard to smoking dose, smoking status (current or exsmoker) and type of smoking tobacco. If this information would not correctly reflect the relevant smoking exposure status, either because of erroneous reporting at entry or due to subsequent changes in habits (differential or nondifferential), residual confounding by smoking might be a concern.

We did, indeed, note certain weaknesses of the smoking information collected in 1971–75. Nonsmokers were not required to actively negate smoking. Instead, they were instructed to simply skip the smoking questions. All cohort members without answers to these questions were coded as nonusers. Thus, the never-smoker category may have contained some smokers, who skipped the smoking questions for other reasons than nonuse. As nonsmokers were instructed to move directly to the snus questions, where absence of any response was likewise coded as nonuse, it is conceivable that of all who skipped the smoking questions the proportion of negligent smokers who skipped it inadequately was greater when both sets of questions were skipped than when the snus questions were answered in the affirmative. Consequently, it was suspected that the reference category of never-smoking nonusers
of snus may have contained more misclassified smokers than did the group classified as nonsmoking snus users. The sensitivity analysis using admittedly self-selected workers with 1 or several repeat visits did not support this suspicion, though.

None of the previous epidemiological studies on snus and esophageal cancer, 1 cohort study and 2 population-based casecontrol studies has shown any significant excess risks, but the point estimates for the relative risk, multivariately adjusted for smoking dose, were above unity in all, ranging between 1.24 and 1.4. Neither of the previous studies had sufficient power to analyze relative risk specifically for esophageal cancer in strata of never-smokers. This was true also for the 2 studies that addressed the association between snus use and risk of stomach cancer.

These studies, 1 population-based case-control study and 1 cohort study combined CSC and N-CSC, adjusted multivariately for smoking, and were both negative with RRs among ever-users, relative to never-users, of 0.9 and 1.1, respectively.

The observed departure from the proportional hazards assumption in our analyses pertaining to both esophageal and gastric cancer forced us to stratify our analyses by attained age (below and above age 70). This suggests effect modification by age. The RRs tended to be higher among workers who were older than 70, compared to those who were younger, consistent with a very long induction time. The oldest were also most exposed to snus from earlier parts of the 20th century. Such snus contained higher levels of carcinogenic TSNAs compared to the snus sold today.

Some additional important caveats need to be highlighted. First, the analyses of some cancer sites in strata of never-smokers were based on small numbers (1, 10 and 8 snus-exposed cases of EAC, ESCC and CSC, respectively). Whereas the relative risk of ESCC among never-smoking snus users was statistically significant with a lower confidence limit of 1.6, chance could still have played a role, particularly since multiple significance testing was done in this study. Second, the lack of information about several confounding factors needs careful consideration. While alcohol is a candidate confounding factor for associations of tobacco use with ESCC and possibly also with CSC and unavailability of alcohol information is serious limitation, the weak or absent of association of alcohol use with N-CSC22 makes such confounding unlikely.

Since there is meager information about lifestyle differences between never-smokers who use snus and those who do not use snus, confounding from other unmeasured exposure cannot be confidently ruled out. The restriction to male construction workers— although a possible threat to the generalizability of our findings— allays concerns about confounding by gender, socioeconomic status and occupational exposures. Confounding by dietary factors remains a viable possibility, though.
Although some uncertainty remains regarding the causality and the strength of the association as well as the generalizability to other populations than Swedish men, we conclude that at present, Scandinavian snus cannot be considered to be without a carcinogenic risk. © 2007 Wiley-Liss, Inc.

Then there is the Lancet article that discussed the increased risk of developing pancreatic cancer from snus. The Lancet article precedes the one above so they should both be read.

"Detailed information about tobacco smoking and snus use was obtained from 279897 male Swedish construction workers in 1978-92. Complete follow-up until end of 2004 was accomplished through links with population and health registers. To distinguish possible effects of snus from those of smoking, we fo-cused on 125576 workers who were reported to be never-smokers at entry. Adjusted relative risks were derived from Cox proportional hazards regression models.

60 cases of oral, 154 of lung, and 83 of pancreatic cancer were recorded in never-smokers. Snus use was independently associated with increased risk of pancreatic cancer (relative risk for ever-users of snus 2•0; 95 CI 1•2-3•3, compared with never-users of any tobacco), but was unrelated to incidence of oral (0•8, 95 CI 0•4-1•7) and lung cancer (0•8, 0•5-1•3).
Use of Swedish snus should be added to the list of tentative risk factors for pancreatic cancer. We were unable to confirm any excess of oral or lung cancer in snus users."

also

"They (the Lancet) found little difference in health adjusted life expectancy between smokers who quit all tobacco and smokers who switch to snus."

http://www.medicalnewstoday.com/articles/70389.php

I now hand over to Zero and Co to explain the stats....

**The Mad Celt** · 04-08-08, 07:11 PM

Well then...

That about settles it then, eh? SnusOn!

**sagedil** · 04-08-08, 08:47 PM

Yup, I'm gonna die some day. I hear it's practically guaranteed.

**Steel Blue 91** · 04-08-08, 11:22 PM