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The 13th World Conference on Tobacco OR Health

Building capacity for a tobacco-free world

July 12-15, 2006, Washington, DC, USA

Friday, July 14, 2006 - 12:00 PM

Smokeless Tobacco, Swedish Snus, and Pancreatic Cancer

Megan Dann Fesinmeyer, MPH, School of Public Health and Community Medicine, Institute for Public Health Genetics, University of Washington, Box 357236, 1959 NE Pacific Avenue, Seattle, WA 98195

Objective: The health risks associated with tobacco vary according to the type of tobacco used. Swedish snus, a type of smokeless tobacco (ST) particularly low in carcinogens, has been advocated as a relatively safe product. Although snus and other STs present a lesser lung cancer risk than cigarettes, these products may carry serious, uncharacterized risks. We performed a literature review of studies investigating the association between all types of ST and pancreatic cancer, and identified knowledge gaps that could be targeted by future research.

Methods: We performed a literature search using PubMed from 1966 to 2005 and included published cohort and case-control human studies examining the association between ST (including snus) and pancreatic cancer risk. Four such studies from the United States and two from Norway were identified. In total, these six studies included 1,383 pancreatic cancer cases, although the two Norwegian cohorts shared some subjects.

Results: Three out of six studies found that use of ST increased pancreatic cancer risk, with statistically significant odds ratios ranging from 1.67 to 3.5, although adjustment for potential confounders (smoking, alcohol, age, race) varied. Definitions of ST also varied between studies, including products of differing toxicity such as snus, chewing tobacco, and inhaled snuff. ST exposure in study populations ranged from 1.3% to 19.7%. Much additional work is needed to clarify the association between ST and pancreatic cancer, to elucidate the ST-related etiology of the disease, and to develop strategies to reduce pancreatic cancer risk among tobacco users.