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Increased cancer risk: Snus use has tripled in Norway

Snus is a moist powder tobacco product originating from a variant of dry snuff from early 18th century Sweden. (Photograph: Andreas Argirakis/Shutterstock)

Wed. 17 December 2014


OSLO, Norway: It has been known for a long time that the consumption of snus endangers oral health. According to a new report by the Norwegian Institute of Public Health, the use of this tobacco, which can cause oral cancer, has tripled in the country over the past five years. Even nicotine-free snus is not a healthy alternative. In 2012, Swedish researchers found that some types of snus contain carbohydrates and starch, which increases the risk of caries.

Scandinavian snus is a smokeless, ground tobacco product that is held between the lip and gums. It is sold as a loose product or as portions supplied in small pouches. Although the sale of snus is illegal in the European Union, some countries are exempt from this law.

According to the report, the increase in Scandinavian snus consumption in Norway is the highest among young people. “The sharp increase in snus use among adolescents and young adults could almost be described as an epidemic. There is nothing to suggest that the increase will stop,” said Prof. Jan Alexander, Deputy Director-General at the Norwegian Institute of Public Health.

Alexander led the working group that was commissioned by the Norwegian Ministry of Health and Care Services to evaluate the health risks of snus consumption.

Over the last five years, the importation of snus and other smokeless tobacco has tripled. In 2009, Norway imported about 602 metric tons, but by 2013 this amount had tripled to 1815 metric tons. In addition to the official import statistics provided by Statistics Norway, there is probably additional significant private imports from traders along the border.

The 2013 figures show that 19 per cent of men and 7 per cent of women use snus daily or occasionally. In the 16–24 age group, 33 per cent of men and 23 per cent of women use snus. For men aged between 16 and 24, there is almost a snus ‘epidemic’, since usage has increased five-fold over the past 10 to 14 years.

Not all pregnant women quit snus use

Approximately 20 per cent of women who use snus seem to continue after they fall pregnant. However, this percentage is based on figures from before 2009 when snus was less popular among young women.

There is no obvious link between the decline in smoking and the increased use of snus. For example, there is a corresponding decline in smoking in countries where snus is prohibited.

Snus contains the biologically active and addictive substance nicotine and carcinogenic tobacco-specific nitrosamines (TSNA). Exposure from a portion of snus is somewhat greater than from a cigarette. Nicotine has acute effects on the cardiovascular system and can increase heart rate, blood pressure and vascular resistance. It can also affect cardiac muscle function. Similar to smoking, there are indications that snus can impair fertility and increase the risk of cancers of the pancreas, oesophagus and oral cavity. Studies suggest that snus also increases the risk of cancers of the stomach, lung, colon and rectum.

“The degree of the increased risk of cancer is difficult to estimate. It will probably depend on how early users start, how often and how much snus they use, and for how many years,” said Alexander. However, he stresses that there is reason to be concerned about the potential number of cancer cases that could result from snus use based on current usage levels.

Higher caries risk with nicotine-free snus

For a long time it was believed that people who use nicotine-containing snus have fewer cavities. A study conducted at Sahlgrenska Academy at the University of Gothenburg in 2012, proved that this is not the case (as reported by Dental Tribune ONLINE). On the other hand, the study also found that snus users do not have more caries than people who do not consume this kind of tobacco.

The research proved that while nicotine-containing snus only contains traces of carbohydrates and starch, nicotine-free snus can contain up to 26 per cent starch and 6.5 per cent carbohydrates, which results in reduced plaque pH of the consumer. Together with the high carbohydrate content, this means that the use of nicotine-free snus can increase the risk of cavities.

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