Talk:Snus/Archives/2013

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I lived in sweden for a while and on my packets of snus that I bought, most of them had a warning stating 'this tobacco product can harm your health and is addictive' (in swedish, obviously). I asked a friend of mine about the indirect wording on it and he said that they used to say that snus caused cancer but they had to change it because some study couldn't prove it did cause cancer. Has anyone else heard about this? zaius 15:19, 10 Feb 2005 (UTC)

Yeah, I have heard the story, too, though I have no idea if it's true or not...

Yes, it's true. The same thing happened in Norway too. Norwegian scientists haven't documented one single case of cancer because of snus. An Norwegian article about this: http://www.lommelegen.no/art/art847.asp

Yeah, see the quote i put in at tobacco#snus. Theoretically, it must be causing some cases, since the carcinogen level is still higher than zero, but there is a limit to how low an additional rate of cancer we can detect versus all the other causes. according to the state of massachusetts, the concentration in snus is 40 times lower than in American chewing tobacco (see my edits to the same article)Gzuckier 03:11, 6 Jun 2005 (UTC)

PS, I forgot to mention that (according to the studies, I wouldn't personally know) snus use is not popular among women, and as a result, the tobacco-related death rate in Swedish women is the same as that in Europe in general, while the rate in men is much lower than in European men. Gzuckier 15:39, 6 Jun 2005 (UTC)

Although it's hard for scientists to prove that snus can cause cancer, it's quite usual that the snus acts corrosive under the lip. If you are an avid user of snus then you might have to change side now and then. And btw as of today, nothing has been changed on the packets of snus. I'm a Swede btw. =) --84.217.14.48 00:30, 2 Apr 2005 (UTC)

well, the nicotine itself is probably responsible for that; but it's not a carcinogen, that's mainly the nitrosamines which result from heating proteins in the absence of oxygen, i.e. smoldering tobacco in cigarettes, firecuring American style snuff, and, of course, frying meat on a flat hot surface instead of "flame-broiling" it on an open grill. (although there is evidence that any repeated long term irritation, especially to tissue which is primed for growth/repair anyway, like the inside of the mouth, can be carcinogenic; like all the asbestos problems, for instance) Gzuckier 15:46, 6 Jun 2005 (UTC)

this snus lack of carcinogenicity was also reported in (i think it was the new york times but I can't find it online now) last week. i put some stuff re this in the tobacco#snus article; I think this article and that should be merged, with the detail of the relatively benign health effects coming over here linked from a mention, and the rest of the snus stuff over there. I'll do it eventually if nobody else wants to. the eventual snus/health article should be linked from the other tobacco/health articles too. this is interesting stuff. Gzuckier 03:11, 6 Jun 2005 (UTC)

If I understand you correctly, I have to disagree - I like having a seperate Snus article from Tobacco. I think that the special mentions of the Public Health debates would potentially bloat the Tobacco article, and it is hard enough to underscore the apparent difference between Swedish snus from American snuff. We don't want people to get the impression that _snuff as a whole_ has an apparent lower rate of cancer. Snus developments appear to merit very specifc treatment as compared to other, more "static" articles about Tobacco. --NightMonkey 09:47, Jun 6, 2005 (UTC)

OK, let's leave it status quo. Thanks for the comment. Gzuckier 13:44, 6 Jun 2005 (UTC)

The health issue isn't really about cancer, it's about snus being extremely harmful for one's mouth. It doesn't say on the box that "snus causes cancer", it says that it's harmful for one's health and of this the doctors agree.

It DID say that snus causes cancer a few years ago, and the comments mentioning that wording are a few years old. 217.208.0.149 (talk) 22:07, 14 February 2008 (UTC)

Yes, snus will cause changes in the mouth over time. Your gums will withdraw somewhat from your teeth, and the point where the face above the lip meets the gums (I'm sorry, I have no idea what the right term for this would be) will be raised. Speaking both from experience and from common knowledge (in Norway) here. YMMV, of course. Zuiram 03:07, 27 October 2006 (UTC)

I question this, and don't know if it's been scientifically proven. For one thing, gums recede a bit over one's life, that's just normal -- could that be what people are seeing? For another, I've read anecdotal accounts of gums un-receding a bit when people switch from cigarettes or American dip to Swedish snus. — Preceding unsigned comment added by 198.161.2.241 (talk) 22:46, 28 August 2012 (UTC)

The article states that ...since women are much less likely to use snus.... It's probably a fact that more men than women use it, but I don't know about "much less likely to". I'm also under the impression, although I don't have any statistics to back it up, that the use among women is increasing. Does anyone have statistics on this? (Entheta 16:16, 12 October 2005 (UTC))

In many circles the use of snuff among women appears to be considered gross- also among women themselves. My friend had to decline a 'pris' offered to him in consideration for his girlfriend. The origin of this notion, however, is totally unknown to me. Personally I find teabag-style snuff much more comfortable than smoking cigarettes, which in my opinion seems to leave an aftertaste far longer. GSchjetne 20:30, 3 November 2005 (UTC)

Do you mean snuff or snus? Confusing me :-)

Other than that, I don't see why it is "gross" to use snus - it's far more clean than smoking, and you don't smell like a dead rabbit in your mouth afterwards. But yes, it is true that snus is still seen as something men has more right to do than women - probably related to past views of the whole thing. --80.217.189.168 01:58, 2 December 2006 (UTC)

Odd wording there from myself, women of course have the same right, but it's not as widely accepted. A man doing it wouldn't raise many eyebrows, if a woman, it might. Also, I too had a girlfriend that got mad if I took a snus while being with her. I understand that, however, as much as I understand not wanting to be with a person that smokes. --80.217.189.168

Some companies have started to segment snus towards women. They are making snus with tastes such as mint, mocca etc. instead of for example general taste or whisky. They also make snus boxes that are designed to look more appealing to women.

—The preceding unsigned comment was added by 24.114.252.226 (talk) 06:13, 21 April 2007 (UTC). Yeah. In Sweden at least

• some women smoke cigarettes
• few men smoke, except at parties
• plenty of men use snuff
• snuff is seen as more acceptable now than (say) in the 1970s, outside the working classes
• "teabag" snuff, when introduced, increased its popularity since it's easier to handle

But as noted above, real statistics is needed. Jgrahn 21:25, 1 April 2006 (UTC)

Norwegian snus retailers' statistics state that an increasing number of women have been buying it lately.

However, the number of women using it is still very low. It is generally considered gross by the female population. Some brands (e.g. Mocca), with smaller bags (less visible and less irritating) and more pleasant taste, have been more successful.

Loose snus appears particularly distasteful to them, which makes sense, as the tactile experience is similar to stuffing dirt/soil under your lip. Personally, I found the taste and tactile impression of loose snus superior to that of portion snus when I started using it, but now my taste has changed sufficiently that the "messiness" of the loose snus is no longer worth the difference.

Also, snus does have a distinct smell to it, which some find offensive. And you have to get rid of it somewhere, which involves pulling a saliva-soaked "teabag" or mush out of your mouth, finding some acceptable place to put it, and cleaning your fingers afterwards. Men have a tendency to wipe their fingers on their pants, which I gather women don't like to do, as well as throwing them just about anywhere, which I find offensive myself.

FWIW, I have not seen any women use anything but the smaller versions. And on most womens' faces, the protrusion would be quite noticeable. Zuiram 03:16, 27 October 2006 (UTC)

http://www.thelocal.se/article.php?ID=644&date=20041118

"As if the horrific breath and stained teeth aren’t argument enough to stop, researchers have now sounded a new cancer warning bell about the snus habit. A study carried out by the World Health Organisation and released this week followed 10,000 Norwegians, of whom two-thirds were snus-lovers. The results show that users of the popular chewing tobacco increase their risk of contracting mouth or pancreatic cancer by 67%."

Sounds a little biased to me but is this worth including/following up?

Well... as usual, reality is more messy and prone to puffing up by the media and advocacy organizations. This appears to be the study mentioned, it's the only Norwegian snus pancreatic cancer 10,000 person study I could find, even though it doesn't mention WHO, and the dates match (the date of publication of the study is 2005, the date of the article above is 2004).

Limited data are available on the carcinogenicity of smokeless tobacco products in organs other than the mouth. Snus is a smokeless tobacco product widely used in Norway. We studied 10,136 Norwegian men enrolled since 1966 in a prospective cohort study, 31.7% of whom were exposed to snus. The relative risk of pancreatic cancer for snus use was 1.67 (95% confidence interval [CI] = 1.12, 2.50); that of oral and pharyngeal cancer was 1.10 (95% CI = 0.50, 2.41), that of esophageal cancer was 1.40 (95% CI = 0.61, 3.24), and that of stomach cancer was 1.11 (95% CI = 0.83, 1.48). The relative risks of cancers of the lung (either all histological types or adenocarcinoma), urinary bladder and kidney were not increased among snus users. The increase in the relative risk of pancreatic cancer was similar in former and current snus users and was restricted to current tobacco smokers. Our study suggests that smokeless tobacco products may be carcinogenic on the pancreas. Tobacco-specific N-nitrosamines are plausible candidates for the carcinogenicity of smokeless tobacco products in the pancreas.

Speaking skeptically (let me hurriedly state that I am not prosmoking, I would be more than happy if smoking were to disappear from the face of the earth, I am not protobacco or prosnus, I am just in the habit of approaching every scientific paper skeptically and every press release from an advocacy group regarding scientific research super skeptically, even (especially!) those I agree with on principle) the first thing that jumps out is the news statement that "users of the popular chewing tobacco increase their risk of contracting mouth or pancreatic cancer by 67%", which is of course quite false; the research states that they increase the risk of pancreatic cancer by 67%, and the risk of mouth cancer by about 10%, a statistically insignificant amount. (Pancreatic and oral cancers have about the same incidence rates, .01% per year[1]). Next quibble, logically, is that they have not properly corrected for multiple comparisons; the accepted false positive error rate is by convention 5% (thus the references to 95% CI), i.e. you expect to have no more than 1 result erroneously identified as statistically significant out of 20 experiments. But this experiment actually contains numerous measurements; the rates of oral cancer, pancreatic cancer, esophageal cancer, stomach cancer, lung cancer, adenocarcinoma lung cancer, bladder cancer, and kidney cancer. That looks to me like 8 measurements, and therefore they have in effect gone from 95% confidence to 1-(8*.05)=60% confidence, which no scientist would consider meaningful. (If you don't follow all that, look up the multiple comparisons article.) Next quibble is the oddity that the effect is only found in smokers; but found in both current snus users and in those who were former users. In other words, even if you quit using snus 50 years ago (this was a 40 year study) but have been smoking since then, you were at risk compared to other 50 year smokers who never ever used snus; but if you have been using snus for 50 years and not smoking, you were not at increased risk over other nonsmokers who never used snus. Makes you wonder what the hell mechanism could snus initiate 50 years ago that would only show up in smokers decades later? On the positive side, however, is evidence (not here, background) that nicotine, which snus delivers a lot of, stimulates cholecystokinin, which stimulates pancreatic growth, which makes the pancreas perhaps more sensitive to snus use compared to the other cancers which are more caused by the nitrosamines created by smoking or flue-curing chewing tobacco, and are not present in snus. So, if you postulate that snus sort of sets the pancreas into a sensitive mode, and the smoking carcinogens later trigger it....?? Anyway, my verdict would be definitely not proved, but still not dismissible as patently ridiculous.

Moving forward, I find this more current overview of the literature, including the study dissected above:

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.

i.e..... definitely not proved, but still not dismissible as patently ridiculous, just like I said. So who wants to write all this into the article? Maybe me! But not today! Gzuckier 18:38, 6 June 2006 (UTC)

Doesn't the article reflect this debate already, sussinctly and without unnecessary bloat? It mentions "chewing tobacco" as well as "snuff" or "snus", which muddies the waters a bit. If that is a translation issue, we should wait for a better translation. :) --NightMonkey 15:19, 7 June 2006 (UTC)

Yeah, that's what I mean; it takes longer to add a short succinct summary than it does to just dump a huge amount of text. Gzuckier 17:54, 7 June 2006 (UTC)

Another study was published in 2007 in the Lancet linking Swedish snus to pancreatic cancer, abstract available here. In regards to the previous comment about the problem of multiple comparisons in the earlier (Boffetta et al.) study, that is a good point. However, there is a biological reason to suspect that snus could cause pancreatic cancer, because snus contains TSNAs which are able to induce pancreatic tumors in lab animals - in fact, TSNAs are the only component of tobacco capable of inducing pancreatic tumors in the lab. So, although Boffetta looked at multiple cancer sites, the Bonferroni correction (dividing the confidence level by the number of comparisons) is overly conservative in this case.

--Pensivefrog 20:49, 10 July 2007 (UTC)

(I cleaned up your comment indentation a bit) Thanks for the info. Your addition to the article, however, doesn't link to the study you link to above (at least, I don't think it does ;) ). The link in the actual article is to a study that appears to only cover TSNA's effects on rats, in general. However, the possible relief from risk that snus may provide is precisely that there is a marked reduction in the level of TSNAs that are present in the tobacco used in Snus (to varying degrees by brand and make) as compared to other preperations. As such, the in-article link may not be appropriately labeled, as it isn't a study of Snus and cancer, per se, but TSNAs and cancer. The link you mention above in your comment, however, does seem germane - that should be added. It is unfortunate that I don't have a subscription to The Lancet to see the full text. ;) --NightMonkey 22:15, 10 July 2007 (UTC)

I added a link to a 2008 article that shows an increased rate of cancer in snus users. "A statistically significant increase in the incidence of the combined category of oral and pharyngeal cancer among daily users of snus (incidence rate ratio 3.1, 95% confidence interval 1.5-6.6) was found. Overall mortality was also slightly increased (hazard ratio 1.10, 95% confidence interval 1.01-1.21)." The abstract cab be found here It doesn't have the multiple comparison problem and is pretty accurate as far as I can tell. Maybe something about this should be added in the main body of the article? 72.141.183.172 (talk) —Preceding undated comment was added at 19:10, 28 January 2009 (UTC).

"Snus is sold mainly in Sweden, Norway, and Denmark" - I believe that Snus has been illegal in the EU since 1992, with the exception of Sweden. How can it therefore be a big seller in Denmark? Grunners (talk) 09:22, 12 March 2008 (UTC)

Not at all. Snus is used, mainly by Africans, under the name of Makla, or Chemma, in many european countries (Belgium, France, ...). Thanks to the widespread interdiction of smoking in public places in those coutry, more and more European begin to be interested in Maklas. Makla Ifrikia is one of the most strong and famous snus I have ever tasted. It is sold in almost every Tobacco shop in south european countries. BruMar (talk) 13:03, 11 April 2008 (UTC)

Denmark was added back, and then removed again. It's not a very long ride between Copenhagen (Denmark) and Malmö (Sweden), so it's possible that some people import their own snus, but this should be clarified if that's the case, with the potential legal consequences for doing this. /Jiiimbooh (talk) 01:58, 10 July 2008 (UTC)

Loose snus is not illegal in Denmark, only snus packed in portions. And because of the lower duties in Denmark, many swedes that work in Denmark buy their snus here. A package of the Danish label of snus "Offroad" costs 2,7€ per can compared with 4,7€ in Sweden. Superlinnet (talk) 12:24, 7 September 2008 (UTC)