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General
Started by Anonymous at 04-11-2007 11:10 PM. Topic has 9 replies.
  
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 04-11-2007, 11:10 PM
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Anonymous
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You guys say that snuff doesn't cause cancer but how can you explain the high rate of oral lesions and leukoplakia.
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04-17-2007, 9:13 AM
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admin
Joined on 12-06-2005
Posts 114
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I think the following taken from Rodu and Godshall's Tobacco harm reduction: an alternative cessation strategy for inveterate smokers answers this in some detail. See the original for further reading or for details on the research behind the report.
Oral
leukoplakia is an ominous sounding term used frequently in discussions
about ST use. The term literally means "white plaque," and it is used
to describe areas of the mouth lining that become thickened by ST use
or smoking. The World Health Organization has determined that
leukoplakias resulting from ST use are considerably different from
those resulting from smoking. The distinctions are based on the
frequency of occurrence, the location in the mouth, and how often these
leukoplakias result in mouth cancer.
The condition is rare, occurring in less than 1% of the general population, primarily in long-time smokers 40 to 60 years old.
Smoking-related leukoplakias most commonly involve the undersurface of
the tongue and throat area, locations that account for 75% of oral
cancer in the U.S..
Oral leukoplakias occur in up to 60% of ST users, within 6 months to 3 years of starting ST use. They primarily occur at the site of ST use and are largely a result of local irritation.
The frequency of appearance depends on the type of ST that is used.
Moist snuff, which is more alkaline than chewing tobacco, more often
leads to leukoplakia. However, moist snuff in pre-portioned pouches causes fewer cases of leukoplakia than does the loose form.
There
are distinct differences in how often ST and smoking leukoplakias show
pre-cancerous changes called dysplasia. Dysplasia is seen infrequently
in ST leukoplakias (less than 3%).
Furthermore, even when dysplasia is present in ST leukoplakia, it
usually is found in earlier stages than in leukoplakias due to smoking, where it is seen in about 20% of cases.
ST
leukoplakias only rarely progress to cancer. For example, one
prospective study found no case of cancer in 1,550 ST users with
leukoplakia who were followed for 10 years, and a second study reported no case of oral cancer among 500 regular ST users followed for six years.
A retrospective study of 200,000 male snuff users in Sweden found only
one case of oral cancer per year, an extremely low frequency. In comparison, a follow-up study reported that 17% of smoking leukoplakias transformed into cancer within seven years.
In
conclusion, oral leukoplakia occurs commonly in ST users, but it
primarily represents irritation and only very rarely progresses to oral
cancer.
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11-04-2007, 4:11 PM
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Anonymous
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Hi there, love the website lots of info. I have researching the lesions caused by smokeless tobacco. Most of the websites I have read say that cancer risk is increased in the lesions. I have also read that a constant irritation can cause cancer in and of itself. Do you think that smokless tobacco users should try and limit irritation? If a user does get lukiplakia should they discontinue use until it clears up? I have read that lukiplakia is considered a precancerous condition. Would alternating placing of the tobacco prevent lesions from forming? Thanks for the reply.
Is keratosis the same thing? I read that leukoplakia is now considered
keratosis when it is caused by smokeless tobacco.
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11-05-2007, 1:08 PM
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admin
Joined on 12-06-2005
Posts 114
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To restate the conclusion from our answer to a
similar query (see above): oral leukoplakia occurs commonly in ST users, but
it primarily represents irritation and only very rarely progresses to oral
cancer. The key thing to keep in mind is this: Modern smokeless
tobacco does not appear to cause oral cancer, at least not enough that we can
measure the increase, so it is impossible for leukoplakia (which is fairly common
among smokeless tobacco users) to represent a cancer risk. If it did,
then there would be a noticeable increase in cancer -- but there is not a
noticeable increase in cancer. It is pretty simple once you think about
it. The people who put out the information you cite either do not think
about it, or are intentionally providing what they know to misleading claims.
The answer to the previous posting will give you details and a
link to follow for more information. By the way, leukoplakia basically
means a white patch, and keratosis simply means a toughening of the tissue. These
are both natural responses to local irritation. In smokeless tobacco users, leukoplakia almost always disappear soon after quitting or
changing the place where the produce is held. If you find you have a localized
irritation when you use smokeless tobacco, especially soon after you switch
from smoking, and you want to get rid of it, use the product at a different
spot in your mouth for a while. Definitely do not switch to smoking,
which is pretty much the worst thing you can do for your oral health.
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12-10-2007, 6:44 PM
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Anonymous
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Is oral cancer insidious or can you "kinda see it coming"? In other words ,do most ST users have early warning signs before cancer cells develop? (i.e. leukoplakia, oral mucosa color changes etc.) It seems like being able to see the body part (mouth) where you place the tobacco is an advantage over smoking (can't see your lungs, heart. etc) for early intervention or possible prevention of cancer. Could you elaborate on this point? Is there any truth to that or do ST users just wake with a cancerous sore? Do you even lessen your odds further by moving the dip around? Finally, if possible, what are the numerical odds of getting cancer from chewing tobacco? Is there any concrete data on this? Thanks
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12-11-2007, 2:07 PM
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admin
Joined on 12-06-2005
Posts 114
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Your question gets rather far from the purpose of this
website. Methods for earlier detection of oral cancer are described in
publications that specialize in such matters, and we defer to them on the
specific point.
We will note the error you make in framing your question that does relate to
the purpose of this website: Exclusive
ST users, just like everyone else who does not
smoke, have such a small chance of getting oral cancer that it should be far
down your list of worries. Smokers have a much greater chance, but it is still
rather small. Moreover, oral cancer is a geriatric disease, and usually
follows about 50 years of smoking. (The handful of cases of oral cancer
in young people are an interesting mystery, since they are not associated with
smoking or drinking -- the known risk factors -- but they are a different
story.)
So, basically, questions like "Do you even lessen your odds further by moving
the dip around?" are based on the premise that ST causes oral cancer to a
measurable degree, which the science shows is not the case. As you will find
recounted in detail in our website (and further under the Oral Lesions
discussion in this forum), there is ample "concrete data" on this
point. Since holding the dip in the same place always creates either zero risk or
such small risk it cannot be measured, moving it around would be an attempt to
go from no additional risk to even less than that, which obviously does not
make sense.
If you are really so inclined to worry about signs of cancer and you are younger
than about 50, keep an eye on your skin. If you are 50 or older, consider
colonoscopy and other screening tests. Beyond that, you are better off
spending the time exercising to prevent disease rather than searching your body
for disease. And, of course, DON'T SMOKE!
If you are concerned about a sore in your mouth, have it
checked by a professional. And if you
happen to be a smokeless tobacco user, and continue to worry about possible
health effects, why not just quit?
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12-17-2007, 9:41 PM
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Anonymous
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Why not just quit? Why don't you ask the same question of smokers?
I still can't figure out why you have the need to trivialize the oral cancer cases highlighted in the media in young smokeless tobacco users who develop the disease. To be perfectly honest, I find it to be somewhat distasteful, if not, disrespectful. (Sean Marsee, Gruen Von Behrens, Rick Bender etc). Even though you've stated it's extemely unlikely that smokeless caused their diseases, it still leaves the possibilty it did. So....if you agree it's possible.... and they, their famlies and presumably their doctors' say it did.....why not just leave it at that? Accepting that these few cases highlighted in "smokeless tobacco propaganda" are factual surely won't change the stastistics regarding the odd of smokeless tobacco users being stricken by oral cancer...would it?
Although I have no background or training in epidemiology or statistics, I am convinced that these cases are genuine. I came to this conclusion by using common sense and the light of reason. (I know...not very scientific). I think a survey would show most people with half a brain would agree. I think it would help your credibilty not to suggest so strongly that these case are "almost certainly coincidences". Just a suggestion.
Young people have and will continue to develop oral cancer from smokeless tobacco.
Thanks for letting me voice my opinion and make a suggestion.
If you don't mind, here's a recent post from a "dippers" website. It's genuine...unless the kid's lying...but I couldn't really imagine why. Check the website to see for yourself, if you'd like.
SMPOST.NET "Where Dippers Meet"
"i was owrkin last night and i had went out to take
the trash, and i put a big pinch of griz in, and i got a call from one
my my best friends who i ogt started dippin like 2 years ago. we talked
for a little while, then he told me that he was startin to feel weird
when he put a dip in so he went to the doctor. then he told me that
things werent looking good. and he has been diagnosed with oral cancer.
he is 18 and he has the same birthday as me. he has to have surgery
next week."
Posted on: 12/12 17:48
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12-20-2007, 9:13 AM
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admin
Joined on 12-06-2005
Posts 114
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The public education parts of this website are directed toward smokers who have not quit smoking. The
goal is that if someone has tried to quit using nicotine and failed, or
if they are not inclined to quit using it, we want to let them know
that they can use nicotine with very low health risks instead of facing
the huge risks from smoking. It should be obvious that we, along with everyone else working in public health, do not oppose quitting. But
we, along with anyone in public health who really cares about people
and respects health ethics, think that if you do not quit nicotine you
deserve an option other than being quite likely to die from it. Public health takes the same attitude toward driving (it is dangerous but since you will not stop, at least put on seat belts).
We do not want to trivialize any
person’s tragedy, but we want to make sure that these stories are not
used to mislead people about the science. Oral cancer is primarily a geriatric disease, but a small number of cases occur in young people. It
would be comforting to attribute these cases to something people could
stop doing, but the facts do not support this and wishful thinking does
not help. The cases in young people are not associated
with the cause of 3/4 of all oral cancers in North America (smoking),
or any other known factor. Of course, coincidence happens: With
a few hundred such cases per year, some of the people smoke, some of
them use smokeless tobacco, some of them have red hair, some of them
drink a lot of coffee, etc., but that does not mean that any one of
these caused the cancers in those people. So even if Sean
Marsee had been a smoker and was being used as a poster boy for the
dangers of smoking, we would have to say it was inappropriate even
though smoking does cause most oral cancer (in much older people
While we cannot teach a full
introductory statistics class in this post (there are some good books
that are easy reads if you want), consider this: Take a
pair of white dice and a red die and roll all three, record the
results, and repeat it 1200 times (hint: do it in a spreadsheet rather
than acutally using dice). Each 6 on the red die represents a case of oral cancer in a young person (roughly how many occur in North America per year). Each
time the white dice added to 12, that represents someone who uses
smokeless tobacco (roughly the prevalence of use in young North
Americans). Did the 12s cause the 6s in those cases? Obviously not. And yet there are probably about 6 occurrences of this combination. That represents about 6 young people per year who both use smokeless tobacco and get oral cancer, purely by coincidence. The
fact that we know the names of three of the dozens of such people
from the past few decades is really not all that informative. The
fact that one of the ones from this year was apparently written about
recently is similarly not informative. It is sad that he got cancer
(which is exactly one of the reasons we encourage smokers to switch: to
avoid getting cancer), but it is not helpful to naively look for a
scientifically incorrect explanation for it.
With that, we hope you now have enough training in statistics to understand your original assessment was wrong. Humans are programmed to see causation not coincidence. It takes a bit more analysis to understand coincidence, but it is really not all that difficult.
As for your comment:
I think a survey would show most
people with half a brain would agree. I think it would help your
credibility not to suggest so strongly that these case are "almost
certainly coincidences". Just a suggestion.
Unfortunately you are right about most people agreeing. We try to do what we can to educate a few of them enough to understand better than that. We
do not think there is much to be gained by misrepresenting basic
statistics just because it might help our credibility; indeed, we think
it would hurt our credibility in the long run. We will stick with trying to educate.
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01-17-2008, 4:21 PM
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Anonymous
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I have a question/observation/theory regarding leukoplakia and ST use. It seems to fit with what you are saying, but I wanted to get your thoughts, considering I'm not a doctor or a scientist.
Is it true/possible that oral leukoplakia would always be present before the very unlikely event of ST use causing oral cancer?
Please comment on the following:
1) 60% of ST users develop leukoplakia, 40% do not. Of the 60% that do, it very rarley develops into cancer (less than 3%). So overall, a cancer threat for ALL ST would be much less than 3% for lifetime users. Is this fair to conclude?
2) It also seems to fit in with what you're saying about young smokeless tobacco users coincidentally getting oral cancer. Maybe some of these victims didn't even have some of the pre-conditions (leukoplakia)....which could maybe rule out any tobacco association. In other words, if there wasn't leukoplakia on their tongue before they developed the disease, smokeless tobacco could be ruled out as a cause.
So just to recap....
Oral leukoplakia will always be present before the rare occurrence of cancer in ST users.... A little over half of ST users develop the condition.....If you develop leukolakia from ST, the risk for is increases but still practically non-existent. If you manage to avoid developing leukoplakia while using ST...you're risk of cancer is zero.
Again, I really have no idea if there is any truth to this, but it seems like a reasonable theory considering what you are saying.
Thanks for time
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01-21-2008, 3:53 PM
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admin
Joined on 12-06-2005
Posts 114
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It is impossible to determine an exact risk for oral
cancer. The occurrence is so low that it
cannot even be certain whether leukoplakia always precede a cancercerous or
pre-cancerous lesion.
We’ve already quoted above from the Rodu & Godshall
article but to add to that some indication of how daunting it is to study the
intersection of smokeless tobacco and oral cancer 1. the prevalence of ST use
in the U.S.
is very low, about 4% among adult men and 0.3% among women (NHIS, 2000); 2. oral
cancer is a rare disease, and 3. the risk of oral cancer among long-term users
of ST is very low.
Consider a 2005 study based on the American Cancer Society's First and Second
Cancer Prevention Surveys, each enrolling over 1 million Americans in a
prospective follow-up study (Cancer Causes and Control 16: 347-358).
After long-term follow-up, the multivariate adjusted hazard ratios for
oropharynx cancer were 2.0 (95% CI = 0.5-7.7) for CPS-I and 0.9 (CI = 0.1-6.7)
for CPS-II, based on 4 cases and 1 case among ST users respectively.
It is hard to generalize about anything or be very certain
of the specifics when out of over a million, you only have four or one events.
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TobaccoHarmRedu... » Administrators » General » oral lesions
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