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Epidemiology of Cancer by Tobacco Products and the Significance of TSNA
Published in Roger O. McClellan, Critical Reviews in Toxicology, 2017
Prakash C. Gupta, P. R. Murti, R. B. Bhonsle
In Western countries, smokeless tobacco is used in the form of chewing tobacco (in the U.S., plug, roll, or twist), snuff dipping (moist or dry), and recently as portion-packed in teabags such as sachets containing moist snuff. Several case-control studies demonstrated high relative risk estimates,58–60 and a strong dose-response relationship61 between smokeless tobacco use and oral/pharyngeal cancer. In a review, it was concluded that there was “sufficient” evidence that smokeless tobacco use is carcinogenic to humans.9 Additional information from three recent studies shows that oral cancer risks were elevated among users of smokeless tobacco with relative risks ranging from 2.3 to 11.2, confirming earlier evaluations.62
Tobacco Products
Published in Barry L. Johnson, Maureen Y. Lichtveld, Environmental Policy and Public Health, 2017
Barry L. Johnson, Maureen Y. Lichtveld
Smokeless tobacco sales in the U.S. are a $5–$6 billion annual business, with sales rising [17]. Convenience stores are the most common place to purchase these products within the U.S. In 2014, U.S. convenience stores generated approximately $5.31 billion from chewing tobacco and snuff products; which amounted to about 1.26 billion units sold [18]. Smokeless tobacco products are highly addictive, owing to their higher content of nicotine [19]. Some users of smokeless tobacco mistakenly consider the products to be a safe or safer alternative to smoking tobacco products, particularly cigarettes. As will be described in the health effects section, there are no tobacco products without adverse health implications.
Overview of biological mechanisms of human carcinogens
Published in Journal of Toxicology and Environmental Health, Part B, 2019
Nicholas Birkett, Mustafa Al-Zoughool, Michael Bird, Robert A. Baan, Jan Zielinski, Daniel Krewski
The term smokeless tobacco implies use of unburned tobacco in the finished product. Smokeless tobacco products may be inhaled or applied orally (chewed, sucked, gargled or applied directly to the gums). The chemical composition depends upon the method of manufacture employed. Smokeless tobacco produces cancer of the oral cavity, esophagus and pancreas. Multiple carcinogens were identified in smokeless tobacco products and the mechanisms by which smokeless tobacco is carcinogenic reflect these carcinogens. DNA-adduct formation was documented in oral tissues of smokeless tobacco users, and there is evidence of chromosomal damage such as sister chromatid exchange and micronuclei and mutations in RAS and TP53. Localized inflammation and oxidative stress were also reported along with production of reactive oxygen species (ROS).
Exhaled carbon monoxide levels correlate with incidence of oral mucosal lesions independent of smoking status
Published in International Journal of Environmental Health Research, 2019
Iwona Gregorczyk-Maga, Agnieszka Wachsmann, Marta Olszewska, Lukasz Partyka
Both smoke and smokeless tobacco products exert toxic effects on oral mucosa. Pathologies include but are not limited to: periodontitis, hyperpigmentation, increased plaque formation, halitosis, delayed wound healing, leukoedema, xerostomia, leukoplakia, nicotine stomatitis, and oral cavity neoplasms. Smoke temperature and physical damages resulting in recurring burns were implicated in mucosal lesions. Nicotine stimulates central nervous system providing an essential component of addictive behavior, and other factors act locally affecting oral mucosa blood flow and inducing local inflammatory reaction and cytopathic and molecular changes characterized as dysplasia and atypical cell formation. They are consequent to exposure to nicotine, other tobacco alkaloids, acrolein, aldehydes, tar, nitric and sulfur oxides, cyanide and other components of smoke and smokeless tobacco products (Hyodo et al. 2013; Michalak et al. 2016).