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Sir, recently, a letter by Shanahan raised some concerns about a recent report by the Science and Technology Committee (STC) suggesting the discontinuation of the ban on snus.1
However, I believe there are some inaccuracies in the letter that I would like to address. The letter cited a study by Warnakulasuriya2 in associating snus with an increased risk for oral cancer. However, that study was mainly referring to oral tobacco products used in Asia, most of which are particularly harmful and associated with elevated risk for oral cancer.
Swedish snus is a very different product. Despite the high rate of snus use among Swedish men, the prevalence of oral cancer in Sweden is among the lowest in the European Union.3
There is strong epidemiological evidence that snus use is not associated with a demonstrable increase in oral cancer risk.4,5
Therefore, it is particularly important to distinguish Swedish snus from other forms of oral tobacco products which have different toxic potential and substantially elevate the risk for disease.
While correctly mentioned by Shanahan that smoking cessation pharmacotherapies are available and safe, their popularity is limited and they are not used as alternatives by smokers unable or unwilling to quit smoking with the use of approved methods.
For the latter, snus and other tobacco harm-reduction products have a role in substituting for smoking and represent a reasonable option considering that the alternative is to continue to smoke.
Tobacco harm-reduction products do not substitute but supplement other existing tobacco control measures, in an effort to rapidly reduce smoking prevalence and smoking-related disease and death.
Considering that Swedish snus has a long history of strong epidemiological evidence, the suggestion by the STC to review the ban seems reasonable and in fact should be followed by other authorities such as the European Union.
References
Shanahan D . Tobacco control: Safer without snus. Br Dent J 2018 225: 685–686.
Warnakulasuriya S, Sutherland G, Scully C . Tobacco, oral cancer, and treatment of dependence. Oral Oncol 2005 41: 244–260.
La Vecchia C, Lucchini F, Negri E, Levi F . Trends in oral cancer mortality in Europe. Oral Oncol 2004 40: 433–439.
Luo J, Ye W, Zendehdel K, Adami J, Adami HO, Boffetta P, Nyrén O . Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study. Lancet 2007 369: 2015–2020.
Lee P N . Summary of the epidemiological evidence relating snus to health. Regul Toxicol Pharmacol 2011 59: 197–214.
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Farsalinos, K. Snus: Swedish snus is different. Br Dent J 226, 85 (2019). https://doi.org/10.1038/sj.bdj.2019.55
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DOI: https://doi.org/10.1038/sj.bdj.2019.55