Send your letters to the Editor, British Dental Journal, 64 Wimpole Street, London, W1G 8YS. bdj@bda.org. Priority will be given to letters less than 500 words long. Authors must sign the letter, which may be edited for reasons of space.
Sir, I was alarmed to see that poor acquaintance with current oral cancer evidence can lead to backward conclusions as stated in the letter by Dr D. Shanahan.
The referenced study by Foulds et al. was a relevant piece when published 15 years ago, but today several later studies provide much more robust data on the public health benefits that have been reaped from snus use in Sweden.1,2
The study by Warnakulasuriya et al. is not only highly outdated but is totally irrelevant with respect to Swedish snus, since it is based on Indian smokeless tobacco products with totally different characteristics. Modern Indian researchers do make the appropriate distinctions resulting in summary statements such as: 'Nasal snuff and snus were not associated with oral cancer risk.'3
The most comprehensive modern summary has been given by the Global Burden of Disease Study 2016 by stating: 'Based on available evidence, for chewing tobacco RRs were significantly higher than one for oral cancer and oesophageal cancer, while for snus or snuff we did not find sufficient evidence of a RR greater than one for any health outcome.'4
The suggestions by the Science and Technology Committee (17 August 2018) are actually well supported by the available scientific evidence.
References
Ramström L, Borland R, Wikmans T . Patterns of Smoking and Snus Use in Sweden: Implications for Public Health. Int J Environ Res Public Health. 2016; 13: 1110.
Ramström L M, Wikmans T . Mortality attributable to tobacco among men in Sweden and other European countries: An analysis of data in a WHO report. Tob Induc Dis 2014; 12: 14.
Asthana S, Labani S, Kailash U, Sinha D N, Mehrotra R . Association of Smokeless Tobacco Use and Oral Cancer: A Systematic Global Review and Meta-Analysis. Nicotine Tob Res 2018; 10.1093/ntr/nty074.
GBD 2016 Mortality Collaborators. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017; 390: 1084–1150.
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Ramström, L. Much safer with snus. Br Dent J 226, 85 (2019). https://doi.org/10.1038/sj.bdj.2019.56
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DOI: https://doi.org/10.1038/sj.bdj.2019.56
