Should doctors encourage patients to use a product that increases their chances of developing pancreatic cancer? Should public health agencies? This is a question that could confront the medical establishment if the Swedish moist smokeless tobacco known as “snus” becomes popular in the United States (and if the tobacco companies push the European Union to withdraw its ban on the product). The product is sometimes advocated as an alternative for reducing harm in inveterate smokers, the heavily addicted ones who are resistant to conventional cessation strategies.

A pair of studies published online today in the Lancet inform this debate. Researchers from the Karolinska Institutet in Stockholm show that Swedish construction workers who use snus alone are at twice the risk of pancreatic cancer when compared with people who have never used tobacco. Yet they have no higher risk of lung or oral cancers. Meanwhile, smokers are at much greater risk of lung, oral, and pancreatic cancers.

So should the public health community just say no to snus, given the higher risk of a cancer that is so often incurable? The second study models the effects of snus usage in Queensland, Australia, and comes up with some interesting conclusions. A male snus user who has never smoked cuts his life expectancy by 0.2-0.5 years, and a female snus user cuts hers by 0.2-0.3 years when compared with people who have never used tobacco. That compares favorably with 2.4-5 years lost by male smokers and 1.9-4.1 years lost by female smokers. Therefore, the researchers conclude, 14-25 ex-smokers, or 14-25 people who have never before used tobacco, would have to take up snus use to offset the health gain from one smoker who switches to snus.

How would the idea of switching hard-core smokers to snus be seen through the lens of U.S. public health policy? As an accompanying Lancet commentary notes, “Sometimes if a product is ‘not safe,’ this may be grounds for banning the product. But such an absolutist position can ignore the complex realities of many of the most important health risks we face.” It’s hard to believe that U.S. tobacco opponents won’t see snus in the same light as they see candy-flavored cigarettes (free access for two weeks) or see it as another coded way to market to teens (free access for two weeks). The National Cancer Institute, for one, makes its opinion clear when it describes snus as a “threat.” Expect to hear more about this in the near future.

This entry was posted on Thursday, May 10th, 2007 at 4:17 pm and is filed under All Categories, Public Health. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.