From the Guidelines
Smokeless tobacco use is a significant risk factor for oropharyngeal cancer, with users having approximately 2-4 times higher risk of developing cancers of the mouth, throat, and esophagus compared to non-users. The risk of oropharyngeal cancer from smokeless tobacco use is a major concern, as it contains at least 28 known carcinogens, including tobacco-specific nitrosamines (TSNAs) that directly damage DNA in oral tissues 1. According to the US Preventive Services Task Force, the prevalence of oral HPV infection, which is a significant risk factor for oropharyngeal cancer, is estimated to be 6.9% in adults aged 14 to 69 years in the United States, and can be as high as 20% for persons who have more than 20 lifetime sexual partners or currently use tobacco 1.
Key Points to Consider
- The risk of oropharyngeal cancer increases with frequency and duration of smokeless tobacco use
- Smokeless tobacco products that require prolonged contact with oral tissues pose a higher risk, especially when used in conjunction with alcohol
- Complete cessation of all tobacco products is strongly recommended to reduce the risk of oropharyngeal cancer
- Nicotine replacement therapies, bupropion, or varenicline can help with cessation
- Regular dental check-ups that include oral cancer screenings are essential for early detection, particularly for those with a history of tobacco use
Reducing Risk and Improving Outcomes
To minimize the risk of oropharyngeal cancer, it is essential to avoid all forms of tobacco use, including smokeless tobacco products. Complete cessation of tobacco use is the most effective way to reduce the risk of oropharyngeal cancer. Additionally, regular dental check-ups and oral cancer screenings can help with early detection and improve treatment outcomes. As noted by the US Preventive Services Task Force, screening all adults for tobacco use and providing tobacco cessation interventions can also help reduce the risk of oropharyngeal cancer 1.
From the Research
Risk of Oropharyngeal Cancer from Smokeless Tobacco Use
- The use of smokeless tobacco (ST) is associated with a high risk of oropharyngeal cancer, with a four times higher risk relative to no history of tobacco use after adjusting for age, ethnicity, and gender 2.
- A review of reviews and meta-analyses found that all smokeless tobacco products sold in different World Health Organization regions, except snus, are strongly associated with oral cancer incidence, with shammah showing the highest association 3.
- A systematic global review and meta-analysis found a significant positive association between smokeless tobacco use and the risk of oral cancer, with a higher risk found for females and for certain types of smokeless tobacco products, such as gutkha and oral snuff 4.
- A systematic review of the relation between smokeless tobacco and cancer in Europe and North America found that the association between smokeless tobacco and oropharyngeal cancer was significant, but only for past smokeless tobacco use in the USA, and not for Scandinavian snuff 5.
- A review of the risks and determinants of smokeless tobacco and oral cancer found that the use of chewing tobacco and moist snuff is associated with low risks for cancers of the oral cavity, while the use of dry snuff is associated with higher risks 6.
Types of Smokeless Tobacco Products and Oropharyngeal Cancer Risk
- Shammah, toombak, gutkha, betel quid with tobacco, and dry snuff are associated with a high risk of oral cancer 3.
- Gutkha, pan tobacco/betel liquid, oral snuff, Mainpuri tobacco, and snus are associated with varying levels of risk for oral cancer, with gutkha showing the highest association 4.
- Dry snuff is associated with higher risks for oral cancer compared to other types of smokeless tobacco products 6.
Demographic Factors and Oropharyngeal Cancer Risk
- Males have a higher risk of oropharyngeal cancer compared to females, with one-third of reported cases occurring among individuals under 40 years 2.
- Females who use smokeless tobacco have a significantly higher risk of oral cancer compared to males 4.
- Certain ethnic groups, such as Urdu-speaking communities, have a higher risk of oropharyngeal cancer compared to other groups 2.