From the Guidelines
The current evidence does not strongly support a direct causal relationship between smokeless tobacco or snuff use and the development of Chronic Lymphocytic Leukemia (CLL) or Non-Hodgkin Lymphoma (NHL). While smokeless tobacco products contain numerous carcinogens that can cause DNA damage and are definitively linked to oral, esophageal, and pancreatic cancers, the association with blood cancers like CLL and NHL is less clear. Some studies have suggested possible modest increases in risk, particularly with long-term use, but the evidence is inconsistent and not as robust as the connections to other cancer types, as noted in a comprehensive review of the evidence 1. The carcinogens in smokeless tobacco, including tobacco-specific nitrosamines and polycyclic aromatic hydrocarbons, can be absorbed into the bloodstream and potentially affect immune cells, which could theoretically contribute to lymphoid malignancies. However, the biological mechanisms specifically linking these products to CLL and NHL development remain incompletely understood.
The most recent guidelines emphasize the importance of discontinuing use of all combustible products as well as smokeless tobacco products for cancer prevention, as stated in the 2016 NCCN clinical practice guidelines in oncology 1. Key points to consider include:
- The lack of strong evidence linking smokeless tobacco to CLL and NHL
- The presence of carcinogens in smokeless tobacco that can cause DNA damage
- The importance of avoiding all tobacco products for overall health and cancer prevention
- The need for further research to understand the biological mechanisms potentially linking smokeless tobacco to lymphoid malignancies.
Given the potential risks and the lack of clear benefits, avoiding all tobacco products, including smokeless forms, is strongly recommended for overall health and cancer prevention, as supported by the evidence from 1 and 1.
From the Research
Smokeless Tobacco and Snuff: Health Risks
- Smokeless tobacco is an extremely addictive substance with various health risks, including leukoplakia, oral cancer, and systemic nicotine effects such as elevated blood pressure and serum cholesterol levels 2.
- The use of smokeless tobacco has been associated with an increased risk of oral cancer, but the risks depend on the chemical composition of the product 3.
- Smokeless tobacco products have been linked to higher mortality rates, particularly in Asia, the Middle East, and Africa, with odds ratios up to 38.7 for certain health outcomes 4.
CLL and NHL: Limited Evidence
- There is limited evidence directly linking smokeless tobacco and snuff to Chronic Lymphocytic Leukemia (CLL) and Non-Hodgkin's Lymphoma (NHL) in the provided studies.
- However, smokeless tobacco products have been associated with various health risks, including cancer, and it is possible that long-term use could increase the risk of developing certain types of cancer, including CLL and NHL 4.
Nicotine Replacement Therapy
- Nicotine replacement therapy (NRT) is a common method for quitting smoking and has been shown to be effective in increasing the chances of successfully stopping smoking 5, 6.
- NRTs are available in various forms, including gum, transdermal patch, nasal spray, inhaler, and sublingual tablets/lozenges, and are generally well-tolerated with minimal adverse effects 5, 6.