smokeless tobacco

[Sacamuelas]

Spent last Friday in a continuing education seminar on Oral/pharyngeal carcinoma. The speaker was the dean of oral pathology at Louisiana State University medical center.

Just wanted to point out some of the interesting findings this Professor has arrived at concerning dip/snuff/chew. I know some of you have been in the process of quitting.

Oral cancer is extremely rare in smokeless tobacco users that do not smoke/drink alcohol on a regular basis.

In one study by Smith and Mincer(Univ. of TN dept. of pathology) which followed 15,500 patients for a full 20 years of follow-up, only 2 (TWO) cases of oral cancer were diagnosed. This actually relates to a lower than average oral cancer rate when compared with the general population. It "could" be said that this study proves that smokeless tobacco could even prevent oral cancer.

No longer do the words that I learned, " Its not a matter of if you will get cancer, but WHEN you will get cancer if you continue to dip", stand true. It appears that some of the hype may not be correct.

One of the most dramatic and particularly well-designed studies that actually does show a direct correlation with cancer and smokeless tobacco was done by a NIH scientist by the name of Debra Winn. She studied female users that ALL had 50+ years of tobacco use. She found that there was a marked increase of oral CA (13-48x more likely). However, even she derived during her research that it took on average at least 40 years of smokeless tobacco for CA to develop. That is why she designed her study to focus on the population that it did. Again, to achieve her remarkable cancer causing stats her study focused only on individuals 50+ yrs of use, which makes it difficult if not impossible to correlate the results with the general population.

This new information drastically differs from what most of us have been told and taught. From the CE, I have noted a few key points that ought to be recognized by practitioners.

1. On average it takes 40 years of use to cause cancer solely due to smokeless tobacco

2. The cancer found is almost exclusively low grade (less aggressive form).

3. Smokeless tobacco is a very mild carcinogen, if at all.

4. Oral cancer involves many cofactors of etiology, smokeless tobacco is just one of the players (a minor one at that). The major ones are alcohol and smoking.

5. Patients do however get oral lesions if they use. On average, 53 % of patients will get an oral lesion of some type (usually a superficial inflammatory reaction that causes thickening of the mucosal epithelium). Most common appearance is a white (leukoplakia) lesion right where the patient places the snuff in his mouth.

6. Its use will cause gingival recession and periodontal problems in the chronic placement areas associate with dip.

7. It has been shown to be associated with a LOWER caries (cavity) rate than in non-users in the same population class.

8. The lesions that are to be considered high risk are almost all red/white mixed or red in apperance. These require biopsy without delay.

Some things I advise my patients of if they are users....

1. I don't dip, and don't plan to start even though it is not as "cancerous" as we initially thought
2. If you use, you should still quit for overall oral health.
3. It can still cause you trouble with your teeth/gums/breath
4. Extreme long-term usage could still cause cancer
5. Do NOT start smoking just to help you stop dipping. Smoking is statistically much worse for you.
6. Most of the lesions associated with dipping appear cancerous but do not histologically progress to carcinoma. Biopsy of particularly “mean� ones is still necessary though.


I thought it was interesting info for some of you. Especially with how commonly we face this in practice.

just a comment for those breathing a sigh of relief...

The average age of people diagnosed with lung cancer is 60. It is unusual for people under the age of 40 to be diagnosed with lung cancer. Keep in mind that most individuals start smoking before the age of 20..... so that tells us what? that it often (or one can perhaps say typically) takes cigerettes more than 40 years to develop cancer within the lung....

therefore, studies need to follow patients out well past 20 years and I would argue that any study with less than a 40 year history of chewing tobacco would not be complete and could very well be misleading.

Just my 2 cents....

keep trying to quit NDD....

doc t.

[DoctorDoom]

x

[Sacamuelas]

DD-

You’re right, there IS a synergistic effect when using alcohol/tobacco together. This particular seminar did not cover that actual statistic.

Note: This is NOT hard statistical fact. But this is what I tell my patients to get it across to them:

Hypothetically, lets say your only a smoker/dipper that it causes a 2x more likely chance of getting cancer. Now, Lets say if you were just a heavy drinker that your chances were 2x more likely to get cancer.
If you smoke and drink, your chances of cancer are not the 4x increase you would think, they are closer to 10-12x more likely to get cancer when used together.

That 10-12X verses double the sum is actually the statistic that my oral pathology professor taught me back in school. I don't know its true scientific accuracy, but I have seen similar numbers in other lectures/seminars.

As to the % of users that drink... I don't have that info, sorry. I agree with your logic on the similarities in Dx the lung ailments.

[NousDefionsDoc]

Well, thanks for the information. Doc T is right, there's no way its good for you, so its better not to start for all you Sluggos out there. It certainly doesn't help your wind when you are training and its a nasty habit not condusive to making friends and influencing people.

We didn't know alot of things when I started that we know now. So if you haven't - don't. Its not cool - It is addictive.

Doc, its easier for me at this stage to keep dipping than try to dispose of all the bodies that would result from the stress.

[NousDefionsDoc]

DD<
You do what you want, but I wouldn't hang out with anybody that smokes asbestos or mesothelioma, tobacco is bad enough.

[DoctorDoom]

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[Sigi]

Originally posted by NousDefionsDoc

Doc, its easier for me at this stage to keep dipping than try to dispose of all the bodies that would result from the stress.

LOL.

I have sometimes gotten out of bed an hour early because my habit woke me up. No kidding.
As soon as I get up I pop in a dip. My new roommate, who also dips, asked me the other day: "How can you pop a dip this early."

Oh, you mean that's a bad thing?

It's not funny, either. I have gone days w/out dipping. I am just not smart enough to quit, even with cancer in my family.

I keep saying someday. Even this info isnt enough. I heard that drinking and dipping together increases your probability for cancer at 25-30%. If you have cancer in your family, and you dip and drink, it goes to 600%.

WTF am I thinking.

Don't start. Ever. It is not a rite of passage. Trust me.