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Review
. 2023 Dec 15;153(12):1942-1953.
doi: 10.1002/ijc.34643. Epub 2023 Jul 21.

A systematic review of cancer risk among users of smokeless tobacco (Swedish snus) exclusively, compared with no use of tobacco

Håkon Valen  1   2 , Rune Becher  1   2 , Gunn Elisabeth Vist  3 , Jørn Andreas Holme  1 , Ibrahimu Mdala  4 , Ida-Kristin Ørjasaeter Elvsaas  3 , Jan Alexander  1 , Vigdis Underland  3 , Bendik Christian Brinchmann  1   5 , Tom Kristian Grimsrud  6
Affiliations
Review

A systematic review of cancer risk among users of smokeless tobacco (Swedish snus) exclusively, compared with no use of tobacco

Håkon Valen et al. Int J Cancer. .

Abstract

The main objective of this systematic review was to assess cancer risk, and mortality after cancer diagnosis, for exclusive users of Swedish snus, compared with non-users of tobacco. We followed international standards for systematic reviews and graded our confidence in the risk estimates using the GRADE approach. Our search gave 2450 articles, of which 67 were assessed in full text against our inclusion criteria. Of these, 14 cohort-studies and one case-control study were included in the review. The studies investigated risk of cancer in the oral cavity or oropharynx (3 studies), esophagus (1 study), stomach (1 study), pancreas (2 studies), colorectum (2 studies), anus (1 study) and lung (1 study), as well as malignant lymphoma (1 study), leukemia and multiple myeloma (1 study), melanoma (1 study), any cancer (1 study) and mortality after cancer diagnosis (4 studies). Cancer risk could only be evaluated in men as there was a general lack of data for women. All included studies were evaluated to have a moderate risk of bias, mostly related to validity of exposure information. An increased risk of cancer of the esophagus, pancreas, stomach and rectum as well as an association between use of snus and increased mortality after a cancer diagnosis was reported. Our confidence in the various risk estimates varied from moderate through low to very low.

Keywords: cancer; smokeless tobacco; snus; tobacco.

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