A more recent study published in 2006 by Dr. Cummings and his colleagues may offer some response to this question. In the study, a panel of experts looked at whether introducing a new LN-SLT product under strict regulations into the marketplace would reduce overall smoking prevalence. The study concluded that cigarette users would switch to smokeless with little change in overall tobacco use and with a limited degree of substitution of LN-SLT for cigarettes. If these results hold, the substantial reduction in health risks associated with LN-SLT use should yield a net public health benefit through reduced mortality (Addictive Behav 2006;31:1190-1200).
Explore This IssueJune 2007
Such data may not be too readily accepted, however, given the strong suspicions about the motivations of tobacco companies to sell their products. The last time the US tobacco companies aggressively marketed smokeless products they stimulated a large increase in use of their products by adolescent males but very little switching among smokers, said Dr. Thun.
Dr. Cummings acknowledges the challenges of debating this issue given the lack of trust that consumers and health care professionals have in the tobacco industry. Both the smoked and smokeless industries have given away their credibility by lying to the American public about the risks and addictive nature of their products, he said.
Prevention of Oral Cancer for Smokeless Tobacco Users
Although there are currently no established guidelines for screening for oral cancer in people who chew tobacco, both Dr. Sturgis and Dr. Day recommend regular physical exams that include an examination of the mouth, throat, and neck. We still recommend that people at risk visit their dentist and physician at least twice a year, said Dr. Day.
And both would advise physicians to counsel their patients against using chewing tobacco in place of smoking tobacco. If we recommend that people switch to chewing tobacco, said Dr. Day, we may potentially be putting them in more risk of other problems that we are not yet aware of due to the effects of the numerous possibly toxic chemicals in these products.
According to Dr. Day, the utility of screening for oral cancer remains controversial, as most studies show no survival improvement in people who are screened versus those who are not.
©2007 The Triological Society