The carcinogenic profiles, trends, and cencer risks of regional smokeless tobacco products
Schoettler, Cameron J.
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Smokeless tobacco products have existed for centuries and vary significantly across geographical regions. The constituents found in each smokeless tobacco product depends on many factors, including social customs, manufacturing regulations, and the availability of local raw ingredients. Unfortunately, tobacco products have been linked to cancer over the past several decades, particularly of the oral cavity. In this study, the carcinogenic profiles, relative risks of oral cancer, and usage trends for three unique smokeless tobacco regions (United States, Sweden, and India) will be evaluated in order to determine the relative safety for each product. In this paper, the chemical analysis of various products from United States, as well as Swedish snus and Indian gutkha were reviewed, to establish constituent profiles. The main carcinogens evaluated were the tobacco-specific n-nitrosamines; gutkha displayed the highest values of these ingredients, with snus displaying the lowest. Studies examining the relative risks for oral cancers associated with each of the three region’s smokeless tobacco products were assessed. Indian gutkha expressed the highest relative risk for developing oral cancers, and Swedish snus expressed the lowest (a very slight increased risk at that). To establish usage habits for each region-specific smokeless tobacco product, various epidemiological studies were analyzed and showed that gutkha was the most prevalently used product in its respective region, with Swedish snus only slightly trailing in use. Smokeless tobacco products were used the least in the United States. These studies concluded that the gutkha habits in India were the most damaging to the public health of the nation with regards to smokeless tobacco use, particularly due to the high prevalence of use and high relative risk of oral cancers. In a purely chemical sense, Swedish snus was less harmful than the counterparts often sold in the United States. Yet, with snus use significantly higher than smokeless tobacco use in the United States, it is thought that Sweden snus habits are more detrimental than those seen in the United States. However, smokeless tobacco is ultimately an unsafe practice in all three regions evaluated, and more should be done to remove carcinogens from the products and promote self-restraint for current users.
Thesis (M.A.)--Boston University