Systematic review of the relation between smokeless tobacco and cancer in Europe and North America.

The overall data show an association with any ST use (1.79, 1.36–2.36) that, though highly significant, is based on an extremely heterogeneous set of estimates ( P < 0.001).

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A significant trend ( P < 0.01) is reported with daily amount of snuff consumed for pancreatic cancer [ 32 ] in never smokers, but this merely reflects the overall relationship, with RRs similar in light and heavy users (1.9 for 1–9 g/day, and 2.1 for 10+ g/day relative to never users).

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For overall cancer, the effect is also to increase the estimate, here to marginal significance, 1.07 (1.00–1.15).

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The exception is for oesophageal cancer, where the marginally significant increased RR seen in relation to snuff use for never smokers (1.92, 1.00–3.68) derives solely from the Swedish Construction Workers study [ 34 ].

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