One advertisement tells the public that a “pinch” of smokeless tobacco between cheek and gum leads to “real tobacco pleasure.” But what the ad doesn’t say is that many researchers believe sustained use can lead to oral cancer as well.
“At least 95 percent of the people I have spoken to who use snuff or chewing tobacco think it is safe,” says Ronald A. Baughman, DDS, professor of oral medicine at the University of Florida College of Dentistry, Gainesville. Dr. Baughman estimates that he sees one patient per month who has developed precancerous lesions from the use of smokeless tobacco.
Advertising campaigns featuring sports celebrities have contributed to a rapid increase in sales of smokeless tobacco over the past 10 years, and medical literature was also promoting the product as a substitute for cigarettes as late as 1980. But with the rise in smokeless tobacco use, especially among middle- and upper-class adolescents and young adults, the incidence of precancerous lesions has increased, prompting researchers to look for a link between the two developments. Today about seven million people in the United States are thought to use smokeless tobacco; the incidence of oral cancer is about 25,000 cases a year.
“Several recent studies and significant clinical experience show an association between the use of chewing tobacco and oral cavity cancer,” according to an American Cancer Society pamphlet.
And the initial results of a 20-year study of teenagers undertaken at the University of Colorado School of Medicine, Denver, hare reconfirmed this relationship.
The researchers have found that 50 percent of the smokeless-tobacco users studies had observable leukoplakia and that 10 percent of those with leukoplakia already had developed lesions likely to become
“If we find precancerous lesions in time, and if the patient stops using tobacco, the lesions may regress and clear themselves,” Dr. Baughman says. He adds that early discovery is difficult because the stronger brands of smokeless tobacco, which can be the most dangerous, tend to periodically leave the user’s mouth burned and raw. This episodic soreness may mask symptoms of a developing oral cancer.
Although dentists play a key role in detecting the lesions, Dr. Baughman suggests two actions primary care physicians can take:
“The physicians can do an oral exam as part of every physical examination of a teenaged or young adult patient. Looking for leukoplakia and cancerous lesions takes less than a minute.
“Also, the physician can routinely ask all patients if they use chewing tobacco and tell those who do it may cause cancer.” Lots of users of smokeless tobacco are being encouraged to use alternatives such as electronic cigarettes or similar in an attempt to reduce harm to themselves and costs to the healthcare system.