CoChat
Sign Up
Cited by 20

No association between moist oral snuff (snus) use and oral cancer: pooled analysis of nine prospective observational studies

Araghi, Marzieh, Galanti, Maria Rosaria, Lundberg, Michael, Liu, Zhiwei, Ye, Weimin, Lager, Anton, Engström, Gunnar, Alfredsson, Lars +8 more·2021·Scandinavian Journal of Public Health
DOI 10.1177/1403494820919572
Open this paper in CoChat — free account

Abstract

Aims: Worldwide, smokeless-tobacco use is a major risk factor for oral cancer. Evidence regarding the particular association between Swedish snus use and oral cancer is, however, less clear. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess the association between snus use and oral cancer. Methods: A total of 418,369 male participants from nine cohort studies were followed up for oral cancer incidence through linkage to health registers. We used shared frailty models with random effects at the study level, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for confounding factors. Results: During 9,201,647 person-years of observation, 628 men developed oral cancer. Compared to never-snus use, ever-snus use was not associated with oral cancer (adjusted HR 0.90, 95% CI: 0.74, 1.09). There were no clear trends in risk with duration or intensity of snus use, although lower intensity use (⩽ 4 cans/week) was associated with a reduced risk (HR 0.65, 95% CI: 0.45, 0.94). Snus use was not associated with oral cancer among never smokers (HR 0.87, 95% CI: 0.57, 1.32). Conclusions: Swedish snus use does not appear to be implicated in the development of oral cancer in men.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1177/1403494820919572

Cites

1 of 1 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Among ever snus users compared to never-users, there is no association between ever snus use and oral cancer (aHR = 0.90; 95% CI: 0.74-1.09).

    “No association between ever snus use and oral cancer (aHR = 0.90; 95% CI: 0.74-1.09)compared to never-users (Araghi et al. 2021)”

    From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Araghi et al. 2021

    The passages returned under this DOI are labeled as a pancreatic-cancer study. Its Results report HR 0.93 (95% CI 0.82–1.06) for ever versus never snus use and pancreatic cancer, not the claimed oral-cancer estimate. Searches for oral cancer and the stated confidence interval found no passage addressing the claim in our copy. (LLM, conf=0.75)

    Experimental — accuracy not yet measured

  • Among never smokers, there is no association between snus use and oral cancer (HR = 0.87; 95% CI: 0.57-1.32).

    “No association between snus use and oral cancer (HR = 0.87; 95% CI: 0.57-1.32) in never smokers”

    From Comparison of the Health Effects Associated with the Use of Snus and Tobacco-Free Oral Nicotine Pouches: A Systematic Review (2026) · cites this paper as Araghi et al. 2021

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 42

  1. Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology 2013;144: 1252-61.
  2. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, Rosso S, Coebergh JW, Comber H, Forman D, Bray F. Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012. Eur J Cancer 2013;49: 1374-403.
  3. Bosetti C, Bertuccio P, Negri E, La Vecchia C, Zeegers MP, Boffetta P. Pancreatic cancer: overview of descriptive epidemiology. Mol Carcinog 2012;51: 3-13.
  4. Iodice S, Gandini S, Maisonneuve P, Lowenfels AB. Tobacco and the risk of pancreatic cancer: a review and meta-analysis. Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie 2008;393: 535-45.
  5. Chowdhury P, MacLeod S, Udupa KB, Rayford PL. Pathophysiological effects of nicotine on the pancreas: an update. Exp Biol Med (Maywood) 2002;227: 445-54.
  6. Holm H, Jarvis MJ, Russell MA, Feyerabend C. Nicotine intake and dependence in Swedish snuff takers. Psychopharmacology (Berl) 1992;108: 507-11.
  7. Hamari AK, Toljamo TI, Kinnula VL, Nieminen PA. Dual use of cigarettes and Swedish snuff (snus) among young adults in Northern Finland. Eur J Public Health 2013;23: 768-71.
  8. Boffetta P, Hecht S, Gray N, Gupta P, Straif K. Smokeless tobacco and cancer. Lancet Oncol 2008;9: 667-75.
  9. Bertuccio P, La Vecchia C, Silverman DT, Petersen GM, Bracci PM, Negri E, Li D, Risch HA, Olson SH, Gallinger S, Miller AB, Bueno-de-Mesquita HB, et al. Cigar and pipe smoking, smokeless tobacco use and pancreatic cancer: an analysis from the International Pancreatic Cancer Case-Control Consortium (PanC4). Ann Oncol 2011;22: 1420-6.
  10. Lee PN, Hamling J. Systematic review of the relation between smokeless tobacco and cancer in Europe and North America. Bmc Med 2009;7.
  11. Hansson J, Galanti MR, Hergens MP, Fredlund P, Ahlbom A, Alfredsson L, Bellocco R, Eriksson M, Hallqvist J, Hedblad B, Jansson JH, Nilsson P, et al. Use of snus and acute myocardial infarction: pooled analysis of eight prospective observational studies. European journal of epidemiology 2012;27: 771-9.
  12. Luo J, Ye W, Zendehdel K, Adami J, Adami HO, Boffetta P, Nyren O. Oral use of Swedish moist snuff (snus) and risk for cancer of the mouth, lung, and pancreas in male construction workers: a retrospective cohort study. Lancet 2007;369: 2015-20.
  13. Manjer J, Carlsson S, Elmstahl S, Gullberg B, Janzon L, Lindstrom M, Mattisson I, Berglund G. The Malmo Diet and Cancer Study: representativity, cancer incidence and mortality in participants and non-participants. European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation 2001;10: 489-99.
  14. Eriksson M, Holmgren L, Janlert U, Jansson JH, Lundblad D, Stegmayr B, Soderberg S, Eliasson M. Large improvements in major cardiovascular risk factors in the population of northern Sweden: the MONICA study 1986-2009. Journal of internal medicine 2011;269: 219-31.
  15. Trolle Lagerros Y, Hantikainen E, Mariosa D, Ye W, Adami HO, Grotta A, Ghilotti F, Bellocco R. The Swedish National March Cohort. International journal of epidemiology 2016.
  16. Pedersen NL, Lichtenstein P, Svedberg P. The Swedish Twin Registry in the third millennium. Twin research : the official journal of the International Society for Twin Studies 2002;5: 427-32.
  17. Carlsson F, Merlo J, Lindstrom M, Ostergren PO, Lithman T. Representativity of a postal public health questionnaire survey in Sweden, with special reference to ethnic differences in participation. Scandinavian journal of public health 2006;34: 132-9.
  18. Svensson AC, Fredlund P, Laflamme L, Hallqvist J, Alfredsson L, Ekbom A, Feychting M, Forsberg B, Pedersen NL, Vagero D, Magnusson C. Cohort profile: The Stockholm Public Health Cohort. International journal of epidemiology 2013;42: 1263-72.
  19. Alfredsson L, Hammar N, Fransson E, de Faire U, Hallqvist J, Knutsson A, Nilsson T, Theorell T, Westerholm P. Job strain and major risk factors for coronary heart disease among employed males and females in a Swedish study on work, lipids and fibrinogen. Scandinavian journal of work, environment & health 2002;28: 238-48.
  20. Mattsson B, Wallgren A. Completeness of the Swedish Cancer Register. Non-notified cancer cases recorded on death certificates in 1978. Acta Radiol Oncol 1984;23: 305-13.
  21. Luo J, Adami HO, Reilly M, Ekbom A, Nordenvall C, Ye W. Interpreting trends of pancreatic cancer incidence and mortality: a nation-wide study in Sweden (1960- 2003). Cancer causes & control : CCC 2008;19: 89-96.
  22. Hidalgo M, Cascinu S, Kleeff J, Labianca R, Lohr JM, Neoptolemos J, Real FX, Van Laethem JL, Heinemann V. Addressing the challenges of pancreatic cancer: future directions for improving outcomes. Pancreatology 2015;15: 8-18.
  23. Johansson LA, Westerling R. Comparing Swedish hospital discharge records with death certificates: implications for mortality statistics. International journal of epidemiology 2000;29: 495-502.
  24. Arslan AA, Helzlsouer KJ, Kooperberg C, Shu XO, Steplowski E, Bueno- de-Mesquita HB, Fuchs CS, Gross MD, Jacobs EJ, Lacroix AZ, Petersen GM, Stolzenberg- Solomon RZ, et al. Anthropometric measures, body mass index, and pancreatic cancer: a pooled analysis from the Pancreatic Cancer Cohort Consortium (PanScan). Arch Intern Med 2010;170: 791-802.
  25. Genkinger JM, Spiegelman D, Anderson KE, Bergkvist L, Bernstein L, van den Brandt PA, English DR, Freudenheim JL, Fuchs CS, Giles GG, Giovannucci E, Hankinson SE, et al. Alcohol intake and pancreatic cancer risk: a pooled analysis of fourteen cohort studies. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 2009;18: 765-76.
  26. Michaud DS, Giovannucci E, Willett WC, Colditz GA, Stampfer MJ, Fuchs CS. Physical activity, obesity, height, and the risk of pancreatic cancer. JAMA 2001;286: 921- 9.
  27. Gullo L, Pezzilli R, Morselli-Labate AM, Italian Pancreatic Cancer Study G. Diabetes and the risk of pancreatic cancer. N Engl J Med 1994;331: 81-4.
  28. Ludvigsson JF, Andersson E, Ekbom A, Feychting M, Kim JL, Reuterwall C, Heurgren M, Olausson PO. External review and validation of the Swedish national inpatient register. BMC Public Health 2011;11: 450.
  29. Wettermark B, Hammar N, Fored CM, Leimanis A, Otterblad Olausson P, Bergman U, Persson I, Sundstrom A, Westerholm B, Rosen M. The new Swedish Prescribed Drug Register--opportunities for pharmacoepidemiological research and experience from the first six months. Pharmacoepidemiol Drug Saf 2007;16: 726-35.
  30. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21: 1539-58.
  31. Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 1999;94: 496-509.
  32. Zheng W, McLaughlin JK, Gridley G, Bjelke E, Schuman LM, Silverman DT, Wacholder S, Co-Chien HT, Blot WJ, Fraumeni JF, Jr. A cohort study of smoking, alcohol consumption, and dietary factors for pancreatic cancer (United States). Cancer causes & control : CCC 1993;4: 477-82.
  33. Muscat JE, Stellman SD, Hoffmann D, Wynder EL. Smoking and pancreatic cancer in men and women. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 1997;6: 15-9.
  34. Alguacil J, Silverman DT. Smokeless and other noncigarette tobacco use and pancreatic cancer: a case-control study based on direct interviews. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 2004;13: 55-8.
  35. Boffetta P, Aagnes B, Weiderpass E, Andersen A. Smokeless tobacco use and risk of cancer of the pancreas and other organs. International journal of cancer Journal international du cancer 2005;114: 992-5.
  36. Johansson LA, Bjorkenstam C, Westerling R. Unexplained differences between hospital and mortality data indicated mistakes in death certification: an investigation of 1,094 deaths in Sweden during 1995. Journal of clinical epidemiology 2009;62: 1202-9.
  37. Eliasson M, Asplund K, Evrin PE, Lundblad D. Relationship of cigarette smoking and snuff dipping to plasma fibrinogen, fibrinolytic variables and serum insulin. The Northern Sweden MONICA Study. Atherosclerosis 1995;113: 41-53.
  38. Lynch SM, Vrieling A, Lubin JH, Kraft P, Mendelsohn JB, Hartge P, Canzian F, Steplowski E, Arslan AA, Gross M, Helzlsouer K, Jacobs EJ, et al. Cigarette smoking and pancreatic cancer: a pooled analysis from the pancreatic cancer cohort consortium. Am J Epidemiol 2009;170: 403-13.
  39. Edderkaoui M, Thrower E. Smoking and Pancreatic Disease. J Cancer Ther 2013;4: 34-40.
  40. Schuller HM. Mechanisms of smoking-related lung and pancreatic adenocarcinoma development. Nat Rev Cancer 2002;2: 455-63.
  41. Bardeesy N, DePinho RA. Pancreatic cancer biology and genetics. Nat Rev Cancer 2002;2: 897-909.
  42. Foulds J, Ramstrom L, Burke M, Fagerstrom K. Effect of smokeless tobacco (snus) on smoking and public health in Sweden. Tob Control 2003;12: 349-59.

Cited by

Sorted by citations

Authors
Araghi, M., Galanti, M. R., Lundberg, M., Liu, Z., Ye, W., Lager, A., Engström, G., Alfredsson, L., Knutsson, A., Norberg, M., Wennberg, P., Lagerros, Y. T., Bellocco, R., Pedersen, N. L., Östergren, P.-O., & Magnusson, C.
Venue
Scandinavian Journal of Public Health
Publisher
SAGE Publications
Published
2020-05-28
Volume
49
Issue
8
Pages
833-840
ISSN
  • 1403-4948
  • 1651-1905
DOI
10.1177/1403494820919572
Cited by
20
References
1
Language
en
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review