A study published in BMC Medicine (here) estimates that the number of cancer deaths due to smokeless tobacco (ST) use in the U.S. and Canada is ZERO.
The researchers, mainly from the UK, had bad news for ST users in Southeast Asia, where products have high levels of contaminants and are mixed with other toxic ingredients like betel. Deaths in that region contributed the lion’s share of the worldwide toll of 267,000 annual deaths from cancer and heart disease among ST users.
The researchers developed risk estimates based on epidemiologic studies from each region. As I have discussed many times, the risk of cancer among Swedish and U.S. ST users is so small that it is not statistically significant. Attributing no U.S. cancer deaths to smokeless tobacco use, the UK researchers confirmed this.
They also estimated deaths from ischemic heart disease among ST users. I have noted that several studies document the risk of heart attack among smokeless users in the U.S. and Sweden as “next to nil” (here, here, here and here). Ignoring these published risk estimates, the UK researchers declared that “no good country-specific risk estimates were available.” They assigned a risk value of 1.6 based on an international heart attack study that included ST use data from countries like Bangladesh, India, Pakistan, Sri Lanka, Nigeria and Cameroon, but not the U.S. or Canada. Due to this, the UK claim of 11,000 heart attack deaths in the U.S. and Canada from ST use is a gross overestimate.
The U.S. and Canadian public should ignore scaremongering about ST deaths, as the real threat lies with adulterated products from Southeast Asia. For Western ST users, there is much to celebrate in this report.