|LETTER TO EDITOR
|Year : 2012 | Volume
| Issue : 4 | Page : 448
Health consequences of smokeless tobacco use
Healis, Sekhsaria Institute for Public Health CBD Belapur (E), Navi Mumbai, Maharashtra, India
|Date of Web Publication||26-Feb-2013|
C S Ray
Healis, Sekhsaria Institute for Public Health CBD Belapur (E), Navi Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Ray C S. Health consequences of smokeless tobacco use. Indian J Cancer 2012;49:448
A large number of smokeless tobacco (SLT) products are produced and used in countries of the South-East Asia Region. Areca nut is commonly used in conjunction with many of them.
Systematic reviews of evidence for the carcinogenicity of SLT and areca nut in the form of epidemiological and animal studies have been undertaken by the International Agency for Research on Cancer (IARC) and published in successive volumes (Available on its website: http://www.iarc.fr/en/publications/list/monographs/index.php )
In its 89 th volume, published in 2007,  the IARC concluded that SLT is carcinogenic to humans and that it causes cancer of the oral cavity and of the pancreas. This new evaluation confirmed its earlier evaluation published in 1985  in vol. 37 and added that there was sufficient evidence that 1) the oral use of tobacco mixed with lime and 2) the habitual chewing of betel quid with tobacco were each carcinogenic to humans. Another evaluation of betel quid and areca nut published in the 85 th volume in 2004  by the IARC stated that betel quid and areca nut chewed without tobacco is carcinogenic to humans and causes oral cancer. It also stated that betel quid with tobacco causes cancer of the oral cavity pharynx and esophagus.
Evidence for a causal role of SLT for other health consequences were also documented in the 89 th volume. The best evidence was for adverse reproductive outcomes and cardiovascular diseases. Adverse reproductive effects, such as reduced birth weight, preterm delivery, and pre-eclampsia were found in association with SLT usage in both Sweden and India. A review concluded that a significant association existed between the use of SLT and the risk of fatal myocardial infarction and stroke. 
In view of all the large accumulation of evidence for disease causation by smokeless tobacco and areca nut, the public in all these countries deserves to be informed of all the disease causing potential of these preparations. Although many of these may have been used for centuries and a part of local culture, their harmful nature must be made known through all means possible e.g., through the mass media and educational curricula. Health care providers need to routinely ask patients if they use smokeless tobacco or areca nut and advise them to stop. For this to happen, medical, dental and nursing curricula need to teach these concepts and train students in the skills for counseling patients along these lines.
| » References|| |
|1.||IARC monographs on the evaluation of the carcinogenic risk of chemicals to humans. Vol. 89. Smokeless Tobacco and Some Tobacco-specific N-Nitrosamines. Lyon: International Agency for Research on Cancer; 2007. |
|2.||IARC monographs on the evaluation of the carcinogenic risk of chemicals to humans. Vol. 37. Tobacco habits other than smoking; betel quid and areca-nut chewing; and some related nitrosamines. Lyon: International Agency for Research on Cancer; 1985. |
|3.||IARC mongraphs on the evaluation of the carcinogenic risk of chemicals to humans. Vol. 85. Betel-quid and areca-nut chewing and some areca-nut-derived nitrosamines. Lyon: International Agency for Research on Cancer; 2004. |
|4.||Boffetta P, Straif K. Use of smokeless tobacco and risk of myocardial infarction and stroke: Systematic review with meta-analysis. BMJ 2009;339:b3060. |