Dr. Brad Rodu of the Department of Pathology at the University of Alabama, was quoted in the Birmingham News during December 2002 as saying: I believe that the Swedes have shown that if safer products existed, smokers could switch to them. It is not nicotine that kills. It is smoking.
Is snus safe and are there any long-term health effects?
Snus is considered by scientists to be 95%, and possibly closer to 99%, less risky than smoking.
Snus poses no respiratory risk. Respiratory diseases, predominantly lung cancer, chronic obstructive pulmonary disease (COPD) and pneumonia account for 46% of deaths due to smoking, according to the Scientific Committee on Emerging and Newly Identified Health Risks, 2008.
Individual studies can produce contradictory findings so evidence must be sought from overviews of key studies and pooled results. A systematic review and meta-analysis examined the evidence relating to snus and health across six major Swedish, Norwegian, Danish and Finnish studies, up to 2010. This concludes that the evidence provides scant support for any major adverse health effects of snus: snus is not associated with cancers of the oropharynx, oesophagus, pancreas, or heart disease or strokes. Compared with smoking snus poses about 1% of the risk of cancer or cardiovascular disease.
A recent definitive study from the Swedish Karolinska Institutet confirms that snus is not associated with an elevated risk of pancreatic cancer. Because snus has been used in Sweden for a long time it is possible to study samples of the population over time (so-called cohort studies) and to link survey data with registers of disease and mortality. A total of 424,152 men from nine cohort studies was followed up for risk of pancreatic cancer through links to health registers. The nine prospective cohort studies included participants of varying ages, who were recruited at different time periods from diverse geographic regions across Sweden. During a cumulative 9,276,054 person-years of observation, compared to never users of snus, current snus use was not associated with risk of pancreatic cancer.
Use of moist oral snuff (snus) and pancreatic cancer: Pooled analysis of nine prospective observational studies
The human cost of the ban on snus
Using data on tobacco-related mortality across the EU, and applying the Swedish mortality data to other EU countries, it has been calculated that among men over the age of 30, 355,000 lives per year could have been saved if the other EU countries had matched Sweden’s tobacco-related mortality rate.
Health effects of switching to snus
Given the lower risk profile for snus it has been calculated that the life expectancy of smokers who switch from smoking to snus is little different to the life expectancy of those who stop smoking altogether. The authors of this study conclude that: ’Individual smokers who switched to snus instead of continuing to smoke and new tobacco users who only used snus rather than smoking would achieve large health gains compared with smokers’.
This finding is confirmed by a recent analysis of six major studies which found that switching from smoking to snus is associated with major reductions in morbidity and that switching to snus appears to have much the same reduced health risk as quitting smoking.
Data on the use of snus
- In 2011, 10 percent of all adult Swedish men smoked daily. The corresponding figure for Norway was 19 percent, and 22 percent for Denmark, with the European average (2010, latest data) at 32 percent (1).
- In 2011, 18 percent of all adult Swedish men used snus on a daily basis, compared with 12 percent of men in Norway who used snus daily, while in Denmark 1.5 percent used some form of smokeless tobacco regularly (1).
- In 2011, 12 percent of all adult Swedish women smoked daily. The corresponding figure for Norway was 19 percent, with 22 percent for Denmark, while the European average (2010, latest data) was 21 percent (1).
- In 2011, 3 percent of all adult Swedish women used snus daily, with the corresponding figure in Norway being 2 percent, while in Denmark 0.2 percent used some form of smokeless tobacco regularly (1).
- In 1997, Sweden became the first country worldwide to meet the WHO’s goal for 2000, namely, that the proportion of adult smokers would be less than 20 percent (3). The second country to meet this target was Iceland in 2005, which also has a long tradition of using smokeless tobacco.
- In 2000, 10 percent of deaths among Swedish men were smoking-related, or the lowest proportion in Europe. The average figure for the 25 EU countries (EU 25) was 23 percent (4).
- Swedish women showed the same smoking-related mortality rate as the average for the EU’s 25 countries in 2000, namely, 7 percent (4).
- In 2000, the risk of a 35-yer-old man dying of a smoking-related illness before the age of 70 was 3 percent in Sweden, compared with 5 percent in Norway, 8 percent in Denmark and an average 9 percent for EU 25 (4).
- Corresponding figures for women were 2.1 percent in Sweden, 2.6 percent in Norway, 5.9 percent in Denmark, and for EU 25 an average of 1.6 percent (4).
- The incidence of lung cancer among Swedish men has fallen during the past 20 years. Swedish women, however, are displaying a rising trend in terms of lung cancer statistics (5).
- Two epidemiological studies conducted in Sweden did not show any relationship between the use of Swedish snus and oral cancer (6, 7).
- Two epidemiological studies on stomach and esophageal cancer did not show any relationship between Swedish snus and a higher risk for any of these cancer forms. (8, 9).
- The cancer mortality rate is not higher among Swedish users of snus (10).
- The risk of heart attack is not higher among snus users (11).
- In a study covering Swedish snus users, researchers find no significant increase in diastolic blood pressure, hemoglobin concentration, white blood cell count, and serum cholesterol or triglyceride levels. These results contrast with similar studies of cigarette smokers (12).
- Snus users as well smokers run a higher risk of dying from heart or cardiovascular illnesses than non-tobacco users. The risk is lower for a snus user than for a smoker. (10).
- There is a high probability that the health risks presented by snus are less than the health risks associated with smoking (13, 14).
The figures within parentheses refer to the list of references.
Snus and the Swedish Food Act
The purpose of the Swedish Food Act is to ensure a high standard of safety in respect of the health of people, as well as the interests of consumers in respect of food. In April 2016, the Swedish National Food Agency implemented an addendum to the directive designed to regulate the content of the foreign substances B(a)P and NNN + NNK, which are present in snus and chewing tobacco. Lead and aflatoxins were already regulated.
Swedish Match welcomes the Swedish National Food Agency’s directives. Through our unique quality standard GOTHIATEK®, we have long been working actively to minimize the levels of foreign substances in our products. All of our products comfortably satisfy the sharpened limits that have now been introduced by the Swedish National Food Agency.
300,000 tests annually
Swedish Match implements just over 300,000 quality tests each year to check that the limits set for your snus are never exceeded. Although slight differences may be noticeable over time because the ingredients are from growing matter, the quality and the substance levels are always guaranteed.
The results of the tests are available on our website. As a consumer, you can – here and now – find out the actual values for your favorite snus from Swedish Match.
Which substances are covered by the Swedish Food Act – and what impact do they have?
Aflatoxins (included in the group mycotoxins)
The aflatoxins B1, B2, G1 and G2 are toxins formed by fungal mold. They thrive in hot tropical climates and thus exist in such imported foods as nuts, spices, corn, rice and figs. The Swedish National Food Agency has set a limit for total aflatoxins in snus. As a result of distinct legislation governing aflatoxins in food, exposure from food is low in Sweden.
It is extremely rare that measurable levels of aflatoxins occur in Swedish snus products from Swedish Match.
B(a)P (Bens(a)pyrene (included in the group polycyclic aromatic hydrocarbons, PAH)
B(a)P is an abbreviation of Bens(a)pyrene and is generated from the combustion of organic material and thus exists in nature. Accordingly, it exists in all food, including fruit, vegetables and grain. Thanks to GOTHIATEK®, the levels in Swedish Match snus are low. For example, it can be said that 18 snus cans contain the same amount as 100 grams of grilled meat. The reason for this extremely low level is that we have completely discontinued the use of dry-cured tobacco, which – prior to the introduction of GOTHIATEK® – had been traditionally used in the production of snus.
Lead (included in the group heavy metals)
Lead is a contaminant that exists in air, soil and water. Low concentrations of lead exists in all food. The Swedish National Food Agency has set a limit of 3 milligrams per kilo for the concentration of lead in snus. Swedish Match snus contains about 0.15 milligrams of lead per kilo. The levels in snus correspond to those existing in fruit and vegetables, although, of course, snus is not intended to be eaten.
Propylene glycol (included in the group polyalcohols)
Propylene glycol is used in snus to retain moisture, keep the product stable and prevent bacterial growth. According to the Swedish National Food Agency’s directive governing snus and chewing tobacco (LIVSFS 2012:6), propylene glycol is approved as a food additive in concentrations of up to 4%. The substance exists in chewing gum, ice cream, toothpaste and frozen products, among others. The level in Swedish Match snus is below the Swedish National Food Agency’s limit.
NNN+NNK (included in the group Nitrosamines)
The tobacco-specific nitrosamines, TSNA, are only found in tobacco and two of them, NNN (and N’-nitrosonornicotine) and NNK (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone), have been proven in animal testing to be carcinogenic at high levels. Swedish Match snus comfortably satisfies the requirements set in the Swedish National Food Agency’s directive. The actual level in the end product is far below the limits set for TSNA, while products similar to snus from other suppliers can contain levels that are several hundred times higher.
People consume other, non-tobacco-specific, nitrosamines that are found in food, drugs and cosmetics, among other products. For example, the content of the volatile nitrosamine NDMA in 100 grams of fried bacon corresponds to the amount in 17 cans of snus.