Smokeless Tobacco and Cancer Risk

Even Without Smoke, Tobacco Is Unsafe

Chewing tobacco cancer, sometimes called dip cancer, is caused by the use of smokeless tobacco. It's associated with throat and esophagus cancers, and mouth cancer of the lips, gum, tongue, and cheeks, as well as pancreatic cancer.

In the United States, more than 2,300 people are diagnosed with these cancer types caused by smokeless tobacco use each year. Of this number, 1,600—about 70%—are oral cancer diagnoses.

This article explains chewing tobacco cancer risk and the types of cancer associated with dip tobacco use. It also offers information about how you can quit chewing tobacco use.

Snuff


Jan Hakan Dahlstrom/Getty Images

What Is Snuff or Dip?

Snuff or dip consists of finely ground tobacco. It can be dry, packaged, or moist. Snuff is packaged in pouches or packets. There are different uses of these smokeless tobaccos. Some types are placed in the mouth and others are inhaled into the nose or sniffed.

The dry snuff is in powder form and fire-cured. Typical use is a pinch of powder through the mouth or inhaled through the nose. Moist snuff is aged and fermented. The tobacco is processed into fine particles. The typical use of moist snuff is placing a “dip” or pinch between the lip and gums or cheek.

Another popular product in the U.S. is snus. This chewing tobacco comes in small pouches that look like small tea bags. The pouch is placed between the teeth or cheek and gums. Unlike the dry snuff and moist snuff, snus don’t require spitting.

Types of Smokeless Tobacco

Smokeless tobaccos come in various forms. These products include:

  • Chewing Tobacco: This form of smokeless tobacco comes in a loose-leaf twist or roll and plug. The loose-leaf form of tobacco is aged—at times sweetened—and packaged in foil pouches. The twist or roll form are aged tobacco leaves that are formed like a rope. The plug form is aged tobacco leaves that are pressed together and wrapped in a tobacco leaf.
  • Snuff: This is a smokeless tobacco that is dry, moist, or comes in packets. The dry form of snuff comes in a powder form and is fire-cured. Moist snuff is fermented and aged tobacco that is processed into fine particles and typically packaged in round cans. Snus come in packages that resemble small tea bags.
  • Dissolvables: This form of tobacco comes in lozenges, orbs that look like small mints, and sticks that look like toothpicks.

How Much Nicotine Is in Dip?

The amount of nicotine in dip tobacco depends on the product. One study of 25 types of smokeless tobacco products found a range of 6.9 milligrams (mg) to 12 mg in a one-gram portion, depending on the brand and style. By comparison, cigarettes deliver between 0.1 to 3 mg for each one smoked.

Worse Than Cigarettes?

Smokeless tobacco is known to deliver more nicotine than cigarette smoking. Dip tobacco contains compounds known to cause cancer that include:

  • Formaldehyde
  • Lead
  • Benzopyrene
  • Tobacco-specific nitrosamines
  • Polonium
  • Cadmium

What's in Dip?

Orally consumed smokeless tobacco products are known to contain more than 30 carcinogens.

Oral Cancer

Usage of snuff or dip can cause cancer in the lips, cheek, and gums. Men over the age of 50 have the greatest risk of oral cancer. Regular smoking, tobacco use, and excessive use of alcohol can increase the risk of oral cancer.

When cancer is caused by smokeless tobacco, it starts with a whitish patch inside the throat or mouth also known as leukoplakia. Another way it forms is with erythroplakia, or a raised red patch that develops inside of the mouth.

An oral cancer screening exam is done by a dentist, usually as part of an exam. An oral brush biopsy is done if there is a concern about the findings or dip cancer symptoms.

The treatment of oral cancer, in general, is surgery and radiation treatment or chemotherapy to destroy additional cancer cells.

Esophageal Cancer

Esophageal cancer occurs when cancer cells form in the tissues of the esophagus. It starts in the inner lining and spreads to the outer layers. In general, individuals who are between the ages of 45 and 70 have the highest risk of esophageal cancer. Men have a higher risk than women to develop esophageal cancer.

Symptoms of esophageal cancer may include:

  • Hoarseness
  • Difficulty swallowing
  • Chronic cough

In order to diagnose esophageal cancer, your healthcare provider may order specific tests, as well as a biopsy sample of esophageal cells. The chewing tobacco cancer risk is higher for this disease, as it is in people who smoke and drink alcohol.

Pancreatic Cancer

Pancreatic cancer is the fourth leading cause of cancer deaths in the United States. The major risk factors include diabetes, obesity, and tobacco smoking.

Research shows that chewing tobacco is a possible risk factor for pancreatic cancer, but the association between cancer and the use of smokeless tobacco is unknown.

Some of the symptoms of pancreatic cancer include:

  • Pain in the back and abdomen
  • Nausea and vomiting
  • Weight loss and poor appetite
  • Jaundice, a yellowing of the eyes and skin

Imaging tests, blood tests, and/or a biopsy are usually conducted to determine whether or not a patient has pancreatic cancer.

Other Health Risks

Other long-term health risks of smokeless tobacco include tooth decay, gum disease, cardiovascular disease, and stroke. Not all of the effects of dip tobacco are in the future, though. One of the immediate effects of tobacco in humans consists of an increase in pulse rate and blood pressure.

Steps to Quit Chewing Tobacco Use

It's never easy to break a tobacco habit and the nicotine addiction. It may help to make a plan and enlist your loved ones in supporting you. The American Cancer Society offers resources and tips to help you stop using tobacco. They include lifestyle choices such as:

  • Eating a healthy diet
  • Setting up an exercise routine
  • Making sure you get enough rest


A Word From Verywell

Regular tobacco use, including chewing tobacco, can lead to consequences for your life, health, and loved ones. It is important to think long-term when it comes to your health. Choosing healthy habits such as diet, exercise, and avoiding habits that can cause health issues are important.

Frequently Asked Questions

  • What are the two main cancers caused by tobacco use?

    The top cancer caused by smoking tobacco is lung cancer, but tobacco use is linked to cancers found throughout the body. The chewing tobacco cancer risk focuses on oral and esophageal cancers, as well as pancreatic cancer.

  • What do the early stages of mouth cancer look like?

    The most common symptoms of oral cancer are a sore or lump in your mouth, lips, or throat. There may be a white or red patch on the tissue. Other symptoms include difficulty swallowing or moving your jaw, pain in one ear, and a numbness in your mouth or tongue.

  • Is mouth cancer curable?

    Oral cancers are treatable. In the United States, about two out of every three people overall who are diagnosed with a mouth cancer will survive at least five years. This improves to 85% when oral and oropharyngeal cancers are caught at an early stage.

Was this page helpful?
18 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. U.S. Food and Drug Administration. Dip, chew, snuff, snus: "Smokeless" doesn't mean "safe".

  2. Centers for Disease Control and Prevention. Smokeless Tobacco: Products and Marketing.

  3. American Cancer Society. Health Risks of Smokeless Tobacco.

  4. Food and Drug Administration. Smokeless Tobacco Products, Including Dip, Snuff, Snus, and Chewing Tobacco.

  5. Jablonski JJ, Cheetham AG, Martin AM. Market survey of modern oral nicotine products: determination of select hphcs and comparison to traditional smokeless tobacco productsSeparations. 2022;9(3):65. doi:10.3390/separations9030065

  6. Centers for Disease Control and Prevention. Trends in Manufacturer-Reported Nicotine Yields in Cigarettes Sold in the United States, 2013–2016.

  7. Janbaz K, Qadir M, Basser H, Bokhari T, Ahmad B. Risk for oral cancer from smokeless tobacco. Contemporary Oncology/Współczesna Onkologia. 2014;18(3):160-164. doi:10.5114/wo.2014.4052

  8. Warnakulasuriya S, Straif K. Carcinogenicity of smokeless tobacco: Evidence from studies in humans & experimental animals. Indian J Med Res. 2018;148(6):681-686. doi:10.4103/ijmr.IJMR_149_18

  9. John Hopkins Medicine. Oral Cancer and Tobacco.

  10. National Cancer Institute. Esophegal Cancer Prevention (PDQ®)–Patient Version.

  11. American Cancer Society. Key Statistics for Pancreatic Cancer.

  12. Burkey MD, Feirman S, Wang H, Choudhury SR, Grover S, Johnston FM. The association between smokeless tobacco use and pancreatic adenocarcinoma: a systematic review. Cancer Epidemiol. 2014;38(6):647-653. doi:10.1016/j.canep.2014.08.010

  13. American Cancer Society. Signs and Symptoms of Pancreatic Cancer.

  14. Centers for Disease Control and Prevention. Smokeless Tobacco: Health Facts.

  15. Mishra A, Chaturvedi P, Datta S, Sinukumar S, Joshi P, Garg A. Harmful effects of nicotineIndian J Med Paediatr Oncol. 2015;36(1):24-31. doi:10.4103/0971-5851.151771

  16. Centers for Disease Control and Prevention. Tobacco and Cancer.

  17. National Institute of Dental and Craniofacial Research. Oral Cancer.

  18. American Society of Clinical Oncology. Oral and Oropharyngeal Cancer: Statistics.