Transcript Bild 1 - UKNSCC

Smoking cessation aided by
low-toxicity smokeless
tobacco can save many lives
Lars M. Ramström
Institute for Tobacco Studies
Täby, Sweden
UKNSCC 2014
Thursday 12th June - Friday 13th June 2014
HEALTH RISKs OF NICOTINE-DELIVERY PRODUCTS
100%
0%
Recommendations for regulation of smokeless tobacco
●The combined concentration of NNN plus NNK in smokeless tobacco
should be limited to 2 μg/g dry weight of tobacco.
●The concentration of benzo[a]pyrene in smokeless tobacco should
be
limited to 5 ng/g dry weight of tobacco.
Cancer of the oral cav ity
Age adj ust ed mort alit y rat es per 100 000
Men in Nort h America, Nort hern and W est ern Europe
Estonia
Lithuania
Latvia
Fr ance
Austr ia
Denm ar k
Ger m any
Ir eland
Belgium
Luxem bour g
Switzer land
Iceland
Nor way
United Kingdom
Canada
The Nether lands
United States
Sweden
0
1
2
3
4
Source: GLOBOCAN 2002 database: http://www.-dep.iarc.fr
5
6
Gartner CE et al. Assessment of Swedish snus for tobacco harm reduction:
an epidemiological modelling study. Lancet 2007; 369: 2010-2014
Reduction of life expectancy:
Tobacco users, age 40, in comparison
with ”Never tobacco users”
Current smokers who
continue to smoke
Estimated number of years lost
Men
Women
5.04
4.09
Current smokers who
quit all tobacco use
0.53
0.34
Current smokers who
switch to snus
0.77
0.52
Current snus users who
never smoked
0.28
0.19
Gartner et al. Lancet 2007
Relative risk of death for male tobacco users(whole bar)
Green sector: Never-smokers' death risk (reference)
Red sector: Excess risk (above Never-smokers)
Cigarette smokers
L ess t h an 9% o f
Snus users
Never-smokers
0,0
0,5
1,0
1,5
2,0
2,5
Data derived from:
B jartveit K , Tverdal A . Health consequences of smoking 1-4 cigarfettes per day. Tobacco Control 2005; 14:315-320.
Levy D T et.al. The Relative Risks of a Low-Nitrosamine S mokeless Tobacco P roduct Compared with S moking
Cigarettes: E stimats of a P anel of E xperts. Cancer E pidemiol B iomarkers P rev 2004; 13(12):2035-2041.
Among boys WITHOUT primary
daily snus use:
- 46% start daily smoking
Among boys WITH primary daily
snus use:
- 18% start daily smoking
Source: FSI / ITS surveys 2003 - 2011
Among all boys who have started
daily smoking…
- 92% come from the group of never
daily snus users
- 8% come from the group of primary
daily snus-users
Source: FSI / ITS surveys 2003 - 2011
Annual sales of snus in Sweden (metric tons)
7500
The upturn of snus use at this particular time appears to reflect an
aw areness of the harmfulness of cigarettes raised by the 1962 and
1964 reports and a subsequent demand for less harmful alternatives.
5000
2500
Smoking and Hea th, RCP 1962
Smoking and Hea th, US Surgeon General 1964
0
1920
1930
1940
1950
1960
1970
1980
1990
2000
QUIT RATES IN SWEDEN
(Proportion of ”Ever daily smokers” having quit
completely)
• All men
All women
63%
54%
• Men WITHOUT a history of daily snus use
55%
Women WITHOUT a history of daily snus use 54%
• Men WITH a history of daily snus use
Women WITH a history of daily snus use
74%
71%
Snus use and cessation of smoking
The numbers in green sectors indicate aid-specific quit ratios (successfulness)
Source: FSI /ITS surveys 2003-2006
Part of the primary daily smokers do
eventually take up daily snus use,
others do not.
What do the endpoints look like in
each category?
ENDPOINTS (MEN)
Primary daily smokers who have NOT
taken up daily snus use
53% no smoking
4% occasional smoking
43% continued daily smoking
Primary daily smokers who HAVE taken
up daily snus use
78% no smoking
9% occasional smoking
4% daily smoking, no daily snus use
9% daily smoking and snus use
Excerpt from:
Ending tobacco smoking in Britain; Radical
strategies for prevention and harm reduction in
nicotine addiction, Royal College of Physicians of
London, 2008.
“In Sweden, the availability and use by men
of an oral tobacco product called snus, one of
the less hazardous smokeless tobacco
products, is widely recognised to have
contributed to the low prevalence of smoking
in Swedish men and consequent low rates of
lung cancer.”
DEATH RATES (PER 100,000) ATTRIBUTABLE TO TOBACCO 2004.
Men and women age 60-69
European Union Member States
other than Sweden
Sweden
Min
Median
Max
MEN
Lung cancer
87
91
220
399
Other cancer
36
41
105
217
All cardiovascular
72
107
170
618
All causes
222
378
550
1388
Lung cancer
61
5
39
127
Other cancer
17
1
10
39
All cardiovascular
63
5
50
222
All causes
173
14
115
690
WOMEN
Letter from 53 scientists in 18 countries all over the world
available at http://nicotinepolicy.net/documents/letters/MargaretChan.pdf
Statement from specialists in nicotine science and public health policy
Dr Margaret Chan
Director General
World Health Organisation
Geneva
CC: FCTC Secretariat, Parties to the FCTC, WHO Regional Offices
26 May 2014
Dear Dr Chan
Reducing the toll of death and disease from tobacco – tobacco harm reduction
and the Framework Convention on Tobacco Control (FCTC)
We are writing in advance of important negotiations on tobacco policy later in the year
at the FCTC Sixth Conference of the Parties. …
…There are now rapid developments in nicotine-based products that
can effectively substitute for cigarettes but with very low risks. These
include for example, e-cigarettes and other vapour products,
low-nitrosamine smokeless tobacco such as snus, and other low-risk
non-combustible nicotine or tobacco products that may become viable
alternatives to smoking in the future. Taken together, these tobacco
harm reduction products could play a significant role in meeting the
2025 UN non- communicable disease (NCD) objectives by driving
down smoking prevalence and cigarette consumption. …
…Indeed, similar arguments have been made about the use of
smokeless tobacco in Scandinavia but the evidence is now clear that
this product has made a significant contribution to reducing both
smoking rates and tobacco-related disease, particularly among
males. …
…The potential for tobacco harm reduction products to reduce the
burden of smoking related disease is very large, and these products
could be among the most significant health innovations of the 21st
Century – perhaps saving hundreds of millions of lives.
SUMMARY
Some kinds of smokeless tobacco
can be a ”quiet killer”
but
Low-toxicity smokeless tobacco
can save many lives