The effect on health of switching from cigarettes to snus - a review

Interest in snus (Swedish type moist snuff) as an alternative to smoking is increasing, but the evidence on the health effects of switching from cigarettes to snus has not previously been reviewed. We identified six epidemiological cohort or case-control studies, all from Sweden, which allowed comparison of cancer or cardiovascular disease risk in current snus users who formerly smoked ("switchers") with that of never snus users who continued to smoke ("continuers") or of never snus users who quit smoking ("quitters"). Based on 13 sets of comparisons, one for oral cancer, one for stomach cancer and 11 for various cardiovascular disease endpoints, switchers were consistently found to have a lower risk than continuers, with relative risks varying from 0.35 to 0.61, and a similar risk to quitters. Based on estimates from four studies for ischaemic/coronary heart disease or acute myocardial infarction, meta-analyses gave combined relative risk estimates of 0.55 (95% confidence interval 0.45-0.68) for switchers vs. continuers and 1.02 (95% confidence interval 0.83-1.26) for switchers vs. quitters. Though based on limited evidence with some weaknesses, these results are consistent with a recent review which found no increased risk of cancer or heart disease from snus use.