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Smokeless Tobacco and Cancer: Questions and Answers 

1. What is smokeless tobacco?

There are two types of smokeless tobacco—snuff and chewing tobacco. Snuff, a finely 

ground or shredded tobacco, is packaged as dry, moist, or in sachets (tea bag-like 

pouches). Typically, the user places a pinch or dip between the cheek and gum. 

Chewing tobacco is available in loose leaf, plug (plug-firm and plug-moist), or twist 

forms, with the user putting a wad of tobacco inside the cheek. Smokeless tobacco is 

sometimes called “spit” or “spitting” tobacco because people spit out the tobacco juices 

and saliva that build up in the mouth. 

2. What harmful chemicals are found in smokeless tobacco?

• Chewing tobacco and snuff contain 28 carcinogens (cancer-causing agents). The 

most harmful carcinogens in smokeless tobacco are the tobacco-specific nitrosamines 

(TSNAs). They are formed during the growing, curing, fermenting, and aging of 

tobacco. TSNAs have been detected in some smokeless tobacco products at levels 

many times higher than levels of other types of nitrosamines that are allowed in 

foods, such as bacon and beer. 

Key Points 

• Snuff is a finely ground or shredded tobacco that is either sniffed through the nose 

or placed between the cheek and gum. Chewing tobacco is used by putting a wad 

of tobacco inside the cheek (see Question 1). 

• Chewing tobacco and snuff contain 28 cancer-causing agents (see Question 2). 

• Smokeless tobacco users have an increased risk of developing cancer of the oral 

cavity (see Question 3). 

• Several national organizations offer information about the health risks of 

smokeless tobacco and how to quit (see Question 8). 
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• Other cancer-causing substances in smokeless tobacco include N-nitrosamino acids, 

volatile N-nitrosamines, benzo(a)pyrene, volatile aldehydes, formaldehyde, 

acetaldehyde, crotonaldehyde, hydrazine, arsenic, nickel, cadmium, benzopyrene, and 

polonium–210. 

• All tobacco, including smokeless tobacco, contains nicotine, which is addictive. The 

amount of nicotine absorbed from smokeless tobacco is 3 to 4 times the amount 

delivered by a cigarette. Nicotine is absorbed more slowly from smokeless tobacco 

than from cigarettes, but more nicotine per dose is absorbed from smokeless tobacco 

than from cigarettes. Also, the nicotine stays in the bloodstream for a longer time. 

3. What cancers are caused by or associated with smokeless tobacco use?

• Smokeless tobacco users increase their risk for cancer of the oral cavity. Oral cancer 

can include cancer of the lip, tongue, cheeks, gums, and the floor and roof of the 

mouth. 

• People who use oral snuff for a long time have a much greater risk for cancer of the 

cheek and gum than people who do not use smokeless tobacco. 

• The possible increased risk for other types of cancer from smokeless tobacco is being 

studied. 

4. What are some of the other ways smokeless tobacco can harm users’ health?

Some of the other effects of smokeless tobacco use include addiction to nicotine, oral 

leukoplakia (white mouth lesions that can become cancerous), gum disease, and gum 

recession (when the gum pulls away from the teeth). Possible increased risks for heart 

disease, diabetes, and reproductive problems are being studied. 

5. Is smokeless tobacco a good substitute for cigarettes?

In 1986, the Surgeon General concluded that the use of smokeless tobacco “is not a safe 

substitute for smoking cigarettes. It can cause cancer and a number of noncancerous 

conditions and can lead to nicotine addiction and dependence.” Since 1991, the National 

Cancer Institute (NCI), a part of the National Institutes of Health, has officially 

recommended that the public avoid and discontinue the use of all tobacco products, 

including smokeless tobacco. NCI also recognizes that nitrosamines, found in tobacco 

products, are not safe at any level. The accumulated scientific evidence does not support 

changing this position. 
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6. What about using smokeless tobacco to quit cigarettes?

Because all tobacco use causes disease and addiction, NCI recommends that tobacco use 

be avoided and discontinued. Several nontobacco methods have been shown to be 

effective for quitting cigarettes. These methods include pharmacotherapies such as 

nicotine replacement therapy and bupropion, individual and group counseling, and 

telephone quitlines. 

7. Who uses smokeless tobacco?

In the United States, the 2000 National Household Survey on Drug Abuse, which was 

conducted by the Substance Abuse and Mental Health Services Administration, reported 

the following statistics: 

• An estimated 7.6 million Americans age 12 and older (3.4 percent) had used 

smokeless tobacco in the past month. 

• Smokeless tobacco use was most common among young adults ages 18 to 25. 

• Men were 10 times more likely than women to report using smokeless tobacco 

(6.5 percent of men age 12 and older compared with 0.5 percent of women). 

People in many other countries and regions, including India, parts of Africa, and some 

Central Asian countries, have a long history of using smokeless tobacco products. 

8. Where can people find help to quit using smokeless tobacco? 

Several national organizations provide information about the health risks of smokeless 

tobacco and how to quit: 

The National Institute of Dental and Craniofacial Research offers a booklet that 

discusses spit tobacco use in a colorful and graphic format. It is designed specifically for 

young men who have decided to quit or are thinking about it. 

Organization: National Oral Health Information Clearinghouse 

 National Institute of Dental and Craniofacial Research 

Address: One NOHIC Way 

 Bethesda, MD 20892–3500 

Telephone: 301–402–7364 

E-mail: nidcrinfo@mail.nih.gov 

Web site: http://www.nidcr.nih.gov/HealthInformation/DiseasesAnd 

Conditions/SpitTobacco/default.htm 
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The Centers for Disease Control and Prevention’s Office on Smoking and Health

provides fact sheets, educational materials, reports, and related materials on smokeless 

tobacco. 

Organization: Centers for Disease Control and Prevention 

Address: 1600 Clifton Road, NE. 

 Atlanta, GA 30333 

Telephone: 1–800–232–4636 (1–800–CDC–INFO) 

E-mail: tobaccoinfo@cdc.gov 

Web site: http://www.cdc.gov/tobacco/smokeless/index.htm 

The mission of the National Spit Tobacco Education Program (NSTEP) is to prevent 

people, especially young people, from starting to use tobacco, and to help users to quit. 

NSTEP offers information and materials on spit tobacco use, prevention, and cessation. 

Organization: National Spit Tobacco Education Program 

 Oral Health America 

Address: Suite 352 

 410 North Michigan Avenue 

 Chicago, IL 60611 

Telephone: 312–836–9900 

Web site: http://www.nstep.org 

 

The American Cancer Society provides information about smokeless tobacco and 

techniques for smokeless tobacco users who want to quit. 

 Organization: American Cancer Society 

 Address: 1599 Clifton Road, NE. 

 Atlanta, GA 30329 

 Telephone: 1–800–227–2345 (1–800–ACS–2345) 

 Web site: http://www.cancer.org 

The American Academy of Family Physicians has a fact sheet with information on how 

to quit using smokeless tobacco. The fact sheet is available at 

http://familydoctor.org/online/famdocen/home/common/addictions/tobacco/177.html on 

the Internet. 

Organization: American Academy of Family Physicians 

Address: 11400 Tomahawk Creek Parkway 

 Leawood, KS 66211–2672 

Web site: http://familydoctor.org 
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A number of other organizations provide information about where to find help to stop 

using smokeless tobacco. State and local health agencies often have information about 

community tobacco cessation programs. The local or county government section in the 

phone book (blue pages) has phone numbers for health agencies. Information to help 

smokers who want to quit is also available through community hospitals, the yellow 

pages (under “drug abuse and addiction”), public libraries, health maintenance 

organizations, health fairs, and community helplines. 

9. What other resources are available? 

A person’s dentist or doctor can be a good source of information about the health risks of 

smokeless tobacco and about quitting. Friends, family members, teachers, and coaches 

can help a person quit smokeless tobacco use by giving them support and encouragement. 

# # # 

Related Resources

Publications (available at http://www.cancer.gov/publications) 

• Smoking and Tobacco Control Monograph 2: Smokeless Tobacco or Health: An 

International Perspective

• Spit Tobacco: A Guide for Quitting 

National Cancer Institute (NCI) Resources

Cancer Information Service (toll-free)

 Telephone: 1–800–4–CANCER (1–800–422–6237) 

 TTY: 1–800–332–8615 

Online 

NCI’s Web site: http://www.cancer.gov 

LiveHelp, NCI’s live online assistance: 

https://cissecure.nci.nih.gov/livehelp/welcome.asp

 

This fact sheet was reviewed on 5/30/03