Use Of Smokeless Tobacco May Lead To Breast Cancer, Wake Forest Team Reports

John G. Spangler, M.D., M.P.H., told the Society of Teachers of Family Medicine, meeting in Orlando, "These preliminary data are the first to document an apparent relationship between smokeless tobacco use and breast cancer."

The study, paid for by the National Cancer Institute, was conducted among Eastern Band Cherokee women 18 and older who live on tribal lands in Western North Carolina and use smokeless tobacco, also called snuff. The investigators found that the risk of breast cancer increased almost eightfold.

The increase "suggests that smokeless tobacco is not a safe alternative to cigarette smoking," said Spangler, assistant professor of family and community medicine.

However, he cautioned that because of the small number of cases, the results "should be confirmed in other studies."

The team found that that 8 percent of Cherokee women currently use smokeless tobacco.

Spangler and his colleagues have been tracking use of smokeless tobacco in North Carolina for several years and have already reported high rates of smokeless tobacco use among North Carolina women - particularly Native American women.

"Although smokeless tobacco use among women nationally is only 0.6 percent, 2.5 percent of women here in North Carolina use smokeless tobacco," Spangler said. "Other investigators have shown that 9 percent of all women in Pitt County use smokeless tobacco. These are extremely high rates compared to the nation."

Ironically, breast cancer mortality rates in North Carolina between 1993 and 1997 were lower among Native American women overall than among whites or African American women.

But when breast cancer is measured just in Lumbee women, the breast cancer mortality rate is 23.2 per 100,000, which is between the 18.9 per 100,000 mortality rate among white North Carolina women and the 26.6 per 100,000 rate among African Americans.

The investigators found that 23 percent of Lumbee women in Robeson County, N.C. used smokeless tobacco, which is 38 times the national average. Among Lumbee women 65 and over, the rate was even higher -- 51 percent - which is 85 times the national average for women

Spangler said that since the breast cancer mortality rate among Lumbee women is higher than the average among Native American women, that "lends support to the hypothesis that use may relate to development of breast cancer."

He added that other studies may confirm that breast cancer could be reduced by eliminating smokeless tobacco.