If you think chewing tobacco is a healthier alternative to smoking, think again. Unfortunately, that theory is misguided.
While it's not linked to lung cancer like smoking, chewing tobacco and other smokeless tobacco products put users at an increased risk for several head, neck and mouth cancers, including squamous cell carcinoma as well as esophageal and pancreatic cancer. "For some reason, some people think that chewing tobacco is not as risky as smoking, but in a lot of ways it's actually even more risky because there is a heavy concentration of tobacco, nicotine and other additives that are highly carcinogenic, in one area of the mouth," says Sunita Manuballa, DDS, Assistant Professor of Oncology, Roswell Park Comprehensive Cancer Center.
Squamous cell carcinoma is the second most common form of skin cancer and can appear almost anywhere in the head and neck area. Chewing tobacco users are especially at risk for squamous cell carcinoma inside their mouths.
Squamous cells make up the mucosa layer (the outermost lining) of tissue on the inside of the mouth, including the lips and cheeks. So when using chewing tobacco, the skin's squamous cells are in direct contact with the tobacco and the various carcinogenic additives. "Typically, users will keep their chewing tobacco in the pocket under their bottom lip or back in the cheek, and the product just sits there and gets directly absorbed into the outermost layer of the mucosa," says Dr. Manuballa.
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Spot the Warning Signs
Usually, squamous cell carcinoma will start as something that seems harmless, like a little white or red bump in the mouth. Someone might not think much of it and expect it to go away after a few days. "The issue is when something doesn't go away. If you remove the cause of the issue, whether it be chewing tobacco, cheek biting or a sharp tooth, and the lesion doesn't go away, that's a problem. That's a warning sign for cancer," says Dr. Manuballa. "Typically the area will be watched for about two weeks, and if it doesn't go away, it needs to be biopsied. So for anything that's in the mouth that isn't healing, make sure you see your dentist or a head and neck specialist and have it looked at as soon as possible."
Another warning sign is developing a condition called oral submucous fibrosis, where the tissue in the jaw becomes inflamed and stiff over time, preventing a person from being able to open their mouth fully.
"What ends up happening is you'll have difficulty opening your mouth because the fibrosis prevents your jaw from stretching as far as it normally would. The condition is considered a premalignant lesion, meaning it can develop into cancer," says Dr. Manuballa. "Someone with oral submucous fibrosis should be watched very carefully by their dentist or doctor."
If you use chewing tobacco, the best thing you can do to limit your cancer risk is to stop immediately and stay vigilant about changes in your mouth, because early detection is key for treating squamous cell carcinoma. "If the cancer is caught early, as a stage I tumor and remains localized, meaning it hasn't spread to other parts of the body, the likelihood of a good prognosis is much higher," says Dr. Manuballa. "However, If the patient sits with the cancer long enough for it to spread into a lymph node or other parts of the body, then the survival rate decreases tremendously."