• Marzieh Araghi, Maria Rosaria Galanti, Michael Lundberg, Zhiwei Liu, Weimin Ye, Anton Lager, Gunnar Engström, Jonas Manjer, Lars Alfredsson, Anders Knutsson, Margareta Norberg, Richard Palmqvist, Björn Gylling, Patrik Wennberg, LagerrosYlva TrolleYT11 Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.12 Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital Huddinge, Stockholm, Sweden., Rino Bellocco, Nancy L Pedersen, Per-Olof Östergren, and Cecilia Magnusson.
• 1 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
• Scand J Public Health. 2017 Dec 1; 45 (8): 741-748.

AimsAlthough smoking is considered to be an established risk factor for colorectal cancer, the current evidence on the association between smokeless tobacco and colorectal cancer is scant and inconclusive. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess this association.MethodsA total of 417,872 male participants from nine cohort studies across Sweden were followed up for incidence of colorectal cancer and death. Outcomes were ascertained through linkage to health registers. We used shared frailty models with random effects at the study level to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsDuring 7,135,504 person-years of observation, 4170 men developed colorectal cancer. There was no clear association between snus use and colorectal cancer overall. Exclusive current snus users, however, had an increased risk of rectal cancer (HR 1.40: 95% CI 1.09, 1.79). There were no statistically significant associations between snus use and either all-cause or colorectal cancer-specific mortality after colorectal cancer diagnosis.ConclusionsOur findings, from a large sample, do not support any strong relationships between snus use and colorectal cancer risk and survival among men. However, the observed increased risk of rectal cancer is noteworthy, and in merit of further attention.

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