Preventive medicine
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Snuff dipping as practiced in North America and Western Europe is causally associated with cancer of the oral cavity and pharynx. In the Sudan, natives use local Nicotiana rustica, a tobacco species with high levels of nicotine and nornicotine, to prepare their own snuff which they call toombak. The finely ground tobacco leaves are mixed with sodium bicarbonate, water is added, and a paste is made. The resulting "saffa" is placed in the oral vestibule where it remains up to several hours. In general, a saffa is replaced 10-30 times per day. ⋯ The need for in-depth epidemiological studies and further laboratory research to prove that toombak chewing causes cancer is discussed. The data at hand point to the urgent need for educational programs and preventive measures against the use of toombak.