The risks of smoking cigarettes are well established. Smoking is the leading cause of preventable death, leading to nearly 6 million deaths a year worldwide.¹ Far less talked about is smokeless tobacco, also known as chewing tobacco and snuff, even though it’s consumed in most countries of the world.

The first global estimates of the burden of disease due to use of smokeless tobacco by adults was recently revealed, based on data from 115 countries.² Worldwide, smokeless tobacco was found to cause 250,000 deaths a year, with the majority (74 percent) occurring in India.

The lead researcher noted, however, that the actual number of deaths may be even higher:³ “It is possible that these figures are underestimated, and future studies may reveal that the impact is even bigger.”

Heart Disease Accounts for Most Smokeless Tobacco-Related Deaths

Many people associate tobacco products with cancer, and they are a leading cause of cancer deaths. However, in the case of smokeless tobacco, most people are dying from heart disease, not cancer.

In 2010, the study found smokeless tobacco caused more than 200,000 deaths from heart disease compared to more than 62,000 deaths due to cancers of the mouth, pharynx, and esophagus.⁴

For cigarette smoking, deaths from cancer and heart disease are similar; about 163,700 die from smoking-related cancer each year compared to 161,000 from smoking-related heart disease.⁵

While smokeless tobacco is often marketed as a less toxic alternative to smoking cigarettes, it is clearly not safe or risk-free. According to the American Cancer Society (ACS):⁶

“The snuff and chewing tobacco products most widely used in the United States have very high levels of cancer-causing agents (carcinogens) called tobacco-specific nitrosamines. These carcinogens cause lung cancer in animals, even when injected into their blood.

There are other cancer-causing agents in smokeless tobacco, too, such as benzo[a]pyrene and other polycyclic aromatic carcinogens.

These carcinogens may be why several types of cancer are linked to use of smokeless tobacco… Smokeless tobacco may also play a role in heart disease and high blood pressure.

Results from a large American Cancer Society study showed that men who switched from cigarettes to snuff or chewing tobacco had higher death rates from heart disease, stroke, cancer of the mouth and lung, and all causes of death combined than former smokers who stopped using all tobacco products.”