Oral cancer can begin anywhere in the mouth. Using chewing tobacco, also called smokeless tobacco, is a major risk factor for oral cancer. These products contain high levels of nicotine and toxic chemicals that can trigger malignant cell changes leading to oral cancer.

The American Cancer Society (ACS) explains that while chewing tobacco exposes people to less harmful chemicals than tobacco smoke, it is still not a safe alternative.

Oral cancers can include cancers at the back of the mouth, on or under the tongue, at the back of the throat, and in the tissues lining the mouth. They account for roughly 3% of all cancers diagnosed in the United States annually.

This article explains whether chewing tobacco can cause oral cancer, oral cancer symptoms, and potential treatments.

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Chewing tobacco is any smokeless oral product that contains nicotine. It can come in various forms, including snuff, loose-leaf, plugs, and twists.

People who use these products receive the same amount of nicotine from them as those who smoke regularly. The products also expose them to more than 25 carcinogenic chemicals, including tobacco-specific nitrosamines.

Although chewing tobacco products may contain fewer harmful chemicals than tobacco smoke, they are not a safe alternative. For example, experts link chewing tobacco to oral cancer.

Studies show that smokeless tobacco use links to head and neck cancers, especially oral cancers. Snuff has a stronger association than chewing tobacco.

Smoking tobacco links to oral cancer in the same way as chewing tobacco. In both cases, people expose themselves to nicotine and toxins that can cause cell changes in the mouth. These can lead to oral cancer.

However, smoking has additional risks. Tobacco smoke contains thousands of toxic chemicals, which can increase a person’s risk of developing various types of cancer, including in the lungs, kidneys, liver, and stomach. It also damages the blood vessels, increasing the risk of cardiovascular diseases such as heart attack and stroke.

Experts associate chewing tobacco with fewer risks. However, it has links with oral cancer, esophageal cancer, and pancreatic cancer. It can cause severe dental problems and is dangerous for pregnant people and developing fetuses.

Leukoplakia describes tissue changes in the mouth or throat. It appears as a white or gray area that does not come off when scraped. The changes could be due to cancer, a precancerous condition called dysplasia, or they could be harmless.

Most cases of leukoplakia do not turn into cancer. However, some may turn into cancer if the person does not seek treatment for the condition

A biopsy helps doctors determine whether leukoplakia has dysplastic (precancerous) or cancerous cells.

Erythroplakia also describes tissue changes in the mouth. It refers to a flat or slightly raised, discolored area that bleeds easily when scraped. It may be precancerous or harmless.

This condition is less common than leukoplakia. However, it is typically more serious. Biopsies reveal that more of these lesions are cancerous or develop into cancer later.

It is important to note that most oral cancers do not develop from preexisting leukoplakia or erythroplakia.

Oral cancer can present as a visible lesion, lump, or sore in the oral cavity. Other symptoms may include:

  • oral sores that do not heal
  • persistent oral pain or discomfort
  • white, red, or speckled patches in the mouth
  • difficulty eating and speaking
  • swelling of the jaw or face
  • a lump in the neck or throat
  • difficulty moving the jaw or tongue
  • numbness of the tongue or lips
  • loose teeth
  • vocal changes

Oral cancer has several potential causes:

The risk of developing oral cancer also increases with age, and most frequently occurs in people over 40 years old.

Doctors can treat oral cancer with a combination of:

Targeted therapy is also an option. This newer treatment uses medications or other substances to precisely identify and attack cancer cells. In comparison, chemotherapy and radiation therapy can also damage healthy cells, leading to unpleasant side effects.

The choice of treatment depends on the person’s general health and the size and stage of the oral cancer.

People with oral cancer may also require additional treatments, such as reconstructive surgery or speech therapy.

The outlook for oral cancer from chewing tobacco depends on how early diagnosis occurs, the type of cancer, and how effective the treatment is. Generally, the earlier a doctor can diagnose oral cancer, the better the outlook.

For example, 93% of people with localized lip cancer survive for at least 5 years after diagnosis. This number drops to 33% if cancer spreads to distant sites in the body.

The best way to help prevent oral cancer is to avoid the risk factors. This means:

  • avoiding tobacco in all forms
  • avoiding consuming large amounts of alcohol
  • using sun protection when outdoors

It is also important for people to visit their doctor regularly for oral cancer screenings, as early diagnosis increases the likelihood of a good outlook.

Chewing tobacco alternatives

People looking for an alternative to chewing tobacco may consider nicotine gum or patches, as these provide a safer way to deliver nicotine. There are also tobacco-free pouches available for oral use that contain safe and natural ingredients, such as mint and coffee.

Other techniques to reduce oral cravings include:

  • sucking on hard candy
  • chewing gum
  • using shredded beef or vegetable jerky to keep oral cravings at bay

Using chewing tobacco increases a person’s risk of oral cancer. Signs and symptoms to look out for include oral sores that do not heal, persistent oral pain or discomfort, and white, red, or speckled patches in the mouth.

Doctors can treat oral cancer with a combination of surgery, chemotherapy, radiation therapy, or targeted therapy. While the outlook for people with oral cancer depends on many factors, avoiding risk factors such as tobacco use can help reduce the risk of developing oral cancer.