The browser you are using is not supported by this website. All versions of Internet Explorer are no longer supported, either by us or Microsoft (read more here:

Please use a modern browser to fully experience our website, such as the newest versions of Edge, Chrome, Firefox or Safari etc.

Smokeless tobacco (snus) use and colorectal cancer incidence and survival : Results from nine pooled cohorts


  • 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
  • Ylva trolle Lagerros
  • Rino Bellocco
  • Nancy L. Pedersen
  • Per Olof Östergren
  • Cecilia Magnusson

Summary, in English

Aims: Although 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. Methods: A 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). Results: During 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. Conclusions: Our 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.

Publishing year







Scandinavian Journal of Public Health





Document type

Journal article


SAGE Publications


  • Cancer and Oncology
  • Public Health, Global Health, Social Medicine and Epidemiology


  • Colorectal cancer
  • incidence; survival
  • snus



Research group

  • Cardiovascular Research - Epidemiology
  • Surgery
  • Social Medicine and Global Health


  • ISSN: 1403-4948