#Suggested Reading
#Suggested Reading
16.01.2026
Ignored risk: NEJM issues warning about smokeless tobacco
Smokeless tobacco accounts for a significant share of oral cancer cases worldwide, warns influential medical journal
Article published in the New England Journal of Medicine (NEJM) warns about the risks of "smokeless tobacco," linking it to an increase in cases of oral cancer worldwide, especially in low- and middle-income countries | Image generated by AI
MY RECOMMENDATION:
The article Smokeless Tobacco and Oral Cancer in Global Perspective, published in the Perspective section of The New England Journal of Medicine in January 2026. The paper, written by Mark Parascandola (US National Cancer Institute); Suzanne T. Nethan (International Agency for Research on Cancer, France); and Kamran Siddiqi (Hull York Medical School, UK), issues a warning about the increased use of smokeless tobacco products, especially in Southeast Asia, directly correlating them with a rise in the number of cases of oral cancer.
WHY IS THIS ARTICLE RELEVANT?
The article examines the substantial contribution of smokeless tobacco to oral cancer incidence and mortality worldwide. This category encompasses a wide range of manufactured and/or custom-made products, including chewing tobacco, snuff, gutka, khaini, toombak, and iqmik.
Although these products are used by more than 360 million people—especially in low- and middle-income South Asian countries such as India, Bangladesh, and Pakistan—they receive far less attention from scientists and public policy makers than smoked tobacco.
The article is important because it calls attention to a major global public health issue that remains underestimated: the impact of smokeless tobacco.
Based on epidemiological and clinical evidence, the authors show that a significant proportion of oral cancer cases worldwide, particularly in low- and middle-income countries, are associated with products often perceived as less harmful than regular cigarettes, a misconception that leads to continued use, as well as gaps in prevention, surveillance, and regulatory policies.
The article is also noteworthy because it repositions the topic in clinical and political debates, making health professionals, officials, and policymakers more aware of the need to integrate smokeless tobacco into global tobacco control strategies.
WHAT MAKES THIS ARTICLE A MUST-READ?
By highlighting regional inequalities, cultural barriers, and regulatory shortcomings, the article emphasizes that oral cancer associated with these products is largely preventable, provided greater priority is given to health communication and evidence-based regulatory actions.
It also presents concrete data on the scale of the problem:
- 389,846 new cases of oral cancer were recorded worldwide in 2022, with increased incidence in countries where the use of these products is common.
- Epidemiological estimates based on data from sources such as the Global Cancer Observatory suggest that approximately 120,200 oral cancer cases (roughly 30% of the total) in 2022 may have been attributable to the use of smokeless tobacco or areca nut, making it a critical and preventable risk factor.
- Most cases attributable to smokeless tobacco occurred in South-Central and Southeast Asia, reflecting regional patterns of use and risk.
These figures demonstrate the global magnitude of the problem addressed in the article: millions of users, hundreds of thousands of new oral cancer cases per year, a large proportion of which are directly attributable to a risk factor that, though preventable, has received insufficient attention in public health policies.
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