Some call it dip, others call it snuff. But after the death of beloved baseball player Tony Gwynn to oral cancer this week, more and more people are calling smokeless tobacco by another name: deadly.
The 54-year-old Hall of Famer, who spent his entire career with the San Diego Padres, died Monday following two surgeries to remove malignant tumors from his right cheek, the spot where he traditionally tucked the tobacco.
Diagnosed with cancer of the salivary gland in October 2010, the athlete openly acknowledged the link between his 20-year smokeless tobacco habit and the disease.
“I haven’t discussed that with the doctors yet, but I’m thinking it’s related to dipping,” he told ESPN.com shortly after his diagnosis. According to the American Cancer Society, smokeless tobacco can lead to cancer of the mouth, tongue, cheek, gum, throat, esophagus and pancreas as well as heart disease, stroke, nicotine addiction, receding gums, bone loss around the roots of the teeth, tooth loss, stained and discolored teeth and more.
Gwynn’s death, which shook many in the baseball world, has prompted a renewed call for a ban on tobacco in Major League Baseball (the organization sought a ban in 2011 but the proposal was rejected by players), a move that was quickly lauded by Fred Hutch researchers.
“Smokeless tobacco use has been a part of the culture of baseball for so long that there will naturally be resistance to going tobacco-free,” said Dr. Jaimee Heffner, a staff scientist in the Tobacco & Health Behavior Science Research Group. “But it’s a battle worth fighting -- for the health of the players, the coaches and the young athletes who are modeling themselves after them.“
Riskier for teens and young adults
A 2003 survey of baseball players found that nearly one-third of rookies starting in the major leagues were already regular smokeless tobacco users and more than two-thirds had tried it. A recent look at smokeless tobacco use within the Boston Red Sox organization found that despite efforts to discourage what Red Sox manager John Farrell called “a nasty habit,” 21 of the 58 players still used it.
Long associated with the sport, smokeless tobacco is prohibited in the minor leagues and restricted in MLB (players can’t carry the tobacco tins in their uniforms or do interviews while using it). But according to the American Cancer Society, “athletes are a large marketing source for smokeless tobacco, are often seen on TV using it … and can influence youth to be more open to and accepting of smokeless tobacco.”
Heffner herself recalls mimicking the behavior of the baseball players she saw on TV when she was a “young tomboy.”
“I remember going to my Little League games and buying some Big League Chew [bubble gum] from the concession stand and practicing spitting in the dirt with my teammates,” she said. “The behavior had a clear antecedent – watching my role models, the big league players, doing this very same thing on television.”
About 9 million people in the U.S. currently use smokeless tobacco and use of the product is higher in younger age groups. More than 5.5 percent of people aged 18 to 25 identify themselves as current users and smokeless tobacco use among high school kids is even higher. The CDC’s 2012 National Youth Tobacco Survey found that about 11 percent of boys and 1.5 percent of girls use smokeless tobacco. Another 4 percent of boys and 1 percent of girls use snus, a finely ground form of moist snuff.
“Adolescence and young adulthood is the period of highest risk for any substance use, including smokeless tobacco,” said Heffner. “It’s also the time in life when our brains are most vulnerable to the effects of addictive substances, and adolescents can become addicted to nicotine very quickly.”
A powerful addiction
Indeed, in the wake of Gwynn’s death, some MLB players have come forward to discuss the powerful addiction.
Eric Byrnes, a former ball player and current MLB Network analyst who started using smokeless tobacco when he was 12, blogged about his habit, which he kicked three years ago.
“Chewing tobacco is the only thing I have ever encountered in my life that I had absolutely no control over,” he wrote. ”Like air, food or water, I felt like I needed chewing tobacco to survive.”
According to Heffner, smokeless tobacco is every bit as addictive as cigarettes.
“Research shows that quitting smokeless tobacco is just as difficult, if not more difficult, than quitting smoking,” she said. And unfortunately, while the prevalence of cigarette smoking has steadily declined in recent years, the use of smokeless tobacco has not.
A 2012 Harvard Medical School study that looked at smokeless tobacco trends in the U.S. from 2000 to 2010 actually found an increase in use, especially of snuff. Part of this may be due to new smoking bans and the resulting marketing efforts by tobacco companies to push smokeless tobacco as an alternative product that can be used “anytime … anywhere.”
Whatever the case, the study concluded that the trend was “more prominent among young adults and likely will have future health-care implications.”
The oral cancer connection
According to Heffner, smokeless tobacco contains 30 known carcinogens and causes numerous cancers including mouth, tongue, cheek, gum, throat, esophageal and pancreatic.
Currently, about 50,000 cases of oral cancers are diagnosed in the U.S. every year and the use of alcohol and tobacco – particularly chewing tobacco or snuff – greatly increases a person’s risk of developing one (other risk factors include prolonged sun exposure and the human papilloma virus or HPV). According to the National Institutes of Health, at least 75 percent of head and neck cancers are related to use of tobacco (including smokeless tobacco) and alcohol. People who use both are at the greatest risk for these cancers.
Baseball’s Babe Ruth, Curt Flood and Bill Tuttle all died of oral cancers thought to be related to their tobacco and/or alcohol use; Brett Butler, who was diagnosed with tonsil cancer in 1996, also attributes his diagnosis to his former snuff use and has since become an ardent anti-tobacco advocate.
But oral cancer is by no means exclusively a ball player’s disease.
Montana resident Rick Bender, a nonsmoker who began using “spit tobacco” at the age of 12, was diagnosed with oral cancer at the age of 26 and had to undergo several disfiguring surgeries in order to eradicate the disease.
“They ended up taking about one third of my tongue and I ended up losing half my jaw to an infection that set in after surgery,” he told KOMO News in a 2004 interview.
Bender, often referred to as “The Man Without a Face” runs the website www.nosnuff.com and has devoted his life to educating others – particularly high school and college students – about the risks of smokeless tobacco, a product he said is “widely thought of as a safe alternative to smoking.”
Fred Hutch’s Dr. Beti Thompson, who worked with Bender on a tobacco prevention program 10 years ago, said that’s still a common misperception.
“There’s some sort of unspoken idea that chewing tobacco is less harmful than smoking tobacco and it’s simply not true,” she said. “I find it very disturbing, especially when we see young people chewing. It’s very, very risky and Rick Bender is a very good example of somebody who’s suffered from the effects of chewing or spit tobacco. He literally lost half of his face.”
Thompson said the best way to avoid the risks of smokeless tobacco is to “never start in the first place.”
But for those who’ve already taken up the habit, there are healthier alternatives. The Boston Red Sox provides its players with plenty of bubble gum and tubs of sunflower seeds and many professional players have swapped their snuff for a tobacco-free mint product.
Support for kicking the tobacco habit can also be found via killthecan.org, the Mouth Cancer Foundation and through Fred Hutch’s WebQuit program.
Solid tumors, such as those of the mouth, tongue, cheek, gum, throat and esophagus and pancreas are the focus of Solid Tumor Translational Research, a network comprised of Fred Hutchinson Cancer Research Center, UW Medicine and Seattle Cancer Care Alliance. STTR is bridging laboratory sciences and patient care to provide the most precise treatment options for patients with solid tumor cancers.
Diane Mapes is a staff writer at Fred Hutchinson Cancer Research Center. She has also written extensively about health issues for nbcnews.com, TODAY.com, CNN.com, MSN.com, Columns and several other publications. She also writes the breast cancer blog, doublewhammied.com.Reach her at dmapes@fredhutch.org.
