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Smokeless Tobacco (Shammah) in Saudi Arabia: A Review of its Pattern of Use, Prevalence, and Potential Role in Oral Cancer

  • Published : 2014.08.30

Abstract

Background: Shammah is a traditional form of chewing tobacco [smokeless tobacco, (ST)] that is commonly used in the Middle East especially in Saudi Arabia (KSA), Yemen and Sudan. The Substance Abuse Research Centre (SARC) at Jazan University noted that no adequate research and information on the prevalence of shammah use in the province of Jazan, and KSA as well, has been provided in the scientific literature. Materials and Methods: An intensive systematic review of online databases was performed, including AMED (The Allied and Complementary Medicine Database), Biological Abstracts, Cochrane Collection Plus, Dentistry and Oral Sciences Source, E-Journals Database, EBSCO Discovery Service, MEDLINE, PEMSoft, PEP Archive, PsycARTICLES, scopus, Sciencedirect and Google Scholar. Results: Shammah is a mixture of powdered tobacco, lime, ash, black pepper, oils and flavorings. ST in KSA is placed in the buccal or lower labial vestibule of the mouth. The user (or dipper) spits out insoluble debris. The importation of ST products is prohibited in KSA. Accessible information on legislative action to control the use of ST in KSA appeared in 1990. The actual percentage use may be higher, than reported since shammah is illegal in KSA and there may be some reluctance to admit to its use. Conclusions: This review paper is an initial step in a funded research project by SARC to understand the pattern of use of shammah and provide adequate epidemiological data. One goal of this review is to generate further data for public health education.

Keywords

References

  1. Abbas AM, Ahmed HG (2013). A case-control study of oral epithelial proliferative markers among Sudanese Toombak dippers using micronuclei assay, argyrophilic nucleolar organizer region, Papanicolaou and crystal violet methods. Rare Tumors, 5, 31. https://doi.org/10.4081/rt.2013.e31
  2. Ahmed HG, Mahgoob RM (2007). Impact of Toombak dipping in the etiology of oral cancer: Gender-exclusive hazard in the Sudan. J Cancer Res Therap, 3, 127-36. https://doi.org/10.4103/0973-1482.34696
  3. Al-Attas SA, Ibrahim SS, Amer HA, Darwish ZES, Hassan MH (2014). Prevalence of potentially malignant oral mucosal lesions among tobacco users in Jeddah, Saudi Arabia. Asian Pac J Cancer Prev, 15, 757-62. https://doi.org/10.7314/APJCP.2014.15.2.757
  4. Al-Balawi SA, Nwoku AL (2002). Management of oral cancer in a tertiary care hospital. Saudi Med J, 23, 156-9.
  5. Albar M (1994). Islamic teachings and cancer prevention. J Family Commun Med, 1, 79-86.
  6. Allard WF, DeVol, EB, Te, OB (1999). Smokeless tobacco (shamma) and oral cancer in Saudi Arabia. Commun Dentist Oral Epidemiol, 27, 398-405. https://doi.org/10.1111/j.1600-0528.1999.tb02038.x
  7. Axell T, Pindborg J, Smith C, Waal, I (1996). Oral white lesions with special reference to precancerous and tobacco related lesions: conclusions of an international symposium held in Uppsala, Sweden, J Oral Path Med, 25, 49-54. https://doi.org/10.1111/j.1600-0714.1996.tb00191.x
  8. Bagchi M, Bagchi D, Hassoun E, Stohs S (1994). Smokeless tobacco induced increases in hepatic lipid peroxidation, DNA damage and excretion of urinary lipid metabolites. Int J Exper Path, 75, 197-201.
  9. Bagchi SSDBM (1997). Toxicity of trace elements in tobacco smoke Inhalation. Toxicol, 9, 867-90.
  10. Bhattacharyya N (2012). Trends in the use of smokeless tobacco in United States, 2000-(2010). The Laryngoscope, 122, 2175-78. https://doi.org/10.1002/lary.23448
  11. Boffetta P, Hecht S, Gray N, Gupta P, Straif K (2008). Smokeless tobacco and cancer. Lancet Oncol, 9, 667-75. https://doi.org/10.1016/S1470-2045(08)70173-6
  12. Brunnemann KD, Hoffmann D (1992). Chemical composition of smokeless tobacco products IN Smokeless tobacco or health An international perspective. Issue 2 of Smoking and tobacco control monographs. DIANE Publishing.
  13. Chole RH, Patil RN, Basak A, Palandurkar K, Bhowate R (2010). Estimation of serum malondialdehyde in oral cancer and precancer and its association with healthy individuals, gender, alcohol, and tobacco abuse. J Cancer Res Therap, 6, 487-98. https://doi.org/10.4103/0973-1482.77106
  14. Christen AG (2001). Tobacco cessation, the dental profession, and the role of dental education. J Dent Ed, 65, 368-74.
  15. Cokkinides V, Bandi P, McMahon C, et al (2009). Tobacco control in the United States-recent progress and opportunities. CACancer J Clin, 59, 352-65. https://doi.org/10.3322/caac.20037
  16. Ebbert J, Montori V, Vickers K, et al (2007). Interventions for smokeless tobacco use cessation (Review). Cochrane Database Syst Rev, 25, 136-45.
  17. Ebbert J, Montori VM, Erwin PJ, Stead LF (2011). Interventions for smokeless tobacco use cessation. Cochrane Database Syst Rev, 2, 213-9.
  18. Ferlay J, Shin HR, Bray F, et al (2010). Estimates of worldwide burden of cancer in 2008, GLOBOCAN (2008). Int J Cancer, 127, 2893-17. https://doi.org/10.1002/ijc.25516
  19. Foulkes M (2013). Oral cancer: risk factors, treatment and nursing care. Nurs Stand, 28, 49-57.
  20. Gross AJ, Lackland DT, Tu DS (1995). Oral cancer and smokeless tobacco: literature review and meta-analysis. Env Int, 21, 381-94. https://doi.org/10.1016/0160-4120(95)00040-R
  21. Gupta B (2013). Burden of smoked and smokeless tobacco consumption in India-results from the global adult tobacco survey India (GATS-India; 2009-2010). Asian Pac J Cancer Prev, 14, 3325-9. https://doi.org/10.7314/APJCP.2013.14.5.3323
  22. Haddock CK, Lando H, Klesges RC, et al (1999). A study of the psychometric and predictive properties of the Fagerstrom Test for Nicotine Dependence in a population of young smokers. Nic Tob Res, 1, 59-66.
  23. Halboub ES, Al-Anazi YM, Al-Mohaya MA, (2011). Characterization of Yemeni patients treated for oral and pharyngeal cancers in Saudi Arabia. Saudi Med J, 32, 1177-82.
  24. Hannan MA, El-Yazigi A, Paul M, Phillip-Gibson D, Phillips RL (1986). Genotoxicity of 'shamma', a chewing material suspected of causing oral cancer in Saudi Arabia. Mutat Res-Genet Tox, 169, 41-6. https://doi.org/10.1016/0165-1218(86)90016-9
  25. Hatsukami D, Ebbert J, Anderson A, et al (2007). Smokeless tobacco brand switching: A means to reduce toxicant exposure? Drug Alcohol Depen, 87, 217-24. https://doi.org/10.1016/j.drugalcdep.2006.08.021
  26. Haustein KO (2010). History of Tobacco, Tobacco or Health? Springer, 1-16.
  27. Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO (1991). The Fagerstrom test for nicotine dependence: a revision of the Fagerstrom Tolerance Questionnaire. Br J Addict, 86, 1119-27. https://doi.org/10.1111/j.1360-0443.1991.tb01879.x
  28. Hecht SS (2003). Tobacco carcinogens, their biomarkers and tobacco-induced cancer. Nature Rev Cancer, 3, 733-44. https://doi.org/10.1038/nrc1190
  29. Hoffmann D, Hecht, S (1985). Nicotine-derived N-nitrosamines and tobacco-related cancer: current status and future directions. Cancer Res, 45, 935-44.
  30. Honarmand M, Farhadmollashahi L, Bekyghasemi M (2013). Use of smokeless tobacco among male students of Zahedan universities in Iran: a cross sectional study. Asian Pac J Cancer Prev, 14, 6385-8. https://doi.org/10.7314/APJCP.2013.14.11.6385
  31. Idris A, Warnakulasuriya K, Ibrahim Y, et al (1996). Toombak associated oral mucosal lesions in Sudanese show a low prevalence of epithelial dysplasia. J Oral Pathol Med, 25, 239-44. https://doi.org/10.1111/j.1600-0714.1996.tb01378.x
  32. Idris AM, Ibrahim SO, Vasstrand EN, et al (1998). The Swedish snus and the Sudanese Toombak: are they different? Oral oncol, 34, 558-66. https://doi.org/10.1016/S1368-8375(98)00047-5
  33. Jaber L, Shaban S, Hariri D, Smith S, (2011). Perceptions of healthcare practitioners in Saudi Arabia regarding their training in oral cancer prevention, and early detection. Int J Health Care Qual Assur, 24, 8-18. https://doi.org/10.1108/09526861111098201
  34. Jalouli J (2010). Human papilloma virus, Epstein-Barr virus, and Herpes simplex virus type-1 in oral squamous cell carcinomas from three populations Uppsala University. Upssala.
  35. Jemal A, Bray F, Center MM, et al (2011). Global cancer statistics. CA-Cancer J Clin, 61, 69-90. https://doi.org/10.3322/caac.20107
  36. Jemal A, Siegel R, Xu J, Ward E, (2010). Cancer statistics, (2010). CA-Cancer J Clin, 60, 277-300. https://doi.org/10.3322/caac.20073
  37. Johnson NW, Jayasekara P, Amarasinghe A (2011). Squamous cell carcinoma and precursor lesions of the oral cavity: epidemiology and aetiology. Periodontol, 57, 19-37. https://doi.org/10.1111/j.1600-0757.2011.00401.x
  38. Kauffman RM, Ferketich AK, Wee AG, et al (2008). Factors associated with smokeless tobacco cessation in an Appalachian population. Addict Behav, 33, 821-30. https://doi.org/10.1016/j.addbeh.2008.01.004
  39. Khan ZU (2012). An Overview of Oral Cancer in Indian Subcontinent and Recommendations to Decrease its Incidence. Webmed Central CANCER, 3, WMC003626.
  40. Klesges RC, Ebbert JO, Morgan GD, et al (2011). Impact of differing definitions of dual tobacco use: implications for studying dual use and a call for operational definitions. Nice Tob Res, 13, 523-31. https://doi.org/10.1093/ntr/ntr032
  41. Klus H, Kunze M, Konig S, Poschl E (2009). Smokeless tobaccoan overview. Beitr Tabakforsch/Contributions to Tobacco Research, 23, 125-28.
  42. Kuper H, Boffetta P, Adami HO (2002). Tobacco use and cancer causation: association by tumour type. J Intern Med, 252, 206-24. https://doi.org/10.1046/j.1365-2796.2002.01022.x
  43. Kurtul N, Gokpinar E (2012). Salivary lipid peroxidation and total sialic acid levels in smokers and smokeless tobacco users as Maras powder. Mediat Inflamm, 25, 123-9.
  44. Mallick S, Agarwal J, Kannan S, et al (2010). PCNA and antiapoptotic Mcl-1 proteins predict disease-free survival in oral cancer patients treated with definitive radiotherapy. Oral oncol, 46, 688-93. https://doi.org/10.1016/j.oraloncology.2010.04.003
  45. Mitchell C, Joyce AR, Piper JT, et al (2010). Role of oxidative stress and MAPK signaling in reference moist smokeless tobacco-induced HOK-16B cell death. Toxicol lett, 195, 23-30. https://doi.org/10.1016/j.toxlet.2010.02.020
  46. Mognetti B, Di Carlo F, Berta G (2006). Animal models in oral cancer research. Oral oncol, 42, 448-60. https://doi.org/10.1016/j.oraloncology.2005.07.014
  47. Moore MA, Ariyaratne Y, Badar F, et al (2010). Cancer epidemiology in South Asia-past, present and future. Asian Pac J Cancer Prev, 11, 49-66.
  48. Mushtaq N, Beebe LA (2012). A review of the validity and reliability of smokeless tobacco dependence measures. Addict Behav, 37, 361-66. https://doi.org/10.1016/j.addbeh.2011.12.003
  49. Neville BW, Day TA (2002). Oral cancer and precancerous lesions. CA-Cancer J Clin, 52, 195-15. https://doi.org/10.3322/canjclin.52.4.195
  50. Petersen PE (2009). Oral cancer prevention and control-The approach of the World Health Organization. Oral Oncol, 45, 454-60. https://doi.org/10.1016/j.oraloncology.2008.05.023
  51. Priebe SL (2009). Oral squamous cell carcinoma and cultural risk factors in patients at Benh Vien Ung Buou Oncology Hospital in Ho Chi Minh City, Vietnam.
  52. Ramya R, Prakash S, Sudha S (2011). Assessment of serum malondialdehyde in oral squamous cell carcinoma patients and its association with tobacco habits. JPBMS, 10, 1-3.
  53. Raveendran R, Nath SG (2012). Precipitants of oral cancer in India. Clin Cancer Invest J, 1, 111-2. https://doi.org/10.4103/2278-0513.102875
  54. Rodu B, Jansson C (2004). Smokeless tobacco and oral cancer: a review of the risks and determinants. Crit Rev Oral Biol M, 15, 252-63. https://doi.org/10.1177/154411130401500502
  55. Russo P, Nastrucci C, Alzetta G, Szalai C, (2011). Tobacco habit: historical, cultural, neurobiological, and genetic features of people's relationship with an addictive drug. Perspect Biol Med, 54, 557-77. https://doi.org/10.1353/pbm.2011.0047
  56. Salem G (1989). Oral lichen planus among 4277 patients from Jazan, Saudi Arabia. Community Dent Oral, 17, 322-24. https://doi.org/10.1111/j.1600-0528.1989.tb00647.x
  57. Salem G (1992). Leukoplakia and tobacco habits in Jazan, Saudi Arabia. Saudi Dent J, 4, 50-54.
  58. Salem G, Juhl R, Schiodt T (1984). Oral malignant and premalignant changes in'Shammah'-users from the Jazan region, Saudi Arabia. Acta Odontologica, 42, 41-5. https://doi.org/10.3109/00016358409041130
  59. Samman MA, Bowen ID, Taiba K, Antonius J, Hannan MA (1998). Mint prevents shammah-induced carcinogenesis in hamster cheek pouch. Carcinogenesis, 19, 1795-801. https://doi.org/10.1093/carcin/19.10.1795
  60. Sawair FA, Al-Mutwakel A, Al-Eryani K, et al (2007). High relative frequency of oral squamous cell carcinoma in Yemen: qat and tobacco chewing as its aetiological background. Int J Env Health Res, 17, 185-95. https://doi.org/10.1080/09603120701254813
  61. Scheifele C, Nassar A, Reichart PA (2007). Prevalence of oral cancer and potentially malignant lesions among shammah users in Yemen. Oral Oncol, 43, 42-50. https://doi.org/10.1016/j.oraloncology.2005.12.028
  62. Spielberger CD, Foreyt JP, Goodrick GK, Reheiser EC (1995). Personality characteristics of users of smokeless tobacco compared with cigarette smokers and non-users of tobacco products. Pers Indiv Differ, 19, 439-48. https://doi.org/10.1016/0191-8869(95)00084-J
  63. Stewart ST, Cutler DM, Rosen AB (2009). Forecasting the effects of obesity and smoking on US life expectancy. N Engl J Med, 361, 2252-60. https://doi.org/10.1056/NEJMsa0900459
  64. Tandon P, Pathak VP, Zaheer A, Chatterjee A, Walford N, (1995). Cancer in the Jazan Province of Saudi Arabia: an eleven year study. Ann Saudi Med, 15, 14-20.
  65. Valdes de la Cruz M, Gonzalez C, Lara R, et al (2010). Genetic diversity of wild species of Nicotiana genus I: Characterization using biochemical markers. Revista de Proteccion Vegetal, 25, 88-97.
  66. Valliani A, Ahmed B, Nanji K (2012). Use of smoke-less tobacco amongst the staff of tertiary care hospitals in the largest City of Pakistan. Asian Pac J Cancer Prev, 13, 2315-7. https://doi.org/10.7314/APJCP.2012.13.5.2315
  67. Walsh MM, Langer TJ, Kavanagh N, et al (2010). Smokeless tobacco cessation cluster randomized trial with rural high school males: Intervention interaction with baseline smoking. Nic Tob Res, 12, 543-50. https://doi.org/10.1093/ntr/ntq022
  68. Warnakulasuriya KAAS, Ralhan R (2007). Clinical, pathological, cellular and molecular lesions caused by oral smokeless tobacco- a review. J Oral Pathol Med, 36, 63-77. https://doi.org/10.1111/j.1600-0714.2007.00496.x
  69. Warnakulasuriya S, Dietrich T, Bornstein MM, et al (2010). Oral health risks of tobacco use and effects of cessation. Int Dent J, 60, 7-30.
  70. Willis D, Popovech M, Gany F, Zelikoff J (2012). Toxicology of Smokeless Tobacco: Implications for Immune, Reproductive, and Cardiovascular Systems. J Toxicol Env Heal B, 15, 317-31. https://doi.org/10.1080/10937404.2012.689553
  71. Winn DM, Blot WJ, Shy H, et al (1981). Snuff dipping and oral cancer among women in the southern United States. N Engl J Med, 304, 745-49. https://doi.org/10.1056/NEJM198103263041301
  72. Winter JC (2000). Tobacco use by Native North Americans: Sacred Smoke and Silent Killer. University of Oklahoma Press.
  73. Zhang X, Schmitz W, Gelderblom H, Reichart P (2001). Shammah-induced oral leukoplakia-like lesions. Oral Oncol, 37, 609-12. https://doi.org/10.1016/S1368-8375(00)00123-8
  74. Zhu SH, Anderson CM, Tedeschi GJ, et al (2002). Evidence of real-world effectiveness of a telephone quitline for smokers. N Engl J Med, 47, 1087-93.

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