In estimating the burden attributable to smokeless tobacco, we found that the risk varies by the toxicity of the type used; there is sufficient evidence that chewing tobacco and other products of similar toxicity cause excess risk of oral and oesophageal cancer while, at this time, existing evidence does not support attributing burden to snus or similar smokeless tobacco products. Globally, smoking tobacco causes far more burden than smokeless tobacco; nonetheless, smokeless tobacco is an important risk factor for oral and oesophageal cancer in India, where more than half of the 32 141 (24 930–39 243) global deaths attributable to smokeless tobacco occur.
