Surveys reveal that as many as 7 percent of former smokers have changed to smokeless tobacco (ST), which they perceive as less risky. Data indicate that this is a positive risk-reduction strategy. The only serious health risk associated with ST use is oral cancer, which occurs at an annual rate of 26 cases per 100,000 long-term users. If all 46 million American smokers instead used ST, then 12,000 cases of oral cancer would be seen each year, representing only 5 percent of all smoking-related cancers, less than one-tenth of smoking-related lung cancers, and only one-half of the oral cancers now attributed to smoking. The annual death rates that would result from ST use compares favorably with the current smoking toll of 419,000 annual deaths. In addition, cardiovascular disease risks related to ST use are negligible, and lifelong ST use appears to result in no appreciable impact on life expectancy. References