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Cover of Smokeless Tobacco and Some Tobacco-specific N-Nitrosamines

Smokeless Tobacco and Some Tobacco-specific N-Nitrosamines

IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, No. 89


This eighty-ninth volume of the IARC Monographs is the third and last of a series on tobacco-related agents. Volume 83 reported on the carcinogenicity of tobacco smoke and involuntary smoking (second-hand smoke or environmental tobacco smoke) (IARC, 2004a). Volume 85 summarized the evidence on the carcinogenic risk of chewing betel quid with and without tobacco (IARC, 2004b). That volume explored the variety of products chewed in South Asia and other parts of the word that contain areca nut in combination with other ingredients, often including tobacco. In this volume, the carcinogenic risks associated with the use of smokeless tobacco, including chewing tobacco and snuff, are considered in a first monograph. The second monograph reviews some tobacco-specific nitrosamines. These agents were evaluated earlier in Volume 37 (IARC, 1985), and information gathered since that time has been summarized and evaluated.


Corrigenda to the IARC Monographs are published online at:


This publication represents the views and expert opinions of an IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, which met in Lyon, 5–12 October 2004

Lyon, France - 2007


In 1969, the International Agency for Research on Cancer (IARC) initiated a programme on the evaluation of the carcinogenic risk of chemicals to humans involving the production of critically evaluated monographs on individual chemicals. The programme was subsequently expanded to include evaluations of carcinogenic risks associated with exposures to complex mixtures, life-style factors and biological and physical agents, as well as those in specific occupations.

The objective of the programme is to elaborate and publish in the form of monographs critical reviews of data on carcinogenicity for agents to which humans are known to be exposed and on specific exposure situations; to evaluate these data in terms of human risk with the help of international working groups of experts in chemical carcinogenesis and related fields; and to indicate where additional research efforts are needed.

The lists of IARC evaluations are regularly updated and are available on the Internet at

This programme has been supported by Cooperative Agreement 5 UO1 CA33193 awarded since 1982 by the United States National Cancer Institute, Department of Health and Human Services. Additional support has been provided since 1986 by the European Commission, Directorate-General EMPL (Employment, and Social Affairs), Health, Safety and Hygiene at Work Unit, and since 1992 by the United States National Institute of Environmental Health Sciences.

  • Published by the International Agency for Research on Cancer,
  • 150 cours Albert Thomas, 69372 Lyon Cedex 08, France
  • ©International Agency for Research on Cancer, 2007
  • Distributed by WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob).
  • Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved.

The International Agency for Research on Cancer welcomes requests for permission to reproduce or translate its publications, in part or in full. Requests for permission to reproduce or translate IARC publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; email: tni.ohw@snoissimrep).

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city, or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

The IARC Monographs Working Group alone is responsible for the views expressed in this publication.

IARC Library Cataloguing in Publication Data

Smokeless Tobacco and Some Tobacco-specific N-Nitrosamines/

  • IARC Working Group on the Evaluation of Carcinogenic Risks to Humans (2004 : Lyon, France)
  • (IARC monographs on the evaluation of carcinogenic risks to humans ; v. 89)
  • 1. Carcinogens 2. Nitrosamines – adverse effects 3. Tobacco, Smokeless – adverse effects
  • I. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans II. Series
  • ISBN 978 92 832 1289 8 (NLM Classification: W1)
  • ISSN 1017-1606
Image front1

Cover legend:

Schematic diagramme of the metabolism of nicotine, an addictive chemical present in all tobacco products. The tobacco-specific N-nitrosamines NNK, NNN, NAB and NAT are reviewed in the second Monograph of this volume.

Cover design: Georges Mollon, IARC

©International Agency for Research on Cancer, 2007.
Bookshelf ID: NBK326497


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