Quantitative Analysis of Serum Levels of Trace Elements in Sudanese Snuff Dippers

Background: Oral cancer in Sudan has high incidence rate due to the use of Toombak , a home- made smokeless tobacco, rich in tobacco specific nitrosamines .There have been calls for continuous monitoring on toombak users to discover very early the carcinogenic changes to avoid mortality, and  morbidity.
Objective: The purpose of this study was to assess technically, and financially affordable  methodologies, that are  reliable, reproducible,  sensitive, specific and cost effective valid  for use  in  mass  screening  amongst  the  high  risk  groups. (The toombak  users).The present study was done to evaluate the levels of copper, zinc and magnesium in serum of toombak dippers.  
Materials and Methods: The levels of copper, zinc, and magnesium were estimated in the serum of 150 toombak dippers . The values were compared with 50 normal age matched, healthy control subjects and 50 patients with oral squamous cell carcinoma, using Atomic absorption spectrophotometry.
 Results: There was significant difference of the mean serum copper, zinc, and magnesium levels of toombak  dippers when compared to the normal controls. In oral cancer patients there was significant difference in the copper, zinc, and magnesium levels. Copper level was found increased gradually starting from control through toombak dippers to oral squamous cell carcinoma patients , while the level of zinc and magnesium was found decreased in the same sequence.
Conclusion: Serum may be used as a potential diagnostic tool, which can be efficiently employed  to evaluate the copper, zinc and magnesium  levels in Sudanese snuff dippers for population based  mass screening .Serum trace elements levels could be used as potential  diagnostic markers for early changes caused by toombak dipping.
Keywords: Atomic absorption spectrophotometry, copper,  magnesiumm , zinc,  oral squamous cell carcinoma, tobacco specific nitrosamines,  serum , toombak.