Cigar Smoking and Cancer

1. How are cigars different from cigarettes?

Cigarettes and cigars differ in both size and the type of tobacco used:

• Cigarettes: Cigarettes are uniform in size and contain less than 1 gram of tobacco each. U.S. cigarettes are made from different blends of tobaccos, which are never fermented, and they are wrapped with paper. Most U.S. cigarettes take less than 10 minutes to smoke.
• Cigars: Most cigars are composed primarily of a single type of tobacco (air-cured and fermented tobacco), and they have a tobacco wrapper. They can contain between 1 gram and 20 grams of tobacco. Cigars vary in size and shape. Three sizes are sold in the United States:

Large cigars can measure more than 7 inches in length, and they typically contain between 5 and 20 grams of tobacco. Some premium cigars contain the tobacco equivalent of an entire pack of cigarettes. Large cigars can take between 1 and 2 hours to smoke.

Cigarillos are a type of smaller cigar. They are a little bigger than little cigars and cigarettes and contain about 3 grams of tobacco.

Little cigars are the same size and shape as cigarettes (20 little cigars in a package) and contain about 1 gram of tobacco. Also, unlike large cigars, some little cigars have a filter, which makes it seem they are designed to be smoked like cigarettes.

2. Are there harmful chemicals in cigar smoke?

Yes. Cigar smoke, like cigarette smoke, contains toxic and cancer-causing chemicals that are harmful to both smokers and nonsmokers. Cigar smoke is possibly more toxic than cigarette smoke. Cigar smoke has:

• A higher level of cancer-causing substances: During the fermentation process for cigar tobacco, high concentrations of cancer-causing nitrosamines are produced. These compounds are released when a cigar is smoked. Nitrosamines are found at higher levels in cigar smoke than in cigarette smoke.
• More tar: For every gram of tobacco smoked, there is more cancer-causing tar in cigars than in cigarettes.
• A higher level of toxins: Cigar wrappers are less porous than cigarette wrappers. The nonporous cigar wrapper makes the burning of cigar tobacco less complete than cigarette tobacco. As a result, compared with cigarette smoke, the concentrations of toxins are higher in cigar smoke.

Also, the larger size of most cigars (more tobacco) and longer smoking time result in higher exposures to many toxic compounds (including carbon monoxide, hydrocarbons, ammonia, cadmium, and other substances).

Cigar smoke can be a major source of indoor air pollution. There is no safe level of exposure to tobacco smoke. If you want to reduce the health risk to yourself and others, stop smoking.

3. What if I don't inhale the cigar smoke?

Almost all cigarette smokers inhale the tobacco smoke while most cigar smokers do not inhale. Cigar smokers have higher rates of lung cancer, coronary heart disease, and lung disease than nonsmokers, but not as high as the rates for cigarette smokers. Smoke inhalation and the differences in daily use probably account for the higher rates among cigarette smokers.

All cigar and cigarette smokers, whether or not they inhale, directly expose the lips, mouth, tongue, throat, and larynx to smoke and its toxic and cancer-causing chemicals. In addition, when saliva containing smoke constituents is swallowed, the esophagus is exposed to carcinogens. These exposures to smoke probably account for the fact that oral and esophageal cancer risks are similar among cigar smokers and cigarette smokers.

4. Do cigars cause cancer and other diseases?

Yes. Cigar smoking can cause cancers of the oral cavity (lip, tongue, mouth, and throat), larynx (voice box), esophagus, and lung. It may also cause cancer of the pancreas. Also, daily cigar smokers, particularly those who inhale, are at increased risk for developing heart disease and other types of lung disease. Regular cigar smokers and cigarette smokers have similar levels of risk for oral and esophageal cancers. The more you smoke, the greater the risk of disease.

5. Are cigars addictive?

Yes. Even if the smoke is not inhaled, high levels of nicotine (the chemical that causes addiction) can be absorbed into the body. A single cigar potentially can provide as much nicotine as a pack of cigarettes.

A cigar smoker can get nicotine by two routes: By inhalation into the lungs and by absorption through the lining of the mouth. Either way, the nicotine that gets into the body is addictive.

6. Do nicotine replacement products help cigar smokers to quit?

Yes. Nicotine replacement products deliver measured doses of nicotine into the body, which helps to relieve the cravings and withdrawal symptoms often felt by people trying to quit smoking. Strong and consistent evidence shows that nicotine replacement products can help people quit smoking.

Selected References

1. Baker F, Ainsworth SR, Dye JT, et al. Health risks associated with cigar smoking. Journal of the American Medical Association 2000; 284(6):735–740.
   
   
2. Kozlowski LT, Dollar KM, Giovino GA. Cigar/cigarillo surveillance: Limitations of the U.S. Department of Agriculture System. American Journal of Preventive Medicine 2008; 34(5):424–426.
   
   
3. National Cancer Institute. Smoking and Tobacco Control Monograph No. 9: Cigars: Health effects and trends. Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service, 1998. Retrieved October 27, 2009, from: http://www.cancercontrol.cancer.gov/tcrb/monographs/9/index.html.
   
   
4. U.S. Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000.

Source: cancer.gov