Cigars and Health Harm

What are cigars and how do they differ from cigarettes?

A cigar is defined as a tube-shaped tobacco product that is made of tightly rolled, cured tobacco leaves in a tobacco leaf wrapper or a wrapper that contains tobacco.[1] Cigars differ in design from cigarettes, typically being composed entirely of whole-leaf tobacco, wrapped in leaf tobacco rather than paper and typically smoked without a filter.[2] According to the World Health Organisation, cigars generally contain several times as much tobacco as cigarettes, but their size is much more variable, ranging from the size of a cigarette to products that are several times the diameter and containing as much tobacco as a package of 20 cigarettes or more.[3]

Does cigar smoking cause health harm?

Yes. Cigar smoking causes cancer and other diseases.[4]

What cancers does cigar smoking cause?

According to the U.S. National Cancer Institute[5], cigar smoking causes cancer of the oral cavity, larynx, oesophagus, and lung. It may also cause cancer of the pancreas. Regular cigar smokers and cigarette smokers have similar levels of risk for oral cavity and oesophageal cancers. The more you smoke, the greater the risk of disease.

What other diseases does cigar smoking cause?

Daily cigar smokers, particularly those who inhale, are at increased risk for developing heart disease and other types of lung disease [6] as well as other diseases and disability referenced below.

What if I don’t inhale the cigar smoke?

Many cigar smokers believe that they are at no risk or less risk of health harm because they do not inhale cigar smoke. The National Cancer Institute addresses the question about inhaling cigar smoke as follows[7]:

“Unlike nearly all cigarette smokers, most cigar smokers do not inhale. Although cigar smokers have lower rates of lung cancer, coronary heart disease, and lung disease than cigarette smokers, they have higher rates of these diseases than those who do not smoke cigars.

All cigar and cigarette smokers, whether or not they inhale, directly expose their lips, mouth, tongue, throat, and larynx to smoke and its toxic and cancer-causing chemicals. In addition, when saliva containing the chemicals in tobacco smoke is swallowed, the oesophagus is exposed to carcinogens. These exposures probably account for the similar oral and oesophageal cancer risks seen among cigar smokers and cigarette smokers.”

More information about cancer, cigars and cigar smoking researched and written by the U.S. National Cancer Institute may be found here: https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/cigars-fact-sheet

What about cigar smoking compared with cigarette smoking?

As noted, there are differences in health harms from cigar and cigarette smoking. However, a scientific study published in 2015 which was a systematic review of 22 studies of the health effects of cigar smoking found that cigar smoking carries many of the same health risks as cigarette smoking.[8] Mortality risks from cigar smoking vary by level of exposure as measured by cigars per day and inhalation level and can be as high as or exceed those of cigarette smoking.

Some key points from this systematic review are to be found at the link below from the online men’s health resource (www.menshealth.com) which says that “lighting up a Cuban could be more lethal than you think: Cigar smokers are at risk of dying from many of the same diseases that affect people who puff on cigarettes”.[9] https://www.menshealth.com/health/a19544365/dangers-of-cigars/

The scientific study was published in 2015 in the peer -reviewed journal BMC Public Health and is available in full at this link:

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1617-5

An overview of scientific studies of cigars and cigar usage

Here are sixteen points from Viegas’s overview of scientific studies of cigars and cigar usage [10]:

1.     Cigar smoking results in a considerable risk of developing smoking-related diseases.

2.     In comparison with individuals who never smoked, cigar smokers have a greater risk of coronary disease and cerebrovascular accident, as well as a higher overall rate of mortality due to other diseases.

3.     The great majority of cigars have more nicotine than the sum of many cigarettes (1-2 mg of nicotine in a cigarette and 100-400 mg of nicotine in a cigar, which contains up to 17 g of tobacco).

4.     Cigar smoke is more alkaline than is that of cigarettes, thereby facilitating its dissolution and absorption by the oral mucosa. This makes it possible to achieve the desired dose of nicotine without the need to inhale the smoke into the lungs. Despite the fact that many cigar smokers do not inhale, cigars can cause nicotine dependence, because they make high levels of nicotine available so rapidly.

5.     Cigar smoke contains a class of highly carcinogenic compounds (nitrosamines, hydrocarbons and aromatic amines) at levels significantly higher than those found in cigarette smoke.

6.     Biochemical analysis has shown that, for an equal number of grams of tobacco smoked, tar, carbon monoxide and ammonia are produced in larger quantities through the burning of cigars than through the burning of cigarettes. In addition, the tar derived from cigars has high concentrations of carcinogenic agents such as polycyclic aromatic hydrocarbons. Viegas explains that this could be the reason that the risk of presenting with lung cancer is up to nine times greater for cigar smokers than for nonsmokers.

7.     The rates of lung cancer among cigar smokers are related to the number of cigars smoked per day and to the degree of inhalation of the smoke.

8.     Cigar smokers who inhale no smoke expose the oral cavity and the tongue to large quantities of smoke, thereby increasing the risk of oral cancer. The constituents of tobacco dissolved in the saliva are also swallowed, increasing the incidence of oesophageal cancer in this group.

9.     Tobacco and alcohol act synergistically to increase the development of oral and pharyngeal cancer.

10.  The risk of developing cancer in the oral cavity (lips, tongue, mouth and throat), larynx or oesophagus is twice as high for cigar smokers as it is for nonsmokers.

11.  Cigar smokers also present an increased risk of developing COPD and coronary disease.

12.  The risk of dying from cancer of the pancreas or bladder has been shown to be two and three times higher, respectively, for cigar smokers who inhale the smoke than for nonsmokers.

13.  Compared with cigarette smokers, cigar smokers also present an increased risk of respiratory and heart diseases, as well as cancer of the oral cavity, throat and oesophagus.

14.  Cigar smoking has been related to the onset of erectile dysfunction in men.

15.  Secondary smoke from cigars contributes more to environmental pollution than does cigarette smoke.

16.  Since cigar smoke contains higher concentrations of toxins and cancerous substances than does cigarette smoke, it also contributes to increasing the risk of lung cancer and other smoking-related diseases in nonsmokers (passive smokers).

All quotes above from Viegas CA: Noncigarette forms of tobacco use. J Bras Pneumol 2008; 34: 1069–1073. The full article is available at this link: https://pdfs.semanticscholar.org/5074/4f764adcd62b86756555b75addf579e23848.pdf

Other useful links about cigars and cigar smoking [11] [12] [13] [14]

You will find more specific information about cigar smoking at these useful links, including about the rise in flavoured cigars aimed at the children’s market:

https://www.cancer.ie/cancer-information/oesophagus-cancer/causes-prevention#sthash.VMuyQpJQ.dpbs

http://cancerpreventionresearch.aacrjournals.org/content/early/2017/11/05/1940-6207.CAPR-17-0084

https://www.verywellmind.com/facts-about-cigar-smoking-2824739

https://www.tobaccofreekids.org/what-we-do/industry-watch/cigar-report

Quitting cigar smoking

You will find information on smoking cessation on the ASH Ireland website here: https://www.ash.ie/quitting-smoking/ including links to the HSE quit.ie resource.

Summary

In short, cigar smoking harms health. Cigar smoking causes cancer, heart disease, chronic obstructive pulmonary disease (COPD), and other diseases. Cigar smoke contains the same toxins as cigarette smoke. Secondhand smoke from cigars harms people around cigar smokers, who are passive smokers. Quitting smoking will improve your health and the health of those around you. Help is available from your GP and from www.quit.ie

References

[1] National Cancer Institute (NCI) 2018. https://www.cancer.gov/ Accessed 12 July 2018.
[2] Viegas CA: Noncigarette forms of tobacco use. J Bras Pneumol 2008; 34: 1069–1073.
[3] http://www.who.int/tobacco/communications/events/wntd/2006/Report_v8_4May06.pdf Accessed 12 July 2018.
[4] Viegas CA: Noncigarette forms of tobacco use. J Bras Pneumol 2008; 34: 1069–1073.
[5] National Cancer Institute (NCI) 2018. https://www.cancer.gov/ 12 July 2018.
[6] Viegas CA: Noncigarette forms of tobacco use. J Bras Pneumol 2008; 34: 1069–1073.
[7] National Cancer Institute (NCI) 2018. https://www.cancer.gov/ Accessed 12 July 2018.
[8] Chang CM, Corey CG, Rostron BL, Apelberg BJ. Systematic review of cigar smoking and all cause and smoking related mortality. BMC Public Health 2015 15:390 https://doi.org/10.1186/s12889-015-1617-5
[9]  https://www.menshealth.com/health/a19544365/dangers-of-cigars/ Accessed 12 July 2018.
[10] Viegas CA: Noncigarette forms of tobacco use. J Bras Pneumol 2008; 34: 1069–1073.
[11] https://www.cancer.ie/cancer-information/oesophagus-cancer/causes-prevention#sthash.VMuyQpJQ.dpbs Accessed 12 July 2018.
[12] http://cancerpreventionresearch.aacrjournals.org/content/early/2017/11/05/1940-6207.CAPR-17-0084 Accessed 12 July 2018.
[13] https://www.verywellmind.com/facts-about-cigar-smoking-2824739 Accessed 12 July 2018.
[14] https://www.tobaccofreekids.org/what-we-do/industry-watch/cigar-report Accessed 12 July 2018.