Key Points

• Cigars are not a safe alternative to cigarettes, causing both cancer and heart disease.

• Cigar-related health risks are related to number smoked and depth of inhalation.

• Risk of tobacco-related disease is increased when smoking is combined with alcohol consumption.

In 2004 the CDC estimated that about 9.4% of men, 1.9% of women, and 14.8% of students grades 8 to 12 were current cigar smokers. The mortality patterns from cigar smoking relate in part to the degree of inhalation by the smoker. Primary cigar smokers, or those who have never or rarely smoked cigarettes, inhale much less than secondary cigar smokers—those who have switched from or are concurrent cigarette smokers. The main reason for the difference is the pH of the smoke, which in cigars is higher than in cigarettes, allowing nicotine to be absorbed across the oral mucosa. Secondary cigar smokers, however, have learned to inhale smoke, and increase their risk of cancer and heart disease.

Cigar smokers have a risk of oral and pharyngeal cancer that is similar to cigarette smokers; their risk of esophageal cancer is several times that of never-smokers. As with cigarette smoking, the use of alcohol multiplies the risk of these cancers, accounting for about 75% of cases in developed nations (Pelucci et al., 2008).

Lung cancer risk varies with depth of inhalation and number of cigars per day. Primary cigar smokers with no or slight inhalation have about a 1.8 mortality ratio of lung cancer; moderate-deep inhalers increase this to 4.9, with an overall mortality ratio of 2.11 compared with nonsmokers. Secondary cigar smokers have a mortality ratio of 5.4; moderate-deep inhalers in this group increase the risk to 9.77. Combined cigarette-cigar smokers have an overall lung cancer mortality ratio of 11.20 (NCI, 1998).

Cigar smokers are also at higher risk for both COPD (RR, 1.45) and coronary artery disease (RR, 1.27) compared with nonsmokers (Iribarren et al., 1999). As with the cancer risk, the level of inhalation increases risk; for example, secondary cigar smokers with moderate-deep inhalation patterns have a fivefold increased risk for COPD (NCI, 1998).

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