Cigar Smoking and Cancer

                                     Key Points

• Cigar smoke, like cigarette smoke, contains toxic and cancer-causing chemicals that are harmful to both smokers and nonsmokers.
• There is no safe tobacco product, and there is no safe level of exposure to tobacco smoke.
• The more you smoke, the greater your risk of disease.
• Cigar smoking causes oral cavity cancers (cancers of the lip, tongue, mouth, and throat) and cancers of the larynx (voice box), esophagus, and lung.
• All cigar and cigarette smokers, whether or not they inhale, directly expose their lips, mouth, tongue, throat, and larynx to tobacco smoke and its toxic and cancer-causing chemical.

1. How are cigars different from cigarettes?

   Cigarettes usually differ from cigars in size and in the type of tobacco used (1–3). Moreover, in contrast with cigarette smoke, cigar smoke is often not inhaled.
   The main features of these tobacco products are:
   
   • 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), and they have a tobacco wrapper. They can vary in size and shape and contain between 1 gram and 20 grams of tobacco. Three cigar 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, are often packaged like 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 (that is, for the smoke to be inhaled). 

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 (3). 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 the burning of cigarette tobacco. As a result, cigar smoke has higher concentrations of toxins than cigarette smoke.
   Furthermore, the larger size of most cigars (more tobacco) and longer smoking time result in higher exposure to many toxic substances (including carbon monoxide, hydrocarbons, ammonia, cadmium, and other substances).
   Cigar smoke can be a major source of indoor air pollution (1). 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. Do cigars cause cancer and other diseases?

   Yes. Cigar smoking causes cancer of the oral cavity, larynx, esophagus, and lung. It may also cause cancer of the pancreas. Moreover, 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 cavity and esophageal cancers. The more you smoke, the greater the risk of disease (3).

4. What if I don’t inhale the cigar smoke?

   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 esophagus is exposed to carcinogens. These exposures probably account for the similar oral and esophageal cancer risks seen among cigar smokers and cigarette smokers (3).

5. Are cigars addictive?

   Yes. Even if the smoke is not inhaled, high levels of nicotine (the chemical that causes addiction) can still be absorbed into the body. 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 smoker becomes addicted to the nicotine that gets into the body.
   A single cigar can potentially provide as much nicotine as a pack of cigarettes (1).

6. Are cigars less hazardous than cigarettes?

   Because all tobacco products are harmful and cause cancer, the use of these products is strongly discouraged. There is no safe level of tobacco use. People who use any type of tobacco product should be encouraged to quit. For help with quitting, see the National Cancer Institute (NCI) fact sheet Where To Get Help When You Decide To Quit Smoking at http://www.cancer.gov/cancertopics/factsheet/tobacco/help-quitting on the Internet.

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

   Nicotine replacement products, or nicotine replacement therapy (NRT), 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 NRT can help people quit smoking cigarettes (4). Limited research has been completed to determine the usefulness of NRT for people who smoke cigars. For help with quitting cigar smoking, ask your doctor or pharmacist about NRT, as well as about individual or group counseling, telephone quitlines, or other methods.