A cigar is defined as a roll of fermented tobacco wrapped in a tobacco leaf or a substance containing tobacco. Despite popular misconceptions, cigars are not a safe alternative to other tobacco products and pose significant health risks, containing the same toxic and carcinogenic compounds found in cigarette smoke. The health dangers associated with cigar use, including addiction and serious disease, are substantial regardless of whether the smoke is intentionally inhaled.
The Chemical Reality of Cigar Smoke
Cigar smoke contains a complex mixture of thousands of chemicals, including over 70 known carcinogens. The unique manufacturing process for cigars, which involves air-curing and fermentation of the tobacco leaf, increases the concentration of certain harmful compounds, particularly tobacco-specific nitrosamines (TSNAs). TSNAs, such as N-nitrosonornicotine (NNN) and nicotine-derived nitrosamine ketone (NNK), are among the most potent cancer-causing agents found in tobacco products.
A single large cigar can contain as much tobacco as an entire pack of cigarettes, leading to a higher concentration of certain toxins in the smoke. Due to the less porous nature of the cigar wrapper compared to cigarette paper, the tobacco does not burn as completely. Cigar smoke often has higher levels of tar, carbon monoxide, nitrogen oxides, and ammonia than cigarette smoke. The smoke produced by most cigars is also distinctly alkaline, a chemical property that is crucial in understanding the mechanism of nicotine absorption.
Nicotine Absorption and the Myth of Safe Use
The common belief that cigars are safer because the smoke is not inhaled overlooks the primary route of nicotine absorption. Most cigar smoke is alkaline, with a pH high enough to ensure that nicotine remains in its un-ionized, or “free,” form. This free nicotine is readily absorbed through the moist lining of the mouth and nasal passages. This means that cigar smokers do not need to inhale the smoke to absorb substantial amounts of nicotine into their bloodstream.
A single large cigar can contain between 5 and 20 grams of tobacco, translating to a total nicotine content ranging from about 5.9 milligrams up to over 300 milligrams. In contrast, a typical cigarette contains around 10 to 12 milligrams of nicotine. Even without inhaling, the nicotine absorbed through the oral mucosa is sufficient to cause and sustain nicotine dependence. This systemic absorption leads to increased heart rate and blood pressure, placing stress on the cardiovascular system, fundamentally undermining the myth of safe use.
Specific Cancer and Disease Risks
The nature of cigar smoking directly exposes the mouth, throat, and esophagus to high concentrations of carcinogens, making these areas particularly vulnerable to disease. Regular cigar smoking increases the risk of cancers of the oral cavity, larynx, pharynx, and esophagus. Even among smokers who report never inhaling, the risk for oral, esophageal, and laryngeal cancers remains elevated compared to non-smokers. The continuous exposure of the oral tissues to the smoke also causes localized damage.
Beyond cancer, cigar use is strongly linked to various serious oral health problems. These include periodontal disease, which affects the gums and supporting bone, and a higher likelihood of tooth loss. Systemic absorption of nicotine and other toxins contributes to cardiovascular risks, increasing the likelihood of heart disease and potentially an aortic aneurysm. While less common than in cigarette smokers, deep inhalation of cigar smoke, particularly with smaller cigars, also increases the risk of lung cancer and chronic obstructive pulmonary disease (COPD).
The Dangers of Secondhand Cigar Smoke
The smoke produced by a burning cigar is a mixture of the smoke exhaled by the smoker and the sidestream smoke from the lit end, which is often unfiltered and contains a higher concentration of toxic and carcinogenic compounds. There is no safe level of exposure to secondhand smoke, and it is considered just as dangerous as secondhand cigarette smoke.
Exposure increases the risk of lung cancer and cardiovascular diseases, including heart attack and stroke, in non-smoking adults. Children are especially vulnerable because their developing lungs and airways put them at higher risk for severe respiratory infections, ear infections, and the exacerbation of conditions like asthma.