Cigars are often seen as a less harmful alternative to cigarettes, a misconception stemming from the idea that cigar smoke is not inhaled. This view overlooks the complex chemical composition of cigar smoke and its various exposure pathways. This article clarifies the health risks of cigar use, focusing on its link to lung and other cancers.
The Harmful Components of Cigar Smoke
Cigar smoke contains toxic and carcinogenic substances similar to cigarette smoke, often in higher concentrations. Fermentation of cigar tobacco leads to elevated levels of cancer-causing nitrosamines released during smoking. Cigar smoke also contains more tar per gram of tobacco than cigarettes.
Less porous cigar wrappers lead to incomplete tobacco burning and higher toxin concentrations. These include carbon monoxide, ammonia, cadmium, and other hazardous compounds. These harmful substances enter the body through direct inhalation or absorption via the oral mucosa, even without intentional inhalation.
Cigar Use and Lung Cancer Risk
Cigar smoking unequivocally contributes to an increased risk of lung cancer. Although the lung cancer risk for cigar smokers may be lower than for regular cigarette smokers, it remains significantly higher than for non-smokers. This elevated risk increases with the number of cigars smoked daily and the depth of inhalation.
Carcinogens in cigar smoke, such as tobacco-specific nitrosamines, polycyclic aromatic hydrocarbons, and benzene, directly damage lung cell DNA, contributing to cancer. Highly carcinogenic tobacco-specific nitrosamines (TSNAs) like NNK and NNN are found in cigar smoke, with levels in some little cigars three to five times higher than in commercial cigarettes. Smoking five or more cigars daily with moderate inhalation can approximate the lung cancer risks of a pack-a-day cigarette smoker. Even among regular cigar smokers who do not inhale, the risk of lung cancer is double that of non-smokers.
Other Cancer Risks from Cigar Use
Beyond lung cancer, cigar use is linked to several other significant cancer types, primarily affecting areas with direct contact with the smoke. Cigar smoking causes cancers of the oral cavity, larynx (voice box), and esophagus. Regular cigar smokers face a significantly higher risk of dying from these cancers, with some studies indicating a 4 to 10 times greater likelihood than non-smokers.
Direct exposure of lips, mouth, tongue, throat, and larynx to smoke and its toxic chemicals, whether inhaled or not, contributes to these risks. When saliva containing these chemicals is swallowed, the esophagus is also exposed to carcinogens, increasing the risk of esophageal cancer. Some research also suggests a link between cigar smoking and pancreatic cancer.
Understanding Varying Risk Levels
Individual risk from cigar use is influenced by frequency, depth of inhalation, and age at which smoking began. While many cigar smokers do not intentionally inhale, nicotine can still be absorbed through the lining of the mouth. This oral absorption exposes the body to nicotine and other harmful chemicals, even without deep inhalation.
There is no safe level of tobacco use; cigars are not a safe alternative to cigarettes. Even occasional cigar use modifies, but does not eliminate, health risks. For instance, smoking one to two cigars daily can double the risk for oral and esophageal cancers. More cigars smoked and deeper inhalation lead to greater health risks.