Cigar and Pipe Smoking and Cancer Risk

Author: Marisa Healy, BSN, RN
Content Contributor: Allyson Van Horn, MPH
Last Reviewed: April 18, 2024

Many people think that cigar and pipe smoking is safer than cigarette smoking. The risk of getting cancer from cigar and pipe smoking is lower than it is with cigarettes. But, there is still a higher risk of cancer in cigar and pipe smokers as compared to non-smokers. How high the risk is based on how many pipes/cigars one smokes and how deeply they inhale (breathe in) the smoke. Even smokers who do not inhale are at increased cancer risk. The risks are highest in current cigar and pipe smokers, so quitting does lower your risk.

What causes increased cancer risk with cigars and pipes?

Cigars cause harm because the tobacco is aged and fermented, which makes nitrates and nitrites. Nitrates and nitrites can cause cancer which means it is carcinogenic. When a cigar is burned, it makes cancer-causing compounds (carcinogens), such as nitrosamine, tar, carbon monoxide, and ammonia. These are found in higher levels in cigar smoke than in cigarette smoke.

One large cigar can have as much tobacco (up to 20 grams) as a pack of cigarettes (1 gram of tobacco per cigarette)! Even though many cigar smokers do not inhale, the amount of nicotine is higher in a cigar (1-2 milligrams in a cigarette versus up to 400 milligrams in a single cigar). This nicotine is quickly absorbed in the saliva. The addiction to cigars is just as strong as that to cigarettes. A smoker's saliva holds the chemicals from the tobacco smoke, exposing the mouth, lips, tongue, and throat to these carcinogens.

Pipes use loose-leaf tobacco that is cured. Most often, the tobacco is placed in the pipe bowl and burned by the smoker, who then inhales through the mouthpiece. Pipe tobacco has many of the same carcinogens as cigarettes. It also has nicotine, making it addictive.

Which cancers are linked to cigars and pipes?

Although lung cancer rates are lower in cigar and pipe smokers than in cigarette smokers, they are still much higher than nonsmokers. The cancers linked with cigar and pipe smoking are: lung, oral (lip, tongue, mouth) and nasal (nose) cavity, sinuses, pharynx (throat), larynx (voice box), esophagus (tube from the throat to the stomach), liver, and bladder.

More research is needed to prove the links between cigar and pipe smoking and cancers of the stomach, pancreas, colon, and rectum.

What other health concerns are linked to smoking cigars and pipes?

Cigar and pipe smokers are at higher risk of heart disease, stroke, and lung diseases than those who do not smoke. Cigar and pipe smoking can lead to gum disease and tooth loss. Because cigars have more tobacco in them than cigarettes, and burn for much longer, they give off higher amounts of secondhand smoke, putting those around you at risk.

Resources for more information:

American Association for Cancer Research. (2018). Tobacco and Cancer Resources.

American Cancer Society (2020). Harmful Chemicals in Tobacco Products. 

Chang, C. M., Corey, C. G., Rostron, B. L., & Apelberg, B. J. (2015). Systematic review of cigar smoking and all cause and smoking related mortality. BMC Public Health, 15(1), 390.

Christensen, C. H., Rostron, B., Cosgrove, C., Altekruse, S. F., Hartman, A. M., Gibson, J. T., ... & Freedman, N. D. (2018). Association of cigarette, cigar, and pipe use with mortality risk in the US population. JAMA internal medicine, 178(4), 469-476.

McCormack, V. A., Agudo, A., Dahm, C. C., Overvad, K., Olsen, A., Tjonneland, A., ... & Hallmans, G. (2010). Cigar and pipe smoking and cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). International Journal of Cancer, 127(10), 2402-2411.

Tverdal, A., & Bjartveit, K. (2011). Health consequences of pipe versus cigarette smoking. Tobacco control, 20(2), 123-130.

Wyss, A., Hashibe, M., Chuang, S. C., Lee, Y. C. A., Zhang, Z. F., Yu, G. P., ... & Sturgis, E. M. (2013). Cigarette, cigar, and pipe smoking and the risk of head and neck cancers: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium. American journal of epidemiology, 178(5), 679-690.

U.S. Food and Drug Administration (2020). Tobacco Products: Products, Ingredients, and Components. 

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