Cigar and Pipe Smoking and Cancer Risk

Author: OncoLink Team
Last Reviewed: April 30, 2020

Many people think of cigar and pipe smoking as being safer than cigarette smoking. While the risk of developing cancer from cigar and pipe smoking is lower than with cigarettes, it is not zero. There is still a higher risk of cancer in cigar and pipe smokers as compared to non-smokers. How high the risk depends on how many pipes/cigars one smokes and how deeply they inhale. Even smokers who do not inhale are at increased cancer risk. The good news is that the risks are highest in current cigar and pipe smokers, so quitting does lower your risk.

What causes increased cancer risk with cigars & pipes?

Cigars are dangerous because the tobacco is aged and fermented, which creates nitrates and nitrites. Nitrates and nitrites are known as a cause of cancer (carcinogenic). When a cigar is burned, it produces more cancer-causing compounds, 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 contain as much tobacco (up to 20 grams) as an entire 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. For this reason, the addiction to cigars is just as strong as to cigarettes. A smoker's saliva contains 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 contains many of the same carcinogens as cigarettes. It also has nicotine, making it addictive. People who smoke pipes are more likely to develop cancers of the head and neck, liver, and lung as compared to nonsmokers. 

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 associated 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 seen between cigar and pipe smoking and cancers of the stomach, pancreas, colon and rectum.

What other health concerns are associated with cigars and pipes?

The risk of developing cancer gets higher with the amount of tobacco someone has used and the number of years they have smoked. Cigar and pipe smokers are more likely to develop 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 contain more tobacco than cigarettes, and burn for much longer, they also give off higher amounts of secondhand smoke, putting those around you at risk.

Resources for more information:

References

American Association for Cancer Research. (2018). Tobacco and Cancer Resources. Retrieved from https://www.aacr.org/professionals/policy-and-advocacy/tobacco-and-cancer/tobacco-and-cancer-resources/ 

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.

Harmful Chemicals in Tobacco Products. The American Cancer Society. https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer/carcinogens-found-in-tobacco-products.html

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.

Tobacco Products: Products, Ingredients & Compounds. US Food & Drug Administration. https://www.fda.gov/TobaccoProducts/Labeling/ProductsIngredientsComponents/default.htm

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.

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