Since 1993, cigar sales in the United States have increased by about 50 percent. Consumption of large cigars has increased nearly 70 percent, which marks a reversal in a 20-year decline in cigar smoking from 1973 to 1993. Most of the increase appears to be among teenagers and young adult males, who see cigars as a safer alternative to cigarettes.

The risk of death related to cigar smoking approaches that of cigarette smoking as the number of cigars smoked and the amount of cigar smoke inhaled increases. Smoking cigars instead of cigarettes does not reduce the risk of nicotine addiction, and cigar-smoking can lead to nicotine dependence even if the smoke is not inhaled.

The nicotine in the smoke of a single cigar can vary from an amount approximate to that in a single cigarette to the amount generated by smoking a pack or more of cigarettes.

Cigars and Cigarettes

The smoke released from cigars and cigarettes contain many of the same toxic agents (carbon monoxide, nicotine, hydrogen cyanide, ammonia and volatile aldehydes) and human carcinogens (benzene, vinyl chloride, ethylene oxide, arsenic, cadmium, nitrosamines, and polynuclear aromatic hydrocarbons).

However, the amounts of these substances present in cigar smoke are different than in cigarette smoke. For example, compared to a cigarette, a large cigar emits up to 20 times more ammonia, five to 10 times more cadmium (a cancer-causing metal) and methylethylnitrosamine(a cancer-causing agent), and up to 80 to 90 times as much of the highly carcinogenic tobacco-specific nitrosamines.

These differences are due to several factors: the long aging and fermentation process for cigar tobacco leaves results in higher concentrations of nitrate in cigar tobaccos; the nonporous cigar wrappers make combustion of cigar tobacco less complete than that of cigarette tobacco producing more toxic compounds in the smoke; the larger size of most cigars produces more smoke.

The result is that daily cigar smoking carries significant health risks. Not only can cigar smoking cause many cancers (oral cancers, including throat cancer, and cancer of the larynx, esophagus, and lung) but also chronic obstructive lung disease and coronary heart disease. There is also evidence which strongly suggests that cigar smoking is associated with cancer of the pancreas. Many of these cancers — lung, esophageal, and pancreatic — are associated with extremely low survival rates. For example, compared to nonsmokers, smoking one to two cigars per day doubles the risk of oral cavity (lip, tongue, mouth, throat) and esophageal cancers, and increases by six times the risk of cancer of the larynx.

Cancer risks increase with the number of cigars smoked per day. Smoking three to four cigars per day increases the risk of oral cancers to 8.5 times the risk for nonsmokers; the risk for esophageal cancer is nearly four times as great as nonsmokers.

The following are some of the differences in the patterns of cigar and cigarette use:

Most cigarette smokers smoke every day and inhale. In contrast, as many as three-quarters of cigar smokers smoke only occasionally, and some may smoke only a few cigars per year.

The majority of cigar smokers do not inhale. In spite of these differences, daily cigar smokers and cigarette smokers have similar levels of risk for oral (including throat), larynx, and esophageal cancers.

Even among daily cigar smokers (smoking one or more cigars per day) who do not inhale, the risk of oral cancers is seven times greater than for nonsmokers and the risk for larynx cancer is more than 10 times greater than for nonsmokers.

Inhalation, however, does have a strong effect on disease risk. Compared to nonsmokers, daily cigar smokers who reported inhaling deeply had 27 times the risk of oral cancer, 15 times the risk for esophageal cancer, and 53 times the risk of cancer of the larynx.

Cigar smokers are also at increased risk for heart and lung disease compared to nonsmokers. Regular cigar smokers who reported inhaling slightly have double the risk of chronic obstructive pulmonary (lung) disease and increase their risk of coronary heart disease by 23 percent. However, compared to cigarette smokers, cigar smokers have lower risks for cancer of the larynx and lung as well as heart and lung disease.

Inhalation probably plays a strong role in lowering these risks. But, with regular use and inhalation, the heart and lung disease risks of cigar smoking increase substantially, and for some diseases may approach the risks seen in cigarette smokers.

In fact, the lung cancer risk from inhaling moderately when smoking five cigars per day is comparable to that from smoking one pack of cigarettes per day.