Cigars Are Butt of NCI’s New Cancer Risk Report

BETHESDA, Md--The National Cancer Institute has raised a red flag to the nation’s current "hot" smoking fad. It warns that daily cigar smoking can cause cancer of the lip, tongue, mouth, throat, larynx, esophagus, and lung. Cigar smoking is also responsible for chronic obstructive pulmonary disease and coronary heart disease.

In a new monograph, "Cigars: Health Effects and Trends," the NCI emphasizes that smoke released from cigars contains many of the same toxic agents as cigarette smoke, including carbon monoxide, nicotine, hydrogen cyanide, ammonia, volatile aldehydes, benzene, vinyl chloride, ethylene oxide, arsenic, cadmium, nitrosamines, and polynuclear aromatic hydrocarbons.

According to NCI director Richard D. Klausner, MD, "the data are clear--the toxic substances and carcinogens in cigar smoke, like cigarettes, are associated with increased risks of several kinds of cancers as well as heart and lung disease. In other words, cigars are not safe alternatives to cigarettes and may be addictive."

The NCI monograph shows that, compared to a cigarette, a large cigar emits up to 20 times more ammonia, 5 to 10 times more cadmium and methylethylnitro-samine, and up to 80 to 90 times more highly carcinogenic tobacco-specific nitrosamines.

This means that daily cigar smokers are exposed to significant health risks, the monograph stressed. Along with a heightened risk of oral, throat, larynx, esophageal, and lung cancer, researchers found evidence that strongly associates cigar smoke with pancreatic cancer.

According to the NCI, smoking one to two cigars a day doubles the risk of oral cavity and esophageal cancers, compared with nonsmokers. The risk of cancer of the larynx increases by six times.

Further, cancer risk increases with the number of cigars smoked daily. Smoking three to four cigars daily increases the oral cancer risk to 8.5 times that of nonsmokers. The risk for esophageal cancer is nearly four times that of nonsmokers.

The report also noted differences in the patterns of cigar and cigarette use. While most cigarette smokers smoke every day and inhale, as many as three-quarters of cigar smokers use cigars only occasionally, and some are known to smoke only a few cigars per year.

The report said that the health risks of such occasional cigar smoking are not known. It is known, however, that daily cigar smokers have similar levels of risk for oral, larynx, and esophageal cancers as do cigarette smokers. Even when daily cigar smokers do not inhale, their oral cancer risk is seven times that of nonsmokers, and their risk of larynx cancer is more than 10 times greater.

If daily cigar users inhale, their risk of cancer rises sharply. Those who reported inhaling deeply had 27 times the risk of oral cancer, 15 times the risk of esophageal cancer, and 53 times the risk of cancer of the larynx, compared with nonsmokers.

However, cigar smokers in general have a lower risk of cancer of the larynx, as well as heart and lung disease, than do cigarette smokers, the NCI said, probably because most cigar smokers do not inhale as often or as deeply. But with regular use and inhalation, the risks increase substantially. The lung cancer risk from inhaling moderately on five cigars per day is comparable to that from smoking one pack of cigarettes per day.

The report also analyzed secondhand smoke from cigars and found that cigar smoke contains most of the same toxins, irritants, and carcinogens found in environmental smoke from cigarettes. Many of these compounds occur in much higher quantities in cigars, including ammonia, carbon monoxide, respirable suspended particulates, and tobacco-specific nitrosamines.

CO Levels Worse Than Freeway

Researchers who looked at the concentrations of carbon monoxide at two cigar social events in San Francisco found CO levels higher than those on a busy California freeway. This indoor exposure, if continued for 8 hours, would have exceeded the Environmental Protection Agency’s National Ambient Air Quality Standards for outdoor air.

The NCI concluded that while there have not been studies to determine the health effects of cigar socials on nonsmokers, there is "a significant body of evidence" pointing to increased lung cancer risk from secondhand smoke.

Cigar smoking is on an upward trend in the United States, with sales increasing by about 50% since 1993. The smoking of small cigars increased only a modest 13%, but consumption of large cigars has increased by 70%.

Of great concern to the NCI is that most of the increase appears to be among teenagers and young adult males who smoke occasionally. Addiction studies with cigarettes and chewing tobacco clearly show that addiction to nicotine occurs almost exclusively during adolescence and young adulthood.

The federal government is concerned that the high rate of adolescent use of cigars may result in higher rates of nicotine dependence in this age group. There are no federally mandated warning labels on cigars, as there are on cigarette packs. But most cigars do come with health warnings to comply with a 1989 California state law.