What are the health risks associated with cigar smoking?

Health Risks Associated with Cigar Smoking

Major Health Risks

Cigar smoking significantly increases the risk of multiple life-threatening conditions including cardiovascular disease, chronic obstructive pulmonary disease (COPD), and various cancers, and should be strongly discouraged in all patients. 1

Cigar smoking poses serious health risks that are similar to those of cigarette smoking, though with some important distinctions:

Cancer Risks

• Oral, pharyngeal, laryngeal cancers: Cigar smokers have a 2.02 times higher risk of developing cancers of the upper aerodigestive tract 2
• Lung cancer: 2.14 times higher risk compared to non-smokers 2, 1
• Esophageal, pancreatic cancers: Significantly elevated risk, with strong dose-response relationships 3

Cardiovascular Risks

• Coronary heart disease: 27% increased risk (relative risk 1.27) compared to non-smokers 2
• Aortic aneurysm: Significantly elevated risk 3
• Stroke: Contributes to increased stroke risk through both acute effects on thrombus generation and chronic effects related to atherosclerosis 1

Respiratory Risks

• COPD: 45% increased risk (relative risk 1.45) compared to non-smokers 2

Dose-Response Relationship

The health risks associated with cigar smoking follow a clear dose-response pattern:

• Risk increases with the number of cigars smoked per day 3
• Risk increases with deeper inhalation 3
• Risk increases with duration of smoking 1

However, it's important to note that even cigar smokers who report no inhalation still have highly elevated risks for oral, esophageal, and laryngeal cancers 3.

Comparison to Cigarette Smoking

While cigar smoking is sometimes perceived as less harmful than cigarette smoking, the evidence shows:

1. As the number of cigars smoked and the amount of smoke inhaled increases, the mortality risk approaches that of cigarette smoking 4
2. Cigar smoke contains higher concentrations of toxic and carcinogenic compounds than cigarettes 4
3. Cigar smoking is a major source of fine-particle and carbon monoxide indoor air pollution 4

Special Considerations

Former Cigarette Smokers

Former cigarette smokers who switch to cigars tend to inhale more deeply than those who have only smoked cigars, resulting in higher carboxyhemoglobin levels and greater health risks 5. While switching from cigarettes to cigars reduces risk compared to continuing cigarette smoking (46% lower risk), it still carries a 68% higher risk of smoking-related diseases than never smoking 5.

Synergistic Effects

There appears to be a synergistic relationship between cigar smoking and alcohol consumption, particularly regarding the risk of oropharyngeal cancers and cancers of the upper aerodigestive tract 2.

Recommendations for Clinical Practice

1. Advise all patients to avoid cigar smoking completely 1
2. For current cigar smokers, strongly encourage cessation 1
3. Provide counseling, nicotine replacement therapy, and formal cessation programs 1
4. For patients with diabetes, emphasize that smoking compounds their already elevated cardiovascular risk 1
5. Warn patients that there is no safe level of cigar smoking - even occasional use or non-inhalation carries significant health risks 3

Common Pitfalls to Avoid

1. Assuming cigars are a safe alternative to cigarettes - They carry many of the same risks 4
2. Focusing only on lung cancer risk - Cigar smoking significantly increases risk for multiple cancers and cardiovascular diseases 1, 2
3. Overlooking secondhand smoke exposure - Cigar smoke creates substantial indoor air pollution that can harm others 4
4. Failing to address cigar smoking in patients with existing health conditions - Particularly important for patients with diabetes, cardiovascular disease, or respiratory conditions 1

Tobacco use remains the single largest preventable cause of disease and premature death in the United States, with approximately 440,000 Americans dying each year from illnesses related to active smoking 1. Cigar smoking contributes significantly to this burden and should be addressed aggressively in clinical practice.