Effect of Cigar Smoking on the Risk of Cardiovascular Disease, Chronic Obstructive Pulmonary Disease and Cancer in Men

Reviewers: Kenneth Blank, MD
Source: The New England Journal of Medicine June 10, 1999 Vol. 340, No. 23, p.1773

Introduction

The association between cigarette smoking and cancer is well established and the efforts of various organizations have educated the American public on this relationship. In contrast, the association of cigar smoking and cancer is not well publicized. In fact, there is a generally held belief that cigars are safer than cigarettes. For this and other reasons, the sales of cigars have skyrocketed in the United States over the past decade. In the June 10, 1999 issue of the New England Journal of Medicine, scientists from the Kaiser Permanente Medical Program in California examined the association between cigar smoking and cancer, heart disease and lung disease.

Methods

Over 17,000 men ages 30 to 85 participated in this cohort study. All men reported never having smoked cigarettes or pipes. 1,546 men reported cigar smoking and were compared to the 16, 228 men who never smoked cigars. Cigar smokers were classified by the quantity of cigars smoked per day: fewer than five, five to ten and greater than ten. Data on the incidence of cancer was obtained from Kaiser Permanente records and from local tumor registries. Follow-up for each man ended upon developing a cancer, leaving the Kaiser health plan or on December 31, 1996, whichever came first.

Statistical analysis consisted of Cox multivariate analysis with covariates including cigar smoking, age, body-mass index, occupational toxin exposure, alcohol consumption, race and history of diabetes.

Results

Multivariate analysis revealed cigar smoking to be associated with an increased risk for the development of lung, upper aerodigestive tract and oropharyngeal cancers. The incidences of other cancers including pancreatic, kidney, bladder, and colorectal cancers, were similar between the two groups. A dose response was evident in that men who smoked greater than five cigars per day had a greater risk of developing a smoking related cancer (defined as cancer of the lung, upper aerodigestive tract, oropharynx, pancreas, kidney, bladder, colon or rectum) compared to men who smoked less than five cigars per day.

Conclusion

Cigar smoking, like cigarette smoking, is an addictive habit that increases one's risk for cancer. In addition to the findings relative to cancer, the study found cigar smoking to increase the risk of lung disease and heart disease. The deleterious effects of cigar smoking cannot be underestimated and public awareness must be heightened.