Smoking cigars significantly increases the risk of developing several types of cancer. Cigars, which are rolls of fermented tobacco wrapped in a tobacco leaf or wrapper, expose the user to numerous toxic and carcinogenic compounds. The risks are substantial, affecting tissues in direct contact with the smoke and organs elsewhere in the body. The long burn time and large volume of tobacco mean a single cigar can deliver a massive dose of harmful chemicals, regardless of size or frequency of use.
The Unique Chemistry of Cigar Smoke
The tobacco in most cigars undergoes a prolonged fermentation process, which alters its chemical composition compared to cigarette tobacco. This process increases the concentration of Tobacco-Specific Nitrosamines (TSNAs). These carcinogens are found at higher levels in cigar smoke, resulting in a greater toxic load.
Cigar smoke is typically more alkaline, meaning it has a higher pH value, especially in larger cigars. This alkaline environment allows nicotine to exist in a free form, which is readily absorbed through the mucus membranes lining the mouth, even without inhalation.
Most cigars lack filters, meaning the smoke contains higher concentrations of tar and particulate matter. A single large cigar can contain as much tobacco as an entire pack of cigarettes. This larger volume and longer smoking time result in a higher total exposure to tar, carbon monoxide, and other toxins per episode.
High Risk Cancers of the Mouth and Throat
The chemical properties of cigar smoke translate into high risks for cancers of the upper aerodigestive tract. Even non-inhaling individuals are at risk because the mouth, throat, and upper airways are continuously coated in the smoke. Carcinogens dissolve in saliva, keeping them in contact with oral tissues before being swallowed.
Cigar smoking is strongly linked to cancers of the oral cavity, including the lip, tongue, cheek, and floor of the mouth. The localized exposure to the smoke’s high concentration of toxins causes cellular damage that can lead to malignant transformation. This contact also elevates the risk for cancers of the pharynx, larynx, and the esophagus.
The risk of dying from cancers of the oral cavity, esophagus, and larynx for regular cigar smokers is comparable to that faced by cigarette smokers. Regular cigar smokers are between four and ten times more likely to die from these cancers than non-smokers. This elevated risk results from the smoke washing over the tissues of the mouth and throat.
Inhalation Risk and Systemic Cancers
While some cigar smokers avoid inhaling, many draw the smoke partially into their lungs, and all users absorb carcinogens into their bloodstream. The depth and frequency of inhalation directly modulate the overall cancer risk. Exclusive cigar smokers who inhale face a significantly elevated risk of lung cancer compared to non-smokers.
The risk of lung cancer is dose-dependent, increasing with the number of cigars smoked and the depth of inhalation. When five or more cigars are smoked daily with moderate inhalation, the lung cancer risk can approach that of smoking a pack of cigarettes per day. This confirms that cigar smoking is not a reduced-risk alternative, especially for frequent users.
Carcinogens absorbed through the lungs and oral mucosa enter the bloodstream, circulating and damaging cells in distant organs, leading to systemic cancers. The bladder and the pancreas are particularly susceptible to these absorbed toxins. Pancreatic cancer and bladder cancer are both associated with cigar smoking.
The kidneys process these circulating carcinogens, and the waste products are stored in the bladder before excretion. This prolonged contact between the bladder lining and the toxins increases the likelihood of tumor development. The cancer risks associated with cigar smoking impact multiple organ systems due to the systemic distribution of tobacco carcinogens.