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August 12, 2002

Overview of Cigar Smoking and Oral Cancer Risks
Margaret J. Fehrenbach, RDH, MS, Dental Hygiene Educational Consultant


From the available scientific evidence as reported by the National Cancer Institute (NCI)1, it is now clear that cigar smoking causes a variety of oral cancers, including cancers of the lip, tongue, oral cavity, and also the associated cancers of the pharynx, esophagus, and larynx. Importantly, many of these oral and related cancers have extremely low cure rates. For example, only 11 to 14 percent of patients with esophageal cancers survive five years after diagnosis. The health risks associated with cigar smoking are significant for daily cigar users (at least one cigar per day). This should eliminate any complacency that cigar smokers may have enjoyed since they were told in the past by cancer experts and other health care professionals that they had less risk of lung cancer than cigarette smokers (still significantly higher than nonsmokers).

Therefore, smoking only one to two cigars per day has significant oral health risks, even though many would consider this light use. For example, smoking one to two cigars per day doubles the risk for oral cancers compared to someone who has never smoked. And someone smoking at the same moderate level (one to two cigars daily) increases the risk of cancer of the larynx by more than six times that of a nonsmoker. Like cigarette smoking, the risks from cigar smoking 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 greater than the risk of a nonsmoker, and smoking more than five cigars daily raises the oral cancer risk to 16 times the level for nonsmokers.

The health risks associated with less than daily smoking (occasional smokers) are not known at this time. However, it is important to note that about three-quarters of cigar smokers smoke only occasionally. But, the trend for smoking cigars is growing and with it an increase in overall use. Sadly, education and regulations have not kept up with this social trend.

Unlike what consumers were told in the past by the tobacco companies, nicotine is the addictive agent in tobacco and tobacco smoke is capable of producing addiction or nicotine dependence. Most cigars contain nicotine in quantities equivalent to several cigarettes and can deliver nicotine in concentrations comparable to those delivered by cigarettes and spit (smokeless) tobacco. For large cigars this can be up to 40 times more nicotine than just one cigarette. When cigar smokers inhale, nicotine is absorbed rapidly as it is with cigarette smoke inhalation. For those who do not actively inhale, nicotine is absorbed predominantly through the lining of the oral cavity which leads to a slower rise and lower peak of nicotine in the blood compared to cigarette smokers who absorb nicotine primarily through the lungs.

However, both inhaled and noninhaled nicotine can be highly addictive. For example, the studies of the large number of people addicted to spit tobacco demonstrate that nicotine absorbed through the lining of the oral cavity is capable of forming a powerful addiction. Studies documenting the frequency or intensity of nicotine dependence and withdrawal symptoms from cigar smoking have not been conducted. However, the pattern of cigar smoking in the population, infrequent use, low number of cigars smoked per day, and lower rates of inhalation compared to cigarette smokers, suggests that cigar smokers are less likely to be dependent on nicotine than cigarette smokers. Specifically, the fraction of adult cigar smokers who smoke daily appears to be smaller than the fraction of everyday cigarette or spit tobacco users. In addition, with that recent data show that increased cigar use among adults is largely an increase in occasional smoking, suggesting that the risk of addiction is lower for cigars than for cigarettes. However, this is not to say that cigar smoking is free of the risk of dependence; cigar smoking is only less of a risk for nicotine dependence than cigarette smoking. One researcher clearly states that there is no safe number of cigars you can smoke.

1National Cancer Institute (NCI) Monograph Number 9 (NIH Publication No. 98-4302): Cigar Smoking: Health Effects and Trends (February 1998) Report summarized and discussed by Margaret J. Fehrenbach, RDH, MS, Dental Hygiene Educational Consultant, Website:http://www.dhed.net

Margaret Fehrenbach has published oral biology textbooks with WB Saunders and presented continuing education courses in the area of oral biology. Ms. Fehrenbach will be presenting at the American Dental Association 2002 Annual Session. She has online case-based continuing education programs with ArcMesa Educators at http://www.arcmesa.org


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