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 While people who exclusively smoke cigarettes have twice the risk of
premature death from all causes compared to people who avoid tobacco
altogether, exclusive cigar smokers have a 20 percent higher risk of
early death, researchers report in JAMA Internal Medicine.
When it comes to fatalities from specific cancers that have been
tied to tobacco use, cigarette smokers have four times the risk of
people who never used tobacco, but cigar smokers are 61 percent more
likely to die of these cancers and pipe users have 58 percent higher
odds.
“We knew exclusive users of cigars and pipes were at greater risk of
disease than people who do not use tobacco,” said lead study author
Carol Christensen of the U.S. Food and Drug Administration’s Center
for Tobacco Products. “However, this study provides information that
reflects today’s patterns of tobacco use.”
These data “underscore the importance of complete quitting,”
Christensen said by email.
For the study, researchers examined nationally-representative survey
data, collected starting in 1985, from 357,420 participants who were
followed through 2011.
Overall, 203,071 people, or about 57 percent, never used tobacco at
all.
Another 57,251 participants were current daily cigarette smokers,
while 9,414 said they had a less frequent habit and 77,773 were
former cigarette smokers.
In addition, 531 people were current daily cigar smokers, while 608
individuals used cigars less frequently and 2,398 had quit.
For pipes, 1,099 participants had a current daily habit, while 78
people used pipes less often and 5,237 had quit.
During the study period, 51,150 people died of all causes.
With a daily cigarette, cigar or pipe habit, people had an elevated
risk of death from tobacco-related cancers including malignancies of
the bladder, esophagus, larynx, lung, mouth and throat, and
pancreas.
Even with a nondaily cigarette habit, people were more than six
times more likely to die of lung cancer than individuals who never
used tobacco. They also had more than seven times the risk of dying
from chronic obstructive pulmonary disease, more than four times the
odds of death from oral cancers, and 43 percent higher odds of death
from a circulatory system disorder.
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Current cigar smokers had more than three times the odds of dying of
lung cancer, and for current pipe smokers the risk was 51 percent
higher, compared to never-smokers. The results are limited, however,
by the relatively small numbers of cigar and pipe smokers in the
sample, the authors note.
Another limitation is that survey questions about tobacco use
changed over time and didn’t determine how often non-daily smokers
might have used cigarettes, cigars or pipes.
Even so, the results suggest that doctors may need to broaden how
they discuss smoking with patients to make sure people understand
they’re at risk even when they don’t have a daily habit, said Dr.
Michael Ong of the University of California Los Angeles and VA
Greater Los Angeles Healthcare System.
“Patients often do not associate occasional use of cigar or pipes
with health risks, but this study shows that current, particularly
daily, cigar use is associated with increased overall risk of
death,” Ong, who wasn’t involved in the study, said by email.
Doctors also need to broaden their message about smoking and
cigarettes to include other tobacco products that are becoming more
popular, said Judith Prochaska, a researcher at Stanford University
in California who wasn’t involved in the study.
Traditionally, doctors have asked just whether people smoked
cigarettes, but they should instead be questioning patients more
broadly about tobacco use, Prochaska said by email.
“The tobacco landscape has been changing dramatically,” Prochaska
added. “While cigarettes remain the primary tobacco product used,
cigars, smokeless tobacco, e-cigarettes, hookah, and even pipe
tobacco have seen gains in use, while cigarette use in the U.S. has
been declining.”
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