Cigars Not Safe ... Heart and Lung Disease and Cancer


Sigmund Freud, the father of psychoanalysis, was rarely photographed without a cigar in his hand. Freud developed leukoplakia, a white patch, in his mouth and then cancer of the soft palate.

An article in the New England Journal of Medicine provides new evidence that cigar smoking may not have been good for Dr. Freud. It confirms that cigar smoking increases the risk of cancer of the mouth, throat, and lung, coronary heart disease, and chronic obstructive pulmonary disease (COPD). (COPD is a blanket term that covers the progressive lung diseases emphysema and chronic bronchitis.)

The report is of a study of nearly 18,000 men enrolled in the Kaiser Permanente Medical Care Program of Northern California. This number included more than 1,500 cigar smokers, none of whom had smoked cigarettes and none of whom currently smoked a pipe.

The investigators, led by Carlos Iribarren, found that the cigar smokers had a 27% higher risk of heart disease and a 45% higher risk of COPD as compared to the men who were not cigar smokers.

Cigar smokers were found to have about twice the risk of cancers of the mouth, throat, and lung and about one-and-a-half times the risk of developing any smoking-related cancer as did the nonsmokers. Additionally, cigar smokers who drank 3 or more alcoholic drinks a day had a risk of mouth and throat cancer almost 8 times that of nonsmokers who drank 2 or fewer drinks per day.

The U.S. Surgeon General, David Satcher, in an accompanying editorial, suggests adopting measures like those used against cigarette smoking; tobacco taxes, health warning labels, public education, and law enforcement.

"We must do a better job of educating the public, especially children and adolescents, about the risks to health associated with cigar smoking," says Dr. Satcher. "Tobacco -- including tobacco in cigars -- is hazardous not only to the health of those who use it, but also to society."

The authors of the report and Dr. Satcher are particularly concerned because of the rising sales of cigars. Between 1993 and 1997, cigar sales went up 50 percent, in large part because of the increasing popularity of cigars among "young and middle-aged men of relatively high socio-economic status." Cigar smoking is also on the rise among women and teenagers.

The popularity of cigars is fueled by the perception that cigars are much safer than cigarettes. This makes no medical sense since cigar smoke is known to contain the same toxic and cancer-causing (carcinogenic) chemicals as cigarette smoke. In fact, the mainstream smoke (that drawn into the mouth from the butt) from a cigar has heavier concentrations of these chemicals than the mainstream smoke from cigarettes.


  1. Iribarren C, Tekawa IS, Sidney S, Friedman GD: Effect of cigar smoking on the risk of cardiovascular disease, chronic obstructive pulmonary disease, and cancer in men. New Engl J Med 340: 1773-80, 1999.
  2. Satcher D: Cigars and public health. New Engl J Med 340: 1829-31, 1999.

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