Cigars: coolish or foolish?

by Jeff Siegel

Movie stars and athletes smoke stogies on the cover of magazines. Bars and liquor stores sell fine cigars the way they do fine brandies. It's a symbol of the good life, '90s style. But riskwise, smoking cigars is not much different than smoking cigarettes. The real difference is in the type of cancer that cigar smokers develop -- head and neck instead of lung.

Krystyna Kiel and David Myssiorek may live half a continent away from each other, but the medical problems they see regularly have entirely too much in common.

Kiel and Myssiorek are oncologists (cancer specialists), and the conditions they both treat with an alarming frequency are head and neck cancers something, each is convinced, is directly related to the increase in popularity in cigar smoking over the past few years.

Are cigars \\

While there are only a few clinical studies specific to the effects and dangers of cigar smoking, the best studies estimate that smoking one cigar is equal to smoking two-and-a-half cigarettes. \\\"Outside of it being a disgusting habit,\\\" says Dr. Myssiorek, who heads the division of head and neck surgery at Long Island Jewish Medical Center in New Hyde Park, N.Y., \\\"it's a dangerous one every bit as dangerous and harmful as chewing tobacco.\\\"

That's a scientific opinion that is so obvious there is no need to say it. Yet the increase in cigar smoking in this decade especially among women and teenagers has been accompanied by the idea that cigars aren't as hazardous to your health as cigarettes. After all, the thinking goes, cigar smokers don't inhale.

\\\"And that's why they get cancers in the mouth and neck, and not the lungs,\\\" says Dr. Kiel, a radiation oncologist at Northwestern University Medical Center in Chicago. \\\"Just because it's a little bit different from cigarettes doesn't mean it's safer. The danger is still there.\\\"

Who\\\s lighting up?

Since 1993, consumption of large cigars and cigarillos has increased 45 percent to the highest level in almost a decade. Use of premium cigars, which can cost more than $10 each, is up an astounding 250 percent in that same period. This marks a reversal in a 20-year decline in cigar smoking from 1973 to 1993.

Most of the increase appears to be among teenagers and young adult males who smoke occasionally. And an amazing number of cigar smokers are children. According to one study by the Centers for Disease Control and Prevention in Atlanta, about one of four teens say they have smoked cigars at least once. That number is 4 out of 10 in a study among Massachusetts' high school seniors.

\"Why do teenagers smoke cigars? Why do they have tattoos and nose rings?\" asks Dr. Kiel, the mother of a teenage daughter. \"Smoking cigars certainly doesn't seem to make much sense, but they see it as a way to make a protest.\"

Teenagers have also seen an effective, if not always intentional, media campaign that has portrayed cigar smoking as hip and glamorous. If cigar smoking is OK for Sylvester Stallone and Arnold Schwarzenegger, who are about as cut and buffed as Hollywood gets, then how bad can it be for the rest of us?

\"I just wish they would put Ulysses S. Grant or Babe Ruth on the cover of a magazine,\" says Dr. Myssiorek with a sigh, who notes that each man suffered a painful and excruciating death from throat cancer, almost certainly caused by the trademark cigars each smoked. \"There is nothing glamorous about the way they died,\" he says.

Yet cigar packages don't carry the Surgeon General's health warning required on other tobacco products, and there have been few cigar studies that have been as thorough as those with cigarettes. No one, in fact, has apparently studied the effects of cigar smoking in women, because so few women have traditionally smoked cigars.


Still, researchers have established links between cigar smoking and a number of health risks:
  • Carcinogens are the same.Most of the same carcinogens and cancer-producing chemicals found in cigarettes, like tars and nicotine, are found in cigars. That means cigar smokers increase their chances of heart disease and stroke.
  • Death rates are higher.Overall cancer deaths among men who smoke cigars are one-third higher than among nonsmokers. There also seems to be a link between an increased chance of male breast cancer otherwise decidedly rare and cigar smoking.
  • Cancer risk increased.Studies indicate that all tobacco users are 5 to 10 times more likely to get cancer of the mouth or throat than their nonsmoking counterparts. Cigar smokers who drink, incidentally, may be at the high end of that range, since alcohol is extremely effective in dissolving the carcinogens into the blood stream.
  • Certain types of cancers more likely.Cigar smokers have 4 to 10 times the risk of nonsmokers of dying from laryngeal, oral, or esophageal cancers. Because of the way cigars are puffed, more carcinogens sit in the mouth, increasing oral cancer risk.

And then there is the risk posed by secondhand smoke to those around cigar smokers. Say what you will about not inhaling cigars, says Dr. Myssiorek, but how are you going to justify the health risk posed to your family by all that smoke the cigar is giving off?

Researchers found that the concentrations of carbon monoxide at two cigar social events in San Francisco were higher than the levels found on a busy California freeway. Had these indoor exposures lasted eight hours, they would have exceeded the National Ambient Air Quality Standards for outdoor air established by the Environmental Protection Agency.

\"You know, I'm a cancer doctor,\" says Dr. Kiel, \"and that means I have to see the results of cancer. And head and neck cancers are ugly. We have to take part of the jaw off. To save the larynx, we have to use radiation and chemotherapy. Imagine what that does to someone's face. If I could tell cigar smokers one thing, it would be that. Let them look at the results of cigar smoking.\"