Cigar and pipe smoking: Safer than cigarettes?

Dear Alice,

Do people get cancer from cigar smoking? I never hear about it. Is cigar smoking or pipe smoking healthier than cigarette smoking? And is smoking all natural cigarettes ok? Because it can't be the tobacco that's killing you, right? I mean, I've never heard from back in the old days of Indians dying from tobacco smoke! I think it's the wrapping paper. What do you think?

Dear Reader,

There's a lot of information out there about tobacco, so good on you for trying to get the story straight. To begin, it is true — people can and do get cancer from cigar smoking… and pipe smoking… and from smoking “natural” cigarettes. Any way you roll it, pack it, or label it — they all contain tobacco. The difference between a cigar and a cigarette is that a cigar is a roll of cut tobacco wrapped in leaf tobacco or a tobacco product. Cigarettes are rolls of tobacco wrapped in paper or another non-tobacco product. When it comes to pipes, you might guess that the tobacco is packed into the pipe and then smoked. In all of these varieties, tobacco is indeed the cancer-causing culprit in question — it produces smoke that contains over 70 known cancer-causing substances. Those same substances may cause other conditions that affect the heart and lungs as well. What’s more, all of these varieties expose the smoker to the addictive substance nicotine that can keep smokers coming back for more. Experts agree that there just aren't safe alternatives to cigarettes. There’s certainly more to know, though, so read on for information about each type of tobacco product you’ve mentioned.

Since you asked about cigars first: Cigar smoking may have the reputation of being less harmful. This is because many cigar smokers are only "occasional" users, and most do not inhale the smoke into their lungs when puffing. However, with frequent use, cigar smoking can be just as, (if not more) harmful than cigarette smoking. Some large cigars pack quite a punch, containing as much tobacco (and nicotine) as an entire pack of cigarettes. Smoking cigars may also lead some to try cigarettes out for size. One study found that cigar smokers are more than twice as likely to take up cigarette smoking for the first time as compared to folks who have never smoked cigars. It's also noted that cigars produce even more environmental tobacco smoke (ETS) than cigarettes, due to their size, long aging and fermentation, and long burning time. In addition to these factors, the air surrounding a cigar smoker has higher concentrations of toxins (such as nitrogen oxides, ammonia, carbon monoxide, and tar) than the air around a cigarette smoker.      

So, what about those who don't inhale? Even if a cigar smoker doesn’t inhale, the carcinogens in the smoke still touch the lips, mouth, tongue, throat, and larynx. Not inhaling may make the risk for lung cancer lower, but it still imparts an increased risk when it comes to oral, esophageal or laryngeal cancers. Other possible health risks for cigar smokers include:

  • Cancers of the stomach and pancreas
  • Chronic bronchitis, emphysema, chronic obstructive pulmonary disease (a lung disease), and exacerbation of asthma
  • Coronary heart disease, including stroke and heart attack
  • Vascular conditions, including aneurysm
  • Conditions affecting the mouth, such as tooth erosion, tooth and supporting bone loss, stained teeth, and chronic bad breath

Like with all other forms of tobacco, the possibility of becoming addicted to cigars is also a concern — each cigar contains between 100 and 200 milligrams (mg) of nicotine (in some cigars up to 444 mg), whereas cigarettes contain about 8.4 mg each. Since nicotine is absorbed very easily through the tissues of the mouth, a cigar smoker can become addicted even without inhaling.

Now, what about pipe tobacco smokers? The American Cancer Society indicates that pipe smokers face many of the same health risks as do cigar smokers. Pipe smokers are also at a heightened risk of death from heart disease, stroke, and chronic lung disease. Even the use of water pipes (a.k.a., hookah) to smoke tobacco is considered to be just as hazardous to your health as cigarettes.

Lastly, you ask about “natural” cigarettes and whether smoking them is ok. While calling a tobacco product “natural” or “additive-free” may make a consumer believe that the product is less harmful, a large number of professional and advocacy groups (including the American Academy of Family Physicians and the American Psychological Association) have concluded that such a label is quite misleading. There is just no evidence to suggest that users of “natural” tobacco products are at any reduced risk than users of other tobacco products. To that end, the U.S. Food and Drug Administration (FDA), in their first use of increased authority outlined in the Family Smoking Prevention and Tobacco Control Act of 2009, has warned a number of “natural” cigarette manufacturers to clarify and explicitly state that their products do not impart a lower- or modified health risk to consumers.

Simply put, there is no safe form of tobacco. Although you may not hear much about people dying as a result of tobacco use in the 'old days', it's likely that it did affect their health, and maybe even mortality rates.

Good luck as you weigh the facts and make decisions about whether to use tobacco in any form.


Last updated Nov 13, 2015
Originally published Mar 31, 2000