This article about cigar smokers showed up in yesterday’s online edition of  MedPage Today:

Most cigar smokers in America are smoking cheaper, unfiltered versions cigarillos and mass market cigars, a government report showed.

Among the 7% of American adults reporting smoking cigars at least sometimes, 62% said they usually smoked cigarillos or mass market cigars, Catherine G. Corey, MSPH, of the FDA’s Center for Tobacco Products in Silver Spring, Md., and colleagues found.

“These findings underscore the importance of public health interventions to reduce cigar smoking among U.S. adults,” Corey and colleagues argued. “Evidence-based tobacco control interventions such as increased taxes, smoke-free policies, and public education campaigns should also address non-cigarette tobacco products.”

“Regular cigar use is estimated to be responsible for approximately 9,000 premature deaths and almost 140,000 years of potential life lost annually,” according to a conservative estimate, Corey’s group noted.

Cigarillos are little cigars (think Swisher Sweets) made with tobacco filler, and from what I’ve seen, people tend to smoke them like cigarettes – one after another, sometimes even inhaling.  Bad idea. Premium cigars, on the other hand, are larger and made from rolled tobacco leaves.  Try inhaling one of those, you’d probably pass out.

When we lived in suburban neighborhoods with streets and sidewalks, I used to take long walks three or four nights per week and smoke a premium cigar while listening to a podcast or audiobook.  Now that we live in the sticks, I don’t take those late-night walks.  So I smoke maybe a couple of cigars per month, usually sitting outside at night after Chareva and the girls have gone to bed.  I’ve never smoked them indoors.

By pure coincidence, I happened to stop at a cigar shop the day before the MedPage Today article ran.  Even though this particular shop only sells premium cigars, there was a big sign (no doubt mandated by law) on the door to the humidor, warning me that according to the Surgeon General, cigars cause cancer.

Hmmm … I’ve been hearing that one for years.  I’ve had people inform me that smoking cigars doubles my risk of mouth and throat cancer.  So a couple of years ago, I looked up the actual data.  In honor of the MedPage Today article, I thought I’d dig up the data and share it.  This isn’t exactly diet-related, of course, but it illustrates how government officials have no qualms about exaggerating risks when they want to discourage us from a habit they don’t find acceptable.

The data I’m quoting here comes from something called the Smoking and Tobacco Control Monograph.  I have a PDF that doesn’t specify the publisher, but from what I can find online, it was apparently produced by the National Cancer Institute.  The paper is a meta-analysis of multiple observational studies on smoking, mortality and disease.   So let’s dig in.

The risks of smoking in the paper are expressed as risk ratios.  In case you’re not familiar with what those mean, here’s the lowdown:  Suppose in a control population of non-smokers we want to use for comparison, 10% of all people end up with heart disease.  That’s what we’d consider normal, so we assign that a risk of 1.0.  Now suppose that among cigar smokers, 12% of them eventually end up with heart disease.  That’s 20% higher, so we’d say their risk ratio is 1.2.  Or we could say for every 1,000 non-smokers, 100 will end up with heart disease, while for every 1,000 cigar smokers, 120 will end up with heart disease — 20 additional cases per 1,000 cigar smokers.

Got the idea?  Good.  On to the data.

We’ll start with the big one: all-cause mortality.  Everyone dies, so I assume they’re talking about premature death.  Cigar smokers as a group have a risk ratio of 1.12.  So that looks kind of bad, doesn’t it?  (Among cigarette smokers, it’s far worse.  The premature-death risk ratio for them is 1.66.)

But who are these cigar smokers?  If it’s the people puffing away on a dozen cigarillos per day, I’d say we can partly blame the cigars, but we might also be looking at people with bad health habits in general.  Not a lot of health-conscious people make a habit of smoking Swisher Sweets.

On the other hand, there are plenty of people like me out there too — health-conscious people who smoke a premium cigar now and then.  In fact, based on the fellow cigar smokers I’ve known, I’d say most people who smoke premium cigars smoke one per day, if that.  After all, we’re talking about a $10 cigar.  Unless you have money to burn (literally), you’re not going to smoke your way through five or 10 of those per day.

The paper doesn’t distinguish between good cigars and cheap cigars, but fortunately it does split out the data by the number of cigars smoked per day, and also by age group.  And that’s where it gets interesting.

For all-cause mortality, here are the risk ratios by age group for men who smoke 1-2 cigars per day:

35-49: 0.70
50-64: 1.10
65-79: 1.02
80+: 0.97

Holy smokes, Batman, look at that low risk ratio among the 35-49 age bracket!  If we saw that result in a study of whole grains, there would be headlines splashed all over the media telling us that A DAILY SERVING OF WHOLE GRAINS REDUCES RISK OF DEATH IN MIDDLE AGE BY 30%!

But we’re talking about cigars, and the Surgeon General doesn’t want us to smoke cigars, so this interesting bit of data remains in the research closet, so to speak.

I’m not suggesting cigars prevent early death, of course – and I’m certainly not encouraging anyone who doesn’t already smoke cigars to start.  My guess is that people in the 35-49 age bracket who smoke a cigar or two per day are more well-to-do, and people with higher incomes tend to have better health outcomes for all kinds of reasons.  But I think we can safely say that smoking a cigar now and then isn’t killing people in that age bracket – and probably not in any age bracket.

Here are the risk ratios for lung cancer among men who smoke one or two cigars per day, divided by the age brackets available in the data tables:

50-64: 0.83
65-79: 1.27
80+: 0.66

CIGARS PREVENT LUNG CANCER IN MIDDLE AGE, OLD AGE, STUDY SHOWS

Okay, just kidding.  That spike in the 65-79 group is interesting, but again, given that cigar smokers in the other two groups have lower rates of lung cancer than non-smokers, I think we can safely say smoking a cigar per day doesn’t cause lung cancer.  The combined risk ratio for all groups, by the way, was 0.90, which means we could say that smoking cigars lowers your risk of lung cancer by 10% — which again is what we’d see in the media if we were talking about whole grains or soy milk.

Here are the risk ratios for coronary heart disease – once again, these are only for men who smoke 1-2 cigars per day, not people who puff away on a dozen cigarillos.

50-64: 0.72
65-79: 0.97
80+: 0.99

Another media headline you’ll never see:  A CIGAR PER DAY PREVENTS HEART DISEASE IN MIDDLE AGE

You get the idea.  But let’s look at the big one, the disease several people (including my mom) warned me about after learning I smoke an occasional cigar: cancer of the esophagus.  We’re talking about men who smoke 1-2 cigars per day, and I smoke maybe two per month now, but for the sake of argument I’ll assume these risk ratios apply to me:

50-64: 1.86
65-79: 2.62

So that’s why I’ve been warned that those Macanudos are doubling my risk of throat cancer.  But as I pointed out in my Science For Smart People speech, whenever you’re presented with a relative risk, the question you want to ask yourself is: What’s the absolute difference?  In other words, how many actual extra cases of esophageal cancer are we talking about?

I found some data on esophageal cancer in another paper put out by the National Cancer Institute.  In the U.S., the incidence rate of esophageal cancer for white males is 8 per 100,000 per year. That number, of course, includes smokers of all kinds, including heavy cigarette smokers.  The NCI didn’t list the rate among non-smokers, but from what I can find elsewhere online, it appears to be around 1.5 per 100,000 per year.  Smoking 1-2 cigars per day more or less doubles that risk.

So here’s the absolute difference:  Among non-smokers, 3 in every 200,000 will develop cancer of the esophagus in a given year.  Among men who smoke 1-2 cigars per day, 6 in 200,000 will develop cancer of the esophagus in a given year.  That’s one extra case of cancer per year for every 67,000 men who smoke a cigar or two per day.

I think I can live with those odds … no matter how many signs the Surgeon General tries to make me read as I walk into the humidor.

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36 Responses to “Cigar Warnings Go Up In Smoke”
  1. Marilyn says:

    We ALL “play the odds” with our habits – and far be it for me to cast aspersions, since I have plenty of my own with which to contend. Granted that government stats are skewed to THEIR agenda – and the fact that many more folks are harmed by consuming the standard American diet than cigar smoking – I think you’ll still run into more resistance to your justification for occasional cigar consumption than you’d like! I lost both of my parents to cancer – whether due to their smoking, poor dietary choices, pollution… to me at this point, it doesn’t matter. They’re still gone now, at relatively young ages (71 and 76). I wonder how YOUR daughters feel about your cigar smoking!? :-)

    • Tom Naughton says:

      The younger one likes the aroma of good cigars tries to catch whiffs if she can. The older one has no opinion at this point. If I smoked cigarettes and the odds were therefore truly high that I’d develop some disease as a result, I’d expect them to have definite opinions. So would Chareva, for that matter.

  2. Boundless says:

    Another confounding factor in the data is diet. I suspect the topic wasn’t even addressed by the magic meta-analyzers, and even if it was, it would not have been possible to tease out the subset that was low carb, much less ketogenic.

    Those doing LCHF and/or keto, who also avoid known inflammatory “foods” are suspecting that reducing blood glucose and reducing inflammatories is providing some protection against cancer incep and growth, but we don’t really know yet.

    • Tom Naughton says:

      That’s another reason I don’t worry about the extra 1 in 67,000 cases of esophageal cancer among people who smoke a cigar per day. I’m not eating a cancer-feeding diet.

  3. James H. says:

    Years ago CIGAR AFFICIONADO ran tests on their people, who of course may smoke several cigars per week, for insurance purposes. As I recall all personnel passed with flying colors.

    • Tom Naughton says:

      Yup, and that’s probably related to them belonging to a higher socioeconomic class.

    • jake3_14 says:

      We don’t trust research data from vested interests for other topics, so why should we trust this data now? Also, casual of any one group at any one point in time is junk science.

  4. Drew says:

    Just an observation: The numbers you’re quoting here make the point you want to make about how do-gooders emphasize the results they like and hide the ones they don’t. But then you conclude by accepting those numbers to say that your relative risk is still pretty low.

    If this were a diet study wouldn’t you have pointed out that it’s observational, hopelessly confounded, and doesn’t provide any useful data at all? What kind of person accepts without question numbers they like and only digs in to the ones they don’t like? :-P

    • Tom Naughton says:

      Correct, it’s observational, which is why I would never actually suggest (despite the numbers) that smoking a cigar per day prevents heart disease or cancer. An association doesn’t prove causation … however, a LACK of an association is pretty strong evidence that there’s no causation. If a college education is associated with a higher income, that doesn’t prove that it’s the degree that leads to the higher income — it could simply be that intelligent people are more likely to go to college and also more likely to earn more money because of their intelligence. However, if we saw no association between a college degree and a higher income, we could justifiably conclude that going to college doesn’t cause a person to end up with a higher income.

      So the lack of an association (actually an inverse association) between smoking a cigar per day and heart disease or cancer is a good indication that a cigar per day causes neither.

  5. b-nasty says:

    Nice post.

    I actually did similar research when I was smoking cigars (premium) on a more regular basis. I concluded the same as you did: there’s very little risk for even a daily cigar smoker. I would posit that some of the ‘unexplained’ lower risk results might also be due to lowering stress. After all, carving out an hour to sit on the back deck on a cool, Summer night to smoke a ‘gar is practically meditative relaxation.

    Other uses of tobacco like snus and snuff also have an almost zero risk and E-cigs are probably safer than eating a Twinki. That doesn’t stop the .gov from trying to control and tax what adults put into their body. I expect it to get even worse with cigars, as the government seems to be especially interested in stamping out traditionally masculine behavior.

    • Tom Naughton says:

      The relaxation angle makes sense. I certainly don’t feel stressed when I sit outside, stare out at the pastures, and puff on a Macanudo.

  6. Bret says:

    One to two cigars a month I’ll bet is less smoke exposure than our ancestors had when sitting around nightly campfires.

    Every toxin is dose-related. Public health officials, even if they understand this concept, seem to construct their advice as though everyone is a chain smoking addict. Silly, stupid citizens…it’s “for their own good,” as Jacob Sullum might say.

    Even on cigarettes, I just the other day ran across the section of Good Calories, Bad Calories where Gary said that it takes upward of two decades of smoking to manifest cancer. I reckon anyone who willingly inhales that much smoke isn’t too worried about the health-related consequences. And no amount of taxation, boldface warnings, or other government busybody b.s. is going to change that.

    • Tom Naughton says:

      Of course, I don’t want cancer two decades from now, but I haven’t seen any evidence whatsoever that an occasional cigar will give me a tumor.

      • Bret says:

        I doubt tremendously you’ll ever have to worry about cancer from such an extremely low dose/frequency. I’d think that an average person’s lifetime of exposure to automobile exhaust would do it before one to two cigars/month.

  7. jclivenz says:

    http://douglassreport.com/search/cigars also William Douglass M.D.published “The Health Benefits of Tobacco”. Note “tobacco” not “cigarettes”. A non smoker myself I have sometimes wondered about the American Indian practice of “smoking the peace pipe”.
    Douglass is still very much alive and kicking against the Establishment “Fatheads” oppose.

    • Tom Naughton says:

      Interesting stuff. I’ve believed for a long time the damage from smoking is caused by inhaling toxins into your lungs, not from puffing on the tobacco itself. Cigarettes in particular are full of non-tobacco ingredients that are toxic.

    • Walter Bushell says:

      Because smoking kills emotions. You’re just making peace with people who have killed your relatives and maybe making important concessions. Tobacco helps to transcend one’s emotions if one has to take a deal.

      Also smoking becomes a habit in the early stages of capital formation as the rise of capitalism in Europe, America and lately in the along the western Pacific realm.

  8. Chris says:

    When I started smoking cigars in college, I decided only to buy cigars that cost $1 or more. That was 1969. Today a “premium” cigar is $8-15. That keeps cigar smoking a hobby instead of a habit. Puffing only. Inhaling is for ex-cigarette smokers who think they are choosing the safer alternative.

    Long ashes.

  9. Elenor says:

    I was amazed to read the information in this guestbook entry:

    http://www.psandman.com/gst2012.htm
    (Stigmatizing smokeless tobacco – and how to fight back)

    because the idea that non-smoking methods (patches, snuff, chew) of nicotine “ingestion” are actually way less likely to cause cancer than smoking — and that “our” govt PREVENTS that lesser incidence of disease to be announced widely/advertised was amazing! I now pressure my smoking friends to switch to a LESS dangerous form of drug ingestion…

    From that guestbook:
    “…
    Four warnings are mandated. One of the four is technically wrong – the smoke-free products on the American market since the 1980s do not increase the risk of mouth cancer. Two are misleading. One warns that the smoke-free product is not a safe alternative to cigarettes. What it does not say is that the smoke-free products on the American marketplace since the 1980s pose a risk of tobacco-attributable illness and death less than 2% the risk posed by cigarettes. The other misleading warning warns of tooth and gum disease. What it does not say is that, again, for the products on the American marketplace since the 1980s, this risk is trivial, and the tooth and gum disease is reversible by quitting.
    …”

    Also, Dr Gabor Mate’ (fascinating Canadian MD who works in addiction; wrote couple a great books too) describes in one of his YouTube vids a huge study in …. ?Lithuania? Romania? some eastern European country … with more than 100,000 ‘subjects.’ Apparently (dim recollection here), smokers, even very heavy (couple pack a day) smokers who did NOT repress their emotions didn’t often get lung cancer; while even light smokers who did repress their emotions had a much higher incidence. Dunno the validity — not ever a smoker, never would be (yuck!) — but the description he gave was interesting!

    • Tom Naughton says:

      I once read that the soldiers who took up smoking during WWI didn’t have near the cancer rate later in life that soldiers who took up smoking during WWII did. Maybe something to do with the ingredients of the cigarettes. Unfortunately, I didn’t bookmark the reference and haven’t been able to find it again.

  10. smkr4 says:

    This is hilarious and great. Well played.

    I was a cigar smoker and am still a (very occasional, once every few months) cigarette smoker. The dose-dependence of these problems is perfectly obvious to anyone who smokes. When I have a cigarette (American Spirits, of course), I know that there will be a 72-hour “hangover” period after which my circulation is more or less cleared of the toxin. My body has a means of “de-toxing,” the same as when I drink.

    Of course, in excess, this mechanism will be overwhelmed, or it will be ineffective altogether. I don’t need to be told that, I *feel* it when I smoke (or drink). I even plan for it and expect it.

    The government doesn’t want us to trust how we feel when we do something we know is bad for us. Every such problem is assumed to be insidious in its effects; likewise, what we know to be toxic (sugar, wheat), makes us feel bad, we are encouraged to believe is actually great.

    How wonderfully Orwellian it all is. Worth contemplating over my next smoke.

    • Tom Naughton says:

      My maternal grandmother smoked one cigarette per day with her morning coffee. I had an uncle who, for most of his adult life, only smoked on Wednesday. I guess there are people who can do that.

  11. Fredrick says:

    I remember my grandfather smoking a pipe when I was very young and how wonderful it smelled. I am 48 years old now and expect I will be seeing grandchildren in the next 3 to 5 years. I have considered taking of occasional pipe smoking for my grandchildrens benefit.

    By any chance have you heard anything about smoking a pipe and cancer?

    • Tom Naughton says:

      No, but my guess is that statistics are about the same as for cigars. We’re talking about puffing, not inhaling.

  12. Mark says:

    Doctors used to advertise and recommend cigarettes to help soothe sore throats didn’t they? Surely Doctors (always spelled with a capital D!) couldn’t have been wrong?

  13. Josh says:

    The reality is that many toxins are dose dependent. Sugar is a good example of that. Perhaps one to two cigars a month may not be a high enough dose to do Tom any harm at all.

  14. Josh says:

    FWIW, I also know a number of people who have managed to quit smoking cigarettes by using cigars to phase out the smoking habit almost entirely. They start by substituting 4-6 cigars a day, and every week few weeks, reduce the daily cigar input by one. In about 6 months they are down to smoking one cigar every few days. At that point they claim they can take it or leave it, and most choose to leave it.

  15. Smug says:

    I have to say this is an astonishingly self-serving article. Governments by nature are forced to act for the lowest common denominator in all circumstances. The fact that you consider yourself well informed enough to make these decisions for yourself is wonderful however many individuals (as you so often point out) follow the dictates of unscientific claptrap all the time. Not what I expected here. Please do whatever you want (not that you need my permission) but while you are smoking your acceptable risk pipe or cigar remember that the second hand smoke and every carcinogenic particle left on the furniture where you smoke are a risk to your children. I’ll admit I didn’t look at any studies to support my conclusions, just those hacks at the mayo clininc and those self-absorbed national cancer council websites and those lying government website of every western nation. Who knew everyone else was wrong?

    • Tom Naughton says:

      1. The “second-hand smoke kills!” warnings are even more overblown than the “cigars will give you cancer!” warnings. I’ve seen the statistics.

      2. The statistics I quoted in the article are taken directly from one of those self-absorbed national cancer councils. So if I quote data from the hacks themselves, how exactly do you manage to interpret it as a case of I’m right and they’re wrong? They warn us that cigars “double your risk!” of throat cancer. I’m agreeing with them and then, using their own data, showing that “double your risk!” means one extra case of throat cancer for every 67,000 men who smoke a cigar per day.

      3. Did you miss the part where I said I never smoke a cigar indoors? Are you concerned about the carcinogenic particles left on the trees outside my house?

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