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:
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:
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.
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:
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.