Health Risks of Cigar Smoking

To the Editor: In their article about the health risks of cigar smoking, Dr Baker and colleagues¹ failed to describe a dose-response relationship. Although there is actually a wide range in how often cigar smokers smoke, the data that linked cigar smoking to lung cancer were limited to men who smoked 3 or more cigars a day. This group experienced lung cancer death at two-thirds the rate of those who smoke 1 pack of cigarettes per day. However, only 5% of cigar smokers smoke 3 or more cigars a day.² In fact, about half of all cigar smokers smoke less than once a week, and another 17.9% smoke 6 or fewer cigars a week.³ Baker et al did cite a study that showed there is a dose-response effect for oral cavity cancer and larynx cancer.⁴ Would they concede that more than 70% of all cigars smokers are at low risk for these cancers because they are exposed to at least 71% less cigar smoke than those who smoke 3 cigars a day?

Future studies need to include the full range of cigar smoking when determining the relative risk of pathology. Not only will such studies provide practical information for the majority of cigar smokers, but they could also give new insight into a possible protective effect of nicotine against Alzheimer disease.⁵ Moderate alcohol consumption improves cholesterol levels and inhibits platelet aggregation, yet excessive alcohol use can raise blood pressure and cause nonischemic cardiomyopathy.⁶ By the same token, excessive cigar use may increase risk for lung cancer, but further research might show that more moderate consumption reduces the risk of Alzheimer disease. Without examining cigar smoking in a realistic quantitative manner, we will never know if or how much average cigar smokers are at risk.