What are cigarettes and cigars?

Related cancers: Cancers of the lung, oral cavity, larynx, pharynx, esophagus, bladder, stomach

Exposure routes: Inhalation is the primary route of exposure to the carcinogens found in cigarettes and cigars. Smoking tobacco produces mainstream smoke that is inhaled by the smoker. Secondhand exposure via sidestream smoke (also called secondhand smoke, passive smoke, or environmental tobacco smoke) can also occur. Cigarettes are the primary source of tobacco smoke exposure; cigars are less common. Direct exposure through the mouth, gums, and swallowed saliva can also occur during smoking.

Where found: Legally sold in the form of cigarettes and cigars

At risk: All users of smoking tobacco are at risk of developing cancer. As of 2007, approximately 21 percent of adults in the United States (45.3 million people) were smokers. In 2006, about 371 billion cigarettes were consumed. The use of tobacco products varies with gender, age, and racial and ethnic background. More men smoke (23.9 percent) than women (18.0 percent). Smoking is much more common among adults ages eighteen to forty-four (48.5 percent) and forty-five to sixty-four (21.9 percent) than among those over age sixty-five (8.6 percent). In addition, of high school students, 23 percent smoke cigarettes and 14 percent smoke cigars. Overall smoking rates are highest among American Indians and Alaska natives (32 percent), whites (21.9 percent), and blacks (21.5 percent).

Each year, approximately 438,000 people in the United States die prematurely from smoking or sidestream smoke exposure; another 8.6 million suffer from smoking-related illnesses. Cancer was among the first diseases causally linked to smoking, and cigarette smoking is the primary cause of cancer mortality in the United States (responsible for at least 30 percent of all cancer deaths). It is the leading risk factor for lung cancer and causes approximately 90 percent of lung cancer deaths in men and almost 80 percent in women. Smoking light cigarettes or those with less tar does not substantially reduce lung cancer risk.

Inhalation of sidestream smoke also increases cancer risk. More than 126 million nonsmoking Americans, including children, are regularly exposed to secondhand smoke, and more than 3,000 nonsmoking Americans die of lung cancer each year, primarily because of exposure to sidestream smoke.

Cigar smoking is a popular habit in the United States. Rates more than doubled in the 1990’s, and approximately 5.1 billion cigars were consumed in 2005. Cigar smoking is most common among men ages thirty-five to sixty-four who have higher incomes and educational backgrounds. Most new cigar users are teenagers and younger males (ages eighteen to twenty-four). In addition, in 2004, about 18 percent of students (grades six to twelve) smoked at least one cigar in the past thirty days.

Etiology and symptoms of associated cancers: Toxic ingredients in cigarette smoke travel throughout the body, causing damage in several different ways. Some carcinogens in tobacco smoke produce substances called epoxides when they undergo oxidation (burning). These epoxides bind to and damage the deoxyribonucleic acid (DNA) in cells, causing them to grow abnormally or divide quickly and uncontrollably, resulting in tumor development. Although nicotine is not considered carcinogenic, it can inhibit cell death, thereby promoting tumor development. Symptoms vary with the type of cancer.

History: Based on the findings of hundreds of scientific articles, the U.S. Surgeon General first reported a causal association between cigarette smoking and cancer in 1964. The health risks associated with sidestream smoke were first published by the Surgeon General in 1972.

Cigarettes are subject to several state and federal regulations. The 1964 Surgeon General’s report led to laws requiring warning labels on tobacco products; however, those laws were only applied to cigars much later. Television advertising of cigarettes has been prohibited since 1971 and has since been expanded to include advertising on radio and other electronic media; these regulations do extend to cigar advertising. Cigarettes and cigars are also subject to taxes, which vary from state to state. In addition, it is currently illegal to sell tobacco products to minors, and in many states it is illegal for a minor to possess any form of tobacco. Many states also prohibit smoking in restaurants and in some public places.

Brandt, A. M. The Cigarette Century: The Rise, Fall, and Deadly Persistence of the Product That Defined America. New York: Basic Books, 2007.

Lapointe, Martin M., ed. Adolescent Smoking and Health Research. New York: Nova Biomedical Books, 2008.

U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Washington, D.C.: Author, 2006.

U.S. Department of Health and Human Services, Public Health Service, National Toxicology Program. Eleventh Report on Carcinogens. Research Triangle Park, N.C.: Author, 2005.

Wesley, Merideth K., and Ingrid A. Sternbach, eds. Smoking and Women’s Health. New York: Nova Science, 2008.