The Facts: Cigar Smoking

It’s not like you are smoking a cigarette. It’s a cigar.

Smoking a cigar on the golf course with friends may sound harmless and like the perfect way to enjoy a day outside. Afterall, unlike when you smoke cigarettes, you aren’t inhaling harmful, cancer-causing chemicals.

Or are you?

Dr. Justin Goralnik, a Middlesex Health pulmonologist and avid golfer, says this is a common misconception. Most people feel safe smoking a cigar, and they are probably not aware of the dangers, he says.

The truth: Cigarettes and cigars both contain similar ingredients, such as tar, tobacco and carcinogens, and when you smoke either of them, you put yourself at risk for serious health issues.

It is worth noting that cigar smoke has been shown to have higher levels of tobacco-specific nitrosamines (many are known carcinogens) than cigarette smoke due to the curing and fermentation process for cigar tobacco. In addition, cigar smoke has also been found to have higher levels of carbon monoxide and nitrogen oxide than cigarette smoke.

And the idea that you don’t inhale when smoking a cigar is subjective, Goralnik says. There’s no way that cigar smokers don’t inhale something.

Regardless of whether you inhale when smoking your cigars, there is still a risk, albeit a small one, for lung cancer. Cigar smokers, however, have a greater risk of getting head and neck cancers, which can impact your tongue, throat and even your voice box. Head and neck cancers are the most common cancers associated with cigar smoking.

As if that’s not enough, smoking cigars can also increase your risk of developing cardiovascular disease or having a stroke. You may also notice poor oral hygiene.

Should you be concerned?

While he doesn't encourage smoking, Dr. Goralnik says your level of concern depends on how much you smoke. If you smoke a cigar or two on the course each week, he says your cigar smoking is probably not a big concern. However, if you smoke several cigars a week, your chances of developing a health problem go up.

One study shows that habitual cigar smokers have a 2.1 percent risk of getting lung cancer, Dr. Goralnik says, adding that the number may be understated. Another study says that 5.1 percent of cigar smokers died of lung cancer over a 12-year period.

The numbers are higher when you talk about head and neck cancers. A study showed that cigar smokers had a 6.5 percent relative risk of getting head or neck cancer.

What to look for

Like with lung cancer, head and neck cancers do not come with many warning signs. You should contact your medical provider if you notice the following:

• A new, persistent cough
• Shortness of breath
• A tongue that doesn’t feel right
• Oral bleeding
• Voice change (new hoarseness)
• Food that gets stuck in the back of your throat before it gets to the esophagus

Treatment of the different cancers can vary, but usually include surgery. For head and neck cancers, the surgeries can be very invasive and life-changing. The results could be clearly visible to others and affect your diet, your voice and increase your risk of aspiration.

Should you quit?

Cigar smoking, including cigar smoking on the golf course, is often a social activity, and it is often hard to stop participating in activities that we enjoy with others. People associate cigar smoking with something fun and often don’t know the risks, Dr. Goralnik says.

Whether you need to quit comes to how much you smoke — and why.

If you smoke several cigars a week, Dr. Goralnik says to consider cutting back or quitting. If you are motivated by a need for nicotine, he says it would be best to quit and consider alternative ways to satisfy your craving. There are products like gum, oral nicotine tablets, and nicotine pouches.

“While nicotine is probably not very good for you, nicotine doesn’t cause cancer,” Dr. Goralnik says.

Cigar smoking is much like cigarette smoking. It can be addicting, and Dr. Goralnik says smoking cessation classes, acupuncture, hypnotherapy and pharmacological products can all help both cigar or cigarette smokers as they work to quit.

What about secondhand smoke?

If you are on the golf course, Dr. Goralnik says secondhand smoke is not a concern unless you have a health issue, such as asthma, that could be aggravated by the smoke. You are outside and in a well ventilated area. If you don’t mind the smoke and it doesn’t negatively affect a pre-existing condition, he says you are not in danger.

The worry is when you are with someone who is smoking in a confined space.

More information

For more information about pulmonary medicine at Middlesex Health, click here. Middlesex Health pulmonologists can treat a variety of respiratory conditions and help you with smoking cessation.