A study lead by Carlos Iribarren, MD, MPH, PhD, published in a recent issue of The New England Journal of Medicine, found men who smoke cigars have a higher risk of both cancer and coronary heart disease.

"Our findings confirm previously known associations of cigar smoking with cancers of the oral cavity, throat, esophagus, and lung as well as chronic obstructive pulmonary disease. What is novel in our study is the finding of an independent [moderate] association between cigar smoking and the risk of coronary heart disease," Dr. Iribarren said.

Nearly 18,000 men aged 30 to 85 enrolled in the Kaiser Permanente Health Plan were followed from 1971 until 1995 for the study. The majority of the participants were white; 12 percent were African American; and 8 percent were Asian. Women were not included in the study because the number of cigar-smoking women in the health plan during that period was too small for valid statistical analysis.

Compared to nonsmokers, cigar smokers had a 27 percent higher risk of coronary heart disease and a 45 percent increased risk of chronic obstructive lung diseases, such as emphysema and chronic bronchitis. Cigar smoking approximately doubled the risk of developing cancers of the mouth, throat, or lungs. These risks were even higher among men who smoke more than five cigars a day.

"The effects of cigar smoking on women is an area that deserves further research, but [up to now] very few women smoked only cigars. My next study is on the effects of exposure to environmental tobacco smoke, although differentiating smoke from cigarettes, cigar, or pipe will not be possible," Dr. Iribarren added. His next study, funded by the Tobacco-Related Disease Research Program of the University of California, will begin in September and he said he hopes to have "interim results" 12 or 14 months later.

Michael Thun, MD, vice president of epidemiology and surveillance research for the American Cancer Society (ACS), said more research in cigar smoking is needed. Specifically, he would like to see research on how easy it is for cigar smokers who do not smoke cigarettes to become addicted.

"For former cigarette smokers who now smoke cigars, the hazard [of becoming addicted] is much greater because they inhale. I'd like to look at only cigar smokers and see what percentage become nicotine addicted," Dr. Thun said.

Dr. Thun said the Kaiser Permanente study is a step in the right direction. "The point of all these studies is that the concept of cigars being safe is false. There is a risk for cancer and heart disease and addiction," he concluded.