Health risks associated with cigar smoking are lower than
those for cigarette smoking, reflecting a lower exposure to smoke toxicants
(see my earlier post here). The same holds true for pipe smoking,
as a 2004 American Cancer Society study documented (abstract here).
Dr. S. Jane Henley and colleagues examined data from the
Cancer Society’s Second Cancer Prevention Survey, which enrolled participants
in 1982. They compared deaths among
exclusive men pipe smokers with those among never tobacco users over the next
18 years. They also considered the
number of pipes smoked each day, duration of smoking, and how much smokers
inhaled. The results are expressed as
hazard ratios (HRs, similar to relative risks); a confidence interval spanning
1.0 means the risk elevation was not statistically significant.
The table shows that pipe smokers had small to moderate
elevations for several smoking-related diseases, with the risk for laryngeal
cancer remarkably high.
The Health Risks of Pipe Smoking | |
---|---|
Disease | Hazard Ratio (95% Confidence Interval) |
Cancer | |
Oral cavity and pharynx | 3.9 (2.2 – 7.1) |
Esophagus | 2.4 (1.5 – 4.0) |
Stomach | 1.2 (0.7 – 1.9) |
Colon Rectum | 1.4 (1.2 – 1.7) |
Pancreas | 1.6 (1.2 – 2.1) |
Larynx | 13.1 (5.2 – 33) |
Lung | 5.0 (4.2 – 6.0) |
Bladder | 1.5 (0.9 – 2.4) |
Kidney | 0.9 (0.8 – 1.6) |
Heart Disease | 1.3 (1.2 – 1.4) |
Stroke | 1.3 (1.1 – 1.5) |
Emphysema | 3.0 (2.2 – 4.1) |
The Cancer Society’s analysis of pipe smoking was thorough (in
stark contrast to its consideration of smokeless tobacco, discussed here), producing a wealth of insights. For
example, the overall HR for lung cancer among pipe smokers was 5.0, but there
was a distinct gradient related to the number of pipes smoked per day. The HR was 2.0 with one to three pipes, but
it increased to 7.7 for 11+ pipes per day.
There was a similar trend with longer duration of smoking, and
inhalation played a major role. The lung
cancer HR was 2.9 for pipe smokers who didn’t inhale, but 11.1 for those reporting
moderate or deep inhalation.
Other diseases showed similar trends with dose, duration and
inhalation, although some results
weren’t statistically significant.
Dr. Henley also illustrated that alcohol is a powerful risk
factor for cancers of the oral cavity, pharynx, larynx and esophagus. Pipe smokers who consumed less than one
alcoholic drink per day had no increased risk for these cancers. Those consuming 1-3 drinks had an HR of 4.7
(CI = 1.8 – 11.9), while those consuming 4+ drinks had much higher risk (HR =
15, CI = 5.9 – 39). Never smokers
consuming 4+ drinks also had elevated risk for these cancers (HR = 2.3, CI =
1.2 – 4.3).
“These risks,” according to the researchers, “were generally
smaller than those associated with cigarette smoking and similar to or larger
than those associated with cigar smoking.”
This confirms one of the tenets of tobacco harm reduction: it’s the
smoke that kills, and the risk is proportionate to how much, how long and how
deeply smoke is inhaled.