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Cigarettes are
not the only type of tobacco products that can lead to premature death or
fatalities from smoking-related cancers, a U.S. study confirms. While people
who exclusively smoke cigarettes have twice the risk of premature death from
all causes compared to people who avoid tobacco altogether, exclusive cigar
smokers have a 20 percent higher risk of early death, researchers report in
JAMA Internal Medicine.
When it comes to
fatalities from specific cancers that have been tied to tobacco use, cigarette
smokers have four times the risk of people who never used tobacco, but cigar
smokers are 61 percent more likely to die of these cancers and pipe users have
58 percent higher odds.
"We knew
exclusive users of cigars and pipes were at greater risk of disease than people
who do not use tobacco," said lead study author Carol Christensen of the
U.S. Food and Drug Administration's Center for Tobacco Products. "However,
this study provides information that reflects today's patterns of tobacco
use."
These data
"underscore the importance of complete quitting," Christensen said by
email. For the study, researchers examined nationally representative survey
data, collected starting in 1985, from 357,420 participants who were followed
through 2011.
Overall, 203,071
people, or about 57 percent, never used tobacco at all. Another 57,251
participants were current daily cigarette smokers, while 9,414 said they had a
less frequent habit and 77,773 were former cigarette smokers. In addition, 531
people were current daily cigar smokers, while 608 individuals used cigars less
frequently and 2,398 had quit. For pipes, 1,099 participants had a current
daily habit, while 78 people used pipes less often and 5,237 had quit.
During the study
period, 51,150 people died of all causes.
With a daily
cigarette, cigar or pipe habit, people had an elevated risk of death from
tobacco-related cancers including malignancies of the bladder, esophagus,
larynx, lung, mouth and throat, and pancreas.
Nondaily users
Even with a
nondaily cigarette habit, people were more than six times more likely to die of
lung cancer than individuals who never used tobacco. They also had more than
seven times the risk of dying from chronic obstructive pulmonary disease, more
than four times the odds of death from oral cancers, and 43 percent higher odds
of death from a circulatory system disorder.
Current cigar
smokers had more than three times the odds of dying of lung cancer, and for
current pipe smokers the risk was 51 percent higher, compared with
never-smokers.
The results were
limited, however, by the relatively small numbers of cigar and pipe smokers in
the sample, the authors noted.
Another
limitation was that survey questions about tobacco use changed over time and
didn't determine how often nondaily smokers might have used cigarettes, cigars
or pipes.
Even so, the
results suggest that doctors may need to broaden how they discuss smoking with
patients to make sure people understand they're at risk even when they don't
have a daily habit, said Dr. Michael Ong of the University of California-Los
Angeles and VA Greater Los Angeles Healthcare
System.
"Patients
often do not associate occasional use of cigar or pipes with health risks, but
this study shows that current, particularly daily, cigar use is associated with
increased overall risk of death," Ong, who wasn't involved in the study,
said by email.
Doctors also
need to broaden their message about smoking and cigarettes to include other
tobacco products that are becoming more popular, said Judith Prochaska, a
researcher at Stanford University in California who wasn't involved in the
study.
Traditionally,
doctors have asked just whether people smoked cigarettes, but they should
instead be questioning patients more broadly about tobacco use, Prochaska said
by email.
"The
tobacco landscape has been changing dramatically," Prochaska added.
"While cigarettes remain the primary tobacco product used, cigars,
smokeless tobacco, e-cigarettes, hookah, and even pipe tobacco have seen gains
in use, while cigarette use in the U.S. has been declining."