title: Association between exclusive pipe smoking and mortality from cancer and other diseases.
abstract: BACKGROUND
  Although many studies have examined the adverse health effects of pipe smoking combined with other forms of tobacco use, few have included large numbers of exclusive pipe smokers. The prevalence of pipe smoking has declined since the 1960s, yet usage is still common regionally, especially among older populations.
  
  
  METHODS
  Using Cox proportional hazards models, we examined the association between pipe smoking and mortality from tobacco-related cancers and other diseases in a cohort of U.S. men enrolled in the Cancer Prevention Study II, an American Cancer Society prospective study. The cohort of 138 307 men included those who reported, in their 1982 enrollment questionnaire, exclusive current or former use of pipes (n = 15,263 men) or never use of any tobacco product (n = 123,044 men). Analyses were based on 23 589 men who died during 18 years of follow-up.
  
  
  RESULTS
  Current pipe smoking, compared with never use of tobacco, was associated with an increased risk of death from cancers of the lung (relative risk [RR] = 5.00, 95% confidence interval [CI] = 4.16 to 6.01), oropharynx (RR = 3.90, 95% CI = 2.15 to 7.08), esophagus (RR = 2.44, 95% CI = 1.51 to 3.95), colorectum (RR = 1.41, 95% CI = 1.15 to 1.73), pancreas (RR = 1.61, 95% CI = 1.24 to 2.09), and larynx (RR = 13.1, 95% CI = 5.2 to 33.1), and from coronary heart disease (RR = 1.30, 95% CI = 1.18 to 1.43), cerebrovascular disease (RR = 1.27, 95% CI = 1.09 to 1.48), and chronic obstructive pulmonary disease (RR = 2.98, 95% CI = 2.17 to 4.11). These risks were generally smaller than those associated with cigarette smoking and similar to or larger than those associated with cigar smoking. Relative risks of lung cancer showed statistically significant increases with number of pipes smoked per day, years of smoking, and depth of inhalation and decreases with years since quitting.
  
  
  CONCLUSIONS
  Results from this large prospective study suggest that pipe smoking confers a risk of tobacco-associated disease similar to cigar smoking.
authors.affiliation: Epidemiology and Surveillance Research, American Cancer Society, Atlanta, GA 30329, USA. jane.henley@cancer.org
authors.forename: S Jane
authors.initials: SJ
authors.lastname: Henley
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Thun
authors.forename: Ann
authors.initials: A
authors.lastname: Chao
authors.forename: Eugenia E
authors.initials: EE
authors.lastname: Calle
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000401:mortality*; D016001:Confidence Intervals; D003327:Coronary Disease / Q000209:etiology / Q000401:mortality*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000209:etiology* / Q000401:mortality*; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000209:etiology / Q000401:mortality*; D018570:Risk Assessment; D012907:Smoking / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology