title: Cigar and pipe smoking and cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC).
abstract: The carcinogenicity of cigar and pipe smoking is established but the effect of detailed smoking characteristics is less well defined. We examined the effects on cancer incidence of exclusive cigar and pipe smoking, and in combination with cigarettes, among 102,395 men from Denmark, Germany, Spain, Sweden and the United Kingdom in the EPIC cohort. Hazard ratios (HR) and their 95% confidence intervals (CI) for cancer during a median 9-year follow-up from ages 35 to 70 years were estimated using proportional hazards models. Compared to never smokers, HR of cancers of lung, upper aerodigestive tract and bladder combined was 2.2 (95% CI: 1.3, 3.8) for exclusive cigar smokers (16 cases), 3.0 (2.1, 4.5) for exclusive pipe smokers (33 cases) and 5.3 (4.4, 6.4) for exclusive cigarette smokers (1,069 cases). For each smoking type, effects were stronger in current smokers than in ex-smokers and in inhalers than in non-inhalers. Ever smokers of both cigarettes and cigars [HR 5.7 (4.4, 7.3), 120 cases] and cigarettes and pipes [5.1 (4.1, 6.4), 247 cases] had as high a raised risk as had exclusive cigarette smokers. In these smokers, the magnitude of the raised risk was smaller if they had switched to cigars or pipes only (i.e., quit cigarettes) and had not compensated with greater smoking intensity. Cigar and pipe smoking is not a safe alternative to cigarette smoking. The lower cancer risk of cigar and pipe smokers as compared to cigarette smokers is explained by lesser degree of inhalation and lower smoking intensity.
authors.affiliation: International Agency for Research on Cancer, Lyon, France.
authors.forename: Valerie A
authors.initials: VA
authors.lastname: McCormack
authors.forename: Antonio
authors.initials: A
authors.lastname: Agudo
authors.forename: Christina C
authors.initials: CC
authors.lastname: Dahm
authors.forename: Kim
authors.initials: K
authors.lastname: Overvad
authors.forename: Anja
authors.initials: A
authors.lastname: Olsen
authors.forename: Anne
authors.initials: A
authors.lastname: Tjonneland
authors.forename: Rudolf
authors.initials: R
authors.lastname: Kaaks
authors.forename: Heiner
authors.initials: H
authors.lastname: Boeing
authors.forename: Jonas
authors.initials: J
authors.lastname: Manjer
authors.forename: Martin
authors.initials: M
authors.lastname: Almquist
authors.forename: Goran
authors.initials: G
authors.lastname: Hallmans
authors.forename: Ingegerd
authors.initials: I
authors.lastname: Johansson
authors.forename: Maria Dolores
authors.initials: MD
authors.lastname: Chirlaque
authors.forename: Aurelio
authors.initials: A
authors.lastname: Barricarte
authors.forename: Miren
authors.initials: M
authors.lastname: Dorronsoro
authors.forename: Laudina
authors.initials: L
authors.lastname: Rodriguez
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Redondo
authors.forename: Kay-Tee
authors.initials: KT
authors.lastname: Khaw
authors.forename: Nick
authors.initials: N
authors.lastname: Wareham
authors.forename: Naomi
authors.initials: N
authors.lastname: Allen
authors.forename: Tim
authors.initials: T
authors.lastname: Key
authors.forename: Elio
authors.initials: E
authors.lastname: Riboli
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005060:Europe / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000209:etiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*