Cigar and pipe smoking and lung cancer risk: A multicenter study from Europe

Background: Because limited information is available on the quantitative as sociation between consumption of tobacco products other than cigarettes and lung cancer risk, we undertook a case-control study of this relationship. Methods: We investigated lung cancer risk among smokers of cigars and/or ci garillos only and of pipes only and compared these risks with the risk of s mokers of cigarettes only in a case-control study conducted in seven Europe an areas. Our study population consisted of 5621 male case patients with lu ng cancer and 7255 male control subjects. Each subject or his proxy was int erviewed with respect to the subject's smoking history and other risk facto rs for lung cancer. Results: The odds ratio (OR) for smoking cigars and cig arillos only was 9.0 (95% confidence interval [CI] = 5.8-14.1), based on 43 exposed case patients and 77 exposed control subjects, and the OR for smok ing a pipe only was 7.9 (95% CI = 5.3-11.8), representing 61 case patients and 129 control subjects. The OR for smoking cigarettes only was 14.9 (95% CI = 12.3-18.1), based on 4204 case patients and 3930 control subjects. A d ose-response relationship was present for duration of use and cumulative co nsumption both for cigars and cigarillos and for pipe tobacco. An effect wa s also suggested for inhalation of cigar and cigarillo smoke. The dose-resp onse relationships between lung cancer risk and either duration of smoking or average and cumulative consumption were similar for cigar and cigarillo smoking, pipe smoking, and cigarette smoking. Conclusion: Our results sugge st that smoking of European cigars, cigarillos, and pipe tobacco might exer t a carcinogenic effect on the lung comparable to that of cigarettes.