In 2013, 4.7% of the American population smoked cigars. Cigars are addictive even if the smoke is not being inhaled. High levels of nicotine can still be absorbed into the body. A cigar smoker can get nicotine by two routes: by inhalation into the lungs and by absorption through the oral mucosa. Either way, the smoker becomes addicted to nicotine. A single cigar can potentially provide as much nicotine as a pack of cigarettes.
Most cigars are composed primarily of a single type of tobacco (air-cured and fermented), with a tobacco wrapper. Cigar smoke is possibly more toxic than cigarette smoke. Cigar smoke has a higher level of cancer-causing substances which originate from the fermentation process of the cigar manufacturing. Nitrosamines are found at higher levels in cigar smoke than in cigarette smoke. Cigar wrappers also have higher concentrations of toxins when compared to cigarettes. Furthermore, many cigars are larger resulting in a longer smoking time and higher exposure to many toxic substances including carbon monoxide, hydrocarbons, ammonia, and cadmium.
Cigar smoking has been linked to cancer of the oral cavity, larynx, esophagus, and lung. It may also cause cancer of the pancreas. Although cigar smokers have lower rates of lung cancer, coronary heart disease, and lung disease than cigarette smokers, they have higher rates of these diseases than those who do not smoke cigars. All cigar and cigarette smokers, whether or not they inhale, directly expose their lips, mouth, tongue, throat, larynx and lungs to smoke and its toxic, cancer-causing chemicals. In addition, when saliva containing the chemicals in tobacco smoke is swallowed, the esophagus is exposed to carcinogens. These exposures most likely account for the similar oral and esophageal cancer risks seen among cigar and cigarette smokers.24