Annette's Story

Annette experimented with cigarettes as a teenager, smoking occasionally. But by the time she turned 20, Annette was a regular smoker.

When she was 50, Annette heeded her granddaughter’s advice and quit cold turkey after having smoked for more than 30 years. But by then she already had cancer. At age 52, Annette went to the doctor because she was having difficulty breathing and was diagnosed with lung cancer so advanced it was necessary to remove one of her lungs. A few years later, she was diagnosed with oral cancer and surgery was again required. Today, at age 57, Annette is smoke-free and cancer-free.

More About Annette

Biography

•   Annette's Biography

Print Ads

• Annette's Tip [PDF - 279 KB]
• En Español:
  
  El consejo de Annette [PDF - 788 KB]

Get the Facts

More Stories

Key Points

• Cigar smoke, like cigarette smoke, contains toxic and cancer-causing chemicals that are harmful to both smokers and nonsmokers.
• There is no safe tobacco product, and there is no safe level of exposure to tobacco smoke.
• The more you smoke, the greater your risk of disease.
• Cigar smoking causes oral cavity cancers (cancers of the lip, tongue, mouth, and throat) and cancers of the larynx (voice box), esophagus, and lung.
• All cigar and cigarette smokers, whether or not they inhale, directly expose their lips, mouth, tongue, throat, and larynx to tobacco smoke and its toxic and cancer-causing chemicals.

1. How are cigars different from cigarettes?

   Cigarettes usually differ from cigars in size and in the type of tobacco used (1–3). Moreover, in contrast with cigarette smoke, cigar smoke is often not inhaled.

   The main features of these tobacco products are:

   • Cigarettes: Cigarettes are uniform in size and contain less than 1 gram of tobacco each. U.S. cigarettes are made from different blends of tobaccos, which are never fermented, and they are wrapped with paper. Most U.S. cigarettes take less than 10 minutes to smoke.

   • Cigars: Most cigars are composed primarily of a single type of tobacco (air-cured and fermented), and they have a tobacco wrapper. They can vary in size and shape and contain between 1 gram and 20 grams of tobacco. Three cigar sizes are sold in the United States:

     • Large cigars can measure more than 7 inches in length, and they typically contain between 5 and 20 grams of tobacco. Some premium cigars contain the tobacco equivalent of an entire pack of cigarettes. Large cigars can take between 1 and 2 hours to smoke.

     • Cigarillos are a type of smaller cigar. They are a little bigger than little cigars and cigarettes and contain about 3 grams of tobacco.

     • Little cigars are the same size and shape as cigarettes, are often packaged like cigarettes (20 little cigars in a package), and contain about 1 gram of tobacco. Also, unlike large cigars, some little cigars have a filter, which makes it seem they are designed to be smoked like cigarettes (that is, for the smoke to be inhaled). 

2. Are there harmful chemicals in cigar smoke?

   Yes. Cigar smoke, like cigarette smoke, contains toxic and cancer-causing chemicals that are harmful to both smokers and nonsmokers. Cigar smoke is possibly more toxic than cigarette smoke (3). Cigar smoke has:

   • A higher level of cancer-causing substances: During the fermentation process for cigar tobacco, high concentrations of cancer-causing nitrosamines are produced. These compounds are released when a cigar is smoked. Nitrosamines are found at higher levels in cigar smoke than in cigarette smoke.

   • More tar: For every gram of tobacco smoked, there is more cancer-causing tar in cigars than in cigarettes.

   • A higher level of toxins: Cigar wrappers are less porous than cigarette wrappers. The nonporous cigar wrapper makes the burning of cigar tobacco less complete than the burning of cigarette tobacco. As a result, cigar smoke has higher concentrations of toxins than cigarette smoke.

   Furthermore, the larger size of most cigars (more tobacco) and longer smoking time result in higher exposure to many toxic substances (including carbon monoxide, hydrocarbons, ammonia, cadmium, and other substances).

   Cigar smoke can be a major source of indoor air pollution (1). There is no safe level of exposure to tobacco smoke. If you want to reduce the health risk to yourself and others, stop smoking.

3. Do cigars cause cancer and other diseases?

   Yes. Cigar smoking causes cancer of the oral cavity, larynx, esophagus, and lung. It may also cause cancer of the pancreas. Moreover, daily cigar smokers, particularly those who inhale, are at increased risk for developing heart disease and other types of lung disease. Regular cigar smokers and cigarette smokers have similar levels of risk for oral cavity and esophageal cancers. The more you smoke, the greater the risk of disease (3).

4. What if I don’t inhale the cigar smoke?

   Unlike nearly all cigarette smokers, most cigar smokers do not inhale. 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, and larynx to smoke and its toxic and cancer-causing chemicals. In addition, when saliva containing the chemicals in tobacco smoke is swallowed, the esophagus is exposed to carcinogens. These exposures probably account for the similar oral and esophageal cancer risks seen among cigar smokers and cigarette smokers (3).

5. Are cigars addictive?

   Yes. Even if the smoke is not inhaled, high levels of nicotine (the chemical that causes addiction) 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 lining of the mouth. Either way, the smoker becomes addicted to the nicotine that gets into the body.

   A single cigar can potentially provide as much nicotine as a pack of cigarettes (1).

6. Are cigars less hazardous than cigarettes?

   Because all tobacco products are harmful and cause cancer, the use of these products is strongly discouraged. There is no safe level of tobacco use. People who use any type of tobacco product should be encouraged to quit. For help with quitting, see the National Cancer Institute (NCI) fact sheet Where To Get Help When You Decide To Quit Smoking.

7. Do nicotine replacement products help cigar smokers to quit?

   Nicotine replacement products, or nicotine replacement therapy (NRT), deliver measured doses of nicotine into the body, which helps to relieve the cravings and withdrawal symptoms often felt by people trying to quit smoking. Strong and consistent evidence shows that NRT can help people quit smoking cigarettes (4). Limited research has been completed to determine the usefulness of NRT for people who smoke cigars. For help with quitting cigar smoking, ask your doctor or pharmacist about NRT, as well as about individual or group counseling, telephone quitlines, or other methods.

8. How can I get help quitting smoking?

   NCI and other agencies and organizations can help smokers quit:

   • Go online to Smokefree.gov, a website created by NCI’s Tobacco Control Research Branch, and use the Step-by-Step Quit Guide.

   • Call NCI’s Smoking Quitline at 1–877–448–7848 (1–877–44U–QUIT) for individualized counseling, printed information, and referrals to other sources.

   • Refer to the NCI fact sheet Where To Get Help When You Decide To Quit Smoking.

Quitting will make the people you care about happier and healthier. This may be one of your reasons for quitting.

Dangers of Secondhand Smoke

The main way smoking hurts non-smokers is through secondhand smoke. Secondhand smoke is the combination of smoke that comes from a cigarette and smoke breathed out by a smoker. When a non-smoker is around someone smoking, they breathe in secondhand smoke.

Secondhand smoke is dangerous to anyone who breathes it in. It can stay in the air for several hours after somebody smokes. Breathing secondhand smoke for even a short time can hurt your body.

Take this quiz to see how much you know about the dangers of secondhand smoke.

Health Effects of Secondhand Smoke

Over time, secondhand smoke has been associated with serious health problems in non-smokers: 

• Lung cancer in people who have never smoked. 
• More likely that someone will get heart disease‚ have a heart attack‚ and die early. 
• Breathing problems like coughing‚ extra phlegm‚ wheezing‚ and shortness of breath.

Secondhand smoke is especially dangerous for children, babies, and women who are pregnant: 

• Mothers who breathe secondhand smoke while pregnant are more likely to have babies with low birth weight. 
• Babies who breathe secondhand smoke after birth have more lung infections than other babies. 
• Secondhand smoke causes kids who already have asthma to have more frequent and severe attacks. 
• Children exposed to secondhand smoke are more likely to develop bronchitis, pneumonia, and ear infections and are at increased risk for sudden infant death syndrome (SIDS). 

The only way to fully protect non-smokers from the dangers of secondhand smoke is to not allow smoking indoors. Separating smokers from non-smokers (like “no smoking” sections in restaurants)‚ cleaning the air‚ and airing out buildings does not get rid of secondhand smoke.

Other Ways Smoking Affects Others

Smoking affects the people in your life in other ways, beyond their health. When you smoke, you may miss out on:

• Spending time with family and friends.
• Having more money to spend on the people you love.
• Setting a good example for your children. Children who are raised by smokers are more likely to become smokers themselves.

Steps You Can Take to Protect Your Loved Ones

The best thing you can do to protect your family from secondhand smoke is to quit smoking. Right away, you get rid of their exposure to secondhand smoke in your home and car, and reduce it anywhere else you go together.

Make sure your house and car remain smokefree. Kids breathe in secondhand smoke at home more than any other place. The same goes for many adults. Don’t allow anyone to smoke in your home or car. Setting this rule will:

• Reduce the amount of secondhand smoke your family breathes in.
• Help you quit smoking and stay smokefree.
• Lower the chance of your child becoming a smoker.

When you’re on the go, you can still protect your family from secondhand smoke:

• Make sure caretakers like nannies, babysitters, and day care staff do not smoke.
• Eat at smokefree restaurants.
• Avoid indoor public places that allow smoking.
• Teach your children to stay away from secondhand smoke.

Find out more about secondhand smoke:

• From the National Cancer Institute, Secondhand Smoke: Questions and Answers
• From the Centers for Disease Control and Prevention‚ Secondhand Smoke (SHS) Facts

Quitting will make the people you care about happier and healthier. This may be one of your reasons for quitting.

Dangers of Secondhand Smoke

The main way smoking hurts non-smokers is through secondhand smoke. Secondhand smoke is the combination of smoke that comes from a cigarette and smoke breathed out by a smoker. When a non-smoker is around someone smoking, they breathe in secondhand smoke.

Secondhand smoke is dangerous to anyone who breathes it in. It can stay in the air for several hours after somebody smokes. Breathing secondhand smoke for even a short time can hurt your body.

Take this quiz to see how much you know about the dangers of secondhand smoke.

Health Effects of Secondhand Smoke

Over time, secondhand smoke has been associated with serious health problems in non-smokers: 

• Lung cancer in people who have never smoked. 
• More likely that someone will get heart disease‚ have a heart attack‚ and die early. 
• Breathing problems like coughing‚ extra phlegm‚ wheezing‚ and shortness of breath.

Secondhand smoke is especially dangerous for children, babies, and women who are pregnant: 

• Mothers who breathe secondhand smoke while pregnant are more likely to have babies with low birth weight. 
• Babies who breathe secondhand smoke after birth have more lung infections than other babies. 
• Secondhand smoke causes kids who already have asthma to have more frequent and severe attacks. 
• Children exposed to secondhand smoke are more likely to develop bronchitis, pneumonia, and ear infections and are at increased risk for sudden infant death syndrome (SIDS). 

The only way to fully protect non-smokers from the dangers of secondhand smoke is to not allow smoking indoors. Separating smokers from non-smokers (like “no smoking” sections in restaurants)‚ cleaning the air‚ and airing out buildings does not get rid of secondhand smoke.

Other Ways Smoking Affects Others

Smoking affects the people in your life in other ways, beyond their health. When you smoke, you may miss out on:

• Spending time with family and friends.
• Having more money to spend on the people you love.
• Setting a good example for your children. Children who are raised by smokers are more likely to become smokers themselves.

Steps You Can Take to Protect Your Loved Ones

The best thing you can do to protect your family from secondhand smoke is to quit smoking. Right away, you get rid of their exposure to secondhand smoke in your home and car, and reduce it anywhere else you go together.

Make sure your house and car remain smokefree. Kids breathe in secondhand smoke at home more than any other place. The same goes for many adults. Don’t allow anyone to smoke in your home or car. Setting this rule will:

• Reduce the amount of secondhand smoke your family breathes in.
• Help you quit smoking and stay smokefree.
• Lower the chance of your child becoming a smoker.

When you’re on the go, you can still protect your family from secondhand smoke:

• Make sure caretakers like nannies, babysitters, and day care staff do not smoke.
• Eat at smokefree restaurants.
• Avoid indoor public places that allow smoking.
• Teach your children to stay away from secondhand smoke.

Find out more about secondhand smoke:

• From the National Cancer Institute, Secondhand Smoke: Questions and Answers
• From the Centers for Disease Control and Prevention‚ Secondhand Smoke (SHS) Facts

Key Points

• Secondhand smoke (also called environmental tobacco smoke, involuntary smoke, and passive smoke) is the smoke given off by a burning tobacco product and the smoke exhaled by a smoker.
• At least 69 chemicals in secondhand smoke are known to cause cancer.
• Secondhand smoke causes lung cancer in nonsmokers.
• Secondhand smoke has also been associated with heart disease in adults and sudden infant death syndrome, ear infections, and asthma attacks in children.
• There is no safe level of exposure to secondhand smoke.

1. What is secondhand smoke?

   Secondhand smoke (also called environmental tobacco smoke, involuntary smoke, and passive smoke) is the combination of “sidestream” smoke (the smoke given off by a burning tobacco product) and “mainstream” smoke (the smoke exhaled by a smoker) (1–4).

   People can be exposed to secondhand smoke in homes, cars, the workplace, and public places, such as bars, restaurants, and recreational settings. In the United States, the source of most secondhand smoke is from cigarettes, followed by pipes, cigars, and other tobacco products (4).

   The amount of smoke created by a tobacco product depends on the amount of tobacco available for burning. The amount of secondhand smoke emitted by smoking one large cigar is similar to that emitted by smoking an entire pack of cigarettes.

2. How is secondhand smoke exposure measured?

   Secondhand smoke exposure can be measured by testing indoor air for nicotine or other chemicals in tobacco smoke. Exposure to secondhand smoke can also be tested by measuring the level of cotinine (a by-product of the breakdown of nicotine) in a nonsmoker’s blood, saliva, or urine (1). Nicotine, cotinine, carbon monoxide, and other smoke-related chemicals have been found in the body fluids of nonsmokers exposed to secondhand smoke.

3. Does secondhand smoke contain harmful chemicals?

   Yes. Among the more than 7,000 chemicals that have been identified in secondhand tobacco smoke, at least 250 are known to be harmful, for example, hydrogen cyanide, carbon monoxide, and ammonia.

   At least 69 of the toxic chemicals in secondhand tobacco smoke cause cancer (1, 5, 6). These include the following:

   • Arsenic
   • Benzene
   • Beryllium (a toxic metal)
   • 1,3–Butadiene (a hazardous gas)
   • Cadmium
   • Chromium (a metallic element)
   • Ethylene oxide
   • Nickel (a metallic element)
   • Polonium-210 (a radioactive chemical element)
   • Vinyl chloride

   Other toxic chemicals in secondhand smoke are suspected to cause cancer, including (1):

   • Formaldehyde
   • Benzo[a]pyrene
   • Toluene

   Many factors affect which chemicals are found in secondhand smoke, such as the type of tobacco, the chemicals added to the tobacco, the way the tobacco product is smoked, and, for cigarettes and cigars, the material in which the tobacco is wrapped (1, 3, 4).

4. Does exposure to secondhand smoke cause cancer?

   Yes. The U.S. Environmental Protection Agency, the U.S. National Toxicology Program, the U.S. Surgeon General, and the International Agency for Research on Cancer have all classified secondhand smoke as a known human carcinogen (a cancer-causing agent) (1, 3, 5, 7).

   Inhaling secondhand smoke causes lung cancer in nonsmoking adults (4, 5). Approximately 3,000 lung cancer deaths occur each year among adult nonsmokers in the United States as a result of exposure to secondhand smoke (2). The U.S. Surgeon General estimates that living with a smoker increases a nonsmoker’s chances of developing lung cancer by 20 to 30 percent (4).

   Some research also suggests that secondhand smoke may increase the risk of breast cancer, nasal sinus cavity cancer, and nasopharyngeal cancer in adults and the risk of leukemia, lymphoma, and brain tumors in children (4). Additional research is needed to learn whether a link exists between secondhand smoke exposure and these cancers.

5. What are the other health effects of exposure to secondhand smoke?

   Secondhand smoke is associated with disease and premature death in nonsmoking adults and children (4, 5). Exposure to secondhand smoke irritates the airways and has immediate harmful effects on a person’s heart and blood vessels. It may increase the risk of heart disease by an estimated 25 to 30 percent (4). In the United States, secondhand smoke is thought to cause about 46,000 heart disease deaths each year (8). There may also be a link between exposure to secondhand smoke and the risk of stroke and hardening of the arteries; however, additional research is needed to confirm this link.

   Children exposed to secondhand smoke are at increased risk of sudden infant death syndrome, ear infections, colds, pneumonia, bronchitis, and more severe asthma. Being exposed to secondhand smoke slows the growth of children’s lungs and can cause them to cough, wheeze, and feel breathless (4, 5).

6. What is a safe level of secondhand smoke?

   There is no safe level of exposure to secondhand smoke. Even low levels of secondhand smoke can be harmful. The only way to fully protect nonsmokers from secondhand smoke is to completely eliminate smoking in indoor spaces. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot completely eliminate exposure to secondhand smoke (4).

7. What is being done to reduce nonsmokers’ exposure to secondhand smoke?

   On the national level, several laws restricting smoking in public places have been passed. Federal law bans smoking on domestic airline flights, nearly all flights between the United States and foreign destinations, interstate buses, and most trains. Smoking is also banned in most federally owned buildings. The Pro-Children Act of 1994 prohibits smoking in facilities that routinely provide federally funded services to children.

   Many state and local governments have passed laws prohibiting smoking in public facilities, such as schools, hospitals, airports, bus terminals, parks, and beaches, as well as private workplaces, including restaurants and bars. Some states have passed laws regulating smoking in multiunit housing and cars. More than half of the states have enacted statewide bans on workplace smoking.

   To highlight the health risks from secondhand smoke, the National Cancer Institute, a component of the National Institutes of Health, holds meetings and conferences in states, counties, cities, or towns that are smoke free, unless specific circumstances justify an exception to this policy. More information is available online.

   The U.S. Department of Health and Human Services Healthy People 2020, a comprehensive, nationwide health promotion and disease prevention agenda, includes the goal of reducing illness, disability, and death related to tobacco use and secondhand smoke exposure. Currently, most Americans are exposed to secondhand smoke, and children are at greatest risk. For 2020, the goal is to reduce the proportion of people exposed to secondhand smoke by 10 percent. To assist with achieving this goal, Healthy People 2020 includes ideas for community interventions, such as encouraging the introduction of smoke-free policies in workplaces and other public areas.

   More information about this program is available on the Healthy People 2020 website.

   Internationally, a growing number of nations, including France, Ireland, New Zealand, Norway, and Uruguay, require all workplaces, including bars and restaurants, to be smoke free.

Key Points

• Smokeless tobacco is tobacco that is not burned. Smokeless tobacco is also known as chewing tobacco, oral tobacco, spit or spitting tobacco, dip, chew, and snuff/snus.
• Smokeless tobacco causes cancer and other diseases.
• Smokeless tobacco is not a safe substitute for cigarettes.

1. What is smokeless tobacco?

   Smokeless tobacco is tobacco that is not burned. It is also known as chewing tobacco, oral tobacco, spit or spitting tobacco, dip, chew, and snuff. Most people chew or suck (dip) the tobacco in their mouth and spit out the tobacco juices that build up, although “spitless” smokeless tobacco has also been developed. Nicotine in the tobacco is absorbed through the lining of the mouth.

   People in many regions and countries, including North America, northern Europe, India and other Asian countries, and parts of Africa, have a long history of using smokeless tobacco products.

   There are two main types of smokeless tobacco:

   • Chewing tobacco, which is available as loose leaves, plugs (bricks), or twists of rope. A piece of tobacco is placed between the cheek and lower lip, typically toward the back of the mouth. It is either chewed or held in place. Saliva is spit or swallowed.

   • Snuff, which is finely cut or powdered tobacco. It may be sold in different scents and flavors. It is packaged moist or dry; most American snuff is moist. It is available loose, in dissolvable lozenges or strips, or in small pouches similar to tea bags. The user places a pinch or pouch of moist snuff between the cheek and gums or behind the upper or lower lip. Another name for moist snuff is snus (pronounced “snoose”). Some people inhale dry snuff into the nose.

2. Are there harmful chemicals in smokeless tobacco?

   Yes. There is no safe form of tobacco. At least 28 chemicals in smokeless tobacco have been found to cause cancer (1). The most harmful chemicals in smokeless tobacco are tobacco-specific nitrosamines, which are formed during the growing, curing, fermenting, and aging of tobacco. The level of tobacco-specific nitrosamines varies by product. Scientists have found that the nitrosamine level is directly related to the risk of cancer.

   In addition to a variety of nitrosamines, other cancer-causing substances in smokeless tobacco include polonium–210 (a radioactive element found in tobacco fertilizer) and polynuclear aromatic hydrocarbons (also known as polycyclic aromatic hydrocarbons) (1).

3. Does smokeless tobacco cause cancer?

   Yes. Smokeless tobacco causes oral cancer, esophageal cancer, and pancreatic cancer (1).

4. Does smokeless tobacco cause other diseases?

   Yes. Using smokeless tobacco may also cause heart disease, gum disease, and oral lesions other than cancer, such as leukoplakia (precancerous white patches in the mouth) (1).

5. Can a user get addicted to smokeless tobacco?

   Yes. All tobacco products, including smokeless tobacco, contain nicotine, which is addictive (1). Users of smokeless tobacco and users of cigarettes have comparable levels of nicotine in the blood. In users of smokeless tobacco, nicotine is absorbed through the mouth tissues directly into the blood, where it goes to the brain. Even after the tobacco is removed from the mouth, nicotine continues to be absorbed into the bloodstream. Also, the nicotine stays in the blood longer for users of smokeless tobacco than for smokers (2).

   The level of nicotine in the blood depends on the amount of nicotine in the smokeless tobacco product, the tobacco cut size, the product’s pH (a measure of its acidity or basicity), and other factors (3).

   A Centers for Disease Control and Prevention study of the 40 most widely used popular brands of moist snuff showed that the amount of nicotine per gram of tobacco ranged from 4.4 milligrams to 25.0 milligrams (3). Other studies have shown that moist snuff had between 4.7 and 24.3 milligrams per gram of tobacco, dry snuff had between 10.5 and 24.8 milligrams per gram of tobacco, and chewing tobacco had between 3.4 and 39.7 milligrams per gram of tobacco (4).

6. Is using smokeless tobacco less hazardous than smoking cigarettes?

   Because all tobacco products are harmful and cause cancer, the use of all of these products should be strongly discouraged. There is no safe level of tobacco use. People who use any type of tobacco product should be urged to quit. For help with quitting, refer to the NCI fact sheet Where To Get Help When You Decide To Quit Smoking.

   As long ago as 1986, the advisory committee to the Surgeon General concluded that the use of smokeless tobacco “is not a safe substitute for smoking cigarettes. It can cause cancer and a number of noncancerous oral conditions and can lead to nicotine addiction and dependence” (5). Furthermore, a panel of experts convened by the National Institutes of Health (NIH) in 2006 stated that the “range of risks, including nicotine addiction, from smokeless tobacco products may vary extensively because of differing levels of nicotine, carcinogens, and other toxins in different products” (6).

7. Should smokeless tobacco be used to help a person quit smoking?

   No. There is no scientific evidence that using smokeless tobacco can help a person quit smoking (7). Because all tobacco products are harmful and cause cancer, the use of all tobacco products is strongly discouraged. There is no safe level of tobacco use. People who use any type of tobacco product should be urged to quit. For help with quitting, ask your doctor about individual or group counseling, telephone quitlines, or other methods.

8. How can I get help quitting smokeless tobacco?

   NCI offers free information about quitting smokeless tobacco:

   • Call NCI’s Smoking Quitline at 1–877–44U–QUIT (1–877–448–7848). Talk with a smoking cessation counselor about quitting smokeless tobacco. You can call the quitline, within the United States, Monday through Friday, 9:00 a.m. to 9:00 p.m., Eastern time.

   • Use LiveHelp online chat. You can have a confidential online text chat with an NCI smoking cessation counselor Monday through Friday, 9:00 a.m. to 9:00 p.m., Eastern time.

   For other resources, you may be interested in the NCI fact sheet Where To Get Help When You Decide To Quit Smoking.