Eric M. Newman
President
c/o J.C. Newman Cigar Co.
P.O. Box 2030
2701 Sixteenth Street
Tampa, Florida 33601

Dear Mr. Newman,

This letter responds to the cigar health concerns of the Moffitt Cancer Center and Research Institute. Two specific "sound bites" from the Institute's "fact sheet", What's The Burning Issue Behind Cigars? are discussed here. First, whether "cigar smokers are more likely than nonsmokers to suffer from persistent coughs and phlegm and also face an increased risk of peptic ulcers. (American Journal of Public Health, November, 1987)" and second, "cigar smokers have 4-10 times the risk of dying of laryngeal, oral, and esophageal cancers as nonsmokers. (European Journal of Cancer, 1993.)"

I called the Moffitt Cancer Center Foundation and spoke with Mary to secure a more complete bibliography and access the above articles. She told me that they did not actually have the articles. In addition, the Foundation may have quoted other sources and not directly from the articles. She was kind enough to send me a complete bibliography. There are 13 cigar related statements in this bibliography, of which, only 4 come from primary source, scientific journals. The other statements are referenced from newspaper articles, government summaries, other societies fact sheets, or popular magazine articles.

The first statement of concern, regarding persistent cough and phlegm as well as the increased incidence of peptic ulcer disease and cigar usage, was referenced back to an article by Judith K. Ockene, Ph.D. et al., "Does Switching from Cigarettes to Pipes or Cigars Reduce Tobacco Smoke Exposure", American Journal of Public Health, pages 1412-1416, 1987. This prospective study (enclosed) concluded that "smokers who stopped all tobacco products had a greater drop in serum thiocyanate and carbon monoxide than those who switched to pipes and cigars. The findings strongly suggest that cessation of all tobacco products is the best strategy for decreasing exposure to tobacco smoke."

This paper's authors do not discuss peptic ulcers nor chronic sputum production. The concern the foundation has for cigars, chronic bronchitis, and peptic ulcers was not addressed in their referenced article so I cannot comment further.

The second concern was that of cigar smokers dying with an increased risk of 4-10 times compared to nonsmokers of laryngeal, oral and esophageal cancers. They referenced Eduardo De Stefani, et al., Black (Air-cured) and Blond (Flue-cured) Tobacco and Cancer Risk III: Oesophageal Cancer., European Journal of Cancer, Vol. 29A, No. 5, pages 763-766, 1993. This article (enclosed) discusses the relative esophageal cancer risk of types of cigarette tobacco, specifically, black and blond tobaccos. No new information is presented as this article is purely a review of previous research. In fact, the only mention of cigars in the article pertained to esophageal cancer risk.

Let's discuss the only cigar related information the article contains. One table (Table 3) in this paper summarizes 5 articles that pertain to esophageal cancer and cigarettes, pipes and cigars. Three of the summarized studies do not present any cigar data. Of the remaining two that do, neither take into account cigar-only smokers, but include pipe smokers as a cigar/pipe smoker group or pipe-only smokers. Hence, no specific conclusions can be drawn regarding cigar-only usage and esophageal cancer risk. In addition, no death statistics are discussed, only relative risk of disease development. Wynder, 1961 concludes that pipe-only smokers have a relative risk of esophageal cancer of 9 compared with the general nonsmoking population. Cigar/pipe smokers in the same study had a relative risk of 6, implying that the addition of cigars lowered the relative risk of developing esophageal cancer.

The authors do not address the "risk of dying" from laryngeal, oral, and esophageal cancer, as was referenced by the Moffitt Foundation. When I queried the Foundation for their bibliography, the information they gave me came directly from the American Cancer Society's "Position Statement on Cigars and Fact Sheet on Cigars" (enclosed.) The Cancer Society's bibliography contains the same "sound bites" with the same referenced articles as listed on the "fact sheet" from the Moffitt Foundation.

In summary it would appear that the Moffitt Foundation has not reviewed their own statements regarding cigars and health that were made on their "fact sheet." The two health concerns discussed above cannot be referenced in their bibliography. The Foundation apparently copied, verbatim, from the American Cancer Society's "fact sheet."

The American Cancer Society's statements regarding peptic ulcer disease and chronic phlegm production cannot be found in their referenced articles either. The "risk of dying/laryngeal cancer/oral cancer risk and cigars" statement is equally unfounded based upon the Society's referenced article. In fact, the addition of cigar smoking to pipe smoking may even lower the incidence of esophageal cancer when compared to the pipe-only smoking population.

Finally, it is clear that neither the Moffitt Foundation nor the American Cancer Society correctly referenced their concerns regarding cigars and health risk. It is doubtful that either entity actually has the articles needed to back up their "facts" regarding cigars and health risks.

Sincerely,

Marc J. Schneiderman, M.D.
MJS/ms

References

American Cancer Society, Position Statement on Cigars and Fact Sheet on Cigars. California Division, Inc. American Cancer Society, 1997.

H. Lee Moffitt Cancer Center and Research Institute. What's the Burning Issue Behind Cigars? Fact sheet, 1997.

Ockene, Judith K., Terry F. Pechacek, Thomas Vogt, and Ken Svendsen. Does Switching from Cigarettes to Pipes or Cigars Reduce Tobacco Smoke Exposure? American Journal of Public Health, 77 (11): 1412-1416; 1987.

De Stefani, Eduardo, Enrique Barrios and Luis Fierro. Black (Air-cured) and Blond (Flue-cured) Tobacco and Cancer Risk III: Oesophageal Cancer. European Journal of Cancer, 29A: 763-766, 1993.

Wynder, E.L., and I.J. Bross. A study of etiological factors in cancers of the oesophagus. Cancer, 14:389-413, 1961.