They're a way cool symbol of life in the 90s. Arnold Schwarzenegger clamps down on a stogie in a recent photo spread in Vanity Fair. Glamorous actresses are seen puffing away on Oscar night. Even the president lights up on occasion. What seems to be obscured in the clouds of smoke are the health risks associated with this tobacco product.

UCSF oral cancer specialist Sol Silverman, Jr., DDS, professor in the School of Dentistry’s department of stomatology, says that although cigars haven't been as well studied as cigarettes, they are unquestionably associated with serious health risks.

Studies performed both in the laboratory and in patients show a strong relationship between smoking and an increased risk of oral cancer, a risk that seems to be compounded to some extent by alcohol use. According to the American Cancer Society, cigar smokers have 4-10 times the risk of dying from oral, laryngeal and esophageal cancer as non-smokers and they are three times as likely as nonsmokers to get lung cancer.

And yet, cigar sales are soaring. According to the American Cancer Society (ACS) and the Centers for Disease Control and Prevention (CDC), 1994 marked the first increase in consumption of cigars since 1970 and nearly 4.5 billion cigars were consumed in 1996, with sales surpassing $1 billion for a second consecutive year. Equally troubling are increases in the use of cigars by women and teens. According to the CDC nearly one third of 14-19 year-olds admit to having smoked a cigar within the past year.

Congress did not explicitly include cigars in the 1984 law requiring health warnings on cigarettes, so cigar packages bear no warning from the Surgeon General. According to Silverman, however, there is a movement afoot to change that. Second-hand smoke from a cigar can be just as lethal as cigarette smoke. Attempting to breathe in one of the increasingly popular cigar bars can be an overwhelming experience.

"If you are not into tobacco it can knock you over to walk through some of these places." says Silverman. "If you look at the various chemicals in cigar smoke, including tar, nicotine and carcinogens, you find they are more concentrated and more numerous in cigars," says Silverman. "One cigar could equal 10 cigarettes in terms of your exposure to these toxins," says Silverman. "Unquestionably, more studies are needed to establish precise risk."

Silverman's specialty is treating oral cancer -- growths on the lips and surfaces inside the mouth cavity. According to Silverman 31,000 new cases of oral cancer are diagnosed in the US each year and that figure climbs to 50,000 if cancers of the salivary glands, larynx and pharynx are included. Only about 50% of people diagnosed with oral cancer survive, says Silverman, and complications of treatment are severe, including impairment of speech, swallowing, eating and appearance.

Particularly troubling, says Silverman, are increasing reports of oral cancer in young people. The typical age for diagnosis of oral cancer has been the sixth decade of life, but now specialists in oral cancer report increasing instances of the disease in younger patients, even as young as 30. What link if any this has to tobacco smoking is not clear, says Silverman.

In the meantime, it's in your best interests to stub out that stogie.

By Leslie Lingaas

1st appeared 7/03/97