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Pipe Smoking vs. Cigarette Smoking

Some mistakenly believe that pipe smoking is less harmful than cigarette smoking. It is true that the amounts of the different types of cancers and other diseases experienced by pipe smokers may differ from cigarette smokers. Nevertheless, the dangers of pipe smoking are well known. In some cases, pipe smoking creates a greater risk of getting cancer, such as oral cancer, than the use of cigarettes.

Let’s look at some of the research on pipe smoking. This research is for regular pipes, such as those made from Meerschaum or Briarwood and does not consider the use of a “hookah,” which is a glass pipe used for smoking.

Research Studies on Pipe Smoking *

Large Study of Thousands of American Men Over 18 Years
The Journal of the National Cancer Institute published the results of a study in 2004, which examined the links between cancer and other diseases with the exclusive use of pipe smoking.

This study included 138,307 men. Of that those, 15,263 men reported the exclusive use of pipe smoking, during the study or previously, and 123,044 men reported that they had never used any tobacco products. The study examined the incidences of cancer and other diseases in the 23,589 men from the total group that died during the 18 years of the study.

The conclusion from the study is that pipe smokers, when compared to those who never used tobacco, had significant risk of these diseases:

  • Lung cancer
  • Oropharynx cancer – This is the middle section of the throat behind the mouth, which includes the back of the tongue, the side and rear walls of the throat, and the soft palate.
  • Esophagus cancer – This tube leads to the lungs and stomach.
  • Colorectal cancer
  • Pancreatic cancer
  • Larynx (voice box) cancer
  • Coronary heart disease
  • Cerebrovascular disease (brain stroke)
  • Chronic Obstructive Pulmonary Disease (COPD) –This includes chronic bronchitis and emphysema.

The risks for pipe smokers were somewhat smaller that the same risks for cigarette smokers. When compared to cigar smoking, pipe smokers had similar or greater risks. Pipe smoking increases the risk of causing cancers in the lips, in the mouth, and on the tongue.

Study of Over 16,000 Men in Norway
This study reported on the U.S. National Institutes of Health website, estimated the risk of dying, from any cause and from diseases caused by smoking, in a group of 16,932 men from three counties in Norway.

At the beginning of the study, the men were between the ages of 20 and 49. In the mid-1970’s, at the beginning of the study, they received screening for cardiovascular risk. They received screening a second time for this cardiovascular risk during the period of three to thirteen years later, while the study was ongoing. The study continued until 2007.

During the study, deaths of 4,993 of the study participants occurred. The study categorized the men into groups of non-smokers, those who smoked only a pipe, those who smoked cigarettes, and those who stopped smoking cigarettes to change to a pipe only smoker instead.

Using the deaths of the non-smokers in the study as a baseline, when the researchers compared the deaths of pipe smokers to cigarette smokers, there was no significant difference between dying from any cause in both groups or from dying from smoke-related diseases. This particular study concluded that when considering all the risks, pipe smoking is not safer than smoking cigarettes.

Study of Over 20,000 American Men, Some Who Switched from Cigarettes to Pipes
This study looked at 21,520 men who were between 35 and 64 years old during the recruitment period of the study that happened during 1975 to 1982. The study estimated the risks of smoking-related diseases for those who stopped smoking cigarettes, over the 20 years before the study began and switched to pipe smoking instead.

The study reported the following:

Previous cigarette smokers, who changed to pipe smokers,

  • had a 51% increased risk of dying from smoking-related diseases when compared to pipe smokers who never smoked cigarettes.
  • had a 68% increased risk of dying from smoking-related diseases, when compared to those that never smoked.
  • had a 46% lower risk of dying from smoking-related diseases, when compared to those that continued to smoke cigarettes.

The study’s conclusion was that switching to pipe smoking was better than continuing to smoke cigarettes, depending on the reduced quantity of tobacco use and less inhaling of the smoke. Nevertheless, previous cigarette smokers did not achieve the same lower risk levels as pipe smokers who never used cigarettes and all pipe smokers have a greater risk of lung cancer than former smokers or those who never smoked.

Lung Cancer Rates in Cigar and Pipe Smokers Compared to Cigarette Smokers
A study conducted between 1977 and 1984 compared 2,085 patients with lung cancer to 3,948 matched controls. The study wanted to discover the difference between lung cancer rates of cigarette smokers, cigar, and pipe smokers.
The conclusions of the study were:

In comparison to non-smokers who never smoked,

  • Cigarette smokers had 16.0 times higher risk of lung cancer.
  • Among pipe and cigar smokers, lung cancer risk was 12.3 times greater for those who smoked more than five cigars or pipe bowls per day and inhaled.
  • Cigarette, cigar, and pipe smokers had 10.5 times higher risk of lung cancer.
  • Among pipe and cigar smokers, lung cancer risk was 6.7 times greater for those who smoked more than 10 cigars or pipe bowls per day and did not inhale.
  • Among pipe and cigar smokers, lung cancer risk was 3.2 times greater for those who smoked more than five cigars or pipe bowls per day and did not inhale.
  • Cigar only smokers had 3.1 times higher risk of lung cancer.
  • Cigar and pipe smokers had 2.5 times higher risk of lung cancer.
  • Pipe only smokers had 1.9 times higher risk of lung cancer.

Pipe smokers who smoked only occasionally and did not inhale had the lowest risk of lung cancer; however, both cigar smokers and pipe smokers had a greater risk of Kreyberg I cancers than cigarette smokers. Kreyberg type I lung cancer is smoking-related and includes carcinomas (cancers) of three types, large cell, squamous cell, and small cell.

Not Inhaling and Secondhand Smoke *

Many pipe smokers choose not to inhale the smoke from the pipe. Some falsely believe this eliminates the risk. While it does reduce risk slightly, it does not eliminate it. Even when a person does not inhale directly from smoking the pipe (mainstream smoke), the room is filled with copious amounts of secondhand smoke. If that person is breathing, they are automatically inhaling lots of secondhand smoke.

Secondhand smoke has many cancer risks, similar to mainstream smoke. In some cases, secondhand smoke is more dangerous because of the particulate size of the smoke and the lower temperature of the smoke, allows it to carry more carbon monoxide that is poisonous and increases the level of absorption of the toxins by the persons in the room.

The American Cancer Society says secondhand smoke increases the risks of these cancers and diseases, even in persons who are non-smokers:

  • Bladder cancer
  • Brain cancer and stroke
  • Breast cancer
  • COPD
  • Heart disease
  • Larynx cancer
  • Nasal Passages cancer
  • Pharynx cancer
  • Rectum cancer
  • Stomach cancer

Women are less likely to be pipe smokers than men are. If a female has a male partner that smokes a pipe in the same room or inside the home, she would be wise to tell him to take it outside or better yet to quit.

Other Diseases Related to Pipe Smoking *

WebMD concurs with the warnings about increased disease risk from smoking a pipe, which include:

  • Asthma and increased asthma attacks of more severity
  • Double the risk for COPD and lung diseases, such as chronic bronchitis and emphysema. With emphysema, a person has difficulty breathing out and struggles to expel air from the lungs in order to be able to take another breath.
  • A 30% increase in the chance of premature death from coronary heart disease.
  • Greater chance of stroke.
  • Male smokers have twice the incidence of erectile dysfunction when compared to non-smokers.
  • Headaches.
  • Burning eyes.
  • Problems with teeth and mouth – This includes increased cancer risk of oral cancer, increased chance of gum disease, which may result in tooth loss. One study noted by WebMD showed that cigar and pipe smokers had an average of four missing teeth. Smoking a pipe or cigar stains teeth and creates serious bad breath.

Healthday gives more information about diseases in the mouth caused by pipe smoking. These include the following:

  • Leukoplakia – This pre-cancerous lesion is sometimes called “smoker’s white patch.” If it appears in the mouth, it is a serious warning of bad things to come.
  • Erythroplakia – This is another type of pre-cancerous lesion that has a red velvet color.
  • Black Hairy Tongue – Pipe smokers can develop bumps that look like fur on the tongue if the cells on the tongue do not replace themselves naturally with new ones. If this layer of cells is tobacco stained, it makes the tongue look black.

What about Nicotine? *

The amount of nicotine that pipe smokers ingest depends on the inhalation of the mainstream smoke, the amount of secondhand smoke in the room, and the brand of pipe tobacco used.

A person does not need to inhale nicotine into the lungs for it to be absorbed by the body. The mucous membranes inside the mouth are perfectly capable of absorbing nicotine and so is the skin, yet to a lesser degree.

Cigarettes are loaded with nicotine because not only is nicotine in tobacco; it is also sometimes added as an ingredient in the production of cigarettes. Pipe tobacco is very different. There are some pipe tobaccos, which contain little or no nicotine.

WARNING: For those trying to stop smoking, reviewing the information that follows may be a trigger of the craving to smoke, so it should be avoided.

Pipe magazine has a general discussion about the differences between the pipe tobaccos. Besides nicotine, pipe tobacco contains sugar. Generally, the more sugar found in a pipe tobacco, the less nicotine it has. The curing method of the tobacco affects the sugar content as well. Most commercial pipe tobaccos are blends of more than one variety. Some specialty shops sell individual varieties and make custom blends.

Here are some general grades of nicotine content for popular types of pipe tobacco:

There are high nicotine levels in air-cured and some fire-cured varieties of these tobaccos:

  • Burly
  • Green River Kentucky
  • Kentucky
  • Perique

Low nicotine levels are in flue-cured varieties of:

  • Virginia
  • Maryland
  • Oriental
  • Turkish

Nicotine withdrawal is difficult. By changing the tobacco blend to a lower nicotine blend, it is possible to reduce nicotine intake significantly with pipe tobacco smoking. Regardless of efforts to make pipe smoking safer, it will never be 100% safe. For best health, abstain from all tobacco products entirely.

Summary *

If a person wants to avoid cancer, the best thing to do is to quit smoking everything as soon as possible. The research shows the risks of pipe smoking are substantial; however these risks are substantially lower for a pipe smoker when compared to a cigarette smoker, as long as the pipe smoker is smoking outside (to avoid secondhand smoke), smokes only occasionally, and does not inhale. If you inhale deeply, frequent pipe smoking is worse than cigarette smoking.

For those who find it difficult to quit cigarette smoking, switching to a pipe is better than continuing to smoke cigarettes. Nicotine levels are far less when pipe smoking and not inhaling, so a nicotine supplement like a patch or gum, needs to be used as well, as a stop smoking aid, to reduce the cravings from the nicotine addiction.

After awhile, taper off the nicotine, use the pipe to have something in the hand and provide an oral distraction with something to hold in the mouth and then stop lighting it to become a free, happy non-smoker. Millions have done this and are now smoke free. Do not make the mistake of thinking pipe smoking is safe.


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