Cancer Trends Progress Report

Cigarette smoking is the leading preventable cause of death in the United States. It increases the risk of cancers of the lung, larynx, mouth, esophagus, pharynx, bladder, pancreas, kidney, cervix, stomach, and acute myeloid leukemia. Altogether it causes approximately 30 percent of all U.S. cancer deaths each year. The prevalence of adult cigarette smoking in the United States has dropped over 50% since the first Surgeon General Report on the harms of tobacco in 1964, when it was 42%. Yet, since 1991, there has been a slower decrease in smoking rates, with an estimated 29.7 million adults still smoking cigarettes daily. The American Cancer Society estimates that in 2015, almost 171,000 of the estimated 589,430 cancer-related deaths will be caused by tobacco.

Tobacco use does not end with cigarettes. Other forms of tobacco use are common. In 2016, the National Survey on Drug Use and Health, a survey by the US Substance Abuse and Mental Health Service Administration, reported that 11.8 million adults smoked cigars and 8.4 million adults used smokeless tobacco.

A cigar is defined as a roll of tobacco wrapped in leaf tobacco or in a substance that contains tobacco (whereas a cigarette is defined as a roll of tobacco wrapped most often in paper or some other non-tobacco substance). There are three major types of cigars currently sold in the U.S. - large cigars, cigarillos, and little cigars. Little cigars are about the same size as a cigarette and often include a filter. Historically, cigar smoking in the United States has been a behavior of older men, but the industry’s increased marketing of these products to targeted groups in the 1990s has increased the prevalence of use among adolescents and young adults.

Cigar smoke, like cigarette smoke, contains the same toxic and carcinogenic compounds that are harmful to both smokers and nonsmokers. Cigar smoking causes oral cavity cancers (cancers of the lip, tongue, mouth, and throat) and cancers of the larynx (voice box), esophagus, and lung. Gum disease and tooth loss are also linked to cigar smoking, and heavy cigar smokers and those who inhale deeply may further be at increased risk of developing coronary heart disease. Heavy cigar smoking increases the risk for lung diseases, such as emphysema and chronic bronchitis.

Smokeless tobacco is tobacco that is not burned. It is also known as oral tobacco, chewing tobacco, chew, plug, twist, spit or spitting tobacco, snuff, dip, or snus. Snuff is a finely cut or powdered tobacco that is either placed between the cheek and gum, or sniffed through the nose, respectively. Some moist snuff and all snus come in tea bag-like pouches. Chewing tobacco is used by putting a wad (loose leaves, plug, or twist) of tobacco inside the cheek. Smokeless tobacco can also take the form of dissolvable tobacco (lozenge, film or stick), but this type is not widely distributed in the U.S.

Chewing tobacco and snuff contain at least 28 cancer-causing agents. Use of smokeless tobacco causes oral, esophageal, and pancreatic cancer. Smokeless tobacco also causes serious oral health problems, including gum disease, other non-cancerous oral lesions, and tooth loss, and increases the risk of heart disease.