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).
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.
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).
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).
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).
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.
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.
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.
Secondhand smoke (sometimes called passive smoke, environmental tobacco smoke, or involuntary smoke) is a mixture of sidestream smoke (the smoke from the burning tip of a cigarette or other smoked tobacco product) and mainstream smoke (smoke exhaled by a smoker that is diluted by the surrounding air) (1–3).
Major settings of exposure to secondhand smoke include workplaces, public places such as bars, restaurants and recreational settings, and homes (4). Workplaces and homes are especially important sources of exposure because of the length of time people spend in these settings. The home is a particularly important source of exposure for infants and young children. Children and nonsmoking adults can also be exposed to secondhand smoke in vehicles, where levels of exposure can be high. Exposure levels can also be high in enclosed public places where smoking is allowed, such as restaurants, bars, and casinos, resulting in substantial exposures for both workers and patrons (3).
In the United States, most secondhand smoke comes from cigarettes, followed by pipes, cigars, and other smoked tobacco products.
How is secondhand smoke exposure measured?
Secondhand smoke exposure can be measured by testing indoor air for respirable (breathable) suspended particles (particles small enough to reach the lower airways of the human lung) or individual chemicals such as nicotine or other harmful and potentially harmful constituents of tobacco smoke (3, 5).
Exposure to secondhand smoke can also be evaluated by measuring the level of biomarkers such as cotinine (a byproduct of nicotine metabolism) in a nonsmoker’s blood, saliva, or urine (1). Nicotine, cotinine, and other chemicals present in secondhand smoke have been found in the body fluids of nonsmokers exposed to secondhand smoke.
Does secondhand smoke contain harmful chemicals?
Yes. Many of the harmful chemicals that are in the smoke inhaled by smokers are also found in secondhand smoke (1, 3, 6, 7), including some that cause cancer (1, 3, 7, 8).
Many factors affect which chemicals and how much of them are found in secondhand smoke. These factors include the type of tobacco used in manufacturing a specific product, the chemicals (including flavorings such as menthol) added to the tobacco, the way the tobacco product is smoked, and—for cigarettes, cigars, little cigars, and cigarillos—the material in which the tobacco is wrapped (1–3, 7).
Does 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, 7, 9). In addition, the National Institute for Occupational Safety and Health (NIOSH) has concluded that secondhand smoke is an occupational carcinogen (3).
The Surgeon General estimates that, during 2005-2009, secondhand smoke exposure caused more than 7,300 lung cancer deaths among adult nonsmokers each year (10).
Some research also suggests that secondhand smoke may increase the risk of breast cancer, nasal sinus cavity cancer, and nasopharyngeal cancer in adults (10) and the risk of leukemia, lymphoma, and brain tumors in children (3). Additional research is needed to determine whether a link exists between secondhand smoke exposure and these cancers.
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 (3, 7). Exposure to secondhand smoke irritates the airways and has immediate harmful effects on a person’s heart and blood vessels. It increases the risk of heart disease by about 25 to 30% (3). In the United States, secondhand smoke is estimated to cause nearly 34,000 heart disease deaths each year (10). Exposure to secondhand smoke also increases the risk of stroke by 20 to 30% (10).
Secondhand smoke exposure during pregnancy has been found to cause reduced fertility, pregnancy complications, and poor birth outcomes, including impaired lung development, low birth weight, and preterm delivery (11).
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 (3, 7, 10).
There is no safe level of exposure to secondhand smoke. Even low levels of secondhand smoke can be harmful.
How can you protect yourself and your family from secondhand smoke?
The only way to fully protect nonsmokers from secondhand smoke is to eliminate smoking in indoor workplaces and public places and by creating smokefree policies for personal spaces, including multiunit residential housing. Opening windows, using fans and ventilation systems, and restricting smoking to certain rooms in the home or to certain times of the day does not eliminate exposure to secondhand smoke (3, 4).
Steps you can take to protect yourself and your family include:
not allowing smoking in your home
not allowing anyone to smoke in your car, even with the windows down
making sure the places where your children are cared for are tobacco free
teaching children to avoid secondhand smoke
seeking out restaurants, bars, and other places that are smokefree (if your state still allows smoking in public areas)
protecting your family from secondhand smoke and being a good role model by not smoking or using any other type of tobacco product. For help to quit see smokefree.gov or call 1-877-44U-QUIT.
Do electronic cigarettes emit secondhand smoke?
Electronic cigarettes (also called e-cigarettes, vape pens, vapes, and pod mods) are battery-powered devices designed to heat a liquid, which typically contains nicotine, into an aerosol for inhalation by a user. Following inhalation, the user exhales the aerosol (12).
The use of electronic cigarettes results in exposure to secondhand aerosols (rather than secondhand smoke). Secondhand aerosols contain harmful and potentially harmful substances, including nicotine, heavy metals like lead, volatile organic compounds, and cancer-causing agents. More information about these devices is available on CDC’s Electronic Cigarettes page.
What is being done to reduce nonsmokers’ exposure to secondhand smoke?
On the federal level, several policies restricting smoking in public places have been implemented. Federal law prohibits smoking on airline flights, interstate buses, and most trains. Smoking is also prohibited in most federal buildings by Executive Order 13058 of 1997. The Pro-Children Act of 1994 prohibits smoking in facilities that routinely provide federally funded services to children. The Department of Housing and Urban Development published a final rule in December 2016, which was fully implemented in July 2018, that prohibits the use of cigarettes, cigars, pipes, and hookah (waterpipes) in public housing authorities, including all living units, indoor common areas, and administrative offices, as well as outdoor areas within 25 feet of buildings.
Many state and local governments have enacted laws that prohibit smoking in workplaces and public places, including restaurants, bars, schools, hospitals, airports, bus terminals, parks, and beaches. These smokefree policies have substantially decreased exposure to secondhand smoke in many U.S. workplaces (13). More than half of all states have implemented comprehensive smokefree laws that prohibit smoking in indoor areas of workplaces, restaurants, and bars, and some states and communities also have enacted laws regulating smoking in multi-unit housing and cars (14). The American Nonsmokers’ Rights Foundation provides a list of state and local smokefree air policies.
To highlight the health risks from secondhand smoke, the National Cancer Institute requires that meetings and conferences organized or primarily sponsored by NCI be held in a state, county, city, or town that has adopted a comprehensive smokefree policy, unless specific circumstances justify an exception to this policy.
Healthy People 2020, a comprehensive nationwide health promotion and disease prevention framework established by the U.S. Department of Health and Human Services (HHS), includes several objectives addressing the goal of reducing illness, disability, and death caused by tobacco use and secondhand smoke exposure. For 2020, the Healthy People goal is to reduce the proportion of nonsmokers exposed to secondhand smoke by 10%. To assist with achieving this goal, Healthy People 2020 includes ideas for community interventions, such as encouraging the introduction of smokefree policies in all workplaces and other public gathering places, such as public parks, sporting arenas, and beaches.
Because of these policies and other actions, the percentage of nonsmokers who are exposed to secondhand smoke declined from 52.5% during 1999–2000 to 25.3% during 2011–2014 (15). Exposure to secondhand smoke declined among all population subgroups, but disparities still exist. During 2011–2014, 38% of children ages 3–11 years, 50% of non-Hispanic blacks, 48% of people living below the poverty level, and 39% of people living in rental housing were exposed to secondhand smoke (15).
Cancerprevention is action taken to lower the chance of getting cancer. By preventing cancer, the number of new cases of cancer in a group or population is lowered. Hopefully, this will lower the number of deaths caused by cancer.
To prevent new cancers from starting, scientists look at risk factors and protective factors. Anything that increases your chance of developing cancer is called a cancer risk factor; anything that decreases your chance of developing cancer is called a cancer protective factor.
Some risk factors for cancer can be avoided, but many cannot. For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided. Regular exercise and a healthy diet may be protective factors for some types of cancer. Avoiding risk factors and increasing protective factors may lower your risk but it does not mean that you will not get cancer.
General Information About Tobacco Use
Key Points
Smoking is the leading cause of cancer in the United States.
Smoking causes many other health problems.
Being exposed to secondhand smoke increases the risk of cancer and other diseases.
Smoking is the leading cause of cancer in the United States.
Smoking increases the risk of many types of cancer. These include:
A smoker’s risk of cancer can be 2 to 10 times higher than it is for a person who never smoked. This depends on how much and how long the person smoked.
Lung cancer is the leading cause of cancer death in both men and women. In 2014, about 19% of adult men and about 15% of adult women were smokers. In the last 30 years, the total number of smokers has decreased, especially among men. Since the 1980s, deaths caused by lung cancer in men have been decreasing.
From 2011 to 2014, smoking decreased among middle school and high school students. Cigarette smoking among male and female high school students of all ethnic groups increased markedly during the early 1990s, with rates between 20% and 30%. By 2021, smoking in this population had declined to 2%. Raising the legal age to buy and use tobacco products is being studied as a way to prevent or decrease smoking and other tobacco use among young people.
Smoking causes many other health problems.
Smoking is linked with many diseases besides cancer. These include:
Smoking during pregnancy may cause problems such as slow growth of the fetus and low birth weight.
Being exposed to secondhand smoke increases the risk of cancer and other diseases.
Smoking can also affect the health of nonsmokers. Smoke that comes from the burning of a tobacco product or smoke that is exhaled by smokers is called secondhand smoke. Inhaling secondhand smoke is called involuntary or passive smoking.
The same cancer-causing chemicals inhaled by tobacco smokers are inhaled in lower amounts by people exposed to secondhand tobacco smoke. Nonsmokers who are exposed to secondhand smoke have a higher risk of lung cancer and coronary heart disease. Children exposed to tobacco smoke have higher risks of the following:
Respiratory problems such as lung infections, coughing, wheezing, or trouble breathing.
Health Risks of Smoking and Ways to Quit
Key Points
Quitting smoking improves health in smokers of all ages.
Different ways to quit smoking have been studied. The following are the most common methods used to help smokers quit:
Counseling
Drug treatment
Smoking reduction
There are new and different types of tobacco and nicotine products.
Cancer prevention clinical trials are used to study ways to prevent cancer.
New ways to help smokers quit are being studied in clinical trials.
Quitting smoking improves health in smokers of all ages.
The risk of most health problems from smoking, including cancer and heart and lung disease, can be lowered by stopping smoking. People of all ages can improve their health if they quit smoking. Quitting at a younger age will improve a person’s health even more. People who quit smoking cut their risk of lung cancer by 30% to 50% after 10 years compared to people who keep smoking, and they cut their risk of cancer of the mouth or esophagus in half within 5 years after quitting.
The damage caused by smoking is even worse for people who have had cancer. They have an increased risk of cancer recurrence, new cancers, and long-term side effects from cancer treatment. Quitting smoking and stopping other unhealthy behaviors can improve long-term health and quality of life.
The Public Health Service has a set of guidelines called Treating Tobacco Use and Dependence. It asks health care professionals to talk to their patients about the health problems caused by smoking and the importance of quitting smoking.
Different ways to quit smoking have been studied. The following are the most common methods used to help smokers quit:
Counseling
People who have even a short counseling session with a health care professional are more likely to quit smoking. Your doctor or other health care professional may take the following steps to help you quit:
The Lung Health Study found that heavy smokers who received counseling from a doctor, took part in group sessions with other smokers to change their behavior, and used nicotine gum were more likely to quit smoking compared with smokers who did not receive counseling from a doctor, take part in group sessions, and use nicotine gum. They also had a lower risk of lung cancer, other cancers, heart disease, and respiratory disease.
Childhood cancersurvivors who smoke may be more likely to quit when they take part in programs that use peer-counseling. In these programs, childhood cancer survivors are trained in ways to give support to other childhood cancer survivors who smoke and want to quit. More people quit smoking with peer-counseling than with self-help programs. If you are a childhood cancer survivor and you smoke, talk to your doctor about peer-counseling programs.
Drug treatment
Treatment with drugs is also used to help people quit smoking. These include nicotine replacement products and non-nicotine medicines. People who use any type of drug treatment are more likely to quit smoking after 6 months than those who use a placebo or no drug treatment at all.
Nicotine replacement products have nicotine in them. You slowly reduce the use of the nicotine product in order to reduce the amount of nicotine you take in. Using a nicotine replacement product can help break the addiction to nicotine. It lessens the side effects of nicotine withdrawal, such as feeling depressed or nervous, having trouble thinking clearly, or having trouble sleeping. Nicotine replacement products, used alone or in combination, have been shown to help people quit smoking. These include:
Varenicline may also cause serious heart problems.
Before starting to take bupropion or varenicline, talk to your doctor about the important health benefits of quitting smoking and the small but serious risk of problems with the use of these drugs.
Smoking reduction
When smokers do not quit smoking completely but smoke fewer cigarettes (smoking reduction) they may still benefit. The more you smoke, the higher your risk of lung cancer and other cancers related to smoking. Studies show that smokers who cut back are more likely to stop smoking in the future.
Smoking less is not as helpful as quitting smoking altogether, and is harmful if you inhale more deeply or smoke more of each cigarette to try to control nicotine cravings. In smokers who do not plan to quit smoking completely, nicotine replacement products have been shown to help them cut down the number of cigarettes they smoke, but this effect does not appear to last over time.
The following resources can help you quit smoking:
Consumer information about quitting smoking is available at the www.smokefree.gov website.
The online QuitGuide may help you understand reasons for smoking and the best ways to quit.
The booklet Clearing the Air: Quit Smoking Today can be ordered at 1-800-4-CANCER (1-800-422-6237) or printed here.
There are new and different types of tobacco and nicotine products.
The use of new or different types of tobacco products and devices that deliver nicotine is increasing rapidly in the United States, especially the use of electronic-cigarettes (e-cigarettes) by adults and adolescents.
Examples of new and different tobacco and nicotine products and devices include the following:
More studies are needed to understand the risks and benefits of using these products.
Cancer prevention clinical trials are used to study ways to prevent cancer.
Cancer preventionclinical trials are used to study ways to lower the risk of developing certain types of cancer. Some cancer prevention trials are conducted with healthy people who have not had cancer but who have an increased risk for cancer. Other prevention trials are conducted with people who have had cancer and are trying to prevent another cancer of the same type or to lower their chance of developing a new type of cancer. Other trials are done with healthy volunteers who are not known to have any risk factors for cancer.
The purpose of some cancer prevention clinical trials is to find out whether actions people take can prevent cancer. These may include eating fruits and vegetables, exercising, quitting smoking, or taking certain medicines, vitamins, minerals, or food supplements.
New ways to help smokers quit are being studied in clinical trials.
Physician Data Query (PDQ) is the National Cancer Institute’s (NCI’s) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.
PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government’s center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.
Purpose of This Summary
This PDQ cancer information summary has current information about the prevention and cessation of cigarette smoking and the control of tobacco use. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
Reviewers and Updates
Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary (“Updated”) is the date of the most recent change.
The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Screening and Prevention Editorial Board.
Clinical Trial Information
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become “standard.” Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Clinical trials can be found online at NCI’s website. For more information, call the Cancer Information Service (CIS), NCI’s contact center, at 1-800-4-CANCER (1-800-422-6237).
Permission to Use This Summary
PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks in the following way: [include excerpt from the summary].”
The best way to cite this PDQ summary is:
PDQ® Screening and Prevention Editorial Board. PDQ Cigarette Smoking. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: /causes-prevention/risk/tobacco/quit-smoking-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389305]
Images in this summary are used with permission of the author(s), artist, and/or publisher for use in the PDQ summaries only. If you want to use an image from a PDQ summary and you are not using the whole summary, you must get permission from the owner. It cannot be given by the National Cancer Institute. Information about using the images in this summary, along with many other images related to cancer can be found in Visuals Online. Visuals Online is a collection of more than 3,000 scientific images.
Disclaimer
The information in these summaries should not be used to make decisions about insurance reimbursement. More information on insurance coverage is available on Cancer.gov on the Managing Cancer Care page.
Contact Us
More information about contacting us or receiving help with the Cancer.gov website can be found on our Contact Us for Help page. Questions can also be submitted to Cancer.gov through the website’s E-mail Us.
Tobacco manufacturers have been redesigning cigarettes since the 1950s. Certain redesigned cigarettes with the following features were marketed as “light” cigarettes:
Cellulose acetate filters (to trap tar).
Highly porous cigarette paper (to allow toxic chemicals to escape).
Ventilation holes in the filter tip (to dilute smoke with air).
Different blends of tobacco.
When analyzed by a smoking machine, the smoke from a so-called light cigarette has a lower yield of tar than the smoke from a regular cigarette. However, a machine cannot predict how much tar a smoker inhales. Also, studies have shown that changes in cigarette design have not lowered the risk of disease caused by cigarettes (1).
On June 22, 2009, President Barack Obama signed into law the Family Smoking Prevention and Tobacco Control Act, which granted the U.S. Food and Drug Administration the authority to regulate tobacco products. One provision of the new law bans tobacco manufacturers from using the terms “light,” “low,” and “mild” in product labeling and advertisements. This provision went into effect on June 22, 2010. However, some tobacco manufacturers are using color-coded packaging (such as gold or silver packaging) on previously marketed products and selling them to consumers who may continue to believe that these cigarettes are not as harmful as other cigarettes (2–4).
Are light cigarettes less hazardous than regular cigarettes?
No. Many smokers chose so-called low-tar, mild, light, or ultralight cigarettes because they thought these cigarettes would expose them to less tar and would be less harmful to their health than regular or full-flavor cigarettes. However, light cigarettes are no safer than regular cigarettes. Tar exposure from a light cigarette can be just as high as that from a regular cigarette if the smoker takes long, deep, or frequent puffs. The bottom line is that light cigarettes do not reduce the health risks of smoking.
Moreover, there is no such thing as a safe cigarette. The only guaranteed way to reduce the risk to your health, as well as the risk to others, is to stop smoking completely.
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 quit. For help with quitting, refer to the National Cancer Institute (NCI) fact sheet Where To Get Help When You Decide To Quit Smoking.
Do light cigarettes cause cancer?
Yes. People who smoke any kind of cigarette are at much greater risk of lung cancer than people who do not smoke (5). Smoking harms nearly every organ of the body and diminishes a person’s overall health.
People who switched to light cigarettes from regular cigarettes are likely to have inhaled the same amount of toxic chemicals, and they remain at high risk of developing smoking-related cancers and other disease (1). Smoking causes cancers of the lung, esophagus, larynx (voice box), mouth, throat, kidney, bladder, pancreas, stomach, and cervix, as well as acute myeloid leukemia (6).
Regardless of their age, smokers can substantially reduce their risk of disease, including cancer, by quitting.
What were the tar yield ratings used by the tobacco industry for light cigarettes?
Although no Federal agency formally defined the range of tar yield for light or ultralight cigarettes, the tobacco industry used the ranges shown in the table below (5, 7).
These ratings were not an accurate indicator of how much tar a smoker might have been exposed to, because people do not smoke cigarettes the same way the machines do and no two people smoke the same way.
Ultralight and light cigarettes are no safer than full-flavor cigarettes. There is no such thing as a safe cigarette (1).
Are machine-measured tar yields misleading?
Yes. The ratings cannot be used to predict how much tar a smoker will actually get because the way the machine smokes a cigarette is not the way a person smokes a cigarette. A rating of 7 milligrams does not mean that you will get only 7 milligrams of tar. You can get just as much tar from a light cigarette as from a full-flavor cigarette. It all depends on how you smoke. Taking deeper, longer, and more frequent puffs will lead to greater tar exposure. Also, a smoker’s lips or fingers may block the air ventilation holes in the filter, leading to greater tar exposure (7).
Why would someone smoking a light cigarette take bigger puffs than with a regular cigarette?
Cigarette features that reduce the yield of machine-measured tar also reduce the yield of nicotine. Because smokers crave nicotine, they may inhale more deeply; take larger, more rapid, or more frequent puffs; or smoke extra cigarettes each day to get enough nicotine to satisfy their craving. As a result, smokers end up inhaling more tar, nicotine, and other harmful chemicals than the machine-based numbers suggest (1).
Tobacco industry documents show that companies were aware that smokers of light cigarettes compensated by taking bigger puffs. Industry documents also show that the companies were aware of the difference between machine-measured yields of tar and nicotine and what the smoker actually inhaled (8).
How can I get help to quit smoking?
There are many groups that can help smokers quit:
Go online to Smokefree.gov (http://www.smokefree.gov), a webcreated by NCI’s Tobacco Control Research Branch, and use the Step-by-Step Quit Guide.
Call NCI’s Smoking Quitline at 1–877–44U–QUIT (1–877–448–7848) for individualized counseling, printed information, and referrals to other sources.
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.
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).
Does smokeless tobacco cause cancer?
Yes. Smokeless tobacco causes oral cancer, esophageal cancer, and pancreatic cancer (1).
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).
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).
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).
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.
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 LiveHelponline 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.
Handling Nicotine Withdrawal and Triggers When You Decide To Quit Tobacco
What are some of the nicotine withdrawal symptoms associated with quitting tobacco?
Because the nicotine in tobacco is highly addictive, people who quit may experience nicotine withdrawal symptoms, especially if they have smoked or used other tobacco products heavily for many years. Although many of the examples in this fact sheet refer to smoking, the tips are relevant for those who are quitting the use of any tobacco product.
Other, less common nicotine withdrawal symptoms include headaches, fatigue, dizziness, coughing, mouth ulcers, and constipation (1, 2).
The good news is that there is much you can do to reduce nicotine cravings and manage common withdrawal symptoms. Also, it may help to know that nicotine withdrawal symptoms do subside over time. They are usually worst during the first week after quitting, peaking during the first 3 days. From that point on, the intensity of symptoms usually drops over the first month. However, everyone is different, and some people have withdrawal symptoms for several months after quitting (3, 4).
What can I do about nicotine cravings after I quit?
People who use tobacco products get used to having a certain level of nicotine in their body. After you quit, cravings develop when your body wants nicotine. This may occur long after your body is no longer addicted to nicotine. In addition to this physical craving, you may experience a psychological craving to use a tobacco product when you see people smoking or are around other triggers. Your mood may change when you have cravings, and your heart rate and blood pressure may go up.
The urge to smoke will come and go. You may start experiencing cravings within an hour or two after your last use of tobacco, and you may have them frequently for the next few days or weeks. As time passes, the cravings will get farther apart. However, you may have occasional mild cravings months or years after you quit.
Here are some tips for managing cravings:
Try nicotine replacement products or ask your doctor about other medications.
As a substitute for smoking, try chewing on carrots, pickles, apples, celery, sugarless gum, or hard candy. Keeping your mouth busy may stop the psychological need to smoke.
Try this exercise: Take a deep breath through your nose and blow out slowly through your mouth. Repeat 10 times.
What can I do about anger, frustration, and irritability after I quit?
After you quit smoking or using other tobacco products, you may feel edgy and short-tempered, and you may want to give up on tasks more quickly than usual. You may be less tolerant of others and get into more arguments.
Studies have found that the most common negative feelings associated with quitting are feelings of anger, frustration, and irritability. These negative feelings peak within 1 week of quitting and may last 2 to 4 weeks (1).
Here are some tips for managing these negative feelings:
Remind yourself that these feelings are temporary.
Engage in an enjoyable physical activity, such as taking a walk.
Reduce caffeine by limiting or avoiding coffee, soda, and tea.
Try meditation or other relaxation techniques, such as getting a massage, soaking in a hot bath, or breathing deeply through your nose and out through your mouth for 10 breaths.
Within 24 hours of quitting smoking or other tobacco products, you may feel tense and agitated. You may feel a tightness in your muscles—especially around the neck and shoulders. Studies have found that anxiety is one of the most common negative feelings associated with quitting. If anxiety occurs, it usually builds over the first 3 days after quitting and may last several weeks (1).
Here are some tips for managing anxiety:
Remind yourself that anxiety will pass with time.
Set aside some quiet time every morning and evening—a time when you can be alone in a quiet environment.
Engage in an enjoyable physical activity, such as taking a walk.
Reduce caffeine by limiting or avoiding coffee, soda, and tea.
Try meditation or other relaxation techniques, such as getting a massage, soaking in a hot bath, or breathing deeply through your nose and out through your mouth for 10 breaths.
It is common to feel sad for a period of time soon after you quit smoking or using other tobacco products. If mild depression occurs, it will usually begin within the first day, continue for a couple of weeks, and go away within a month.
People who have a history of depression often have more-severe withdrawal symptoms, including more-severe depression. Some studies have found that many people with a history of major depression will have a new major depressive episode after quitting (5, 6). However, in those with no history of depression, major depression after quitting is rare.
Many former smokers and people who are quitting have a strong urge to smoke when they feel depressed. Here are some tips for managing feelings of depression:
Get together with a friend.
Identify your specific feelings at the time that you seem depressed. Are you actually feeling tired, lonely, bored, or hungry? Focus on and address these specific needs.
Participate in physical activities that you find enjoyable. This will help to improve your mood, decrease your fatigue, and reduce your depression.
Breathe deeply.
Make a list of things that are upsetting to you and write down solutions for them.
Ask your doctor about prescription medications that may help you with depression. Studies show that bupropion and nortriptyline can help people with a past history of depression who try to quit smoking. Nicotine replacement products may also help (7).
Learn about the signs of depression and where to go for help at the National Institute of Mental Health’s page on depression.
What can I do about weight gain after I quit?
People who quit may gain weight due to increased appetite. Although the weight gain is usually less than 10 pounds, it can be troublesome for some people (8, 9). However, the health benefits of quitting far outweigh the health risks of a small amount of extra weight.
Here are some tips for managing weight gain after quitting:
Balance your physical activity with your calorie intake. This will help you achieve and maintain a desired weight.
Ask your doctor about the medication bupropion. Studies show that it helps counteract weight gain (7).
Although the prospect of weight gain may be unwelcome, it is important to remember that quitting smoking is one of the most important things you can do to improve your health overall. Do not let fear of gaining weight discourage you from quitting.
What are some of the triggers for tobacco use?
Reminders in your daily life of situations when you used to use tobacco products may trigger your desire to do so again.
Triggers may include:
social triggers, such as being around others who use tobacco or in a social gathering or event
emotional triggers, such as feeling stressed or anxious; bored, lonely, sad, or frustrated or upset after an argument; or happy, excited, or relieved
pattern or activity triggers, such as starting the day, being in a car, drinking coffee or tea, enjoying a meal or an alcoholic beverage
Knowing your triggers for using tobacco helps you stay in control because you can choose to avoid those triggers or keep your mind distracted and busy when you cannot avoid them. More specific information on different types of triggers is on Smokefree.gov.
How can I resist the urge to smoke when I’m around smokers?
You may want to analyze situations in which watching others smoke triggers an urge in you to smoke. Figure out what it is about those situations that makes you want to smoke. Is it because you associate feeling happy with being around other smokers? Or is there something special about the situations, such as being around the people you usually smoked with? Is it tempting to join others for routine smoke breaks?
Here are some tips:
Limit your contact with smokers, especially in the early weeks of quitting.
Do not buy, carry, light, or hold cigarettes for others.
If you are in a group and others light up, excuse yourself and don’t return until they have finished.
Do not let people smoke in your home. Post a “No Smoking” sign by your front door.
Ask others to help you stay quit. Give them specific examples of things that are helpful (such as not smoking around you) and things that are not helpful (like asking you to buy cigarettes for them).
Focus on what you’ve gained by quitting. For example, think of how healthy you will be when all smoking effects are gone from your body and you can call yourself smokefree. Also, add up how much money you have saved already by not purchasing cigarettes and imagine (in detail) how you will spend your savings in 6 months.
How can I resist the urge to smoke if I live with a smoker?
Living with someone who smokes can present additional challenges for a person who wants to quit. Here are some tips for people in such a situation:
Make your home a no-smoking environment. Remove all cigarettes, ashtrays, and lighters and don’t allow friends or family to smoke anywhere inside your home.
If the smokers you live with will not go outside to smoke, consider making one room of the home smokefree so you have a nonsmoking indoor area available to you.
Ask the smokers you live with not to offer you any tobacco products or purchase them for you, even if you ask for them. Enlist their help in keeping you smokefree.
How can I start the day without smoking?
Many smokers light up a cigarette right after they wake up. After 6 to 8 hours of sleep, a smoker’s nicotine level drops and they need a boost of nicotine to start the day. After you quit, you must be ready to overcome the physical need and routine of waking up and smoking a cigarette. Instead of reaching for your cigarettes in the morning, here are some tips:
The morning can set the tone for the rest of the day. Plan a different wake-up routine to divert your attention from smoking.
Be sure no cigarettes are available. Instead, keep sugar-free gum, mints, or nuts in the locations where you previously kept your cigarettes so when you automatically reach for cigarettes a healthy alternative is at hand.
Before you go to sleep, make a list of things you need to avoid in the morning that will make you want to smoke. Place this list where you used to place your cigarettes.
Begin each day with a planned activity that will keep you busy for an hour or more. Keeping your mind and body busy will distract you from thinking about smoking.
Begin each day with deep breathing and by drinking one or more glasses of water.
How can I resist the urge to smoke when I’m feeling stressed?
Most smokers report that one reason they smoke is to handle stress. Smoking cigarettes causes temporary changes in your brain chemistry that can cause you to experience decreased anxiety, enhanced pleasure, and alert relaxation. Once you stop smoking and your brain chemistry returns to normal, you may become more aware of stress.
Everyday worries, responsibilities, and annoyances can all contribute to stress. As you go longer without smoking, you will get better at handling stress, especially if you learn stress reduction and relaxation techniques.
Here are some tips:
Know the causes of stress in your life (your job, traffic, your children, money) and identify the stress signals (headaches, nervousness, or trouble sleeping). Once you pinpoint high-risk trigger situations, you can start to develop new ways to handle them.
Create peaceful times in your schedule. For example, set aside an hour where you can get away from other people and your usual environment. Or try visualizing yourself in a peaceful setting.
Try relaxation techniques, such as progressive muscle relaxation or yoga, and stick with the one that works best for you.
Try this breathing exercise: Take a deep breath through your nose and blow out slowly through your mouth. Repeat 10 times.
Try meditation involving focused breathing or repetition of words or phrases to quiet your mind.
Rehearse and visualize your relaxation plan. Put your plan into action. Change your plan as needed.
You may find it helpful to read a book about how to handle stress.
How can I resist the urge to smoke when I’m driving or riding in a car?
You may have become used to smoking while driving—to relax in a traffic jam or to stay alert on a long drive. Like many smokers, you may like to light up when driving to and from work to relieve stress, stay alert, relax, or just pass the time.
Tips for short trips:
Remove the ashtray, lighter, and cigarettes from your car.
Keep healthy substitutions, such as sugar-free gum, mints, or nuts, in your car.
Turn on your favorite music and sing along.
Take an alternate route to work or try carpooling.
Clean your car and use deodorizers to reduce the tobacco smell.
Tell yourself:
“This urge will go away in a few minutes.”
“So, I’m not enjoying this car ride. Big deal! It won’t last forever!”
“My car smells clean and fresh!”
“I’m a better driver now that I’m not smoking while driving.”
When you are driving or riding with other people:
Do not allow passengers to smoke in your car.
If you’re not driving, find something to do with your hands.
Your desire to smoke may be stronger and more frequent on longer trips. On long trips:
Take stretch breaks.
Take healthy snacks along.
Plan rest stops.
How can I resist the urge to smoke when I’m having coffee or tea?
You may be used to smoking when drinking coffee or tea (for example, during or after meals or during work breaks), and you may associate good feelings with drinking a hot beverage. When you give up smoking, expect to feel a strong urge to reach for a cigarette while drinking coffee or tea. Some people quit drinking coffee or tea temporarily while they’re quitting cigarettes to avoid the urge to smoke. Although you do not have to give up coffee or tea to quit smoking, you should expect that coffee or tea will not taste the same without a cigarette.
Here are some tips:
If you used to smoke while drinking coffee or tea, tell people you have quit, so they won’t offer you a cigarette.
Between sips of coffee or tea, take deep breaths to inhale the aroma. Breathe in deeply and slowly while you count to five, and then breathe out slowly, counting to five again.
Try changing your routine around drinking coffee or tea. For example, try switching what drink you consume or try having your coffee or tea in a different location than when you were smoking to help change the routine.
Keep your hands busy by nibbling on healthy foods, doodling, playing games on your phone, or making a list of tasks for the day.
If the urge to smoke is very strong, drink your coffee or tea more quickly than usual and then change activities or rooms.
When you quit smoking, drinking coffee or tea without smoking may make you feel sad. Focus on what you’ve gained by quitting.
How can I resist the urge to smoke when I’m enjoying a meal?
Food often tastes better after you quit smoking, and you may have a bigger appetite. Expect to want to smoke after meals. Your desire to smoke after meals may depend on whether you are alone, with other smokers, or with nonsmokers.
Your urge to smoke may be stronger with certain foods, such as spicy or sweet foods. Also, the urge to smoke may be stronger at different mealtimes.
Here are some tips:
Know what kinds of foods increase your urge to smoke and stay away from them.
If you are alone, call a friend or take a walk as soon as you’ve finished eating.
Brush your teeth or use mouthwash right after meals.
Wash the dishes by hand after eating—you can’t smoke with wet hands!
How can I resist the urge to smoke when I’m drinking an alcoholic beverage?
You may be used to smoking when drinking beer, wine, liquor, or mixed drinks. When you quit smoking, you may feel a strong urge to smoke when you drink alcohol. Know this up front if you are going to drink because your ability to resist triggers to smoke may be impaired under the influence of alcohol.
Here are some tips for the first few weeks after quitting smoking:
Many people find it helpful to drink less alcohol or avoid it completely.
If you do drink, choose different alcoholic beverages than you used to have when smoking.
Stay away from the places you usually drink alcohol.
How can I resist the urge to smoke when I’m feeling bored?
When you quit smoking, you may miss the increased excitement and good feeling that nicotine gave you. This may be particularly true when you are feeling bored.
Here are some tips:
Plan more activities than you have time for.
Make a list of things to do when confronted with free time.
Move! Do not stay in the same place too long.
If you feel bored when waiting for something or someone (a bus, your friend, your kids), distract yourself with a book, magazine, puzzle, or your phone.
Look at and listen to what is going on around you.
Carry something to keep your hands busy.
Listen to a favorite song.
Go outdoors, if you can, but not to places you associate with smoking.
Do nicotine replacement products relieve nicotine cravings and withdrawal symptoms?
Yes. Nicotine replacement products deliver measured doses of nicotine into the body, which helps to relieve the cravings and withdrawal symptoms often felt by people trying to quit tobacco use. Nicotine replacement products are effective treatments that can increase the likelihood that someone will quit successfully (7, 10).
Five forms of nicotine replacement therapy have been approved by the US Food and Drug Administration (FDA):
The nicotine patch is available over the counter (without a prescription). A new patch is worn on the skin each day, supplying a small but steady amount of nicotine to the body. The nicotine patch is sold in varying strengths, usually as an 8- to 10-week quit-smoking treatment. Typically, the nicotine doses are gradually lowered as treatment progresses. The nicotine patch may not be a good choice for people with skin problems or allergies to adhesive tape. Also, some people experience the side effect of having vivid dreams when they wear the patch at night. These people may decide to wear the patch only during the daytime.
Nicotine gum is available over the counter in two strengths (2 and 4 milligrams). When a person chews nicotine gum and then places the chewed product between the cheek and gum tissue, nicotine is released into the bloodstream through the lining of the mouth. To keep a steady amount of nicotine in the body, a new piece of gum can be chewed every 1 or 2 hours. The 4-milligram dose appears to be more effective among highly dependent smokers (those who smoked 20 or more cigarettes per day) (11, 12). Nicotine gum might not be appropriate for people with temporomandibular joint disease or for those with dentures or other dental work, such as bridges. The gum releases nicotine more effectively when coffee, juice, or other acidic beverages are not consumed at the same time.
The nicotine lozenge is also available over the counter in 2 and 4 milligram strengths. The lozenge is used similarly to nicotine gum; it is placed between the cheek and the gums and allowed to dissolve. Nicotine is released into the bloodstream through the lining of the mouth. The lozenge works best when used every 1 or 2 hours and when coffee, juice, or other acidic beverages are not consumed at the same time.
Nicotine nasal spray is available by prescription only. The spray comes in a pump bottle containing nicotine that tobacco users can inhale when they have an urge to smoke. Nicotine is absorbed more quickly via the spray than with other nicotine replacement products. Nicotine nasal spray is not recommended for people with nasal or sinus conditions, allergies, or asthma or for young tobacco users. Side effects from the spray may include sneezing, coughing, and watering eyes, but these problems usually go away with continued use of the spray.
A nicotine inhaler, also available by prescription only, delivers a vaporized form of nicotine to the mouth through a mouthpiece attached to a plastic cartridge. Even though it is called an inhaler, the device does not deliver nicotine to the lungs the way a cigarette does. Most of the nicotine travels only to the mouth and throat, where it is absorbed through the mucous membranes. Common side effects include throat and mouth irritation and coughing. Anyone with a breathing problem such as asthma should use the nicotine inhaler with caution.
Using a long-acting form of nicotine replacement therapy (like the patch) along with a short-acting form (like the gum or the lozenge) can be especially helpful for managing nicotine withdrawal (10). Nicotine replacement therapy is more effective when combined with advice or counseling from a doctor, dentist, pharmacist, or other health care provider.
Are nicotine replacement products safe?
It is far less harmful for a person to get nicotine from a nicotine replacement product than from cigarettes because tobacco smoke contains many toxic and cancer-causing substances. Long-term use of nicotine replacement products has not been associated with any serious harmful effects (12). However, nicotine replacement products are not recommended for use by people who are pregnant or trying to become pregnant.
Are there products to help people quit that do not contain nicotine?
Yes, two medicines that help people quit but do not contain nicotine are available by prescription:
Varenicline, a prescription medicine marketed as Chantix, was approved by FDA in 2006 to help cigarette smokers stop smoking. This drug may help those who wish to quit by easing their nicotine cravings and by blocking the pleasurable effects of nicotine if they do resume smoking. Several side effects are associated with this product. Discuss with your doctor if this medicine is right for you.
Bupropion, a prescription antidepressant, was approved by FDA in 1997 to treat nicotine addiction (under the trade name Zyban). This drug can help reduce nicotine withdrawal symptoms and the urge to smoke and can be used safely with nicotine replacement products. Several side effects are associated with this product. Discuss with your doctor if this medicine is right for you.
Are there alternative methods to help people deal with nicotine withdrawal?
Some people claim that alternative approaches such as hypnosis, acupuncture, acupressure, laser therapy (laser stimulation of acupuncture points on the body), or electrostimulation may help reduce the symptoms associated with nicotine withdrawal. However, in clinical studies these alternative therapies have not been found to help people quit using tobacco (13). There is no evidence that these alternative approaches help tobacco users who are trying to quit.
Can e-cigarettes help people quit?
The evidence to date is inconclusive about whether e-cigarettes can help with smoking cessation (10). In addition, FDA has not approved any e-cigarette as a smoking cessation therapy. Currently, people who smoke are advised to use evidence-based quit strategies, including FDA-approved cessation medication and smoking cessation counseling.
How can I get help if I’m having trouble dealing with nicotine withdrawal or triggers?
NCI can help smokers deal with nicotine withdrawal:
What are some of the health problems caused by cigarette smoking?
Smoking is the leading cause of premature, preventable death in this country. Cigarette smoking and exposure to tobacco smoke cause about 480,000 premature deaths each year in the United States (1). Of those premature deaths, about 36% are from cancer, 39% are from heart disease and stroke, and 24% are from lung disease (1). Mortality rates among smokers are about three times higher than among people who have never smoked (6, 7).
Smoking harms nearly every bodily organ and organ system in the body and diminishes a person’s overall health. Smoking causes cancers of the lung, esophagus, larynx, mouth, throat, kidney, bladder, liver, pancreas, stomach, cervix, colon, and rectum, as well as acute myeloid leukemia (1–3).
Since the 1960s, a smoker’s risk of developing lung cancer or COPD has actually increased compared with nonsmokers, even though the number of cigarettes consumed per smoker has decreased (1). There have also been changes over time in the type of lung cancer smokers develop – a decline in squamous cell carcinomas but a dramatic increase in adenocarcinomas. Both of these shifts may be due to changes in cigarette design and composition, in how tobacco leaves are cured, and in how deeply smokers inhale cigarette smoke and the toxicants it contains (1, 8).
Smoking makes it harder for a woman to get pregnant. A pregnant smoker is at higher risk of miscarriage, having an ectopic pregnancy, having her baby born too early and with an abnormally low birth weight, and having her baby born with a cleft lip and/or cleft palate (1). A woman who smokes during or after pregnancy increases her infant’s risk of death from Sudden Infant Death Syndrome (SIDS) (2, 3). Men who smoke are at greater risk of erectile dysfunction (1, 9).
The longer a smoker’s duration of smoking, the greater their likelihood of experiencing harm from smoking, including earlier death (7). But regardless of their age, smokers can substantially reduce their risk of disease, including cancer, by quitting.
What are the risks of tobacco smoke to nonsmokers?
Secondhand smoke (also called environmental tobacco smoke, involuntary smoking, and passive smoking) is the combination of “sidestream” smoke (the smoke given off by a burning tobacco product) and “mainstream” smoke (the smoke exhaled by a smoker) (4, 5, 10, 11).
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 classified secondhand smoke as a known human carcinogen (cancer-causing agent) (5, 11, 12). Inhaling secondhand smoke causes lung cancer in nonsmoking adults (1, 2, 4). Approximately 7,300 lung cancer deaths occur each year among adult nonsmokers in the United States as a result of exposure to secondhand smoke (1). The U.S. Surgeon General estimates that living with a smoker increases a nonsmoker’s chances of developing lung cancer by 20 to 30% (4).
Secondhand smoke causes disease and premature death in nonsmoking adults and children (2, 4). Exposure to secondhand smoke irritates the airways and has immediate harmful effects on a person’s heart and blood vessels. It increases the risk of heart disease by an estimated 25 to 30% (4). In the United States, exposure to secondhand smoke is estimated to cause about 34,000 deaths from heart disease each year (1). Exposure to secondhand smoke also increases the risk of stroke by 20 to 30% (1). Pregnant women exposed to secondhand smoke are at increased risk of having a baby with a small reduction in birth weight (1).
Children exposed to secondhand smoke are at an increased risk of SIDS, ear infections, colds, pneumonia, and bronchitis. Secondhand smoke exposure can also increase the frequency and severity of asthma symptoms among children who have asthma. Being exposed to secondhand smoke slows the growth of children’s lungs and can cause them to cough, wheeze, and feel breathless (2, 4).
Is smoking addictive?
Smoking is highly addictive. Nicotine is the drug primarily responsible for a person’s addiction to tobacco products, including cigarettes. The addiction to cigarettes and other tobacco products that nicotine causes is similar to the addiction produced by using drugs such as heroin and cocaine (13). Nicotine is present naturally in the tobacco plant. But tobacco companies intentionally design cigarettes to have enough nicotine to create and sustain addiction.
The amount of nicotine that gets into the body is determined by the way a person smokes a tobacco product and by the nicotine content and design of the product. Nicotine is absorbed into the bloodstream through the lining of the mouth and the lungs and travels to the brain in a matter of seconds. Taking more frequent and deeper puffs of tobacco smoke increases the amount of nicotine absorbed by the body.
Are other tobacco products, such as smokeless tobacco or pipe tobacco, harmful and addictive?
Yes. All forms of tobacco are harmful and addictive (4, 11). There is no safe tobacco product.
Smokeless tobacco: Smokeless tobacco is a type of tobacco that is not burned. It includes chewing tobacco, oral tobacco, spit or spitting tobacco, dip, chew, snus, dissolvable tobacco, and snuff. Smokeless tobacco causes oral (mouth, tongue, cheek and gum), esophageal, and pancreatic cancers and may also cause gum and heart disease (11, 14).
Cigars: These include premium cigars, little filtered cigars (LFCs), and cigarillos. LFCs resemble cigarettes, but both LFCs and cigarillos may have added flavors to increase appeal to youth and young adults (15, 16). Most cigars are composed primarily of a single type of tobacco (air-cured and fermented), and have a tobacco leaf wrapper. Studies have found that cigar smoke contains higher levels of toxic chemicals than cigarette smoke, although unlike cigarette smoke, cigar smoke is often not inhaled (11). 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.
Pipes: In pipe smoking, the tobacco is placed in a bowl that is connected to a stem with a mouthpiece at the other end. The smoke is usually not inhaled. Pipe smoking causes lung cancer and increases the risk of cancers of the mouth, throat, larynx, and esophagus (11, 17, 18).
Hookah or waterpipe (other names include argileh, ghelyoon, hubble bubble, shisha, boory, goza, and narghile): A hookah is a device used to smoke tobacco (often heavily flavored) by passing the smoke through a partially filled water bowl before being inhaled by the smoker. Although some people think hookah smoking is less harmful and addictive than cigarette smoking (19), research shows that hookah smoke is at least as toxic as cigarette smoke (20–22).
Bidis: A bidi is a flavored cigarette made by rolling tobacco in a dried leaf from the tendu tree, which is native to India. Bidi use is associated with heart attacks and cancers of the mouth, throat, larynx, esophagus, and lung (11, 23).
Kreteks: A kretek is a cigarette made with a mixture of tobacco and cloves. Smoking kreteks is associated with lung cancer and other lung diseases (11, 23).
Is it harmful to smoke just a few cigarettes a day?
There is no safe level of smoking. Smoking even just one cigarette per day over a lifetime can cause smoking-related cancers (lung, bladder, and pancreas) and premature death (24, 25).
What are the immediate health benefits of quitting smoking?
The immediate health benefits of quitting smoking are substantial:
Heart rate and blood pressure, which are abnormally high while smoking, begin to return to normal.
Within a few hours, the level of carbon monoxide in the blood begins to decline. (Carbon monoxide reduces the blood’s ability to carry oxygen.)
Within a few weeks, people who quit smoking have improved circulation, produce less phlegm, and don’t cough or wheeze as often.
Within several months of quitting, people can expect substantial improvements in lung function (26).
Within a few years of quitting, people will have lower risks of cancer, heart disease, and other chronic diseases than if they had continued to smoke.
What are the long-term health benefits of quitting smoking?
Quitting smoking reduces the risk of cancer and many other diseases, such as heart disease and COPD, caused by smoking.
Data from the U.S. National Health Interview Survey show that people who quit smoking, regardless of their age, are less likely to die from smoking-related illness than those who continue to smoke. Smokers who quit before age 40 reduce their chance of dying prematurely from smoking-related diseases by about 90%, and those who quit by age 45-54 reduce their chance of dying prematurely by about two-thirds (6).
Regardless of their age, people who quit smoking have substantial gains in life expectancy, compared with those who continue to smoke. Data from the U.S. National Health Interview Survey also show that those who quit between the ages of 25 and 34 years live about 10 years longer; those who quit between ages 35 and 44 live about 9 years longer; those who quit between ages 45 and 54 live about 6 years longer; and those who quit between ages 55 and 64 live about 4 years longer (6).
Also, a study that followed a large group of people age 70 and older (7) found that even smokers who quit smoking in their 60s had a lower risk of mortality during follow-up than smokers who continued smoking.
Does quitting smoking lower the risk of getting and dying from cancer?
Yes. Quitting smoking reduces the risk of developing and dying from cancer and other diseases caused by smoking. Although it is never too late to benefit from quitting, the benefit is greatest among those who quit at a younger age (3).
The risk of premature death and the chances of developing and dying from a smoking-related cancer depend on many factors, including the number of years a person has smoked, the number of cigarettes smoked per day, and the age at which the person began smoking.
Is it important for someone diagnosed with cancer to quit smoking?
Quitting smoking improves the prognosis of cancer patients. For patients with some cancers, quitting smoking at the time of diagnosis may reduce the risk of dying by 30% to 40% (1). For those having surgery, chemotherapy, or other treatments, quitting smoking helps improve the body’s ability to heal and respond to therapy (1, 3, 27). It also lowers the risk of pneumonia and respiratory failure (1, 3, 28). In addition, quitting smoking may lower the risk that the cancer will recur, that a second cancer will develop, or that the person will die from the cancer or other causes (27, 29–32).
Where can I get help to quit smoking?
NCI and other agencies and organizations can help smokers quit:
Which health care professionals can help me quit smoking?
Many health care professionals can be good sources of information about the health risks of smoking and the benefits of quitting. Talk to your doctor, dentist, pharmacist, or other health care provider about the proper use and potential side effects of nicotine replacement products and other medicines. They can also help you find local resources for assistance in quitting smoking. See the fact sheet Handling Nicotine Withdrawal and Triggers When You Decide To Quit Tobacco.
How can I find out about national and local resources to help me quit smoking?
NCI’s Smokefree.gov offers science-driven tools, information, and support that has helped smokers quit. You will find state and national resources, free materials, and quitting advice from NCI.
Smokefree.gov was established by the Tobacco Control Research Branch of NCI, a component of the National Institutes of Health, in collaboration with the Centers for Disease Control and Prevention and other organizations.
Publications available from the Smokefree.gov Web site include the following:
NCI’s Smoking Quitline at 1–877–44U–QUIT (1–877–448–7848) offers a wide range of services, including individualized counseling, printed information, referrals to other resources, and recorded messages. Smoking cessation counselors are available to answer smoking-related questions in English or Spanish, Monday through Friday, 9:00 a.m. to 9:00 p.m., Eastern time. Smoking cessation counselors are also available through LiveHelp, an online instant messaging service. LiveHelp is available Monday through Friday, 9:00 a.m. to 9:00 p.m., Eastern time.
Your state has a toll-free telephone quitline. Call 1–800–QUIT–NOW (1–800–784–8669) to get one-on-one help with quitting, support and coping strategies, and referrals to resources and local cessation programs. The toll-free number routes callers to state-run quitlines, which provide free cessation assistance and resource information to all tobacco users in the United States. This initiative was created by the Department of Health and Human Services. For more information about quitlines, speak to an expert on the Smokefree.gov Web site.
How can I help someone I know quit smoking?
It’s understandable to be concerned about someone you know who currently smokes. It’s important to find out if this person wants to quit smoking. Most smokers say they want to quit. If they don’t want to quit, try to find out why.
Here are some things you can do to help:
Express things in terms of your own concern about the smoker’s health (“I’m worried about…”).
Acknowledge that the smoker may get something out of smoking and may find it difficult to quit.
Be encouraging and express your confidence that the smoker can quit for good.
Suggest a specific action, such as calling a smoking quitline, for help in quitting smoking.
Ask the smoker for ways in which you can provide support.
Here are some things you should not do:
Don’t send quit smoking materials to smokers unless they ask for them.
Don’t blame or criticize the smoker for their addiction to tobacco.
Don’t criticize, nag, or remind the smoker about past failures.
Tobacco use is a leading cause of cancer and of death from cancer. People who use tobacco products or who are regularly around environmental tobacco smoke (also called secondhand smoke) have an increased risk of cancer because tobacco products and secondhand smoke have many chemicals that damage DNA.
Tobacco use causes many types of cancer, including cancer of the lung, larynx (voice box), mouth, esophagus, throat, bladder, kidney, liver, stomach, pancreas, colon and rectum, and cervix, as well as acute myeloid leukemia. People who use smokeless tobacco (snuff or chewing tobacco) have increased risks of cancers of the mouth, esophagus, and pancreas.
There is no safe level of tobacco use. People who use any type of tobacco product are strongly urged to quit. People who quit smoking, regardless of their age, have substantial gains in life expectancy compared with those who continue to smoke. Also, quitting smoking at the time of a cancer diagnosis reduces the risk of death.
For more information about the harms of tobacco use, see:
Also, NCI offers free, confidential information about quitting tobacco by phone and online:
The NCI quitline, 1-877-44U-QUIT (1-877-448-7848), is available Monday through Friday, 9:00 a.m. to 9:00 p.m. ET.
Smoking cessation counselors are available online by clicking the “Quitting Smoking” button in the LiveHelp pop-up, Monday through Friday, 9:00 a.m. to 9:00 p.m. ET.
Taking low-dose aspirin may reduce the risk of colorectal cancer and researchers are studying whether it reduces the risk of other cancers.
Credit: iStock
In the United States, tens of millions of adults take aspirin to reduce their risk of heart attack or stroke. But studies over the last two decades have suggested that regular use of aspirin may have another important benefit: decreasing the risk of developing or dying from some types of cancer.
Results from some of these studies, in fact, formed the basis for guidance released in April 2016 Exit Disclaimer by an influential federal advisory panel on disease prevention. The panel, the U.S. Preventive Services Task Force (USPSTF), recommended that, for some people, aspirin can be used to help reduce their risk of cardiovascular disease and colorectal cancer.
Several researchers who conducted some of the seminal studies on which the USPSTF based its guidance stressed the importance of the panel’s actions.
Writing in Nature Reviews Cancer, Andrew Chan, M.D., of Harvard Medical School, and several colleagues called the recommendation a “crucial first step in realizing a potential broader population-wide impact of aspirin use” for cancer prevention.
UPDATE (August 2020): Findings from a large clinical trial, called ASPREE, suggest that, for adults aged 70 or older, taking low-dose aspirin daily may increase the risk of advanced cancer. Trial participants who took a low-dose aspirin daily were no more likely to be diagnosed with cancer than those who took a placebo. But they did have a moderately higher risk of being diagnosed with advanced cancer and were more likely to die from advanced cancer. Further details are available in thisCancer Currents story.
The USPSTF recommendations are far from sweeping, however. And researchers are continuing to investigate critical questions, including just how aspirin may reduce colorectal cancer risk and what other cancers, if any, regular use of this century-old drug may help to prevent.
The findings from these studies should help to fill an important informational void. At least one study suggests that, even before the USPSTF made its recommendations, Americans were buying in to the idea of aspirin’s anticancer potential; in that 2015 study, 18% of Americans who were taking aspirin regularly said they were doing so to help prevent cancer.
Consistent Data in Colorectal Cancer
The USPSTF’s recommendation on aspirin and colorectal cancer makes sense, said Ernest Hawk, M.D., division head for Cancer Prevention and Population Sciences at the University of Texas MD Anderson Cancer Center.
In published studies looking at aspirin’s protective effect against cancer, the “greatest consistency” has been in colorectal cancer, Dr. Hawk explained.
For example, in the CAPP2 trial, which tested high-dose daily aspirin in individuals with Lynch syndrome—a hereditary condition that greatly increases the risk of colorectal and endometrial cancers as well as several other cancers—participants given aspirin had a 63% reduction in the relative risk of developing colorectal cancer compared with those given a placebo.
But the evidence also extends to those at average colorectal cancer risk as well. Among the most recent examples is an analysis of two large, long-running cohort studies published in June 2016 in JAMA Oncology. The study, led by Dr. Chan at Harvard, linked the use of aspirin for 6 years or longer with a 19% decreased risk of colorectal cancer and a 15% decreased risk of any type of gastrointestinal cancer.
Based on their analysis, the research team estimated that regular aspirin use could prevent nearly 11% of colorectal cancers diagnosed in the United States each year and 8% of gastrointestinal cancers.
“The data for colorectal cancer are really good,” said Theodore Brasky, Ph.D., an epidemiologist at The Ohio State University Comprehensive Cancer Center whose research focuses on anti-inflammatory drugs and cancer risk.
“Certainly the observational data show that aspirin reduces colorectal cancer risk,” Dr. Brasky continued. And several randomized clinical trials have shown that aspirin use “at any dose” can reduce the incidence of any polyps as well as advanced polyps, he said, both of which can be precursors to colorectal cancer.
Aspirin Offers Most Benefit and Lowest Risk
The USPSTF guidance singles out a population group who the data suggest are likely to get a net benefit with the least risk: people 50 to 59 years old who are at increased risk of cardiovascular disease.
The recommendation also advises that potential candidates should have a life expectancy of at least 10 years and not be at increased risk of bleeding (due to other health conditions or the use of other medications)—a known side effect of long-term aspirin use.
A recommendation for a treatment that covers two distinct diseases is unique, acknowledged USPSTF chair Kirsten Bibbins-Domingo, M.D., Ph.D., M.A.S., of the University of California, San Francisco. But there was a specific logic to the task force’s decision.
“We were trying to simulate how a doctor and patient make…decisions” about prevention, she said. “They don’t necessarily make a separate decision for cardiovascular disease and for cancer.”
The task force concluded that it did not have enough evidence to recommend for or against aspirin in those under age 50 or older than age 70 and said that the decision to use aspirin for people aged 60–69 should be an individual one.
The June 2016 Harvard study also revealed another important finding that should help to clarify a point of debate among prevention researchers, Dr. Hawk stressed: In people who had been screened for colorectal cancer, regular aspirin use produced an added reduction in risk.
“We know that with screening by any approach, there is a certain miss rate and an interval cancer rate,” Dr. Hawk said. The latter refers to cancers that are diagnosed in the interval after a normal screening exam and before the next scheduled screening.
The study’s findings, he said, strongly suggest that aspirin may be able to “complement colorectal cancer screening” by decreasing the risk of interval cancers.
Does Aspirin Reduce Risk of Other Cancers?
The jury is still out on whether aspirin has a future as a way to reduce the risk of cancers other than colorectal.
Findings that regular aspirin use is associated with a reduced risk of other cancers “have been hit or miss,” Dr. Hawk said. In the recent Harvard study, for instance, aspirin use was not linked with a reduced risk of the other most common cancers. There was also no overall reduction in cancer risk in the Women’s Health Study—a randomized clinical trial that tested whether every-other-day use of low-dose aspirin could reduce cancer risk in nearly 40,000 women aged 45 and over.
And for colorectal cancer prevention, there is also evidence from clinical trials and laboratory experiments to support its use. But for many other cancers, “there isn’t much supporting experimental data in humans to rely on,” he said.
Many studies of aspirin and cancer risk often have important limitations, Dr. Brasky said, including missing information on critical factors like aspirin dose and duration of use.
They also often lump aspirin together with other nonsteroidal anti-inflammatory drugs, or NSAIDs, like naproxen, ibuprofen, and celecoxib (Celebrex®), which have also been studied for their potential effects on colorectal cancer risk.
“These are different medicines, different chemicals,” he said. “They have other effects that aren’t well studied.”
So while all of these drugs are part of the NSAID family and have anti-inflammatory effects, when it comes to their effect on cancer risk, he continued, “I’m not convinced, necessarily, that it’s wise to study them as a single class of drugs.”
Aspirin Efficiency May Depend on Cancer Type and Biology
Another wrinkle to consider is that aspirin’s protective effects against cancer may depend as much on biological factors as on cancer type. Some studies, for example, have suggested that NSAIDs like aspirin may not be as effective at preventing cancer in women as in men.
Other studies have identified other factors that may predict who is likely to benefit, factors that hint at the molecular mechanisms by which aspirin may exert its anticancer effects. Much of this work has focused on aspirin’s inhibition of the COX-1 and COX-2 enzymes.
COX-1 and COX-2 are critical components of the body’s inflammatory response. Prolonged inflammation can promote changes in cells that can cause them to become malignant. This appears to be particularly true in colorectal cancer, where inflammation can promote changes in the cells that line the lower gastrointestinal tract, leading to the formation of precancerous growths.
These studies have allowed researchers to home in on key players in this inflammatory cascade, changes which may be markers of cancer risk.
For example, a series of studies from researchers at Harvard and Dana-Farber Cancer Institute—using the same large cohorts as the June 2016 JAMA Oncology study—have pointed to specific biological factors that may influence its preventive potential.
One of their earlier studies, for example, showed that aspirin use appeared to only reduce the risk of colorectal cancers that produced large amounts of COX-2. More recent studies have zeroed in on other components of the COX-2 pathway, including one study that showed that aspirin reduced colorectal cancer risk only in people whose colonic mucosa—the cell layer that lines the colon—overexpressed the gene 15-PGDH, which encodes for an enzyme that disrupts COX-2 activity.
Although these potential biomarkers have not been validated, they start to show how, eventually, decisions about the use of aspirin to reduce cancer risk may potentially be tailored to individual patients, Dr. Brasky noted.
Clinical Trials: Identifying Side Effects, Hastening Translation
Researchers are continuing to investigate aspirin’s potential role in cancer prevention. That research should help to better clarify who might benefit from aspirin, Dr. Bibbins-Domingo said.
“Especially in an environment where we know there can be real harms [of long-term aspirin use], we have to have the best possible information to make sure we know its benefits definitely outweigh its harms,” she said.
Randomized clinical trials can help validate what’s been seen in observational studies and provide “a more complete picture of what’s going on” in people taking aspirin long term, he explained. That includes identifying potential safety concerns that aren’t always apparent in observational studies.
Dr. Umar cited the experience with celecoxib. Evidence of adverse cardiac effects from regular long-term treatment with this drug only emerged when it was tested in large trials with longer patient follow-up, including the NCI-funded Adenoma Prevention with Celecoxib trial.
The chief concern with aspirin is gastrointestinal bleeding. The available data from clinical trials on longer-term aspirin use, however, suggests that this risk may be modest.
In the eight trials included in an influential 2011 meta-analysis which found that regular aspirin use reduced the risk of dying from cancer, for example, there were more fatal bleeding events among participants who took a placebo than among those who took aspirin, although aspirin did increase the risk of nonfatal bleeding.
And in the CAPP2 trial, the number of cases of gastrointestinal bleeding in the aspirin group and placebo groups were very similar.
That doesn’t mean that people using aspirin or their physicians shouldn’t be worried about bleeding.
“The population that primarily develops cancer, people over age 50, also have a greater risk of bleeding” by virtue of their age, Dr. Hawk said. “So we always have to be concerned about that.”
To better answer questions about safety and who is most likely to benefit from aspirin, researchers are awaiting the results of several ongoing clinical trials that are testing aspirin either to reduce the risk of cancer or as an adjuvant therapy to reduce the risk of an already treated cancer from returning.
Included among them are: CAPP3, a follow-on study from CAPP2 that is testing three different aspirin doses in patients with Lynch syndrome; ASPREE, which is testing whether low-dose aspirin can reduce the risk of cancer, heart attack, stroke, or dementia in people aged 65 and older; and Add-Aspirin, which is examining two different doses of aspirin as an adjuvant treatment for people who have undergone surgery for early-stage breast, colorectal, prostate, or esophageal cancer.
These long-term studies, Dr. Umar stressed, “are needed to answer many important questions.”
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