Pipe Smoking

Albert Einstein once remarked that pipe smoking "contributed to a somewhat calm and objective judgment in all human affairs." Whether the observation is true or not, pipe smoking has had many other famous devotees, among them Franklin D. Roosevelt, Mark Twain, and the fictional Sherlock Homes, who often disappeared into a haze of pipe smoke while solving his cases.

Today, pipes are still a symbol of leisurely sophistication. The lengthy rituals of pipe smoking add to that aura: choosing from a variety of pipes and tobaccos, cleaning and loading the briar, puffing and tamping, then sitting in a fragrant swirl of smoke and contemplating life.

Michael Thun, MD, vice president of epidemiology and surveillance for the American Cancer Society, knows the ritual well. He used to be a pipe smoker -- but he found good reason to quit. "Tobacco is highly addictive and remarkably destructive, however you use it," Thun says. In other words, it's doesn't matter if you smoke tobacco or puff it in a pipe: it's a potent cause of cancer and other diseases.

Decades ago, doctors began to notice high rates of tongue cancer in pipe smokers. Since then, pipe smoking has been shown to cause cancer of the mouth, lip, tongue, throat, larynx, and lung, Thun says. According to Thun, pipe smokers may also increase their risk of contracting other cancers that plague cigarette smokers: cancer of the pancreas, kidney, bladder, colon, and cervix as well as leukemia and diseases such as chronic obstructive lung disease, stroke, and coronary heart disease.

A 1996 study published in the journal Preventive Medicine estimated that the number of deaths in the United States attributable to pipe smoking in 1991 ranged from 650 to 2,820, the majority from lung cancer. The middle estimate, a little more than 1,000 deaths, was greater than the number of male deaths from Hodgkin's disease, bone cancer, or tuberculosis in the United States in the same year.

A 2004 National Cancer Institute study followed 138,307 men -- more than 15,000 of whom smoked pipes -- over a period of 18 years. The study found that pipe smoking was associated with increased mortality caused by lung, oropharynx, esophageal, larynx, pancreatic, and colorectal cancers, as well as cardiovascular disease, when compared to the nonsmokers in the study. The researchers reported, pipe smoking confers a risk of tobacco-associated disease similar to cigar smoking.

Pipe smokers on their own

Despite the data, the many dangers of pipe smoking have gone largely unreported. Early studies, when pipe use was more common, focused only on lung cancer and heart disease. Little was known then about the other hazards of tobacco.

Another reason pipe smokers have received relatively little attention is that their ranks are dwindling. Fewer people smoke pipes these days, which means there are fewer studies. While pipe smoking was fairly common in 1965 among men age 20 or older, the prevalence of pipe smoking over the past three decades has "declined drastically" across all races, regions, and education levels, the 1996 Preventive Medicine study reported. These days pipe smokers are usually men 45 years or older. Reasons for the decline may include the pipes' lack of appeal to adolescents and women. (Female pipe smokers remain uncommon, although some fans are said to have included Queen Victoria of England, author Gertrude Stein, actress Greta Garbo, and political activist and professor Angela Davis.)

Perhaps because pipe smoking is on the wane, government health efforts have largely ignored the practice. There have been attempts in Congress to compel manufacturers to label pipe tobacco with the same warnings that cigarettes require. However to date, pipe smokers don't receive the same type of written health warnings given to cigarette smokers and users of smokeless tobacco.

Oral cancer a particular risk

The lack of warnings on pipe tobacco is particularly troubling because pipe smoke contains the same toxic mix of substances found in cigarette and cigar smoke: roughly 4,000 compounds, over 40 of which are known to cause cancer in humans and animals. Burning tobacco -- in pipes or cigarettes -- also produces a "huge" number of combustion products, Thun says. Like cigarettes, pipe tobacco contains nicotine, a powerful nerve stimulant that's the primary cause of addiction to tobacco.

How much smoke a pipe user inhales can make a big difference in how harmful the practice is, say researchers. "The absolute risks of smoking a pipe depend on how one does it," says Thun. "Those who switch from cigarettes to pipes inhale more deeply and tend to create higher lung cancer risks."

The risk also depends on how much you smoke. "Pipe tobacco should be enjoyed like a fine wine," says Chuck Stanion, managing editor of Pipes and Tobaccos, a quarterly magazine based in Raleigh, North Carolina, that goes out to 75,000 pipe smokers and hobbyists. "You sip it as a connoisseur." His magazine also recommends that pipe smokers do not inhale.

But the American Cancer Society insists that all pipe smokers inhale to some degree. And not inhaling deeply won't necessarily protect you against lung cancer. Nicotine -- which itself doesn't cause cancer -- is easily absorbed through the lungs and tissues of the mouth. According to the Canadian Cancer Society, pipe smoke is alkaline, which allows it to enter the bloodstream through the mucous tissues of the mouth more easily than cigarette smoke.

Pipe smokers are particularly prone to oral cancers, most commonly of the lips, tongue, roof and floor of the mouth, pharynx, larynx, and esophagus. (The black, or air-cured, tobacco used in pipes also carries a higher risk of esophageal cancer than the tobacco used for cigarettes.) Each year, about 7,600 people in the United States die from oral cancer -- the eighth most common cancer in the world --- and the primary causes were tobacco and alcohol use, according to the National Cancer Institute. If not for tobacco use, the NCI concludes, oral cancer would be virtually nonexistent as a cause of death.

Gum disease and 'hairy tongue'

Tobacco secretions also stain teeth and cause sores in the mouth and gums, say health researchers. Some of these can be precancerous lesions, including leukoplakia, also called smokers' white patch, and erythroplakia, a red velvety lesion. Pipe smoking can also cause "hairy tongue," furry-looking bumps on the tongue that develop when the top layer of cells doesn't slough off as it normally does. If this layer of cells becomes stained by tobacco, it may even make the tongue look discolored or black.

Pipe smoking, in fact, can take nearly as high a toll in gum disease and tooth loss as cigarette smoking, according to a study in the December 2000 issue of the Journal of Periodontology. Pipe smokers also have a much higher prevalence of moderate and severe periodontitis, or gum disease, than former smokers and nonsmokers.

Unfortunately, the risks of pipe smoking aren't confined to the smokers. People exposed to secondhand pipe smoke should also be concerned, as pipe smoke is no less toxic than cigarette smoke, reported the Harvard Health Letter in 1998. Since pipe tobacco burns at a lower temperature than cigarette tobacco, pipe smoke may actually contain higher concentrations of carbon monoxide, a hazardous gas, as well as other cancer-causing chemicals such as nitrosamine. Smoke from pipes can also cause respiratory infections, headaches, and burning eyes.

Still, the notion that pipes are more benign than cigarettes lives on. In the July 1994 issue of Reason magazine, an article tried to entice readers to take up the pipe. "Pipe smoking is a fun hobby," wrote the author, Rick Newcombe. "It is relaxing. It tastes good. It feels good. It helps us unwind. It helps us cope with stress. It enhances objectivity. It facilitates contemplation." Although Newcombe advocates moderation in pipe smoking to help avoid oral cancer, he asserts, "As a statement of political rebellion against political correctness, it's hard to beat pipe smoking. Also keep in mind that Einstein did not worry about defying convention. To be a pipe smoker in the 1990s you really must be an individualist."

Thun of the American Cancer Society doesn't see it quite that way, Einstein notwithstanding. "Pipe smoking hasn't made anyone smart," he says. And given all the risks of pipe smoke, he adds, "There's a lot more evidence of the opposite."

References

American Cancer Society. Society Report Describes Historic Drop in Cancer Deaths. February 2006. http://www.cancer.org/docroot/NWS/content/ NWS_1_1x_Society_Report_Describes_Historic_Drop_in_Cancer_Deaths.asp

Interview with Michael Thun, MD, vice president of epidemiology and surveillance for the American Cancer Society

Interview with Chuck Stanion, managing editor of Pipes and Tobacco

Cigars and Pipes as Lethal as Cigarettes, International Agency for Research on Cancer (IARC), World Health Organization.

Cigar, Pipe, and Cigarette Smoking as Risk Factors for Periodontal Disease and Tooth Loss, Journal of Periodontology, Dec. 2000

Harvard Health Letter, Dec. 1, 1998, Vol. 24

Henley, SJ et al. Association Between Exclusive Pipe Smoking and Mortality From Cancer and Other Diseases. Journal of the National Cancer Institute. Volume 96, Number 11, 853-861. June 2, 2004. http://jnci.oxfordjournals.org/cgi/content/abstract/96/11/853

Library of Congress. H.R. 3907. http://thomas.loc.gov/cgi-bin/query/z?c107:H.R.3907.IH:

World Health Organization. The World Oral Health Report, 2003. http://www.who.int/oral_health/media/en/orh_report03_en.pdf

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