Pipe smokers have five times the risk of lung cancer and nearly four times the risk of throat cancer as people who use no tobacco, researchers from the U.S. Cancer Society reported.

Writing in Wednesday’s issue of the Journal of the National Cancer Institute, epidemiologist Jane Henley and colleagues said they studied more than 15 thousand male pipe smokers.

They found the pipe smokers also had a higher risk of cancers of the esophagus, larynx, colon and pancreas than people who do not smoke.

In addition, they had a 30 percent higher risk of heart disease, a 27 percent higher risk of stroke and nearly triple the risk of chronic obstructive pulmonary disease compared to non-smokers.

While the health risks for pipe smokers are generally lower than those associated with cigarette smoking, they compare to the risks of smoking cigars, Henley said in a statement.

Harmful pipe smoking includes hookahs and other trendy pipes, the researchers said.

“For example, in the last few years, hookahs have been marketed as a trendy, fun, and less hazardous alternative to cigarette smoking. The significant risks we found should leave no doubt that all tobacco products cause disease and death.”