title: The association between marijuana smoking and lung cancer: a systematic review.
abstract: BACKGROUND
  The association between marijuana smoking and lung cancer is unclear, and a systematic appraisal of this relationship has yet to be performed. Our objective was to assess the impact of marijuana smoking on the development of premalignant lung changes and lung cancer.
  
  
  METHODS
  Studies assessing the impact of marijuana smoking on lung premalignant findings and lung cancer were selected from MEDLINE, PSYCHLIT, and EMBASE databases according to the following predefined criteria: English-language studies of persons 18 years or older identified from 1966 to the second week of October 2005 were included if they were research studies (ie, not letters, reviews, editorials, or limited case studies), involved persons who smoked marijuana, and examined premalignant or cancerous changes in the lung.
  
  
  RESULTS
  Nineteen studies met selection criteria. Studies that examined lung cancer risk factors or premalignant changes in the lung found an association of marijuana smoking with increased tar exposure, alveolar macrophage tumoricidal dysfunction, increased oxidative stress, and bronchial mucosal histopathologic abnormalities compared with tobacco smokers or nonsmoking controls. Observational studies of subjects with marijuana exposure failed to demonstrate significant associations between marijuana smoking and lung cancer after adjusting for tobacco use. The primary methodologic deficiencies noted include selection bias, small sample size, limited generalizability, overall young participant age precluding sufficient lag time for lung cancer outcome identification, and lack of adjustment for tobacco smoking.
  
  
  CONCLUSIONS
  Given the prevalence of marijuana smoking and studies predominantly supporting biological plausibility of an association of marijuana smoking with lung cancer on the basis of molecular, cellular, and histopathologic findings, physicians should advise patients regarding potential adverse health outcomes until further rigorous studies are performed that permit definitive conclusions.
authors.affiliation: Department of Medicine, Case Western Reserve University, Cleveland, Ohio 44106-6003, USA. mehrar@ameritech.net
authors.forename: Reena
authors.initials: R
authors.lastname: Mehra
authors.forename: Brent A
authors.initials: BA
authors.lastname: Moore
authors.forename: Kristina
authors.initials: K
authors.lastname: Crothers
authors.forename: Jeanette
authors.initials: J
authors.lastname: Tetrault
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
mesh_terms: D066246:ErbB Receptors / Q000032:analysis; D006801:Humans; D006965:Hyperplasia / Q000209:etiology; D019394:Ki-67 Antigen / Q000032:analysis; D008168:Lung / Q000187:drug effects / Q000473:pathology; D008175:Lung Neoplasms / Q000209:etiology*; D008385:Marijuana Smoking / Q000009:adverse effects*; D012107:Research Design; D013638:Tars / Q000009:adverse effects
chemical_list: D019394:Ki-67 Antigen; D013638:Tars; D066246:ErbB Receptors