Marijuana use and the risk of lung and upper aerodigestive tract cancers: results of a population-based case-control study.
BACKGROUND
Despite several lines of evidence suggesting the biological plausibility of marijuana being carcinogenic, epidemiologic findings are inconsistent. We conducted a population-based case-control study of the association between marijuana use and the risk of lung and upper aerodigestive tract cancers in Los Angeles.


METHODS
Our study included 1,212 incident cancer cases and 1,040 cancer-free controls matched to cases on age, gender, and neighborhood. Subjects were interviewed with a standardized questionnaire. The cumulative use of marijuana was expressed in joint-years, where 1 joint-year is equivalent to smoking one joint per day for 1 year.


RESULTS
Although using marijuana for > or =30 joint-years was positively associated in the crude analyses with each cancer type (except pharyngeal cancer), no positive associations were observed when adjusting for several confounders including cigarette smoking. The adjusted odds ratio estimate (and 95% confidence limits) for > or =60 versus 0 joint-years was 1.1 (0.56, 2.1) for oral cancer, 0.84 (0.28, 2.5) for laryngeal cancer, and 0.62 (0.32, 1.2) for lung cancer; the adjusted odds ratio estimate for > or =30 versus 0 joint-years was 0.57 (0.20, 1.6) for pharyngeal cancer, and 0.53 (0.22, 1.3) for esophageal cancer. No association was consistently monotonic across exposure categories, and restriction to subjects who never smoked cigarettes yielded similar findings.


CONCLUSIONS
Our results may have been affected by selection bias or error in measuring lifetime exposure and confounder histories; but they suggest that the association of these cancers with marijuana, even long-term or heavy use, is not strong and may be below practically detectable limits.
Hashibe
Mia
M
IARC, Lyon, France.
Morgenstern
Hal
H
Cui
Yan
Y
Tashkin
Donald P
DP
Zhang
Zuo-Feng
ZF
Cozen
Wendy
W
Mack
Thomas M
TM
Greenland
Sander
S
D000230:Adenocarcinoma / Q000453:epidemiology / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects; D018287:Carcinoma, Large Cell / Q000453:epidemiology / Q000209:etiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000209:etiology; D016022:Case-Control Studies; D015986:Confounding Factors, Epidemiologic; D004067:Digestive System Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D007822:Laryngeal Neoplasms / Q000453:epidemiology / Q000209:etiology; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008385:Marijuana Smoking / Q000009:adverse effects* / Q000453:epidemiology*; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000453:epidemiology / Q000209:etiology; D010610:Pharyngeal Neoplasms / Q000453:epidemiology / Q000209:etiology; D011159:Population Surveillance; D012142:Respiratory Tract Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D012307:Risk Factors; D013997:Time Factors