title: Association of marijuana use and the incidence of testicular germ cell tumors.
abstract: BACKGROUND
  The incidence of testicular germ cell tumors (TGCTs) has been increasing the past 4 to 6 decades; however, exposures that account for this rise have not been identified. Marijuana use also grew during the same period, and it has been established that chronic marijuana use produces adverse effects on the human endocrine and reproductive systems. In this study, the authors tested the hypothesis that marijuana use is a risk factor for TGCT.
  
  
  METHODS
  A population-based, case-control study of 369 men ages 18 to 44 years who were diagnosed with TGCT from January 1999 through January 2006 was conducted in King, Pierce and Snohomish Counties in Washington State. The responses of these men to questions on their lifetime marijuana use were compared with the responses of 979 age-matched controls who resided in the same 3 counties during the case diagnosis period.
  
  
  RESULTS
  Men with a TGCT were more likely to be current marijuana smokers at the reference date compared with controls (odds ratio [OR], 1.7; 95% confidence interval [95% CI], 1.1-2.5). In analyses according to histologic type, most of the association between current marijuana use and TGCT was observed in men who had nonseminomas/mixed histology tumors (current use: OR, 2.3; 95% CI, 1.3-4.0). Age at first use among current users (age<18 years [OR, 2.8] vs age>or=18 years [OR, 1.3]) and frequency of use (daily or weekly [OR, 3.0] vs less than once per week [OR, 1.8]) appeared to modify the risk.
  
  
  CONCLUSIONS
  An association was observed between marijuana use and the occurrence of nonseminoma TGCTs. Additional studies of TGCTs will be needed to test this hypothesis, including molecular analyses of cannabinoid receptors and endocannabinoid signaling, which may provide clues regarding the biologic mechanisms of TGCTs.
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA. jdaling@fhcrc.org
authors.forename: Janet R
authors.initials: JR
authors.lastname: Daling
authors.forename: David R
authors.initials: DR
authors.lastname: Doody
authors.forename: Xiaofei
authors.initials: X
authors.lastname: Sun
authors.forename: Britton L
authors.initials: BL
authors.lastname: Trabert
authors.forename: Noel S
authors.initials: NS
authors.lastname: Weiss
authors.forename: Chu
authors.initials: C
authors.lastname: Chen
authors.forename: Mary L
authors.initials: ML
authors.lastname: Biggs
authors.forename: Jacqueline R
authors.initials: JR
authors.lastname: Starr
authors.forename: Sudhansu K
authors.initials: SK
authors.lastname: Dey
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008385:Marijuana Smoking / Q000453:epidemiology*; D009373:Neoplasms, Germ Cell and Embryonal / Q000453:epidemiology* / Q000473:pathology; D018570:Risk Assessment; D012307:Risk Factors; D013736:Testicular Neoplasms / Q000453:epidemiology* / Q000473:pathology