title: Association of marijuana smoking with oropharyngeal and oral tongue cancers: pooled analysis from the INHANCE consortium.
abstract: BACKGROUND
  The incidence of oropharyngeal and oral tongue cancers has increased over the last 20 years which parallels increased use of marijuana among individuals born after 1950.
  
  
  METHODS
  A pooled analysis was conducted comprising individual-level data from nine case-control studies from the United States and Latin America in the INHANCE consortium. Self-reported information on marijuana smoking, demographic, and behavioral factors was obtained from 1,921 oropharyngeal cases, 356 oral tongue cases, and 7,639 controls.
  
  
  RESULTS
  Compared with never marijuana smokers, ever marijuana smokers had an elevated risk of oropharyngeal [adjusted OR (aOR), 1.24; 95% confidence interval (CI): 1.06-1.47] and a reduced risk of oral tongue cancer (aOR, 0.47; 95% CI, 0.29, 0.75). The risk of oropharyngeal cancer remained elevated among never tobacco and alcohol users. The risk of oral tongue cancer was reduced among never users of tobacco and alcohol. Sensitivity analysis adjusting for potential confounding by HPV exposure attenuated the association of marijuana use with oropharyngeal cancer (aOR, 0.99; 95% CI, 0.71-1.25), but had no effect on the oral tongue cancer association.
  
  
  CONCLUSIONS
  These results suggest that the association of marijuana use with head and neck carcinoma may differ by tumor site.
  
  
  CONCLUSIONS
  The associations of marijuana use with oropharyngeal and oral tongue cancer are consistent with both possible pro- and anticarcinogenic effects of cannabinoids. Additional work is needed to rule out various sources of bias, including residual confounding by HPV infection and misclassification of marijuana exposure.
authors.affiliation: Authors' Affiliations: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville; Johns Hopkins School of Medicine; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Community Health, School of Medicine, Brown University, Providence, Rhode Island; International Agency of Research on Cancer; Hospices Civils de Lyon, Pole Information Medicale Evaluation Recherche; Universite Lyon 1, Equipe d'Accueil 4129; International Prevention Research Institute, Lyon, France; Fred Hutchinson Cancer Research Cancer, Seattle, Washington; University of Iowa College of Public Health, Iowa City, Iowa; School of Public Health, University of North Carolina, Chapel Hill, North Carolina; Department of Head and Neck Surgery and Epidemiology, University of Texas MD Anderson Cancer Center, Houston, Texas; UCLA School of Public Health, Los Angeles, California; Departments of Epidemiology and Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan; Penn State College of Medicine, Hershey, Pennsylvania; Boston University School of Public Health, Boston, Massachusetts; Faculdade de Saude Publica, Universidade de Sao Paulo, Sao Paulo; Escola Nacional de Saude Publica, Fundacao Oswaldo Cruz, Rio de Janeiro; Universidade Federal de Pelotas, Pelotas; Hospital de Clinicas de Porto Alegre, Port Alegre, Brazil; Institute Oncology Angel H. Roffo, University of Buenos Aires, Buenos Aires, Argentina; Institute of Oncology and Radiobiology, Havana, Cuba; The Tisch Cancer Institute Mount Sinai School of Medicine, New York, New York; and University of Utah School of Medicine, Salt Lake City, Utah.
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authors.forename: Elena
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authors.lastname: Matos
authors.forename: Ana
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authors.lastname: Menezes
authors.forename: Alexander W
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authors.forename: Leticia
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authors.lastname: Fernandez
authors.forename: Marshall
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authors.lastname: Posner
authors.forename: Paolo
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authors.forename: Yuan-Chin Amy
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mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000209:etiology; D016022:Case-Control Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008385:Marijuana Smoking / Q000009:adverse effects / Q000453:epidemiology*; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000453:epidemiology* / Q000209:etiology; D012307:Risk Factors; D000077195:Squamous Cell Carcinoma of Head and Neck; D064424:Tobacco Use / Q000009:adverse effects / Q000453:epidemiology; D014062:Tongue Neoplasms / Q000453:epidemiology* / Q000209:etiology; D014481:United States / Q000453:epidemiology