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Marijuana Use and the Risk of Lung and Upper Aerodigestive Tract Cancers: Results of a Population-Based Case-Control Study

¹ IARC, Lyon, France; ² Department of Epidemiology, School of Public Health, and Comprehensive Cancer Center, University of Michigan, Ann Arbor, Michigan; ³ Department of Epidemiology and Population Health, Albert Einstein College of Medicine of the Yeshiva University, Bronx, New York; ⁴ Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA; ⁵ Department of Epidemiology, University of California, Los Angeles School of Public Health; ⁶ Department of Preventive Medicine, Keck School of Medicine at University of Southern California; and ⁷ Department of Statistics, University of California, Los Angeles, Los Angeles, California

Requests for reprints: Hal Morgenstern, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029. Phone: 734-764-5435; Fax: 734-764-3192. E-mail: halm{at}umich.edu.

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 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 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 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. (Cancer Epidemiol Biomarkers Prev 2006;15(10):1829–34)

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