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.
Cancer Epidemiol Biomarkers Prev. 2014 Jan;23(1):160-71. doi: 10.1158/1055-9965.EPI-13-0181. Epub 2013 Dec 18.
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.
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.
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.
These results suggest that the association of marijuana use with head and neck carcinoma may differ by tumor site.
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.
在过去的 20 年中，口咽癌和口腔舌癌的发病率有所上升，这与 1950 年后出生的人群中大麻使用量的增加是一致的。
对美国和拉丁美洲 INHANCE 联盟的 9 项病例对照研究进行了汇总分析。从 1921 例口咽癌病例、356 例口腔舌癌病例和 7639 例对照中获得了关于大麻吸烟、人口统计学和行为因素的自我报告信息。
与从不吸烟大麻的人相比，曾经吸烟大麻的人患口咽癌的风险增加（调整后的比值比[aOR]，1.24；95%置信区间[CI]：1.06-1.47），而患口腔舌癌的风险降低（aOR，0.47；95%CI，0.29，0.75）。从不吸烟和饮酒的人群中，口咽癌的风险仍然升高。从不吸烟和饮酒的人群中，口腔舌癌的风险降低。调整 HPV 暴露潜在混杂因素的敏感性分析减弱了大麻使用与口咽癌的相关性（aOR，0.99；95%CI，0.71-1.25），但对口舌癌的相关性没有影响。
这些结果表明，大麻使用与头颈部癌的相关性可能因肿瘤部位而异。
大麻使用与口咽癌和口腔舌癌的相关性与大麻素可能具有的促癌和抗癌作用一致。需要开展更多的工作来排除各种偏倚来源，包括 HPV 感染的残余混杂和大麻暴露的错误分类。
