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.

Impact: 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.

Figure 1

Forest plots for study specific associations of ever marijuana marijuana use with oropharyngeal and oral tongue cancer among studies in the INHANCE consortium (Reference group is “Never users”) [95% Population effect interval (PEI)_{[Oropharyngeal cancer]} = (0.81, 1.94)]; 95% Population effect interval (PEI)_{[Oral tongue cancer]} = (0.38, 0.57)].