Keywords
Risk of Lung Cancer
Systematic Review
Meta-Analysis
Cannabis
Possitive Association
Risk Factors
Categories
How to Cite
Abstract
Background: Cannabis is the illicit psychoactive substance the most consumed in the world. Little is known about the association between the use of cannabis and the risk of lung cancer.
Objective: The objective of this meta-analysis is to determine whether the use of cannabis is a risk factor for lung cancer.
Methods: We conducted a systematic review and meta-analyses of all language articles using relevant computerized databases. MEDLINE (online PubMed), Web of Knowledge, Embase, EBSCO CINAHL, ScienceDirect, Scopus, Cochrane Library, and Directory of Open Access Journals were searched to September 2014 for cohorts and case-control studies that assessed the risk of lung cancer associated with cannabis smoking. The literature search was performed with a combination of medical subject headings terms, "cannabis" and "lung neoplasms". Data extraction: Two investigators independently analyzed and extracted results from eligible studies. Our study's registration number on PROSPERO is CRD42014008872.
Results: The search strategy identified 2476 citations. 13 studies were eligible for inclusion: 2 pooled analyses of 9 case-control studies, one case-control study, and 3 cohorts.
The cumulative analysis for all the studies under a fixed-effects model showed that cannabis smoking determined an increased risk of developing lung cancer in the future (relative risk 1.22, 95% confidence interval 0.999–1.5; p=0.051), with no evidence of heterogeneity across the studies (I2: 34%; p¼0.01).
Conclusions: The use of cannabis with or without tobacco smoking is associated with an increased risk for lung cancer.
References
Hall W, Degenhardt L. Adverse health effects of non-medical cannabis use. Lancet. 2009 Oct 17; 374(9698):1383-91. https://doi.org/10.1016/s0140-6736(09)61037-0
Maertens RM, White PA, Rickert W, Levasseur G, Douglas GR, Bellier PV, et al. The genotoxicity of mainstream and sidestream marijuana and tobacco smoke condensates. Chem Res Toxicol. 2009 Aug; 22(8):1406-14. https://doi.org/10.1021/tx9000286
Callaghan RC, Allebeck P, Sidorchuk A. Marijuana use and risk of lung cancer: a 40-year cohort study. Cancer Causes Control. 2013 Oct; 24(10):1811-20. https://doi.org/10.1007/s10552-013-0259-0
Moir D, Rickert WS, Levasseur G, Larose Y, Maertens R, White P, et al. A comparison of mainstream and sidestream marijuana and tobacco cigarette smoke produced under two machine smoking conditions. Chem Res Toxicol. 2008 Feb; 21(2):494-502. https://doi.org/10.1021/tx700275p
Marselos M, Karamanakos P. Mutagenicity, developmental toxicity and carcinogenicity of cannabis. Addict Biol. 1999 Jan; 4(1):5-12. https://doi.org/10.1080/13556219971786
Mehra R, Moore BA, Crothers K, Tetrault J, Fiellin DA. The association between marijuana smoking and lung cancer: a systematic review. Arch Intern Med. 2006 Jul 10; 166(13):1359-67. [Accessed 25th May 2021]. Available From: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/410634
Aldington S, Harwood M, Cox B, Weatherall M, Beckert L, Hansell A, et al. Cannabis use and risk of lung cancer: a case–control study. Eur Respir J. 2008 Feb; 31(2):280-6. https://doi.org/10.1183/09031936.00065707
Rickert WS, Robinson JC, Rogers B. A comparison of tar, carbon monoxide and pH levels in smoke from marihuana and tobacco cigarettes. Can J Public Health. Nov-Dec 1982; 73(6):386-91.
Alberg AJ, Ford JG, Samet JM. Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007 Sep; 132(3Supp):29S-55S. https://doi.org/10.1378/chest.07-1347
Underner M, Urban T, Perriot J, de Chazeron I, Meurice JC. [Cannabis smoking and lung cancer]. Rev Mal Respir. 2014 Jun; 31(6):488-98. https://doi.org/10.1016/j.rmr.2013.12.002
Doll R, Peto R. Mortality in relation to smoking: 20 years' observations on male British doctors. Br Med J. 1976 Dec 25; 2(6051):1525-36. https://doi.org/10.1136/bmj.2.6051.1525
Doll R, Peto R. Cigarette smoking and bronchial carcinoma: dose and time relationships among regular smokers and lifelong non-smokers. J Epidemiol Community Health (1978). 1978 Dec; 32(4):303-13. [Accessed 28th May 2021]. Available From: https://www.jstor.org/stable/25566056?seq=1
Voirin N, Berthiller J, Benhaim-Luzon V, Boniol M, Straif K, Ayoub WB, et al. Risk of lung cancer and past use of cannabis in Tunisia. J Thorac Oncol. 2006 Jul; 1(6):577-9. https://doi.org/10.1016/S1556-0864(15)30362-2
Hashibe M, Morgenstern H, Cui Y, Tashkin DP, Zhang ZF, Cozen W, et al. Marijuana use and the risk of lung and upper aerodigestive tract cancers: results of a population-based case-control study. Cancer Epidemiol biomarkers Prev. 2006 Oct; 15(10):1829-34. https://doi.org/10.1158/1055-9965.epi-06-0330
Hsairi M, Achour N, Zouari B, Ben Romdhane H, Achour A, Maalej M, et al. [Etiologic factors in primary bronchial carcinoma in Tunisia]. Tunis Med. 1993 May; 71(5):265-8.
Sridhar KS, Raub WA Jr, Weatherby NL, Metsch LR, Surratt HL, Inciardi JA, et al. Possible role of marijuana smoking as a carcinogen in the development of lung cancer at a young age. J Psychoactive Drugs. Jul-Sep 1994; 26(3):285-8. https://doi.org/10.1080/02791072.1994.10472442
Fung M, Gallagher C, Machtay M. Lung and aero-digestive cancers in young marijuana smokers. Tumori. Mar-Apr 1999; 85(2):140-2. [Accessed 28th May 2021]. Available From: https://pennstate.pure.elsevier.com/en/publications/lung-and-aero-digestive-cancers-in-young-marijuana-smokers
Sasco AJ, Merrill RM, Dari I, Benhaim-Luzon V, Carriot F, Cann CI, et al. A case-control study of lung cancer in Casablanca, Morocco. Cancer causes control. 2002 Sep; 13(7):609-16. https://doi.org/10.1023/a:1019504210176
Fligiel SE, Roth MD, Kleerup EC, Barsky SH, Simmons MS, Tashkin DP. Tracheobronchial histopathology in habitual smokers of cocaine, marijuana, and/or tobacco. Chest. 1997 Aug; 112(2):319-26. https://doi.org/10.1378/chest.112.2.319
Gong H, Jr., Fligiel S, Tashkin DP, Barbers RG. Tracheobronchial changes in habitual, heavy smokers of marijuana with and without tobacco. Am Rev Respir Dis. 1987 Jul; 136(1):142-9. https://doi.org/10.1164/ajrccm/136.1.142
Barsky SH, Roth MD, Kleerup EC, Simmons M, Tashkin DP. Histopathologic and molecular alterations in bronchial epithelium in habitual smokers of marijuana, cocaine, and/or tobacco. J Natl Cancer Inst. 1998 Aug 19; 90(16):1198-205. https://doi.org/10.1093/jnci/90.16.1198
Busch FW, Seid DA, Wei ET. Mutagenic activity of marihuana smoke condensates. Cancer Lett. 1979 May; 6(6):319-24. https://doi.org/10.1016/s0304-3835(79)80088-9
Roy PE, Magnan-Lapointe F, Huy ND, Boutet M. Chronic inhalation of marijuana and tobacco in dogs: pulmonary pathology. Res Commun Chem Pathol Pharmacol.1976 Jun; 14(2):305-17. [Accessed 28th May 2021]. Available From: https://www.herbalorganic.com/ca/pubmed/Chronic_inhalation_of_marijuana_and_tobacco_in_dogs_pulmonary_pathology_940962
Zhu LX, Sharma S, Stolina M, Gardner B, Roth MD, Tashkin DP, et al. Delta-9-tetrahydrocannabinol inhibits antitumor immunity by a CB2 receptor-mediated, cytokine-dependent pathway. J Immunol. 2000 Jul 1; 165(1):373-80. https://doi.org/10.4049/jimmunol.165.1.373
Hoffmann D, Brunnemann K, Gori G, Wynder E. On the carcinogenicity of marijuana smoke. Recent Advances in Phytochemistry: Springer. 1975; 63-81. https://doi.org/10.1007/978-1-4684-0823-2_3
Galve-Roperh I, Sanchez C, Cortes ML, Gomez del Pulgar T, Izquierdo M, Guzman M. Anti-tumoral action of cannabinoids: involvement of sustained ceramide accumulation and extracellular signal-regulated kinase activation. Nat Med. 2000 Mar; 6(3):313-9. https://doi.org/10.1038/73171
Hart S, Fischer OM, Ullrich A. Cannabinoids induce cancer cell proliferation via tumor necrosis factor alpha-converting enzyme (TACE/ADAM17)-mediated transactivation of the epidermal growth factor receptor. Cancer Res. 2004 Mar 15; 64(6):1943-50. https://doi.org/10.1158/0008-5472.can-03-3720
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009 Jul 21; 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. Jama. 2000 Apr 19; 283(15):2008-12. https://doi.org/10.1001/jama.283.15.2008
Wells G, Shea B, O’connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Our Reasearch. 2000. [Accessed 5th June 2021]. Available From: http://www3.med.unipmn.it/dispense_ebm/20092010/Corso%20Perfezionamento%20EBM_Faggiano/NOS_oxford.pdf
Zhang LR, Morgenstern H, Greenland S, Chang SC, Lazarus P, Teare MD, et al. Cannabis smoking and lung cancer risk: Pooled analysis in the International Lung Cancer Consortium. Int J Cancer. 2015 Feb 15; 136(4):894-903. https://doi.org/10.1002/ijc.29036
Wang Y, McKay JD, Rafnar T, Wang Z, Timofeeva MN, Broderick P, et al. Rare variants of large effect in BRCA2 and CHEK2 affect risk of lung cancer. Nat Genet. 2014 Jul; 46(7):736-41. https://doi.org/10.1038/ng.3002
Gallagher CJ, Muscat JE, Hicks AN, Zheng Y, Dyer A-M, Chase GA, et al. The UDP-glucuronosyltransferase 2B17 gene deletion polymorphism: sex-specific association with urinary 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol glucuronidation phenotype and risk for lung cancer. Cancer Epidemiol Biomarkers Prev. 2007 Apr; 16(4):823-8. https://doi.org/10.1158/1055-9965.epi-06-0823
ReSoLuCENT PJW. Resource for the Study of Lung Cancer Epidemiology in North Trent.vol. 2013, 2009, 45. [Accessed 28th May 2021]. Available From: http://resolucent.group.shef.ac.uk/
Han B, Gfroerer JC, Colliver JD. Associations between Duration of Illicit Drug Use and Health Conditions: Results from the 2005–2007 National Surveys on Drug Use and Health. Ann Epidemiol. 2010 Apr; 20(4):289-97. https://doi.org/10.1016/j.annepidem.2010.01.003
Berthiller J, Straif K, Boniol M, Voirin N, Benhaim-Luzon V, Ayoub WB, et al. Cannabis smoking and risk of lung cancer in men: a pooled analysis of three studies in Maghreb. J Thorac Oncol. 2008 Dec; 3(12):1398-403. https://doi.org/10.1097/jto.0b013e31818ddcde
Sidney S, Quesenberry C Jr, Friedman GD, Tekawa IS. Marijuana use and cancer incidence (California, United States). Cancer causes control.1997 Sep; 8(5):722-8. https://doi.org/10.1023/A:1018427320658
Roth MD, Arora A, Barsky SH, Kleerup EC, Simmons M, Tashkin DP. Airway inflammation in young marijuana and tobacco smokers. Am J Respir Crit Care Med. 1998 Mar; 157(3 Pt 1):928-37. https://doi.org/10.1164/ajrccm.157.3.9701026
Leuchtenberger C, Leuchtenberger R. The effects of naturally occurring metabolites (L-cysteine, vitamin C) on cultured human cells exposed to smoke of tobacco or marijuana cigarettes. Cytometry. 1984 Jul; 5(4):396-402. https://doi.org/10.1002/cyto.990050417
Underner M, Urban T, Perriot J, Peiffer G, Meurice JC. [Cannabis use and impairment of respiratory function]. Rev Mal Respir. 2013 Apr; 30(4):272-85. https://doi.org/10.1016/j.rmr.2013.01.013
Chiesara E, Cutrufello R, Rizzi R. Chromosome Damage in Heroin-Marijuana and Marijuana Addicts. Arch Toxicol Suppl. 1983;6:128-30.https://doi.org/10.1007/978-3-642-69083-9_20
Murison G, Chubb CB, Maeda S, Gemmell MA, Huberman E. Cannabinoids induce incomplete maturation of cultured human leukemia cells. Proc Natl Acad Sci U S A. 1987 Aug; 84(15):5414-8. https://doi.org/10.1073/pnas.84.15.5414
Wu T-C, Tashkin DP, Djahed B, Rose JE. Pulmonary hazards of smoking marijuana as compared with tobacco. N Engl J Med. 1988 Feb 11; 318(6):347-51. https://doi.org/10.1056/nejm198802113180603
Drugs UNOo. World drug report 2010: United Nations Publications. 2010. [Accessed 28th May 2021]. Available From: https://www.unodc.org/unodc/en/data-and-analysis/WDR-2010.html
Shafey O, Dolwick S, Guindon GE. Tobacco control country profiles. Atlanta: American Cancer Society. 2003; 356. [Accessed 28th May 2021]. Available From: https://www.who.int/tobacco/global_data/country_profiles/en/
Jag H, Khalsa JH, Genser S, Francis H, Martin B. Clinical consequences of marijuana. J Clin Pharmacol. 2002; 42(S1):7S-10S.https://doi.org/10.1002/j.1552-4604.2002.tb05997.x
Hall W, Solowij N. Adverse effects of cannabis. Lancet. 1998 Nov 14; 352(9140):1611-6. https://doi.org/10.1016/S0140-6736(98)05021-1
Hibell B, Guttormsson U, Ahlström S, Balakireva O, Bjarnason T, Kokkevi A, et al. The 2011 ESPAD Report. Substance Use Among Students in 36 European Countries. Tukholma: The Swedish Council for Information on Alcohol and other Drugs, 2012. Viitattu 27.9. 2013.
Degenhardt L, Bucello C, Calabria B, Nelson P, Roberts A, Hall W, et al. What data are available on the extent of illicit drug use and dependence globally? Results of four systematic reviews. Drug alcohol Depend. 2011 Sep 1; 117(2-3):85-101. https://doi.org/10.1016/j.drugalcdep.2010.11.032
Wiencke JK, Kelsey KT. Teen smoking, field cancerization, and a" critical period" hypothesis for lung cancer susceptibility. Environ Health Perspect. 2002 Jun; 110(6):555-8. https://doi.org/10.1289/ehp.02110555
Johnston LD, O'Malley PM, Bachman JG, Schulenberg JE. Monitoring the Future National Survey Results on Drug Use, 1975-2010. Volume I, Secondary School Students. Institute for Social Research. 2011. [Accessed 05th Jun 2021]. Available From: https://eric.ed.gov/?id=ED514370
Hayat MJ, Howlader N, Reichman ME, Edwards BK. Cancer statistics, trends, and multiple primary cancer analyses from the Surveillance, Epidemiology, and End Results (SEER) Program. The Oncologist. 2007 Jan; 12(1):20-37. https://doi.org/10.1634/theoncologist.12-1-20
Holmberg L, Sandin F, Bray F, Richards M, Spicer J, Lambe M, et al. National comparisons of lung cancer survival in England, Norway and Sweden 2001–2004: differences occur early in follow-up. Thorax. 2010 May; 65(5):436-41. https://doi.org/10.1136/thx.2009.124222
Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010 Dec 15; 127(12):2893-917. https://doi.org/10.1002/ijc.25516
Room R. Cannabis policy: moving beyond stalemate: Oxford University Press; 2010.[Accessed 28th May 2021]. Available From : https://global.oup.com/academic/product/cannabis-policy-9780199581481?cc=us&lang=en&
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2014 Bouti K et al.
