{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,11]],"date-time":"2026-11-11T23:13:28Z","timestamp":1794438808887,"version":"4.9.1"},"reference-count":49,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2024,12,1]]},"abstract":"<jats:sec id=\"ab-ooi240052-4\"><jats:title>Importance<\/jats:title><jats:p>Cannabis is the most commonly used illicit substance worldwide. Whether cannabis use is associated with head and neck cancer (HNC) is unclear.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240052-5\"><jats:title>Objective<\/jats:title><jats:p>To assess the clinical association between cannabis use and HNC.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240052-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This large multicenter cohort study used clinical records from a database that included 20 years of data (through April 2024) from 64 health care organizations. A database was searched for medical records for US adults with and without cannabis-related disorder who had recorded outpatient hospital clinic visits and no prior history of HNC. Propensity score matching was performed for demographic characteristics, alcohol-related disorders, and tobacco use. Subsequently, relative risks (RRs) were calculated to explore risk of HNC, including HNC subsites. This analysis was repeated among those younger than 60 years and 60 years or older.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240052-7\"><jats:title>Exposure<\/jats:title><jats:p>Cannabis-related disorder.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240052-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Diagnosis of HNC and any HNC subsite.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240052-9\"><jats:title>Results<\/jats:title><jats:p>The cannabis-related disorder cohort included 116\u202f076 individuals (51\u202f646 women [44.5%]) with a mean (SD) age of 46.4 (16.8) years. The non\u2013cannabis-related disorder cohort included 3\u202f985\u202f286 individuals (2\u202f173\u202f684 women [54.5%]) with a mean (SD) age of 60.8 (20.6) years. The rate of new HNC diagnosis in all sites was higher in the cannabis-related disorder cohort. After matching (n\u2009=\u2009115\u202f865 per group), patients with cannabis-related disorder had a higher risk of any HNC (RR, 3.49; 95% CI, 2.78-4.39) than those without cannabis-related disorder. A site-specific analysis yielded that those with cannabis-related disorder had a higher risk of oral (RR, 2.51; 95% CI, 1.81-3.47), oropharyngeal (RR, 4.90; 95% CI, 2.99-8.02), and laryngeal (RR, 8.39; 95% CI, 4.72-14.90) cancer. Results were consistent when stratifying by older and younger age group.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi240052-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This cohort study highlights an association between cannabis-related disorder and the development of HNC in adult patients. Given the limitations of the database, future research should examine the mechanism of this association and analyze dose response with strong controls to further support evidence of cannabis use as a risk factor for HNCs.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2024.2419","type":"journal-article","created":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T15:01:15Z","timestamp":1723129275000},"page":"1068","source":"Crossref","is-referenced-by-count":48,"title":["Cannabis Use and Head and Neck Cancer"],"prefix":"10.1001","volume":"150","author":[{"given":"Tyler J.","family":"Gallagher","sequence":"first","affiliation":[{"name":"Keck School of Medicine of the University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan S.","family":"Chung","sequence":"additional","affiliation":[{"name":"Keck School of Medicine of the University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew E.","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Department of Disease Prevention, Stanford University, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels C.","family":"Kokot","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"3","key":"ooi240052r1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.21660","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"issue":"1","key":"ooi240052r2","doi-asserted-by":"publisher","first-page":"17","DOI":"10.3322\/caac.21763","article-title":"Cancer statistics, 2023.","volume":"73","author":"Siegel","year":"2023","journal-title":"CA Cancer J Clin"},{"issue":"12","key":"ooi240052r3","doi-asserted-by":"publisher","first-page":"2562","DOI":"10.1016\/j.joms.2017.05.008","article-title":"Epidemiological trends of head and neck cancer in the United States: a SEER population study.","volume":"75","author":"Mourad","year":"2017","journal-title":"J Oral Maxillofac Surg"},{"issue":"12","key":"ooi240052r4","doi-asserted-by":"publisher","first-page":"1749","DOI":"10.1001\/jamaoncol.2019.2996","article-title":"Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2017: a systematic analysis for the global burden of disease study.","volume":"5","author":"Fitzmaurice","year":"2019","journal-title":"JAMA Oncol"},{"issue":"2","key":"ooi240052r5","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1158\/1055-9965.EPI-08-0347","article-title":"Interaction between tobacco and alcohol use and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium.","volume":"18","author":"Hashibe","year":"2009","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"3","key":"ooi240052r6","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1097\/PPO.0000000000000115","article-title":"Prevalence of human papillomavirus in oropharyngeal cancer: a systematic review.","volume":"21","author":"Stein","year":"2015","journal-title":"Cancer J"},{"issue":"Suppl 1","key":"ooi240052r7","doi-asserted-by":"publisher","first-page":"S104","DOI":"10.1007\/s12105-012-0368-1","article-title":"Human papillomavirus in non-oropharyngeal head and neck cancers: a systematic literature review.","volume":"6","author":"Isayeva","year":"2012","journal-title":"Head Neck Pathol"},{"issue":"8","key":"ooi240052r8","doi-asserted-by":"publisher","first-page":"1130","DOI":"10.1038\/s41416-018-0029-6","article-title":"The fraction of cancer attributable to modifiable risk factors in England, Wales, Scotland, Northern Ireland, and the United Kingdom in 2015.","volume":"118","author":"Brown","year":"2018","journal-title":"Br J Cancer"},{"issue":"14","key":"ooi240052r9","doi-asserted-by":"publisher","first-page":"1194","DOI":"10.1093\/jnci\/91.14.1194","article-title":"Tobacco smoke carcinogens and lung cancer.","volume":"91","author":"Hecht","year":"1999","journal-title":"J Natl Cancer Inst"},{"issue":"4","key":"ooi240052r10","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1080\/009841097160393","article-title":"The changing cigarette, 1950-1995.","volume":"50","author":"Hoffmann","year":"1997","journal-title":"J Toxicol Environ Health"},{"issue":"1","key":"ooi240052r11","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1038\/s41572-020-00224-3","article-title":"Head and neck squamous cell carcinoma.","volume":"6","author":"Johnson","year":"2020","journal-title":"Nat Rev Dis Primers"},{"issue":"1","key":"ooi240052r12","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/S1470-2045(05)70024-3","article-title":"Cannabinoids and cancer: causation, remediation, and palliation.","volume":"6","author":"Hall","year":"2005","journal-title":"Lancet Oncol"},{"issue":"3","key":"ooi240052r13","doi-asserted-by":"publisher","first-page":"339","DOI":"10.1165\/ajrcmb.24.3.4252","article-title":"Induction and regulation of the carcinogen-metabolizing enzyme CYP1A1 by marijuana smoke and delta (9)-tetrahydrocannabinol.","volume":"24","author":"Roth","year":"2001","journal-title":"Am J Respir Cell Mol Biol"},{"issue":"3","key":"ooi240052r14","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1046\/j.1360-0443.2002.00003.x","article-title":"Cannabis use and cancer.","volume":"97","author":"Hall","year":"2002","journal-title":"Addiction"},{"issue":"4","key":"ooi240052r15","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1002\/ijc.29036","article-title":"Cannabis smoking and lung cancer risk: pooled analysis in the International Lung Cancer Consortium.","volume":"136","author":"Zhang","year":"2015","journal-title":"Int J Cancer"},{"issue":"1","key":"ooi240052r16","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1186\/s12889-020-8253-4","article-title":"Marijuana legalization and historical trends in marijuana use among US residents aged 12-25: results from the 1979-2016 National Survey on drug use and health.","volume":"20","author":"Yu","year":"2020","journal-title":"BMC Public Health"},{"issue":"3","key":"ooi240052r17","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1016\/0014-2999(96)00015-5","article-title":"N-(2-hydroxyethyl)hexadecanamide is orally active in reducing edema formation and inflammatory hyperalgesia by down-modulating mast cell activation.","volume":"300","author":"Mazzari","year":"1996","journal-title":"Eur J Pharmacol"},{"issue":"3","key":"ooi240052r18","doi-asserted-by":"publisher","first-page":"1616","DOI":"10.1074\/jbc.M109.069294","article-title":"Cannabinoids ?(9)-tetrahydrocannabinol and cannabidiol differentially inhibit the lipopolysaccharide-activated NF-kappa B and interferon-\u00df\/STAT proinflammatory pathways in BV-2 microglial cells.","volume":"285","author":"Kozela","year":"2010","journal-title":"J Biol Chem"},{"issue":"1","key":"ooi240052r19","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1038\/s41572-021-00247-4","article-title":"Cannabis use and cannabis use disorder.","volume":"7","author":"Connor","year":"2021","journal-title":"Nat Rev Dis Primers"},{"key":"ooi240052r20","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanepe.2021.100227","article-title":"Public health monitoring of cannabis use in Europe: prevalence of use, cannabis potency, and treatment rates.","volume":"10","author":"Manthey","year":"2021","journal-title":"Lancet Reg Health Eur"},{"issue":"11","key":"ooi240052r21","doi-asserted-by":"publisher","first-page":"1017","DOI":"10.1001\/jamaoto.2018.0486","article-title":"Association of marijuana use with psychosocial and quality of life outcomes among patients with head and neck cancer.","volume":"144","author":"Zhang","year":"2018","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"3","key":"ooi240052r22","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1002\/lio2.154","article-title":"Therapeutic cannabis and endocannabinoid signaling system modulator use in otolaryngology patients.","volume":"3","author":"Bryant","year":"2018","journal-title":"Laryngoscope Investig Otolaryngol"},{"issue":"5","key":"ooi240052r23","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1007\/s00213-021-06001-8","article-title":"Associations between cannabis use, cannabis use disorder, and mood disorders: longitudinal, genetic, and neurocognitive evidence.","volume":"239","author":"Kuhns","year":"2022","journal-title":"Psychopharmacology (Berl)"},{"issue":"August","key":"ooi240052r24","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2021.676850","article-title":"Cannabis use and the risk of cardiovascular diseases: a mendelian randomization study.","volume":"8","author":"Zhao","year":"2021","journal-title":"Front Cardiovasc Med"},{"issue":"5","key":"ooi240052r25","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1023\/A:1018427320658","article-title":"Marijuana use and cancer incidence (California, United States).","volume":"8","author":"Sidney","year":"1997","journal-title":"Cancer Causes Control"},{"issue":"8","key":"ooi240052r26","doi-asserted-by":"publisher","first-page":"6029","DOI":"10.1007\/s13277-015-3279-4","article-title":"Cannabis smoke can be a major risk factor for early-age laryngeal cancer\u2014a molecular signaling-based approach.","volume":"36","author":"Bhattacharyya","year":"2015","journal-title":"Tumour Biol"},{"issue":"2","key":"ooi240052r27","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooad035","article-title":"A global federated real-world data and analytics platform for research.","volume":"6","author":"Palchuk","year":"2023","journal-title":"JAMIA Open"},{"issue":"10","key":"ooi240052r29","doi-asserted-by":"publisher","first-page":"1094","DOI":"10.1097\/MAO.0000000000004031","article-title":"Association of smoke and nicotine product consumption with sensorineural hearing loss: a population-level analysis.","volume":"44","author":"Li","year":"2023","journal-title":"Otol Neurotol"},{"issue":"5","key":"ooi240052r30","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1001\/jamaoto.2023.4739","article-title":"Exogenous estrogen in the development of head and neck cancer.","volume":"150","author":"Doll","year":"2024","journal-title":"JAMA Otolaryngol Head Neck Surg"},{"issue":"6","key":"ooi240052r31","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1093\/jnci\/djn025","article-title":"Distinct risk factor profiles for human papillomavirus type 16-positive and human papillomavirus type 16-negative head and neck cancers.","volume":"100","author":"Gillison","year":"2008","journal-title":"J Natl Cancer Inst"},{"issue":"1","key":"ooi240052r32","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1158\/1055-9965.EPI-13-0181","article-title":"Association of marijuana smoking with oropharyngeal and oral tongue cancers: pooled analysis from the INHANCE consortium.","volume":"23","author":"Marks","year":"2014","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"issue":"3","key":"ooi240052r33","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1016\/j.otohns.2007.12.002","article-title":"Cannabis use and cancer of the head and neck: case-control study.","volume":"138","author":"Aldington","year":"2008","journal-title":"Otolaryngol Head Neck Surg"},{"issue":"11","key":"ooi240052r34","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.16318","article-title":"Association between marijuana use and risk of cancer: a systematic review and meta-analysis.","volume":"2","author":"Ghasemiesfe","year":"2019","journal-title":"JAMA Netw Open"},{"issue":"10","key":"ooi240052r35","doi-asserted-by":"publisher","first-page":"777","DOI":"10.1093\/jnci\/djk179","article-title":"Alcohol drinking in never users of tobacco, cigarette smoking in never drinkers, and the risk of head and neck cancer: pooled analysis in the International Head and Neck Cancer Epidemiology Consortium.","volume":"99","author":"Hashibe","year":"2007","journal-title":"J Natl Cancer Inst"},{"issue":"4","key":"ooi240052r36","first-page":"263","article-title":"Alcohol consumption and the risk of cancer: a meta-analysis.","volume":"25","author":"Bagnardi","year":"2001","journal-title":"Alcohol Res Health"},{"issue":"1","key":"ooi240052r37","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1002\/ijc.23033","article-title":"Tobacco smoking and cancer: a meta-analysis.","volume":"122","author":"Gandini","year":"2008","journal-title":"Int J Cancer"},{"issue":"1","key":"ooi240052r38","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s42238-019-0003-z","article-title":"Cannabis use patterns at the dawn of US cannabis reform.","volume":"1","author":"Kumar","year":"2019","journal-title":"J Cannabis Res"},{"issue":"1","key":"ooi240052r39","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1111\/j.1525-1497.2004.40081.x","article-title":"Respiratory effects of marijuana and tobacco use in a U.S. sample.","volume":"20","author":"Moore","year":"2005","journal-title":"J Gen Intern Med"},{"issue":"2","key":"ooi240052r40","first-page":"26","article-title":"Periodontal and oral manifestations of marijuana use.","volume":"92","author":"Rawal","year":"2012","journal-title":"J Tenn Dent Assoc"},{"issue":"S17F","key":"ooi240052r41","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1002\/jcb.240531027","article-title":"TGF-a and EGFR in head and neck cancer.","volume":"17F","author":"Grandis","year":"1993","journal-title":"J Cell Biochem Suppl"},{"issue":"7","key":"ooi240052r42","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/cancers12071985","article-title":"Anti-cancer potential of cannabinoids, terpenes, and flavonoids present in cannabis.","volume":"12","author":"Tomko","year":"2020","journal-title":"Cancers (Basel)"},{"issue":"2","key":"ooi240052r43","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1007\/s11481-015-9608-y","article-title":"The antitumor activity of plant-derived non-psychoactive cannabinoids.","volume":"10","author":"McAllister","year":"2015","journal-title":"J Neuroimmune Pharmacol"},{"issue":"6","key":"ooi240052r44","doi-asserted-by":"publisher","first-page":"1286","DOI":"10.1165\/ajrcmb.20.6.3424","article-title":"Oxidative stress produced by marijuana smoke: an adverse effect enhanced by cannabinoids.","volume":"20","author":"Sarafian","year":"1999","journal-title":"Am J Respir Cell Mol Biol"},{"issue":"1","key":"ooi240052r45","doi-asserted-by":"publisher","first-page":"373","DOI":"10.4049\/jimmunol.165.1.373","article-title":"?-9-Tetrahydrocannabinol inhibits antitumor immunity by a CB2 receptor-mediated, cytokine-dependent pathway.","volume":"165","author":"Zhu","year":"2000","journal-title":"J Immunol"},{"issue":"3","key":"ooi240052r46","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/S0162-3109(98)00041-1","article-title":"Delta 9 tetrahydrocannabinol and cannabidiol alter cytokine production by human immune cells.","volume":"40","author":"Srivastava","year":"1998","journal-title":"Immunopharmacology"},{"issue":"6","key":"ooi240052r47","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1177\/2045125312457586","article-title":"Cannabis, a complex plant: different compounds and different effects on individuals.","volume":"2","author":"Atakan","year":"2012","journal-title":"Ther Adv Psychopharmacol"},{"issue":"11","key":"ooi240052r48","doi-asserted-by":"publisher","first-page":"8631","DOI":"10.1007\/s00432-023-04807-x","article-title":"Causal relationship between cannabis use and cancer: a genetically informed perspective.","volume":"149","author":"Huang","year":"2023","journal-title":"J Cancer Res Clin Oncol"},{"issue":"6","key":"ooi240052r49","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1080\/00952990.2019.1569668","article-title":"Time trends in US cannabis use and cannabis use disorders overall and by sociodemographic subgroups: a narrative review and new findings.","volume":"45","author":"Hasin","year":"2019","journal-title":"Am J Drug Alcohol Abuse"},{"key":"ooi240052r28","unstructured":"TriNetX Advanced Analytics. TriNetX. Accessed April 19, 2024. https:\/\/trinetx.com\/real-world-data\/advanced-analytics\/"}],"container-title":["JAMA Otolaryngology\u2013Head &amp; Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/articlepdf\/2822269\/jamaotolaryngology_gallagher_2024_oi_240052_1740605205.56535.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,27]],"date-time":"2025-02-27T16:00:42Z","timestamp":1740672042000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaotolaryngology\/fullarticle\/2822269"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,1]]},"references-count":49,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2024,12,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaoto.2024.2419","relation":{},"ISSN":["2168-6181"],"issn-type":[{"value":"2168-6181","type":"print"}],"subject":[],"published":{"date-parts":[[2024,12,1]]}}}