Cancer Causes & Control

, Volume 24, Issue 10, pp 1811–1820 | Cite as

Marijuana use and risk of lung cancer: a 40-year cohort study

  • Russell C. CallaghanEmail author
  • Peter Allebeck
  • Anna Sidorchuk
Original paper



Cannabis (marijuana) smoke and tobacco smoke contain many of the same potent carcinogens, but a critical—yet unresolved—medical and public-health issue is whether cannabis smoking might facilitate the development of lung cancer. The current study aimed to assess the risk of lung cancer among young marijuana users.


A population-based cohort study examined men (n = 49,321) aged 18–20 years old assessed for cannabis use and other relevant variables during military conscription in Sweden in 1969–1970. Participants were tracked until 2009 for incident lung cancer outcomes in nationwide linked medical registries. Cox regression modeling assessed relationships between cannabis smoking, measured at conscription, and the hazard of subsequently receiving a lung cancer diagnosis.


At the baseline conscription assessment, 10.5 % (n = 5,156) reported lifetime use of marijuana and 1.7 % (n = 831) indicated lifetime use of more than 50 times, designated as “heavy” use. Cox regression analyses (n = 44,284) found that such “heavy” cannabis smoking was significantly associated with more than a twofold risk (hazard ratio 2.12, 95 % CI 1.08–4.14) of developing lung cancer over the 40-year follow-up period, even after statistical adjustment for baseline tobacco use, alcohol use, respiratory conditions, and socioeconomic status.


Our primary finding provides initial longitudinal evidence that cannabis use might elevate the risk of lung cancer. In light of the widespread use of marijuana, especially among adolescents and young adults, our study provides important data for informing the risk–benefit calculus of marijuana smoking in medical, public-health, and drug-policy settings.


Marijuana use Lung cancer Cohort Incidence Tobacco Swedish conscripts 



This research was supported indirectly by an institutional grant (which helped to provide salary support for Dr. Russell C. Callaghan, PhD) from the Ontario Ministry of Health and Long-Term Care to the Centre for Addiction and Mental Health (CAMH). The Ontario Ministry of Health and Long-Term Care did not have any role in the study design, analyses, interpretation of results, manuscript preparation, or approval to submit the final version of the manuscript for publication. The views expressed in this paper do not necessarily reflect those of the Ministry. This work was also funded by a research grant from the Swedish Council for Working Life and Social Research (FAS 2009-1611 to PA), which helped to provide salary support for Dr. Anna Sidorchuk, MD, PhD. The funders had no role in study design, data collection, data analyses, manuscript preparation, or approval to publish.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10552_2013_259_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 kb)


  1. 1.
    United Nations Office on Drugs and Crime (2010) World drug report 2010 (United Nations Publication, Sales No. E.10.XI.13). United Nations Office on Drugs and Crime, Vienna, AustriaGoogle Scholar
  2. 2.
    Degenhardt L, Hall W (2012) Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet 379:55–70PubMedCrossRefGoogle Scholar
  3. 3.
    Mehra R, Moore BA, Crothers K (2006) The association between marijuana smoking and lung cancer: a systematic review. Arch Intern Med 166:1359–1367PubMedCrossRefGoogle Scholar
  4. 4.
    Hall W, Degenhardt L (2009) Adverse health effects of non-medical cannabis use. Lancet 374:1383–1391PubMedCrossRefGoogle Scholar
  5. 5.
    Hashibe M, Straif K, Tashkin DP, Morgenstern H, Greenland S, Zhang ZF (2005) Epidemiologic review of marijuana use and cancer risk. Alcohol 35:265–275PubMedCrossRefGoogle Scholar
  6. 6.
    Alberg AJ, Ford JG, Samet JM, American College of Chest Physicians (2007) Epidemiology of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132:29S–55SPubMedCrossRefGoogle Scholar
  7. 7.
    Maertens RM, White PA, Rickert W et al (2009) The genotoxicity of mainstream and sidestream marijuana and tobacco smoke condensates. Chem Res Toxicol 22:1406–1414PubMedCrossRefGoogle Scholar
  8. 8.
    Moir D, Rickert WS, Levasseur G et al (2008) A comparison of mainstream and sidestream marijuana and tobacco cigarette smoke produced under two machine smoking conditions. Chem Res Toxicol 21:494–502PubMedCrossRefGoogle Scholar
  9. 9.
    Marselos M, Karamanakos P (1999) Mutagenicity, developmental toxicity and carcinogenicity of cannabis. Addict Biol 4:5–12PubMedCrossRefGoogle Scholar
  10. 10.
    Tashkin DP, Baldwin GC, Sarafian T, Dubinett S, Roth MD (2002) Respiratory and immunologic consequences of marijuana smoking. J Clin Pharmacol 42:71S–81SPubMedGoogle Scholar
  11. 11.
    Barsky SH, Roth MD, Kleerup EC, Simmons M, Tashkin DP (1998) Histopathologic and molecular alterations in bronchial epithelium in habitual smokers of marijuana, cocaine, and/or tobacco. J Natl Cancer Inst 90:1198–1205PubMedCrossRefGoogle Scholar
  12. 12.
    Fligiel SEG, Roth MD, Kleerup EC, Barsky SH, Simmons MS, Tashkin DP (1997) Tracheobronchial histopathology in habitual smokers of cocaine, marijuana, and/or tobacco. Chest 112:319–326PubMedCrossRefGoogle Scholar
  13. 13.
    Tashkin DP (2001) Airway effects of marijuana, cocaine, and other inhaled illicit agents. Curr Opin Pulm Med 7:43–61PubMedCrossRefGoogle Scholar
  14. 14.
    Roth MD, Arora A, Barsky SH, Kleerup EC, Simmons M, Tashkin DP (1998) Airway inflammation in young marijuana and tobacco smokers. Am J Respir Crit Care Med 157:928–937PubMedCrossRefGoogle Scholar
  15. 15.
    Sidney S, Quesenberry CP Jr, Friedman GD, Tekawa IS (1997) Marijuana use and cancer incidence (California, United States). Cancer Cause Control 8:722–728CrossRefGoogle Scholar
  16. 16.
    Aldington S, Harwood M, Cox B et al (2008) Cannabis use and risk of lung cancer: a case–control study. Eur Respir J 31:280–286PubMedCrossRefGoogle Scholar
  17. 17.
    Sasco AJ, Merrill RM, Dari I et al (2002) A case–control study of lung cancer in Casablanca, Morocco. Cancer Cause Control 13:609–616CrossRefGoogle Scholar
  18. 18.
    Berthiller J, Straif K, Boniol M et al (2008) Cannabis smoking and risk of lung cancer in men: a pooled analysis of three studies in Maghreb. J Thorac Oncol 3:1398–1403PubMedCrossRefGoogle Scholar
  19. 19.
    Hashibe M, Morgenstern H, Cui Y et al (2006) Marijuana use and the risk of lung and upper aerodigestive tract cancers: results of a population-based case–control study. Cancer Epidemiol Biomarkers Prev 15:1829–1834PubMedCrossRefGoogle Scholar
  20. 20.
    Lee MH, Hancox RJ (2011) Effects of smoking cannabis on lung function. Expert Rev Respir Med 5:537–546PubMedCrossRefGoogle Scholar
  21. 21.
    Aldington S, Harwood M, Cox B et al (2008) Cannabis use and cancer of the head and neck: case–control study. Otolaryngol Head Neck 138:374–380CrossRefGoogle Scholar
  22. 22.
    Otto U (1976) Males youths. A sociopsychiatric study of a total annual population of Swedish adolescent boys. Acta Psychiatr Scand Suppl 264:1–312PubMedGoogle Scholar
  23. 23.
    Andréasson S, Engström A, Allebeck P, Rydberg U (1987) Cannabis and schizophrenia: a longitudinal study of Swedish conscripts. Lancet 330:1483–1486CrossRefGoogle Scholar
  24. 24.
    Ludvigsson JF, Otterblad-Olausson P, Pettersson BU, Ekbom A (2009) The Swedish personal identity number: possibilities and pitfalls in healthcare and medical research. Eur J Epidemiol 24:659–667PubMedCrossRefGoogle Scholar
  25. 25.
    Lunde AS, Lundeborg S, Lettenstrom GS, Thygesen L, Huebner J (1980) The person-number systems of Sweden, Norway, Denmark, and Israel. Vital Health Stat 2(84):1–59Google Scholar
  26. 26.
    Zammit S, Allebeck P, Andreasson S, Lundberg I, Lewis G (2002) Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort study. BMJ 325:1199PubMedCrossRefGoogle Scholar
  27. 27.
    Bjartveit K, Tverdal A (2005) Health consequences of smoking 1–4 cigarettes per day. Tob Control 14:315–320PubMedCrossRefGoogle Scholar
  28. 28.
    Mattsson B, Rutqvist LE, Wallgren A (1985) Comparison between diagnoses in the Stockholm Regional Cancer Register and certified underlying causes of death. Acta Radiol Oncol 24:219–226PubMedCrossRefGoogle Scholar
  29. 29.
    Mattsson B, Rutqvist LE (1985) Some aspects on validity of breast cancer, pancreatic cancer and lung cancer registration in Swedish official statistics. Radiother Oncol 4:63–70PubMedCrossRefGoogle Scholar
  30. 30.
    Ramsey SD, Scoggins JF, Blough DK, McDermott CL, Reyes CM (2009) Sensitivity of administrative claims to identify incident cases of lung cancer: a comparison of 3 health plans. J Manag Care Pharm 15:659–668PubMedGoogle Scholar
  31. 31.
    Brewster D, Muir C, Crichton J (1995) Registration of lung cancer in Scotland: an assessment of data accuracy based on review of medical records. Cancer Cause Control 6:303–310CrossRefGoogle Scholar
  32. 32.
    Greenland S, Lash TL (2008) Bias analysis. In: Rothman KJ, Greenland S, Lash TL (eds) Modern epidemiology, 3rd edn. Lippincott Williams & Wilkins, Philadelphia, pp 345–380Google Scholar
  33. 33.
    Chao C (2007) Associations between beer, wine, and liquor consumption and lung cancer risk: a meta-analysis. Cancer Epidemiol Biomarkers Prev 16:2436–2447PubMedCrossRefGoogle Scholar
  34. 34.
    Freudenheim JL, Ritz J, Smith-Warner SA et al (2005) Alcohol consumption and risk of lung cancer: a pooled analysis of cohort studies. Am J Clin Nutr 82:657–667PubMedGoogle Scholar
  35. 35.
    Brenner DR, McLaughlin JR, Hung RJ (2011) Previous lung diseases and lung cancer risk: a systematic review and meta-analysis. PLoS ONE 6:e17479PubMedCrossRefGoogle Scholar
  36. 36.
    Boffetta P, Ye W, Boman G, Nyren O (2002) Lung cancer risk in a population-based cohort of patients hospitalized for asthma in Sweden. Eur Respir J 19:127–133PubMedCrossRefGoogle Scholar
  37. 37.
    Santillan AA, Camargo CA, Colditz GA (2003) A meta-analysis of asthma and risk of lung cancer (United States). Cancer Cause Control 14:327–334CrossRefGoogle Scholar
  38. 38.
    Rosenberger A, Bickeböller H, McCormack V et al (2012) Asthma and lung cancer risk: a systematic investigation by the International Lung Cancer Consortium. Carcinogenesis 33:587–597PubMedCrossRefGoogle Scholar
  39. 39.
    StataCorp (2009) Stata statistical software: release 11. College Station, StataCorp LP, TXGoogle Scholar
  40. 40.
    Hayat MJ, Howlader N, Reichman ME, Edwards BK (2007) Cancer statistics, trends, and multiple primary cancer analyses from the surveillance, epidemiology, and end results (SEER) program. Oncologist 12:20–37PubMedCrossRefGoogle Scholar
  41. 41.
    Holmberg L, Sandin F, Bray F et al (2010) National comparisons of lung cancer survival in England, Norway and Sweden 2001–2004: differences occur early in follow-up. Thorax 65:436PubMedCrossRefGoogle Scholar
  42. 42.
    Tashkin DP (2005) Smoked marijuana as a cause of lung injury. Monaldi Arch Chest Dis 63:93–100PubMedGoogle Scholar
  43. 43.
    Bowles DW, O’Bryant CL, Camidge DR, Jimeno A (2011) The intersection between cannabis and cancer in the United States. Crit Rev Oncol Hematol 83:1–10PubMedCrossRefGoogle Scholar
  44. 44.
    Melamede R (2005) Cannabis and tobacco smoke are not equally carcinogenic. Harm Reduct J 2:21PubMedCrossRefGoogle Scholar
  45. 45.
    Hall W, Christie M, Currow D (2005) Cannabinoids and cancer: causation, remediation, and palliation. Lancet Oncol 6:35–42PubMedGoogle Scholar
  46. 46.
    Pisanti S, Bifulco M (2009) Endocannabinoid system modulation in cancer biology and therapy. Pharmacol Res 60:107–116PubMedCrossRefGoogle Scholar
  47. 47.
    Pisanti S, Malfitano AM, Grimaldi C et al (2009) Use of cannabinoid receptor agonists in cancer therapy as palliative and curative agents. Best Pract Res Clin Endocrinol Metab 23:117–131PubMedCrossRefGoogle Scholar
  48. 48.
    Degenhardt L, Bucello C, Calabria B et al (2011) What data are available on the extent of illicit drug use and dependence globally? Results of four systematic reviews. Drug Alcohol Depend 117:85–101PubMedCrossRefGoogle Scholar
  49. 49.
    Hibell B, Guttormsson U, Ahlström S et al (2012) The 2011 ESPAD report: substance use among students in 36 European countries. The European School Survey Project on Alcohol and Other Drugs, LisbonGoogle Scholar
  50. 50.
    Wiencke JK, Kelsey KT (2002) Teen smoking, field cancerization, and a “critical period” hypothesis for lung cancer susceptibility. Environ Health Perspect 110:555–558PubMedCrossRefGoogle Scholar
  51. 51.
    Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE (2011) Monitoring the future national results on adolescent drug use: overview of key findings. Institute for Social Research, The University of Michigan, Ann Arbor, MIGoogle Scholar
  52. 52.
    Danseco ER, Kingery PM, Coggeshall MB (1999) Perceived risk of harm from marijuana use among youth in the USA. School Psychol Int 20:39–56CrossRefGoogle Scholar
  53. 53.
    Swaim RC (2003) Individual and school level effects of perceived harm, perceived availability, and community size on marijuana use among 12th-grade students: a random effects model. Prev Sci 4:89–98PubMedCrossRefGoogle Scholar
  54. 54.
    Bachman JG, Johnson LD, O’Malley PM (1998) Explaining recent increases in students’ marijuana use: impacts of perceived risks and disapproval, 1976 through 1996. Am J Public Health 88:887–892PubMedCrossRefGoogle Scholar
  55. 55.
    Cuijpers P (2002) Effective ingredients of school-based drug prevention programs. A systematic review. Addict Behav 27:1009–1023PubMedCrossRefGoogle Scholar
  56. 56.
    Donaldson SI, Graham JW, Hansen WB (1994) Testing the generalizability of intervening mechanism theories: understanding the effects of adolescent drug use prevention interventions. J Behav Med 17:195–216PubMedCrossRefGoogle Scholar
  57. 57.
    White D, Pitts M (1998) Educating young people about drugs: a systematic review. Addiction 93:1475–1487PubMedCrossRefGoogle Scholar
  58. 58.
    Faggiano F, Vigna-Taglianti FD, Versino E, Zambon A, Borraccino A, Lemma P (2005) School-based prevention for illicit drugs’ use. Cochrane Database Syst Rev 18(2):003020Google Scholar
  59. 59.
    Room R, Fischer B, Hall W, Lenton S, Reuter P (2010) Cannabis policy: moving beyond stalemate. Oxford University Press, New YorkGoogle Scholar
  60. 60.
    Hall W, Lynskey M (2009) The challenges in developing a rational cannabis policy. Curr Opin Psychiatry 22:258–262PubMedCrossRefGoogle Scholar
  61. 61.
    Cohen PJ (2009) Medical marijuana: the conflict between scientific evidence and political ideology. Part one of two. J Pain Palliat Care Pharmacother 23:4–25PubMedCrossRefGoogle Scholar
  62. 62.
    Cohen PJ (2009) Medical marijuana: the conflict between scientific evidence and political ideology. Part two of two. J Pain Palliat Care Pharmacother 23:120–140PubMedCrossRefGoogle Scholar
  63. 63.
    Rehm J, Taylor B, Room R (2006) Global burden of disease from alcohol, illicit drugs and tobacco. Drug Alcohol Rev 25:503–513PubMedCrossRefGoogle Scholar
  64. 64.
    Chassin L, Presson CC, Rose JS, Sherman SJ (1996) The natural history of cigarette smoking from adolescence to adulthood: demographic predictors of continuity and change. Health Psychol 15:478–484PubMedCrossRefGoogle Scholar
  65. 65.
    Chen K, Kandel DB (1995) The natural history of drug use from adolescence to the mid-thirties in a general population sample. Am J Public Health 85:41–47PubMedCrossRefGoogle Scholar
  66. 66.
    Ellickson PL, Martino SC, Collins RL (2004) Marijuana use from adolescence to young adulthood: multiple developmental trajectories and their associated outcomes. Health Psychol 23:299–307PubMedCrossRefGoogle Scholar
  67. 67.
    Perkonigg A, Goodwin RD, Fiedler A et al (2008) The natural course of cannabis use, abuse and dependence during the first decades of life. Addiction 103:439–449 discussion 450–451PubMedCrossRefGoogle Scholar
  68. 68.
    Perkonigg A, Lieb R, Hofler M, Schuster P, Sonntag H, Wittchen HU (1999) Patterns of cannabis use, abuse and dependence over time: incidence, progression and stability in a sample of 1,228 adolescents. Addiction 94:1663–1678PubMedCrossRefGoogle Scholar
  69. 69.
    Benson G, Holmberg MB (1985) Validity of questionnaires in population studies on drug use. Acta Psychiatr Scand 71:9–18PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Russell C. Callaghan
    • 1
    • 2
    • 3
    Email author
  • Peter Allebeck
    • 4
  • Anna Sidorchuk
    • 4
    • 5
  1. 1.Northern Medical ProgramUniversity of Northern British Columbia (UNBC)Prince GeorgeCanada
  2. 2.Dalla Lana School of Public HealthUniversity of TorontoTorontoCanada
  3. 3.Human Brain LaboratoryCentre for Addiction and Mental Health (CAMH)TorontoCanada
  4. 4.Department of Public Health SciencesKarolinska InstitutetStockholmSweden
  5. 5.Department of Epidemiology, Parasitology and DesinfectologyNorth-Western State Medical University Named After I.I. MechnikovSaint PetersburgRussian Federation

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