Opium use and risk of lung cancer: A multicenter case-control study in Iran

Hamideh Rashidian, Maryam Hadji, Mahin Gholipour, Ahmad Naghibzadeh-Tahami, Maryam Marzban, Elham Mohebbi, Roya Safari-Faramani, Mahdieh Bakhshi, Monireh Sadat Seyyedsalehi, Bayan Hosseini, Reza Alizadeh-Navaei, Habib Emami, Ali Akbar Haghdoost, Abbas Rezaianzadeh, Abdolvahab Moradi, Alireza Ansari-Moghaddam, Azim Nejatizadeh, Soodabeh ShahidSales, Alireza Rezvani, Mohammad Hasan LarizadehFarid Najafi, Hossein Poustchi, Mohammad Ali Mohagheghi, Paul Brennan, Elisabete Weiderpass, Joachim Schüz, Eero Pukkala, Neal D. Freedman, Paolo Boffetta, Reza Malekzadeh, Arash Etemadi, Afarin Rahimi-Movaghar, Farin Kamangar, Kazem Zendehdel

Research output: Contribution to journalArticleScientificpeer-review


Opium use was recently classified as a human carcinogen for lung cancer by the International Agency for Research on Cancer. We conducted a large, multicenter case-control study evaluating the association between opium use and the risk of lung cancer. We recruited 627 cases and 3477 controls from May 2017 to July 2020. We used unconditional logistic regression analyses to estimate the odds ratios (OR) and 95% confidence intervals (CI) and measured the association between opium use and the risk of lung cancer. The ORs were adjusted for the residential place, age, gender, socioeconomic status, cigarettes, and water pipe smoking. We found a 3.6-fold risk of lung cancer for regular opium users compared to never users (95% CI: 2.9, 4.6). There was a strong dose-response association between a cumulative count of opium use and lung cancer risk. The OR for regular opium use was higher for small cell carcinoma than in other histology (8.3, 95% CI: 4.8, 14.4). The OR of developing lung cancer among opium users was higher in females (7.4, 95% CI: 3.8, 14.5) than in males (3.3, 95% CI: 2.6, 4.2). The OR for users of both opium and tobacco was 13.4 (95% CI: 10.2, 17.7) compared to nonusers of anything. The risk of developing lung cancer is higher in regular opium users, and these results strengthen the conclusions on the carcinogenicity of opium. The association is stronger for small cell carcinoma cases than in other histology.

Original languageEnglish
Pages (from-to)203-213
Number of pages11
JournalInternational journal of cancer
Issue number2
Early online date13 Aug 2022
Publication statusPublished - 15 Jan 2023
Publication typeA1 Journal article-refereed


  • adenocarcinoma
  • Iran
  • lung cancer
  • opiate
  • opium
  • small cell
  • squamous cell

Publication forum classification

  • Publication forum level 2

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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