Opium use and the risk of head and neck squamous cell carcinoma

Elham Mohebbi, Maryam Hadji, Hamideh Rashidian, Abass Rezaianzadeh, Maryam Marzban, Ali Akbar Haghdoost, Ahmad Naghibzadeh Tahami, Abdolvahab Moradi, Mahin Gholipour, Farid Najafi, Roya Safari-Faramani, Reza Alizadeh-Navaei, Alireza Ansari-Moghaddam, Mahdieh Bakhshi, Azim Nejatizadeh, Masumeh Mahmoudi, Soodabeh Shahidsales, Saeideh Ahmadi-Simab, Ali Asghar Arabi Mianroodi, Monireh Sadat SeyyedsalehiBayan Hosseini, Vahideh Peyghambari, Mohammad Shirkhoda, Reza Shirkoohi, Elmira Ebrahimi, Soheila Manifar, Mohammad Ali Mohagheghi, Laura Rozek, Paul Brennan, Hossein Poustchi, Arash Etemadi, Eero Pukkala, Joachim Schüz, Reza Malekzadeh, Elisabete Weiderpass, Afarin Rahimi-Movaghar, Paolo Boffetta, Farin Kamanagar, Kazem Zendehdel

Research output: Contribution to journalArticleScientificpeer-review

2 Citations (Scopus)


Scant evidence exists to support the association of opium use with head and neck cancer, limited to the larynx and oral cavity. In a multicenter case-control study—Iran Opium and Cancer study, we recruited 633 cases of head and neck squamous cell carcinoma (HNSCC) (254 lip and oral cavity, 54 pharynx, 327 larynx and 28 other subsites within the head and neck) and 3065 frequency-matched controls from April 2016 to April 2019. Odds ratios (ORs) for opium use and 95% confidence intervals (95% CIs) were obtained using mixed-effects logistic regression because of heterogeneity among centers. The adjusted OR (95% CI) for regular opium use was 3.76 (2.96-4.79) for all HNSCC combined. Strong dose-response effects were observed by frequency or amount of use, and duration of use. Regular opium uses significantly increased the risk of HNSCC of the pharynx, larynx and other subsites within the head and neck with OR (95% CI) of 2.90 (1.40-6.02), 6.55 (4.69-9.13) and 5.95 (2.41-14.71), respectively. The observed associations were significant even among never tobacco smokers (including cigarette and water-pipe smoking). Moreover, by the multiplicative interaction scale, the effect of opium use could be varied by cigarette smoking on HNSCC, 8.16 (6.20-10.74). For the first time, the current study showed opium users have an increased risk of several anatomic subsites of HNSCC.

Original languageEnglish
Pages (from-to)1066-1076
JournalInternational journal of cancer
Issue number5
Early online dateSept 2020
Publication statusPublished - Mar 2021
Publication typeA1 Journal article-refereed


  • drug-related disorders
  • morphine
  • neoplasm
  • opium
  • otorhinolaryngologic neoplasms

Publication forum classification

  • Publication forum level 2

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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