Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: Human papillomavirus (HPV) has been recognized as a key player in the pathogenesis of head and neck oropharyngeal squamous cell carcinoma (SCC). With the increased recreational use and legalization of marijuana, there is a need to better understand the role of marijuana use in the development of HPV-positive oropharyngeal SCC. The objective of this systematic review is to characterize the impact of smoking cannabis on the development of HPV-positive oropharyngeal SCC.
Methods: Two reviewers independently analyzed all retrieved studies in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and predefined inclusion and exclusion criteria. Medline, PubMed, Scopus, Google Scholar, and Cochrane databases were systematically searched using keywords relevant to cannabis, HPV, oropharyngeal cancer, and squamous cell carcinoma. Demographic data, marijuana history, and odds ratio for incidence of oropharyngeal SCC were recorded from included studies. The methodological quality of the studies was evaluated using the Newcastle-Ottawa Scale criteria. Meta-analysis, heterogeneity statistics and risk bias were performed.
Results: Of thirty-six articles, six-met inclusion criteria for systematic review. All included studies were case-control studies. Meta-analysis revealed no significant association between marijuana smoking and incidence of HPV positive oropharyngeal SCC with high heterogeneity in the current literature (weighted odds ratio: 1.13 (0.98-1.30); heterogeneity statistic, I2=86.3).
Conclusions: There is limited literature regarding the impact of cannabis use on the development of HPV positive oropharyngeal SCC and their association remains unclear based on our results. Long-term studies regarding marijuana use in patients who develop oropharyngeal SCC are required to further understand and draw concrete conclusions. Future studies may have important implications for patient education, counseling, and public health.