Maryam Hadji
1,2, Hamideh Rashidian
2, Maryam Marzban
3,4, Mahin Gholipour
5, Ahmad Naghibzadeh-Tahami
6, Elham Mohebbi
2,7, Elmira Ebrahimi
2, Bayan Hosseini
2,8, Ali Akbar Haghdoost
9,10, Abbas Rezaianzadeh
11, Afarin Rahimi-Movaghar
12, Abdolvahab Moradi
5, Monireh Sadat Seyyedsalehi
2, Reza Shirkoohi
2, Hossein Poustchi
13, Sareh Eghtesad
13, Farid Najafi
14,15, Roya Safari-Faramani
16, Reza Alizadeh-Navaei
17, Ali Reza Ansari Moghadam
18, Mahdieh Bakhshi
18, Azim Nejatizadeh
19, Masumeh Mahmudi
19, Soudabeh Shahid-Sales
20, Saideh Ahmadi-Simab
20, Omid Nabavian
21, Paolo Boffetta
22,23, Eero Pukkala
1,24*, Elisabete Weiderpass
8, Farin Kamangar
25*, Kazem Zendehdel
2,26,27*1 Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
2 Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
3 Clinical Research Development Center, “The Persian Gulf Martyrs”, Bushehr University of Medical Science, Bushehr, Iran
4 Department of Public Health, School of Public Health, Bushehr University of Medical Science, Bushehr, Iran
5 Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
6 Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
7 Pathology and Stem Cell Research Center, Kerman University of Medical Sciences, Kerman
8 International Agency for Research on Cancer, Lyon, France
9 Department of Biostatistics and Epidemiology, Kerman University of Medical Sciences, Kerman, Iran
10 Regional Knowledge HUB for HIV/AIDS Surveillance, Research Centre for Modelling in Health, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
11 Colorectal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
12 Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
13 Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
14 Research Center for Environmental Determinants of Health, Institute of Health, Kermanshah Medical Sciences University, Kermanshah, Iran
15 Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
16 Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah Medical Sciences University, Kermanshah, Iran
17 Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
18 Health Promotion Research Center, Zahedan University of Medical sciences, Zahedan, Iran
19 Bandar-e-Abbas University of Medical Sciences, Bandar-e-Abbas, Iran
20 Mashhahd University of Medical Sciences, Mashhad, Iran
21 Department of Anesthesiology, Imam Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
22 Stony Brook Cancer Center, Stony Brook University, Stony Brook, NY, USA
23 Department of Medical and Surgical Sciences, University of Bologna, Italy
24 Finnish Cancer Registry - Institute for Statistical and Epidemiological Cancer Research, Helsinki, Finland
25 Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD, USA
26 Cancer Biology Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
27 Breast Disease Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Background: The International Agency for Research on Cancer (IARC) recently classified opium use as a Group 1 carcinogen. However, much remains to be studied on the relation between opium and cancer. We designed the Iranian Opium and Cancer (IROPICAN) study to further investigate the association of opium use and cancers of the head and neck, bladder, lung, and colon and rectum. In this paper, we describe the rationale, design, and some initial results of the IROPICAN Study.
Methods: The IROPICAN is a multi-center case-control study conducted in 10 provinces of Iran. The cases were all histologically confirmed and the controls were selected from hospital visitors who were free of cancer, were not family members or friends of the cancer patients, and were visiting the hospital for reasons other than their own ailment. The questionnaires included detailed questions on opium use (including age at initiation, duration, frequency, typical amount, and route), and potential confounders, such as tobacco use (e.g., cigarettes, nass and water-pipe), and dietary factors. Biological samples, including blood and saliva, were also collected.
Results: The validation and pilot phases showed reasonably good validity, with sensitivities of 70% and 69% for the cases and controls, respectively, in reporting opium use. The results also showed excellent reliability, with intra-class correlation coefficients of 0.96 for ever opium use and 0.88 (95% CI: 0.80, 0.92) for regular opium use. In the main phase, we recruited 3299 cancer cases (99% response rate) and 3477 hospital visitor controls (89% response rate). The proportion of ever-use of opium was 40% among cases and 18% among controls.
Conclusion: The IROPICAN study will serve as a major resource in studies addressing the effect of opium on risk of cancers of the head and neck, bladder, lung, and colon and rectum.