Maryam Hadji1,2, Hamideh Rashidian2, Maryam Marzban3,4, Mahin Gholipour5, Ahmad Naghibzadeh-Tahami6, Elham Mohebbi2,7, Elmira Ebrahimi2, Bayan Hosseini2,8, Ali Akbar Haghdoost9,10, Abbas Rezaianzadeh11, Afarin Rahimi-Movaghar12, Abdolvahab Moradi5, Monireh Sadat Seyyedsalehi2, Reza Shirkoohi2, Hossein Poustchi13, Sareh Eghtesad13, Farid Najafi14,15, Roya Safari-Faramani16, Reza Alizadeh-Navaei17, Ali Reza Ansari Moghadam18, Mahdieh Bakhshi18, Azim Nejatizadeh19, Masumeh Mahmudi19, Soudabeh Shahid-Sales20, Saideh Ahmadi-Simab20, Omid Nabavian21, Paolo Boffetta22,23, Eero Pukkala1,24, Elisabete Weiderpass8, Farin Kamangar25, Kazem Zendehdel2,26,27. 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.
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 cancerpatients, 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.