Regular Opioid Use May Increase the Risk of Lung Cancer

Regular use of opioids is associated with an increased risk of lung cancer, according to research presented at the 2023 World Conference on Lung Cancer.

In a large study, researchers found that patients who used opioids regularly had a roughly 30% higher risk of lung cancer than patients who did not use opioids.

“Given the explosive growth in opioid use …, we need studies to urgently evaluate this association,” said study presenter Mahdi Sheikh, MD, PhD, of the World Health Organization’s International Agency for Research on Cancer (IARC) in Lyon, France.

Dr Sheikh noted that the IARC recently classified opium as a group 1 carcinogen in humans, with “sufficient” evidence suggesting that opium can cause lung, laryngeal, and bladder cancers. Dr Sheikh and colleagues sought to determine whether regular use of prescription opioids is similarly associated with the risk of lung cancer.

The researchers analyzed data from the UK Biobank cohort, which included 473,067 patients who were recruited between 2006 and 2010 and were followed until 2021. A total of 27,856 patients reported regular opioid use, and 3480 patients were diagnosed with lung cancer.

When assessing the association between opioid use and lung cancer, the researchers adjusted for many potential confounders, including age, sex, education, deprivation, body mass index, alcohol use, smoking status, pack-years, and opioid-related comorbidities.

In this adjusted analysis, there was a 32% increase in the risk of lung cancer among patients who used opioids regularly (hazard ratio [HR], 1.32; 95% CI, 1.19-1.46).

The researchers observed a dose-response relationship as well. Patients who were taking strong opioids had a greater risk of lung cancer (HR, 1.82; 95% CI, 1.29-2.57) than patients taking weak opioids (HR, 1.30; 95% CI, 1.17-1.44).

In addition, the risk of lung cancer was lower among patients taking short-acting opioids (HR, 1.31; 95% CI, 1.16-1.47) or intermediate-acting opioids (HR, 1.28; 95% CI, 1.06-1.54) than among those taking long-acting opioids (HR, 1.85; 95% CI, 1.29-2.65).

To rule out reverse causality (cancer-related pain driving opioid use), the researchers dropped the first 2 years of follow-up and stratified patients by chronic pain and chronic conditions. Results in these analyses were similar to results in the main analysis. Results were also similar when the researchers stratified patients by sex and socioeconomic status.

The researchers also investigated the potential impact of genetics in a Mendelian randomization analysis of 29,266 lung cancer cases and 56,450 control individuals. The results suggested that genetic predisposition to using opioids was associated with an increased risk of lung cancer (odds ratio, 1.16; 95% CI, 1.05-1.28).

Dr Sheikh noted that, although these findings are important, they should be interpreted carefully because this study may be limited by underreporting bias, one-time measurement of dynamic behavior, and small sample sizes for some subgroups.

Dr Sheikh said more research into this association is “urgently” needed. To that end, the IARC-led Opioid Cohort Consortium is bringing together researchers involved in 13 studies worldwide to investigate the relationship between opioids and cancer in more than 2 million people.

Disclosures: No disclosures were provided. 

Reference

Sheikh M, Alcala K, Mariosa D, et al. Regular use of pharmaceutical opioids and subsequent risk of lung cancer. Presented at WCLC 2023. September 9-12, 2023. Abstract MA03.08.

This article originally appeared on Cancer Therapy Advisor