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January 6, 1989

Metastatic Lung Cancer in a Young Marijuana Smoker

JAMA. 1989;261(1):41-42. doi:10.1001/jama.1989.03420010051016

To the Editor. —  We describe a case of an extremely frequent, long-term marijuana smoker who presented with a clinical diagnosis of metastatic epidermoid carcinoma. Postmortem examination identified a tumor pattern most compatible with primary lung cancer.

Report of a Case. —  A 27-year-old Jamaican-born man presented to the emergency department with bizarre behavior. He had been raised as a Rastafarian, a group centered in the West Indies with whom marijuana smoking, even as children, is an integral part of the cultural experience. The patient admitted to smoking his first "joint" at age 3 years, and since age 11 years had smoked an estimated 20 joints, or 28 g of marijuana, per day (confirmed by two other family members). He also admitted to occasional cocaine use and tobacco smoking for the last ten years. The latter apparently never exceeded one pack per day during this time and often was much