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We supplement the recent IARC evaluation by conducting an extended systematic review as well as a quantitative meta-analytic assessment of the role of opium consumption and risk for selected cancers, evaluating in detail various aspects of study quality on meta-analytic findings. We searched the published literature to identify all relevant studies on opium consumption and risk of selected cancers in humans through 31 October, 2022. Meta-relative risks (mRRs) and associated 95% confidence intervals (CIs) were estimated using random-effects models for studies of cancer of the urinary bladder, larynx, lung, oesophagus, pancreas, and stomach. Heterogeneity among studies was assessed using the <jats:italic>I<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup> statistic. We assessed study quality and conducted sensitivity analyses to evaluate the impact of potential reverse causation, protopathic bias, selection bias, information bias, and confounding.\nIn total, 2 prospective cohort studies and 33 case\u2013control studies were included. The overall pooled mRR estimated for \u2018<jats:italic>ever or regular<\/jats:italic>\u2019 versus \u2018<jats:italic>never<\/jats:italic>\u2019 use of opium ranged from 1.50 (95% CI 1.13\u20131.99, <jats:italic>I<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup>\u2009=\u20090%, 6 studies) for oesophageal cancer to 7.97 (95% CI 4.79\u201313.3, <jats:italic>I<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup>\u2009=\u200962%, 7 studies) for laryngeal cancer. Analyses of cumulative opium exposure suggested greater risk of cancer associated with higher opium consumption. Findings were robust in sensitivity analyses excluding studies prone to potential methodological sources of biases and confounding. Findings support an adverse association between opium consumption and cancers of the urinary bladder, larynx, lung, oesophagus, pancreas and stomach.<\/jats:p>","DOI":"10.1007\/s10654-023-00969-7","type":"journal-article","created":{"date-parts":[[2023,2,11]],"date-time":"2023-02-11T07:43:14Z","timestamp":1676101394000},"page":"373-389","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["The carcinogenicity of opium consumption: a systematic review and meta-analysis"],"prefix":"10.1007","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3655-8482","authenticated-orcid":false,"given":"Adalberto","family":"M. 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