Abstract
ObjectiveThe association between opium use and bladder cancer has been investigated in many studies, with varying reporting results reported. This study aims to estimate the total odds ratio for the association between bladder cancer and opium consumption using meta-analysis.MethodsThe study was designed according to PRISMA guidelines. Two independent researchers searched for the relevant studies using PubMed, Web of Science, Scopus, OVID, Embase, and Google Scholar. After systematic screening of the studies identified during the first step, Cochrane risk of bias tool was determined for the selected studies. The case-control and the cohort studies were investigated to assess risk of bladder cancer due to opium use. In addition, the cross-sectional studies were analysed separately to assess frequency of opium consumption. These estimates were combined using the inverse variance method. Fixed or random effect models were applied to combine the point odds ratios. The heterogeneity between the primary results was assessed using the Cochran test and I-square index. The suspected factors for heterogeneity were investigated using meta-regression models. An Egger test was conducted to identify any probable publication bias. Forest plots illustrated the point and pooled estimates. All analyses were performed using Stata version 14 software and RevMan version 5.3.ResultsWe included 17 primary studies (11 case-control, one cohort and five cross-sectional) in the final meta-analysis. The total odds ratios (95% confidence intervals) for developing bladder cancer by opium use alone, and concurrent use of opium and cigarettes were estimated as 3.85 (3.05–4.87) and 5.7 (1.9–16.3) respectively. The odds ratio (95% confidence interval) for opium use with or without cigarette smoking was estimated as 5.3 (3.6–7.7).ConclusionThis meta-analysis showed that opium use similar to cigarette smoking and maybe with similar mechanisms can be a risk factor for bladder cancer. It is therefore expected to be a risk factor for other cancers.
Highlights
Bladder cancer is responsible for more than 7% of neoplasms, especially among men [1]
The odds ratio (95% confidence interval) for opium use with or without cigarette smoking was estimated as 5.3 (3.6–7.7). This meta-analysis showed that opium use similar to cigarette smoking and maybe with similar mechanisms can be a risk factor for bladder cancer
Based on the results of the above-mentioned studies, behavior/status of opium users can strongly distort or modify the association between opium use and bladder cancer, and should be taken into consideration when assessing the carcinogenic effect of opium addiction
Summary
Bladder cancer is responsible for more than 7% of neoplasms, especially among men [1]. Several risk factors are reported to be responsible for developing bladder cancer such as high body mass index [4], genetic factors [5], occupational hazards [6,7], environment and nutrition [8], and behavioral factors [7, 9,10,11]. Behavioral factors, especially cigarette smoking and opium addiction, have been mentioned in previous studies as the most important risk factors for many cancers including bladder cancer [12, 13]. Based on the results of the above-mentioned studies, behavior/status of opium users can strongly distort or modify the association between opium use and bladder cancer, and should be taken into consideration when assessing the carcinogenic effect of opium addiction. The total effect of opium on developing bladder cancer controlling for the confounding influence of cigarette smoking has not been estimated elsewhere
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