Abstract
Mortality from bladder cancer has shown downward trends over the last 2 decades in several western European countries (albeit 10–15 years later than similar trends in the US), but is still increasing in some eastern European countries. Tobacco smoking and occupational exposure to aromatic amines are the two major established environmental risk factors for bladder cancer. Controlling exposure to these factors has been an important contributor to the reduction in bladder cancer mortality, particularly among men. Diet could influence bladder carcinogenesis, as many compounds contained in foods—and their metabolites—are excreted through the urinary tract. Fruit and vegetable consumption was inversely related with bladder cancer in many studies, but no consistent association has emerged between intake of related micronutrients and reduced risk of bladder cancer. Other widely investigated lifestyle habits are probably not associated with risk of developing bladder cancer (e.g. coffee consumption, artificial sweetener use, hair dyes) or are difficult to assess (e.g. fluid intake). Infections and stones in the urinary tract might cause chronic irritation of the bladder epithelium, and thus increase bladder cancer risk. First-degree relatives of bladder cancer patients have a 50–100% increased relative risk of developing the disease, a risk that could be even higher when the proband is diagnosed at an early age.
Key Points
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Trends in male mortality rates in Europe and other developed areas of the world are declining, reflecting reduced exposure to tobacco smoking and occupational carcinogens mainly in male populations
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Cigarette smoking, occupational exposure to aromatic amines, and infection with Schistosoma haematobium are the main recognized risk factors for developing bladder cancer
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Other potential etiologic factors for bladder cancer include occupational exposure to polycyclic aromatic hydrocarbons, low consumption of vegetables and fruit, urinary tract infections (other than Schistosoma haematobium), and drinking tap water with chlorine or chlorination byproducts or water contaminated with arsenic
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Slow N-acetyltransferase-2 acetylation status is associated with a modest increase in bladder cancer risk
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A positive family history of bladder cancer in first-degree relatives approximately doubles the risk of the same cancer: potential interactions between genetic and environmental factors in bladder cancer risk have been reported, but are still not consistently assessed
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Acknowledgements
This work was conducted with the contribution of the Italian Association for Cancer Research, the Italian League against Cancer and the Italian Ministry of Education (PRIN 2005). The authors thank Mrs I Garimoldi for her editorial assistance before submitting the article.
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Pelucchi, C., Bosetti, C., Negri, E. et al. Mechanisms of Disease: the epidemiology of bladder cancer. Nat Rev Urol 3, 327–340 (2006). https://doi.org/10.1038/ncpuro0510
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DOI: https://doi.org/10.1038/ncpuro0510
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