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Global trends in the epidemiology of bladder cancer: challenges for public health and clinical practice

  • Review Article
  • Published:

From Nature Reviews Clinical Oncology

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Abstract

Bladder cancer is among the ten most common cancers globally, causes considerable morbidity and mortality and is, therefore, a substantial burden for health-care systems. The incidence of bladder cancer is affected by demographic trends, most notably population growth and ageing, as well as exposure to risk factors, especially tobacco smoking. Consequently, the incidence has not been stable throughout the world over time, nor will it be in the near future. Further primary prevention efforts are of the utmost importance to reduce the medical and financial burden of bladder cancer on populations and health-care systems. Simultaneously, less-invasive and lower-cost approaches for the diagnosis of both primary and recurrent bladder cancers are required to address challenges posed by the increasing shortage of health-care professionals and limited financial resources worldwide. In this regard, urinary biomarkers have demonstrated promising diagnostic accuracy and efficiency. Awareness of the risk factors and symptoms of bladder cancer should also be increased in society, particularly among health-care professionals and high-risk groups. Studies investigating the associations between lifestyle factors and bladder cancer outcomes are scarce and should be a research priority. In this Review, we outline global trends in bladder cancer incidence and mortality, and discuss the main risk factors influencing bladder cancer occurrence and outcomes. We then discuss the implications, challenges and opportunities of these epidemiological trends for public health and clinical practice.

Key points

  • The rising incidence of bladder cancer, a growing shortage of health-care professionals worldwide and limited financial resources underline the need to reduce the substantial burden of bladder cancer globally.

  • Awareness regarding risk factors for and symptoms of bladder cancer should be increased in society, particularly among both health-care professionals and high-risk groups.

  • Given the undisputed association between smoking and bladder cancer, further efforts focused on primary prevention should be undertaken, most importantly through greater implementation of tobacco control policies worldwide.

  • Less-invasive and cheaper approaches for the diagnosis of primary and recurrent bladder cancers in clinical practice are urgently needed.

  • Literature on the potential associations between lifestyle factors and bladder cancer outcomes is scarce. Given the observational data indicating beneficial effects of a healthy lifestyle on clinical outcomes in other cancer types, this aspect should be a priority for bladder cancer research.

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Fig. 1: Bladder wall and different stages of tumour invasion.
Fig. 2: Bladder cancer incidence worldwide in 2020.
Fig. 3: Summary of demographic characteristics that are relevant to bladder cancer incidence across countries worldwide.
Fig. 4: Bladder cancer mortality worldwide in 2020.
Fig. 5: Worldwide implementation of effective tobacco control measures.

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Authors and Affiliations

  1. Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands

    Lisa M. C. van Hoogstraten & Anke Richters

  2. Department for Health Evidence, Radboud university medical center (Radboudumc), Nijmegen, Netherlands

    Lisa M. C. van Hoogstraten, Alina Vrieling, Anke Richters & Lambertus A. Kiemeney

  3. Department of Urology, Radboudumc, Nijmegen, Netherlands

    Antoine G. van der Heijden & Lambertus A. Kiemeney

  4. Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain

    Manolis Kogevinas

  5. Universitat Pompeu Fabra (UPF), Barcelona, Spain

    Manolis Kogevinas

  6. CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain

    Manolis Kogevinas

  7. Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain

    Manolis Kogevinas

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van Hoogstraten, L.M.C., Vrieling, A., van der Heijden, A.G. et al. Global trends in the epidemiology of bladder cancer: challenges for public health and clinical practice. Nat Rev Clin Oncol 20, 287–304 (2023). https://doi.org/10.1038/s41571-023-00744-3

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