Cancer Causes & Control

, Volume 13, Issue 1, pp 83–90 | Cite as

A prospective study on active and environmental tobacco smoking and bladder cancer risk (The Netherlands)

  • Maurice P.A. Zeegers
  • R. Alexandra Goldbohm
  • Piet A. van den Brandt


Objective: In a prospective cohort study among 120,852 adult subjects the authors investigated the associations between cigarette, cigar, pipe, environmental tobacco smoking (ETS), and bladder cancer. Methods: In 1986 all subjects completed a questionnaire on cancer risk factors. Follow-up for incident bladder cancer was established by linkage to cancer registries until 1992. The case–cohort analysis was based on 619 cases and 3346 subcohort members. Results: Compared with lifelong non-smokers the age- and sex-adjusted incidence rate ratios (RR) for ex- and current cigarette smokers were 2.1 (95% CI 1.5–3.0) and 3.3 (95% CI 2.4–4.6), respectively. The RR for smoking duration was 1.03 (95% CI: 1.02–1.04) per 1-year increment. The RR per 10 cigarettes/day was 1.3 (95% CI 1.2–1.4). Tar and nicotine exposure increased bladder cancer risk only weakly. It appeared that associations of cigarette smoking characteristics with bladder cancer risk were largely attributable to cigarette smoking duration only. Smoking cessation, age at first exposure, filter-tip usage, cigar and pipe smoking, and ETS were no longer associated with bladder cancer risk after adjustment for frequency and duration of smoking. Conclusions: The authors conclude that current cigarette smokers have a three-fold higher bladder cancer risk than non-smokers. Ex-smokers experience a two-fold increased risk. About half of male bladder cancer and one-fifth of female bladder cancer was attributable to cigarette smoking. Other smoking types (cigar, pipe, or ETS) were not associated with increased risks.

bladder neoplasms epidemiology smoking tobacco smoke pollution urologic neoplasms 


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  1. 1.
    Parkin DM, Pisani P, Ferlay J (1999) Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer 80: 827-841.Google Scholar
  2. 2.
    Morrison AS (1984) Advances in the etiology of urothelial cancer. Urol Clin N Am 11: 557-566.Google Scholar
  3. 3.
    World Health Organization (1986) IARC Monographs on the Evaluation of Carcinogenic Risks to Humans: Tobacco Smoking. Lyon: World Health Organization.Google Scholar
  4. 4.
    Dolin PJ (1991) An epidemiological review of tobacco use and bladder cancer. J Smoking Related Dis 2: 129-143.Google Scholar
  5. 5.
    Silverman DT, Hartge P, Morrison AS, Devesa SS (1992) Epidemiology of bladder cancer. Hematol Oncol Clin N Am 6: 1-30.Google Scholar
  6. 6.
    Shirai T (1993) Etiology of bladder cancer. Semin Urol 11: 113-126.Google Scholar
  7. 7.
    Shirai T, fraået Y, Huland H, et al. (1995) The etiology of bladder cancer: are there any new clues or predictors of behavior? Int J Urol 2 (3 Suppl.): 64-75.Google Scholar
  8. 8.
    Silverman DT, Morrison AS, Devesa SS (1996) Bladder cancer. In: Schottenfeld D, fraåmeni JF, eds. Cancer Epidemiology and Prevention. New York and Oxford: Oxford University Press, pp. 1156-1179.Google Scholar
  9. 9.
    Ross RK, Jones PA, Yu MC (1996) Bladder cancer epidemiology and pathogenesis. Semin Oncol 23: 536-545.Google Scholar
  10. 10.
    Johansson SL, Cohen SM (1997) Epidemiology and etiology of bladder cancer. Semin Surg Oncol 13: 291-298.Google Scholar
  11. 11.
    van der Meijden APM (1998) Bladder cancer. BMJ 317: 1366-1369.Google Scholar
  12. 12.
    Zeegers MP, Tan FE, Dorant E, van den Brandt PA (2000) The impact of characteristics of cigarette smoking on urinary tract cancer risk: a meta-analysis of epidemiologic studies. Cancer 89: 630-639.Google Scholar
  13. 13.
    Sorahan T, Sole G (1990) Coarse fishing and urothelial cancer: a regional case-control study. Br J Cancer 62: 138-141.Google Scholar
  14. 14.
    Hartge P, Hoover R, Kantor A (1985) Bladder cancer risk and pipes, cigars and smokeless tobacco. Cancer 15: 901-906.Google Scholar
  15. 15.
    Slattery ML, Schumacher MC, West DW, Robison LM (1988) Smoking and bladder cancer. The modifying effect of cigarettes on other factors. Cancer 61: 402-408. Smoking and bladder cancer 89Google Scholar
  16. 16.
    Jensen OM, Knudsen JB, McLaughlin JK, Sorensen BL (1988) The Copenhagen case-control study of renal pelvis and ureter cancer: role of smoking and occupational exposures. Int J Cancer 41: 557-561.Google Scholar
  17. 17.
    Burch JD, Rohan TE, Howe GR, et al. (1989) Risk of bladder cancer by source and type of tobacco exposure: a case-control study. Int J Cancer 44: 622-628.Google Scholar
  18. 18.
    Armstrong B, Garrod A, Doll R (1976) A retrospective study of renal cancer with special reference to coffee and animal protein consumption. Br J Cancer 33: 127-136.Google Scholar
  19. 19.
    Wynder EL, Goldsmith R (1977) The epidemiology of bladder cancer: a second look. Cancer 40: 1246-1268.Google Scholar
  20. 20.
    Dunham LJ, Rabson AS, Steward HS, fraåk A, Young JL (1968) Rates, interview, and pathology study of cancer of the urinary bladder in New Orleans, Lousiana. J Natl Cancer Inst 41: 683-709.Google Scholar
  21. 21.
    Tyrrell AB, MacAirt JG, McCaughey WT (1971) Occupational and non-occupational factors associated with vesical neoplasm in Ireland. J Ir Med Assoc 64: 213-217.Google Scholar
  22. 22.
    Sorahan T, Hamilton L, Wallace DM, Bathers S, Gardiner K, Harrington JM (1998) Occupational urothelial tumours: a regional case-control study. Br J Urol 82: 25-32.Google Scholar
  23. 23.
    Mommsen S, Aagaard J (1983) A case-control study of bladder cancer: a multivariate, stratified analysis of a low-risk population. Dan Med Bull 30: 427-432.Google Scholar
  24. 24.
    Mommsen S, Aagaard J (1983) Tobacco as a risk factor in bladder cancer. Carcinogenesis 4: 335-338.Google Scholar
  25. 25.
    Moller-Jensen O, Wahrendorf J, Blettner M, Knudsen JB, Sorensen BL (1987) The Copenhagen case-control study of bladder cancer: role of smoking in invasive and non-invasive bladder tumours. J Epidemiol Commun Health 41: 30-36.Google Scholar
  26. 26.
    Prentice RL (1986) A case-cohort design for epidemiologic cohort studies and disease prevention trials. Biometrika 73: 1-11.Google Scholar
  27. 27.
    van den Brandt PA, Goldbohm RA, van het Veer PAV, Hermus RJJ, Sturmans F (1990) A large-scale prospective cohort study on diet and cancer in the Netherlands. J Clin Epidemiol 43: 285-295.Google Scholar
  28. 28.
    van den Brandt PA, Schouten LJ, Goldbohm RA, Dorant E, Hunen PHM (1990) Development of a record linkage protocol for use in the Dutch cancer registry for epidemiological research. Int J Epidemiol 19: 553-558.Google Scholar
  29. 29.
    Goldbohm RA, van den Brandt PA, Dorant E (1994) Estimation of the coverage of Dutch municipalities by cancer registries and PALGA based on hospital discharge data. Tijdschr Soc Gezond 72: 80-84.Google Scholar
  30. 30.
    Volovics A, van den Brandt PA (1997) Methods for the analyses of case-cohort studies. Biomet J 2: 195-214.Google Scholar
  31. 31.
    StataCorp (1999) Stata Statistical Software: Release 6.0. College Station, TX: Stata Corporation.Google Scholar
  32. 32.
    Barlow WE (1994) Robust variance estimation for the case-cohort design. Biometrics 50: 1064-1072.Google Scholar
  33. 33.
    Lin DY, Ying Z (1993) Cox regression with incomplete covariate measurements. J Am Stat Assoc 88: 1341-1349.Google Scholar
  34. 34.
    Zeegers MPA, Tan FES, Goldbohm RA, van den Brandt PA (2000). Are coffee and tea consumption associated with urinary tract cancer risk: a systematic review and meta-analysis. Int J Epidemiol (In press).Google Scholar
  35. 35.
    Zeegers MP, Tan FE, Verhagen AP, Weijenberg MP, van den Brandt PA (1999) Elevated risk of cancer of the urinary tract for alcohol drinkers: a meta-analysis. Cancer Causes Control 10: 445-451.Google Scholar
  36. 36.
    Steinmaus CM, Nunez S, Smith AH (2000) Diet and bladder cancer: a meta-analysis of six dietary variables. Am J Epidemiol 151: 693-702.Google Scholar
  37. 37.
    van den Brandt PA, van het Veer P, Goldbohm RA (1993) A prospective cohort study on dietary fat and the risk of postmenopausal breast cancer. Cancer Res 53: 75-82.Google Scholar
  38. 38.
    Castelao JE, Yuan JM, Skipper PL, et al. (2001) Gender-and smoking-related bladder cancer risk. J Natl Cancer Inst 93: 538-545.Google Scholar
  39. 39.
    Morrison AS, Cole (1976) Epidemiology of bladder cancer. Urol Clin Am 3: 13-29.Google Scholar
  40. 40.
    Vineis P (1992) Epidemiological models of carcinogenesis: the example of bladder cancer. Cancer Epidemiol Biomarkers Prev 1: 149-153.Google Scholar
  41. 41.
    Lopez Abente G, Gonzalez CA, Errezola M, et al. (1991) Tobacco smoke inhalation pattern, tobacco type, and bladder cancer in Spain. Am J Epidemiol 134: 830-839.Google Scholar
  42. 42.
    Peach H, Shah D, Morris RW (1986) Validity of smokers' information about present and past cigarette brands-implications for studies of the effects of falling tar yields of cigarettes on health. Thorax 41: 203-207.Google Scholar
  43. 43.
    Herning RI, Jones RT, Benowitz NL, Mines AH (1983) How a cigarette is smoked determines blood nicotine levels. Clin Pharmacol Ther 33: 84-90.Google Scholar
  44. 44.
    Tobacco use-United States, 1900-1999. JAMA 282: 2202-2204.Google Scholar
  45. 45.
    Matanoski GM, Elliott EA (1981) Bladder cancer epidemiology. Epidemiol Rev 3: 203-229.Google Scholar
  46. 46.
    Morrison AS, Buring JE, Verhoek WG, et al. (1984) An international study of smoking and bladder cancer J Urol 131: 650-654.Google Scholar
  47. 47.
    Sandler DP, Wilcox AJ, Everson RB (1985). Cumulative effects of lifetime passive smoking on cancer risk. Lancet 1: 312-315.Google Scholar
  48. 48.
    Bos RP, Theuws JL, Henderson PT (1983) Excretion of mutagens in human urine after passive smoking. Cancer Lett 19: 85-90.Google Scholar
  49. 49.
    Sandler DP, Everson RB, Wilcox AJ (1985) Passive smoking in adulthood and cancer risk. Am J Epidemiol 121: 37-48.Google Scholar

Copyright information

© Kluwer Academic Publishers 2002

Authors and Affiliations

  • Maurice P.A. Zeegers
    • 1
  • R. Alexandra Goldbohm
    • 2
  • Piet A. van den Brandt
    • 1
  1. 1.Department of EpidemiologyMaastrichtThe Netherlands
  2. 2.Department of Nutritional EpidemiologyTNO Nutrition and Food ResearchZeistThe Netherlands

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