Risk factors for superficial and invasive bladder cancer were examined in a case-control study of 470 cases Identified in 1967–68 in the Brockton and Boston Standard Metropolitan Areas (MA, United States) and of 500 population-based controls. Histologic specimens were reviewed and classified as superficial or invasive, following a standardized protocol. The tobacco-associated risk for superficial bladder cancer was odds ratio (OR)=2.6 (95 percent confidence interval [CI]=1.7–4.1) and the risk for invasive bladder cancer was OR=1.7 (CI=1.1–2.5). For subjects less than 60 years of age, the risks were greater for invasive tumors (OR=4.3, CI=1.2–15) than for superficial tumors (OR=0, CI=0.9–4.2), but this pattern for tobacco use was not found in older subjects. A strong trend of increased risk with increased amount of cigarettes smoked was shown only for invasive bladder tumors. No clear pattern of excess risk for invasive bladder tumors was seen for age at first use and years since last use of tobacco. The risk associated with occupational exposure to aromatic amine bladder carcinogens was OR=1.7 (CI=0.8–3.3) for superficial and OR=1.5 (CI=0.8–3.0) for invasive bladder cancer. For subjects less than 60 years of age, the risks were greater for invasive (OR=12.0, CI=2.1–65) than for superficial tumors (OR=4.3, CI=0.8–24), but this pattern for occupational exposure was not found in older subjects. Risk by age at first exposure to occupational aromaticamine, bladder carcinogens was similar for superficial and invasive tumors. Overall, there was no association between known bladder-cancer risk-factors and more advanced bladder cancer. The relative risk associated with cigarette smoking and occupational exposure to aromatic amines was higher for invasive than superficial cancer only for men less than 60 years of age.
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References
Whitmore WF (discussant). Bladder Cancer Screening in High Risk Groups, Proceedings of the International Conference on Bladder Cancer Screening in High-Risk Groups. (Schulte PA, Halperin WA, Ward EM, Ruder AM, eds.). J Occup Med 1990; 32: 940.
Brooks DR, Geller AC, Chang J, Miller DR. Occupation, smoking, and the risk of high-grade invasive bladder cancer in Missouri. Am J Ind Med 1992; 21: 699–713.
Cole P, Monson RR, Haning H, et al. Smoking and cancer of the lower urinary tract. N Engl J Med 1971; 284: 129–32.
Cole P, Hoover R, Friedell GH. Occupation and cancer of the lower urinary tract. Cancer 1972; 29: 1250–60.
Hoover R, Cole P. Temporal aspects of occupational bladder carcinogenesis. N Engl J Med 1973; 288: 1040–3.
Hoar SK, Morrison AS, Cole P, Silverman DT. An occupation and exposure linkage system for the study of occupational carcinogenesis. J Occup Med 1980; 22: 722–6.
Breslow NE, Day NE: Statistical Methods in Cancer Research, Vol. I. The Analysis of Case Control Studies. Lyon, France: International Association for Research on Cancer, 1980; IARC Sci. Publ. No. 32.
Lynch CF, Platz CE, Jones MP, Gazzaniga JM. Cancer registry problems in classifying bladder cancer. JNCI 1991; 83: 429–33.
Decarli A, Peto J, Piolatto G, La Vecchia C. Bladder cancer mortality of workers exposed to aromatic amines: analysis of models of carcinogenesis. JR Stat Soc A 1971; 134: 133–55.
Gaffney M, Althuser B. Public health implications of carcinogenic exposure under the multistage model. Am J Epidemiol 1986; 124: 1021–30.
Vineis P, Esteve J, Hartge P, Hoover R, Silverman DT, Terracine B. Cigarette-induced bladder cancer: effects of time and type of tobacco. Cancer Res 1988; 48: 3849–52.
Case RAM, Hosker ME, McDonald DB, Pearson JT. Tumors of the urinary bladder in workmen employed in the manufacture and use of certain dyestuffs intermediates in the British chemical industry. Br J Ind Med 1954; 11: 75–104.
Hayes RB, Environmental Epidemiology Branch, US National Cancer Institute, Bethesda, MD. Unpublished data.
Ward E, Carpenter A, Markowitz S, Roberts D, Halperin W. Excess bladder cancer in workers exposed to ortho-toluidine and aniline. JNCI 1991; 83: 501–6.
Thompson IM, Peek M, Rodriguez FR. The impact of cigarette smoking on stage, grade and number of recurrences of transitional cell carcinoma of the bladder. J Urol 1987; 137: 401–3.
Carpenter AA. Clinical experience with transitional cell carcinoma of the bladder with special reference to smoking. J Urol 1989; 141: 527–8.
Moller Jensen O, Wahrendorf J, Blettner M, Knudsen JB, Sorensen BL. The Copenhagen case-control study of bladder cancer: role of smoking in invasive and non-invasive bladder tumors. J Epidemiol Commun Health 1987; 41: 30–6.
Morrison AS, Proppe KH, Verhock WG, et al. Histological features of bladder cancer in Boston, USA, Manchester, UK, and Nagoya, Japan. Int J Cancer 1982: 30: 701–5.
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Drs Hayes and Zahm are with the Environmental Epidemiology Branch, National Cancer Institute, Bethesda, MD, USA. Authors are affiliated also with the Lucille P. Markey Cancer Center, Lexington, KN, USA (Dr Friedell) and the Department of Epidemiology, University of Alabama, Birmingham, AL, USA (Dr Cole). Address correspondence to Dr Hayes, Environmental Epidemiology Branch, National Cancer Institute, EPN 418, Bethesda, MD 20892, USA.
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Hayes, R.B., Friedell, G.H., Zahm, S.H. et al. Are the known bladder cancer risk-factors associated with more advanced bladder cancer?. Cancer Causes Control 4, 157–162 (1993). https://doi.org/10.1007/BF00053157
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DOI: https://doi.org/10.1007/BF00053157