Bladder cancer is the most common urinary system malignancy and the fourth most frequently occurring cancer among men. Although it occurs in both sexes, the disease is 2.5 times more likely to develop in men, probably because of life-style factors such as smoking and occupational exposures. The estimated 47,000 new cases and 10,200 bladder cancer deaths in 1989 constitute almost 5% of all new cancer cases and approximately 2.2% of all cancer deaths. More than half of new cases occur in persons 70 and older. The incidence rate for whites is approximately 37% greater than the rate for blacks. (However, only 50% of blacks have localized disease at diagnosis as compared with 72% for whites.) The 51% increase in incidence over 35 years has been greatly tempered through earlier detection and improved treatment resulting in improved survival and a 33% reduction in mortality. Overall survival has improved by more than 45% during the past 35 years, within each stage as well as overall. The relative 5-year survival rates for whites v blacks are overall, 81% v 58%; for localized disease, 88% v 74%; for regional disease, 44% v 30%; for distant disease, 9% v 8%; and for unknown stage, 61% v 35%.