Mechanisms of Disease: the epidemiology of bladder cancer

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Abstract
Epidemiological trends in bladder cancer incidence and mortality are influenced by the exposure of different populations to environmental risk factors. In this article, the authors discuss the different factors that contribute to the risk of developing bladder cancer. The current trend for decreasing mortality from bladder cancer in some developed countries, where exposure to environmental risk factors is becoming less common, is also highlighted. 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.

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