Urinary bladder cancer in Wegener's granulomatosis: is it more than cyclophosphamide?

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Abstract
In this issue of the Annals Knight and coworkers from Sweden report some interesting data on the incidence of urinary bladder cancer in patients with Wegener’s granulomatosis (WG) which, in contrast with previous reports from single or multicentre cohorts, are derived from a population based, nationwide inpatient register.1 The data of that study confirm the increased risk of bladder cancer in patients with WG after exposure to cyclophosphamide, but the results also indicate that there might be an increased risk for bladder cancer even before the onset of WG.1 Within a cohort of 1065 patients with WG eight patients had a diagnosis of bladder cancer before WG was diagnosed. Although not statistically significant, the increased incidence of bladder cancer seen before the onset of WG resulted in a relative risk of 2.1 (95% confidence interval (CI) 0.6 to 3.6) compared with the expected prevalence of bladder cancer in Sweden.