Rates, Interview, and Pathology Study of Cancer of the Urinary Bladder in New Orleans, Louisiana

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Abstract
An incidence, interview, and pathology study of cancer of the urinary bladder in whites and Negroes was carried out in New Orleans, Louisiana, from 1958–64. A total of 702 patients were identified with a presumptive or confirmed diagnosis of tumor of the bladder. The physicians in practice in New Orleans initially diagnosed the cancers of the patients in this study. Insofar as possible, pathologists at the National Cancer Institute reviewed the diagnoses. The reviewers aimed to make as certain as possible the diagnosis of the neoplastic lesion, the site of its origin, and its histologic type. In the pathology study the following patients initially reported as having bladder cancer were not included: 2.3% with clinical diagnoses only, 1.1 % with the histologic diagnosis made by the New Orleans pathologists but not reviewed by National Cancer Institute pathologists, and 6.7% with a diagnosis of primary cancer in the bladder that was not confirmed after review. The histologic types of 22 (3.5%) of the 631 cancers in the pathology study were changed after review; 92% were transitional cell carcinomas (29% Grade 1; 39% Grade 2; and 24% Grade 3); 4.3% were squamous cell carcinomas; 1.1% were adenocarcinomas; 1.7% were undifferentiated cell carcinomas; 0.6% were sarcomas; and 0.3 % were malignant tumors, unclassified type. Negro females (49) had larger percentages of squamous cell carcinoma, adenocarcinoma, and undifferentiated cell carcinoma than the other groups, and Negro males had a larger percentage of squamous cell carcinoma than the white males. Age-standardized incidence rates (new cases of bladder cancer per 100,000 per year) were determined for the three parishes of New Orleans (St. Bernard, Jefferson, and Orleans) combined. There were 564 patients, 97.2% with histologic diagnosis of their cancer. In the 6 years 1958–64, incidence rates ranged from 14.3–25.2 for white males, 7.5–15.9 for Negro males, 5.5–10.2 for white females, and 5.5–8.7 for Negro females, indicating considerable yearly variation. The incidence rate for bladder cancer for the total 6-year period was 11.4, i.e., 19.0 for white males, 11.2 for Negro males, 7.4 for white females, and 7.2 for Negro females. The corresponding rates for 1947, as determined in the study by Dorn and Cutler, were 21.2. i.e., 34.6, 7.0, 17.6, and 14.6. An interviewer questioned 493 patients with bladder cancer (98.8 % histologically confirmed) and 527 control patients about (actors that might have influenced their disease. Cystitis, in all males, and prostatic diseases in white males were more frequent for patients with cancer of the bladder than for the controls. The ratios of “Observed” to “Expected” cases in white male patients from the incidence rates study were excessive for sailors and deckhands, tinsmiths and coppersmiths, machinists, civil engineers, plumbers, structural metal workers, barbers, and carpenters. Exposure to dusts, especially chromate dusts, was slightly more frequent in white male cancer patients than in the controls. However, doubts about the validity of some of the methods of study concerned with these factors left us unwilling to conclude that the associations observed were related to the causes of cancer of the bladder. There was a significant correlation between bladder cancer and tobacco use, all forms combined, among males only; however, this correlation did not exist when data were analyzed by type of tobacco or amounts used. Bladder cancer in our study was not associated with the history of amounts of total daily fluid ingested, alcoholic or nonalcoholic beverages, or various types of coffees, or with dietary habits, or preparations for the hair and scalp.

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