The Relationship of Bladder Cancer to Smoking

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Abstract
Stimulated by Holsti and Ermala''s report of the experimental production of bladder cancer in mice by the application of tobacco tar on the oral mucosa, several retrospective studies were conducted in humans. These showed a relationship between bladder cancer and cigarette smoking to the extent that cigarette smokers had about a 1.5 to 3.0 fold excess risk of developing bladder cancer. Results of 2 prospective studies confirmed the relationship and indicated a relative risk of about 2. However, the original experimental work was not confirmed by other workers using a different strain of mice and a different method of preparation of the tobacco tar. These results were considered to be biologically reasonable since other studies have shown the presence of various combustion products of tobacco in the urine of smokers. To determine epidemiological consistency, data were presented on trends of death and incidence rates of bladder cancer, on the socioeconomic distribution of bladder cancer as compared to lung cancer, the correlation between death rates from bladder cancer and lung cancer in 20 countries and each state of the U. S. The data on trends and socioeconomic distribution were not consistent; the bladder cancer death rates were slightly correlated with those from lung cancer for males but not for females. It was concluded that the bladder cancer-smoking relationship were not sufficiently consistent to consider it as being causal. Further investigative work was suggested.