Elsevier

European Urology

Volume 63, Issue 2, February 2013, Pages 234-241
European Urology

Platinum Priority – Review – Bladder Cancer
Editorial by Maurizio A. Brausi on pp. 242–243 of this issue
Epidemiology and Risk Factors of Urothelial Bladder Cancer

https://doi.org/10.1016/j.eururo.2012.07.033Get rights and content

Abstract

Context

Urothelial bladder cancer (UBC) is a disease of significant morbidity and mortality. It is important to understand the risk factors of this disease.

Objective

To describe the incidence, prevalence, and mortality of UBC and to review and interpret the current evidence on and impact of the related risk factors.

Evidence acquisition

A literature search in English was performed using PubMed. Relevant papers on the epidemiology of UBC were selected.

Evidence synthesis

UBC is the 7th most common cancer worldwide in men and the 17th most common cancer worldwide in women. Approximately 75% of newly diagnosed UBCs are noninvasive. Each year, approximately 110 500 men and 70 000 women are diagnosed with new cases and 38 200 patients in the European Union and 17 000 US patients die from UBC. Smoking is the most common risk factor and accounts for approximately half of all UBCs. Occupational exposure to aromatic amines and polycyclic aromatic hydrocarbons are other important risk factors. The impact of diet and environmental pollution is less evident. Increasing evidence suggests a significant influence of genetic predisposition on incidence.

Conclusions

UBC is a frequently occurring malignancy with a significant impact on public health and will remain so because of the high prevalence of smoking. The importance of primary prevention must be stressed, and smoking cessation programs need to be encouraged and supported.

Introduction

Urothelial bladder cancer (UBC) is the 7th most common cancer in men and the 17th most common in women worldwide. UBC is more common in developed countries and is the fourth and ninth most common cancer in men and women, respectively in the Western world [1]. This frequency, coupled with the relapsing nature of UBC, means that UBC poses an enormous burden on health care systems [2]. Approximately 75% of newly diagnosed UBCs are noninvasive and have a high rate of recurrence and progression despite local therapy. The remaining 25% of newly diagnosed UBCs present with muscle invasion and need either radical surgery or radiotherapy but often still have poor outcomes despite systemic therapy [3], [4]. Several reviews have focused on the clinical challenges in managing bladder cancer (BCa) [5], [6], [7]. In this work we will elucidate epidemiologic aspects of UBC and focus on factors that increase the incidence of urothelial carcinoma of the bladder, since this represents the most common histology [3], [4].

Section snippets

Evidence acquisition

In preparation for this review, a literature search in English was performed using PubMed between February and May 2012 for the keywords bladder cancer, incidence, prevalence, risk, risk factor, and hazard, and one keyword for each risk factor described in the literature retrieved. More than 5000 publications were retrieved. Relevant papers were preselected by two authors (M.B. and Y.L.), and the list of papers to be included was edited by all of the authors.

Epidemiology of urothelial bladder cancer: incidence, prevalence, and mortality

Although exact numbers for cancer incidence and outcome are difficult to obtain and inherently delayed, the International Agency for Research on Cancer provides statistics and estimates. Details are depicted in Fig. 1, Fig. 2. The incidence of UBC ranks it as the sixth most common cancer and as the fourth most common if UBC stage Ta is included [1]. The variations noted can partly be attributed to different methodology, mainly the inclusion of UBC stage Ta or carcinoma in situ in different

Conclusions

UBC is a common malignancy. Most data available are based on retrospective analyses, and each risk factor for UBC has to be seen in light of genetic–environmental interactions to better evaluate its impact. It is evident, however, that UBC will remain frequent because of the ongoing high prevalence of smoking, which represents its main risk factor. The importance of primary prevention needs to be stressed, and smoking cessation programs should be encouraged and supported.

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