BERKELEY, CA (UroToday.com) - It is well known that smoking is a risk factor for bladder cancer and is responsible for a fair proportion (50% in men and 25% in women) of the 63,000 new cases of bladder cancer occurring each year in the USA. It has been suggested that the latent effects of former tobacco use coupled with the overall increase in age of the population is responsible for the increased incidence being trended in developed world. It has also been hypothesized that the dwell time of carcinogens in the bladder results in prolonged exposure to carcinogenic amines from cigarette smoking including, amines such as 4-aminobiophenyl and orthotoluidine. As such, patients who have a history of smoking have 4-fold increased risk of bladder cancer with a dose–response relationship.

Prior studies have suggested that stopping smoking might allow a risk reduction with respect to bladder cancer incidence. Here, Chen and colleagues have shown that continued smokers have a 2.2-fold greater risk of bladder cancer recurrence compared to those who quite smoking. They evaluated 265 male patients with Ta or T1 disease (no CIS) including 64 non-smokers, 59 quitters (who ceased smoking within a year before and 3 months after diagnosis), 64 ex-smokers, (who ceased smoking more that a year before diagnosis) and 78 continued smokers. After a median follow-up of 38 months and after controlling for tumor stage, grade, multiplicity, and intravesical therapy the 3-year recurrence-free survival of continued smokers was 45% compared to 70% for quitters. Notably, quitters had a lower risk of recurrence than did either continued smokers or non-smokers, and had a similar risk to ex-smokers. This suggests that those who might benefit most from stopping smoking are those in whom the tumors developed in the milieu of tobacco carcinogens.

Data such as this must be used in fashioning interventions for patients with bladder cancer since stopping smoking might be one way to enhance the efficacy of existing treatments and useful in reducing the recurrence of bladder cancer. At the very least, such an intervention would reduce morbidity and mortality from cardiovascular disease.

Chen CH, Shun CT, Huang KH, Huang CY, Tsai YC, Yu HJ and Pu YS

BJU. 100(2): 281-6, August 2007.
doi:10.1111/j.1464-410X.2007.06873.x

UroToday.com Bladder Cancer Section

UroToday.com Bladder Cancer Detection and Monitoring Center

Written by Ashish M. Kamat, a Contributing Editor with UroToday.

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