Bladder cancer (BC) is common worldwide and poses a significant public health challenge. External risk factors and the wider exposome (totality of exposure from external and internal factors) contribute significantly to the development of BC. Therefore, establishing a clear understanding of these risk factors is the key to prevention.
To perform an up-to-date systematic review of BC's epidemiology and external risk factors.
Two reviewers (I.J. and S.O.) performed a systematic review using PubMed and Embase in January 2022 and updated it in September 2022. The search was restricted to 4 yr since our previous review in 2018.
Our search identified 5177 articles and a total of 349 full-text manuscripts. GLOBOCAN data from 2020 revealed an incidence of 573 000 new BC cases and 213 000 deaths worldwide in 2020. The 5-yr prevalence worldwide in 2020 was 1 721 000. Tobacco smoking and occupational exposures (aromatic amines and polycyclic aromatic hydrocarbons) are the most substantial risk factors. In addition, correlative evidence exists for several risk factors, including specific dietary factors, imbalanced microbiome, gene-environment risk factor interactions, diesel exhaust emission exposure, and pelvic radiotherapy.
We present a contemporary overview of the epidemiology of BC and the current evidence for BC risk factors. Smoking and specific occupational exposures are the most established risk factors. There is emerging evidence for specific dietary factors, imbalanced microbiome, gene-external risk factor interactions, diesel exhaust emission exposure, and pelvic radiotherapy. Further high-quality evidence is required to confirm initial findings and further understand cancer prevention.
Bladder cancer is common, and the most substantial risk factors are smoking and workplace exposure to suspected carcinogens. On-going research to identify avoidable risk factors could reduce the number of people who get bladder cancer.
European urology. 2023 May 15 [Epub ahead of print]
Ibrahim Jubber, Sean Ong, Laura Bukavina, Peter C Black, Eva Compérat, Ashish M Kamat, Lambertus Kiemeney, Nathan Lawrentschuk, Seth P Lerner, Joshua J Meeks, Holger Moch, Andrea Necchi, Valeria Panebianco, Srikala S Sridhar, Ariana Znaor, James W F Catto, Marcus G Cumberbatch
Academic Urology Unit, University of Sheffield, Sheffield, UK; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. Electronic address: ., EJ Whitten Foundation Prostate Cancer Research Centre, Epworth HealthCare, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia., Fox Chase Cancer Center, Philadelphia, PA, USA., Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada., Department of Pathology, Medical University of Vienna, Vienna, Austria., Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA., Radboud University Medical Center, Nijmegen, The Netherlands., EJ Whitten Foundation Prostate Cancer Research Centre, Epworth HealthCare, Melbourne, Australia; Department of Surgery, University of Melbourne, Melbourne, Australia; Department of Surgery, Royal Melbourne Hospital, Melbourne, Australia., Scott Department of Urology, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA., Departments of Urology and Biochemistry, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA., Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland., Department of Medical Oncology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy., Department of Radiological Sciences, Oncology, and Pathology, Sapienza University of Rome, Rome, Italy., Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada., Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France., Academic Urology Unit, University of Sheffield, Sheffield, UK; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.