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Are you aware of the risk factors for bladder cancer?

Robin Wulffson MD's picture
bladder cancer, smoking, graphic cigarette ads, awareness

Many are aware of the lung cancer risk associated with smoking; however, many are unaware of an increased risk of other cancers such as bladder cancer. A new Canadian study set out to determine the awareness level of the risk of bladder cancer from smoking. It also evaluated the impact of graphic warning labels on cigarette packs that described the risk. The findings were presented online in the Journal of Urology.

A campaign to place graphic ads on cigarette packs was defeated in the United States; however, graphic warnings depicting the health hazards from smoking are mandated in Canada. In that nation, cigarette and little cigar manufacturers must cover 75% of their product’s packages with warnings that include graphic images of people with various cancers and conditions linked to smoking. To both evaluate the impact of the graphic ads and evaluate awareness of bladder cancer risk, the investigators conducted a prospective cross-sectional study involving patients who presented to urology and family practice clinics. A questionnaire was used to assess knowledge regarding the association between smoking and various diseases. Participants were also asked to evaluate a smoking warning label for bladder cancer.

A total of 291 (97%) patients responded to the questionnaire: 143 (95.3%) in urology clinics vs. 148 (98.7%) in family practice clinics. The investigators found that, overall, only 45.2% of the individuals were aware of the association between smoking and bladder cancer; however, 97.4% knew that there was an association between smoking and lung cancer. No significant difference in the degree of knowledge was found between those who visited a urology and those who presented at a family practice clinic.

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The researchers also found that after viewing the warning label, 58.1% of subjects stated that it had changed their opinion on smoking and bladder cancer and 74.8% felt that this label would be an effective tool to raise awareness of the issue. Respondents who changed their opinion had statistically significant less initial knowledge about the association between smoking and bladder cancer (less knowledge: 36.7%; more knowledge: 57.5%).

The investigators concluded that awareness regarding the association between smoking and bladder cancer remains low. However, the use of a smoking warning label may help raise awareness of this important public health issue.

As with most other cancers, the exact cause of bladder cancer is uncertain. However, several factors may contribute to its development:

  • Cigarette smoking. Smoking increases the risk of developing bladder cancer nearly fivefold. As many as 50% of all bladder cancers in men and 30% in women may be caused by cigarette smoke. People who quit smoking have a gradual decline in risk.
  • Chemical exposure at work. About one in four cases of bladder cancer is caused by exposure to cancer-causing chemicals (carcinogens) on the job. Dye workers, rubber workers, aluminum workers, leather workers, truck drivers, and pesticide applicators are at the highest risk. Arylamines are the chemicals most responsible. However, arylamines have been reduced or eliminated in many workplaces.
  • Radiation and chemotherapy. Women who received radiation therapy for the treatment of cervical cancer have an increased risk of developing transitional cell bladder cancer. Some people who have received the chemotherapy drug cyclophosphamide (Cytoxan) are also at increased risk.
  • Bladder infection. A long-term (chronic) bladder infection or irritation may lead to the development of squamous cell bladder cancer. Bladder infections do not increase the risk of transitional cell cancers.
  • Parasite infection. In third world countries, infection with the schistosomiasis parasite has been linked to the development of bladder cancer.

The association between artificial sweeteners and bladder cancer has been studied and is weak or nonexistent.

Reference: The Journal of Urology