Elsevier

European Urology

Volume 74, Issue 6, December 2018, Pages 784-795
European Urology

Collaborative Review – Bladder Cancer
Epidemiology of Bladder Cancer: A Systematic Review and Contemporary Update of Risk Factors in 2018

https://doi.org/10.1016/j.eururo.2018.09.001Get rights and content

Abstract

Context

Bladder cancer (BC) is a significant health problem, and understanding the risk factors for this disease could improve prevention and early detection.

Objective

To provide a systematic review and summary of novel developments in epidemiology and risk factors for BC.

Evidence acquisition

A systematic review of original articles was performed by two pairs of reviewers (M.G.C., I.J., F.E., and K.P.) using PubMed/Medline in December 2017, updated in April 2018. To address our primary objective of reporting contemporary studies, we restricted our search to include studies from the last 5 yr. We subdivided our review according to specific risk factors (PICO [Population Intervention Comparator Outcome]).

Evidence synthesis

Our search found 2191 articles, of which 279 full-text manuscripts were included. We separated our manuscripts by the specific risk factor they addressed (PICO). According to GLOBOCAN estimates, there were 430 000 new BC cases and 165 000 deaths worldwide in 2012. Tobacco smoking and occupational exposure to carcinogens remain the factors with the highest attributable risk. The literature was limited by heterogeneity of data.

Conclusions

Evidence is emerging regarding gene-environment interactions, particularly for tobacco and occupational exposures. In some populations, incidence rates are declining, which may reflect a decrease in smoking. Standardisation of reporting may help improve epidemiologic evaluation of risk.

Patient summary

Bladder cancer is common worldwide, and the main risk factors are tobacco smoking and exposure to certain chemicals in the working and general environments. There is ongoing research to identify and reduce risk factors, as well as to understand the impact of genetics on bladder cancer risk.

Introduction

Bladder cancer (BC) is the ninth most common cancer worldwide with a yearly incidence of approximately 430 000 cases [1], and it ranks 13th in terms of yearly mortality from cancer [1]. There is a male predominance, and it is the seventh most common cancer worldwide in men [2]. In the USA, BC is the fourth most common cancer in men [3]. BC is a cancer of industrialized nations with an age-standardized incidence rate, which is three-fold greater in high-resource versus low-resource countries [4]. The highest incidence rates are in North America, Europe, and parts of Western Asia. However, mortality rates are greater in developing regions [5].

Urothelial BC is the most common subtype. Approximately 75% of patients present with non–muscle-invasive disease, confined to the bladder mucosa/submucosa. This stage is usually managed with local treatment and surveillance, and has a particularly high prevalence due to the nonaggressive natural history of this disease [6]. The remaining 25% have muscle-invasive disease and often undergo cystectomy, multimodal therapy (transurethral resection, chemotherapy, and radiation therapy), or palliation [7].

In 2013, Burger et al. [8] published a detailed review on the epidemiology of BC and its risk factors. In our work, we have searched contemporary series to compile a current-day picture of BC epidemiology, and provide a discussion of further work that is needed to impact environmental causes of BC.

Section snippets

Evidence acquisition

A systematic review of original articles was performed using PubMed/Medline in December 2017 and again in April 2018. We used the following search terms (Fig. 1): ((Bladder cancer [MeSH terms] and incidence [MeSH terms]) (OR) (Bladder cancer [MeSH terms] and prevalence [MeSH]) (OR) (Bladder cancer [MeSH terms] and risk) (OR) (Bladder cancer [MeSH terms] and risk factor [MeSH terms]) (OR) Bladder cancer [MeSH terms] and hazard)). Manuscripts were excluded if they were not in English, had <50

Evidence synthesis

Our search found 2191 articles, of which 279 full-text manuscripts were included. We separated our manuscripts by the specific risk factor they addressed (PICO [Population Intervention Comparator Outcome]), for example, tobacco smoking (Table 1) [10].

Conclusions

BC is common, and a significant proportion of the cases are attributable to tobacco use as well as occupational and environmental factors (Table 2 summarises the best-known risk factors).

Incidence patterns and trends are dependent on changes in smoking behaviour and shifting occupational and environmental regulations, such as workplace sanctions on known or suspected carcinogens. The evidence is growing for the role of genetic susceptibility and interplay with other risk factors.

One of the

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