Incidence and Mortality

Bladder cancer is the fourth most commonly diagnosed malignancy in men in the United States and the ninth most commonly diagnosed malignancy in U.S. women. It is estimated that 67,160 new cases of bladder cancer are expected to occur in the United States in 2007.[1]

Bladder cancer is diagnosed almost twice as often in whites as in blacks of either sex. The incidence of bladder cancer among other ethnic and racial groups in the United States falls between that of blacks and whites. The incidence of bladder cancer increases with age. Approximately 80% of newly diagnosed cases in both men and women occur in people aged 60 years and older.[2]

Since the 1950s, the incidence of bladder cancer has risen by approximately 50%. It is to be anticipated that, with the aging of the U.S. population, this trend will continue. In contrast, there has been a decrease of approximately 33% in bladder cancer mortality during the same interval (National Cancer Institute’s Surveillance, Epidemiology, and End Results program, 1973–1997). It is estimated that 13,750 Americans will die of bladder cancer in 2007.[1]

The age-adjusted mortality from bladder cancer has decreased in all races and sexes over the past 30 years,[3] but blacks and women have a disproportionately higher mortality rate than that of white males. These changes may reflect earlier diagnosis, better therapy, less exposure to carcinogens, or some combination of these factors.

More than 90% of cancers in the bladder are transitional cell carcinomas (TCC), also called urothelial cancer. Other important histologic types include squamous cell carcinoma and adenocarcinoma. Urothelial cancer can also rarely develop in the lining of the renal pelvis, ureter, prostate, and urethra.

Risk Factors

There are no studies of the prevention of bladder or other urothelial cancers. Reduction in environmental and occupational exposures would presumably reduce urothelial cancer risk. Differences in age, gender, race, and geographic distribution may reflect differences in environmental and occupational exposure to possible toxicants. Relevant exposures include chemical exposures; cigarette smoking; infection with bacteria, parasitic fungi, or viruses; harboring bladder calculi; and treatment with certain chemotherapeutic agents.[4]

Several populations with a variety of exposures appear to be at higher risk of developing bladder cancer. By far the greatest known environmental risk factor in the general population is tobacco, especially cigarette smoking, with individuals who smoke having a fourfold to sevenfold increased risk of developing bladder cancer than individuals who have never smoked.[5,6,7] Risk is reduced with cessation of smoking, but a relatively small decrease in incidence is seen for the first 5 to 7 years after cessation. Even after 10 years, the risk of an individual developing bladder cancer is still almost twice that of an individual who has never smoked.