The interpretation of incidence rates of bladder cancer is difficult, since it is not easy to distinguish between papillomas and malignant tumour, and thus the rates recorded in various cancer registries may partly reflect different diagnostic criteria.10,11 This caution notwithstanding, the highest incidence rates are recorded in Europe and North America, although Northern Africa and Western Asia are also high-risk areas.1
In Europe, the highest incidence rates for men were recorded in northern Italy, Spain, and Geneva, Switzerland, with rates of more than 30/100,000 men, while rates were intermediate in the UK, Germany and France, and low in several eastern and northern European countries, as well as in other Swiss registration areas.12 The highest mortality rates in men were around 9/100,000 men in Denmark, Italy, Malta and Spain, while low rates (around 4/100,000 men) were recorded in Sweden, Finland and Iceland. In women, the highest mortality rates were between 2 and 3/100,000 women and were recorded in Denmark and the UK.12
As far as time trends are concerned, incidence rates tended to increase in both sexes in the United States between 1969 and 1990, whereas mortality tended to decline, particularly in men.4 In Europe, mortality rates increased in southern and eastern Europe between the mid-1950s and late 1980s, while a decline has been observed in several northern European countries over the last two decades. This pattern was similar to that of lung cancer, and underlines the importance of tobacco-smoking as an etiologic factor.13
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