Implications for prevention

There are several factors that are known to or suspected to influence bladder cancer carcinogenesis. The proportion of bladder cancer attributable to each factor (attributable risk) depends not only on the relative risk associated to a factor, but also on the frequency of exposure, and thus varies according to geographical area and calendar period.

Cigarette-smoking is the major identified cause of bladder cancer. The proportion of cases attributable to tobacco was about 80% in men and 30% in women in a study in the UK, about 50% in men and 30% in women in a study from the United States, around 70% in men and 30% in women in a study from Italy, and more than 70% in men (but very low in women) in Alexandria, Egypt.15,87-9 Thus, reducing cigarette-smoking is an imperative for prevention.

Occupational exposure to aromatic amines and to other chemicals has been estimated to cause 5-10% of bladder cancers in the UK and North America.87 In several developed countries, the control of occupational exposures to bladder carcinogens has probably led to a substantial decrease of the proportion of cases of bladder cancer due to occupational factors, and this reduction may become even more evident over the next decades, when the effects of exposures that happened decades ago will affect incidence rates to a smaller degree.87,88 Less information is available for some other heavily industrialized areas of the world, where measures to reduce occupational hazard may still not be adequate.5

Reduction of infection by Schistosoma haematobium is an important preventive measure in endemic areas, such as Egypt and Tanzania.89 It is difficult to quantify the potential for prevention of reducing urinary tract infections in other populations.

Selected aspects ofdiet may influence bladder carcinogenesis but - apart from a possibly favourable effect of vegetable consumption - available data are still inadequate to provide indications for prevention.

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