Occupational bladder cancer in Japan and the world

An overview of the epidemiological association of bladder cancer with occupations is presented and the proportion of occupational bladder cancer in Japan was estimated. Epidemiological features of bladder cancer in the world are also reviewed. Bladder cancer was found to have a relatively narrower international variation in incidence rate as compared to other sites of cancer such as lung or esophageal cancer. In Japan, the trend in bladder cancer mortality is apparently downward in females and virtually unchanged in males, whereas the incidence rate is increasing in males and unchanged in females in the recent decade. Approximately 45 occupations/industries were epidemiologically associated with an increased risk of bladder cancer in the world literature. The lowest proportion of occupational bladder cancer was estimated to be 0.4% in Japan, though the highest estimate was 19% in males and 12% in females.     

Morphologic characteristics of the urothelial bladder tumors

Cancer of the urinary bladder is the fourth most common cancer in men and the ninth in women. Approximately 67,000 people (50,000 males and 17,000 females) develop bladder cancer each year in the United States, and 13,750 individuals (9,630 males and 4,120 females) are expected to die from it. In the showing of the morphologic characteristics of the tumors, authors underlining the increasing of the incidence, pathogenesis, premalignant lesions and the risk factors of disease.     

Bladder Cancer Incidence and Mortality: A Global Overview and Recent Trends

Context

Bladder cancer has become a common cancer globally, with an estimated 430 000 new cases diagnosed in 2012.

Mechanisms of disease: The epidemiology of bladder cancer

Mortality from bladder cancer has shown downward trends over the last 2 decades in several western European countries (albeit 10-15 years later than similar trends in the US), but is still increasing in some eastern European countries. Tobacco smoking and occupational exposure to aromatic amines are the two major established environmental risk factors for bladder cancer. Controlling exposure to these factors has been an important contributor to the reduction in bladder cancer mortality, particularly among men. Diet could influence bladder carcinogenesis, as many compounds contained in foods--and their metabolites--are excreted through the urinary tract. Fruit and vegetable consumption was inversely related with bladder cancer in many studies, but no consistent association has emerged between intake of related micronutrients and reduced risk of bladder cancer. Other widely investigated lifestyle habits are probably not associated with risk of developing bladder cancer (e.g. coffee consumption, artificial sweetener use, hair dyes) or are difficult to assess (e.g. fluid intake). Infections and stones in the urinary tract might cause chronic irritation of the bladder epithelium, and thus increase bladder cancer risk. First-degree relatives of bladder cancer patients have a 50-100% increased relative risk of developing the disease, a risk that could be even higher when the proband is diagnosed at an early age.     

Urologic cancer mortality in France]

In 1989, 14,150 men died from urological cancer in France: 64% of these deaths were due to prostatic cancer, which represents the second highest cause of male cancer mortality in France. Deaths from urological cancer are mainly observed after 50 years of age, with a frequency which increases very rapidly with age, except for testicular cancer for which one out of every two deaths occurs between 20 and 45 years of age. Between 1968 and 1989, increased mortality was observed in males due to prostate cancer and kidney cancers, whereas a decreased mortality was observed for testicular cancer, especially in males between 20 and 45 years of age. Mortality was stable for bladder cancer and cancer of the penis. In females during the same period, mortality was stable for cancer of the kidney and bladder. During the period 1979 to 1984, a significant increase in mortality due to bladder cancer was observed in certain Northern departments and those surrounding the Mediterranean basin, although the mortality for other cancer sites is generally lower in this latter region. A significant increase in mortality was also observed for cancer of the kidney in Auvergne and in Alsace-Lorraine. Regarding prostatic cancer, geographical variations are minor and no particular region with an increased or decreased mortality could be identified.     

Epidemiology of pancreatic cancer

Worldwide, over 200000 people die annually of pancreatic cancer. The highest incidence and mortality rates of pancreatic cancer are found in developed countries. In the United States, pancreatic cancer is the 4(th) leading cause of cancer death, and in Europe it is the 6th. Because of high fatality rates, pancreatic cancer incidence rates are almost equal to mortality rates. Pancreatic cancer is diagnosed late in the natural history of the disease, given the few early indicators of illness, and the lack of screening tests for this disease. Treatment has not improved substantially over the past few decades and has little effect on prolonging survival time. Therefore, prevention could play an important role in reducing pancreatic cancer mortality. International variations in rates and time trends suggest that environmental factors are likely to play a role in the etiology of pancreatic cancer. Variations in rates are substantial and occur even within industrialized nations. While rates have been stabilizing over the past 2 decades in many countries where they are already high, they continue to increase in countries where rates were relatively low 4 decades ago, such as Japan. In the US, the highest rates of pancreatic cancer incidence and mortality are observed among blacks, who have some of the highest rates in the world. A known cause of pancreatic cancer is tobacco smoking. This risk factor is likely to explain some of the international variations and gender differences. A number of studies observed a reduction in pancreatic cancer risk within a decade after smoking cessation, when compared to current smokers. With tobacco smoking as an exception, risk factors for pancreatic cancer are not well-established. Over the past 2 decades, epidemiological studies on pancreatic cancer have been plagued with methodological issues associated with studying a highly fatal disease, and inconsistent findings have hindered our understanding of the etiology of pancreatic cancer. Although familial pancreatic cancer is well-documented, the genes responsible for this condition have not been identified and are unlikely to explain more than 5-10% of all pancreatic cancer cases. Chronic pancreatitis and diabetes mellitus are medical conditions that have been consistently related to pancreatic cancer. Data from numerous studies suggest that these conditions are likely to be causally related to pancreatic cancer, rather than being consequences of the cancer. Recent cohort studies, which are less prone to biases than case-control studies, suggest that obesity increases the risk of pancreatic cancer. Other studies support the hypothesis that glucose intolerance and hyperinsulinemia are important in the development of pancreatic cancer. Other potential risk factors include physical inactivity, aspirin use, occupational exposure to certain pesticides, and dietary factors such as carbohydrate or sugar intake.     

Epidemiology of kidney cancers]

Renal carcinomas represent 2% of all tumors. More than 90% of these cancers occur in adults with the frequency in adult males being twice as high as that in adult females. The frequency of renal carcinomas is relatively high in France especially in males. Renal carcinomas mortality has been increasing in France over the last 40 years by more than 2% per year and suggests that tobacco is involved in this increase. Obesity, especially in women, and chronic renal failure are two other frequent associations found with renal carcinomas. The prognosis for this cancer is not clear-cut as the relative 5-year survival rate for all adult tumors ranges from 36 to 54%.     

Onkologische Beckenchirurgie unter urologischen Gesichtspunkten

The aim of the treatment of invasive bladder cancer with radical cystectomy and subsequent urinary diversion is to combine a safe oncological procedure with a satisfactory quality of life. Radical cystectomy is the treatment of choice for all patients with recurrent or multifocal high grade T1 bladder cancer, T1 tumors with high risk of progression, failure of Bacillus Calmette-Guérin treatment and muscle-invasive bladder cancer. Radical cystectomy offers excellent recurrence-free and cancer-specific survival rates as well as local tumor control in patients with organ-confined and node-negative diseases. Tumor control in non-organ-confined tumors is still satisfactory with long term recurrence-free survival (RFS) rates of about 50%. Nerve-sparing cystectomy is of importance for lower urinary tract function, including continence rates after orthotopic urinary diversion and for sexual function in males and females. Orthotopic urinary reconstruction using a neobladder achieves good continence rates. Overall quality of life after radical cystectomy remains good in most patients irrespective of the type of urinary diversion.     

Bladder cancer mortality in The Netherlands, 1955-1988.

In 1955, 234 men and 116 women died from bladder cancer in the Netherlands. In 1988 the numbers were 794 and 317 respectively. After adjusting for the ageing of the Dutch population since 1955, female mortality rates per 10(5) person-years appear to be very stable: 2.9 from 1955 to 1959 and 3.0 from 1985 to 1988. By contrast, an increasing trend exists in males. From 1955 to 1959 and from 1985 to 1988, bladder cancer mortality rates per 10(5) person-years were 7.5 and 12.4 respectively. For men in particular, increasing mortality (and incidence) rates are seen all over the world. In many cases this increasing trend is thought to originate from a higher risk of dying from bladder cancer in successive birth cohorts rather than from a higher risk in successive calendar periods. This so-called cohort effect is explained by changes in smoking behaviour in the male population. Statistical modelling of bladder cancer mortality data from 1955 to 1988 in the Netherlands shows that the increasing temporal trend in men can also be described as a cohort effect. The risk of dying from bladder cancer increases from the 1875 birth cohort to the 1910 birth cohort, but decreases thereafter. It is concluded that this decreasing risk for generations born after 1910 will probably result in a decreasing trend in mortality in the near future, when more and more of these "youngsters" reach the age of 70+.     

Bladder cancer mortality in the Epirus district population (Greece)

Objective: To describe the pattern of bladder cancer mortality in the Epirus district population (North-Western Greece) and to establish some relationships with cigarette smoking. Patients and methods: Mortality rates of bladder cancer in the Epirus district population were analysed according to the official data from the Department of Statistics of the University Hospital of Ioannina during the last decade (January 1990–January 2000). Age –standardization of death rates was done by the direct method, using the world population as a standard. Fisher's test was used as a significance test for linear regression coefficient in time trend analysis of mortality. Results: The average annual standardized mortality rates from bladder cancer during the study period were 5.23 per 100,000population (96% Confidence Interval – CI 4.02–5.63)in males and 1.63 per 100,000 population (96% Confidence Interval– CI 1.18–1.96) in females. Significantly increasing trends of the rates were observed in males (y = 2.421 + 0.231x; p < 0.01), but not in females (y = 1.263 +0.027x; p > 0.05). The greatest increase in age –specific rates in males was observed in the age group of 70 and more years (y = 25.602 + 3.673x; p < 0.01). In females,all age – specific rates except for the group 60–69 years showed significantly increasing tendency. The increasing tendency of bladder cancer mortality is followed by the rise of per capita cigarette consumption among the Epirus district population. Conclusion:Further studies are needed for the explanation of the irregularities in the age-specific rates. This revised version was published online in September 2006 with corrections to the Cover Date.     

Bladder Cancer Mortality in the Netherlands, 1955–1988

Summary— In 1955, 234 men and 116 women died from bladder cancer in the Netherlands. In 1988 the numbers were 794 and 317 respectively. After adjusting for the ageing of the Dutch population since 1955, female mortality rates per 10⁵ person-years appear to be very stable: 2.9 from 1955 to 1959 and 3.0 from 1985 to 1988. By contrast, an increasing trend exists in males. From 1955 to 1959 and from 1985 to 1988, bladder cancer mortality rates per 10⁵ person-years were 7.5 and 12.4 respectively. For men in particular, increasing mortality (and incidence) rates are seen all over the world. In many cases this increasing trend is thought to originate from a higher risk of dying from bladder cancer in successive birth cohorts rather than from a higher risk in successive calendar periods. This so-called cohort effect is explained by changes in smoking behaviour in the male population. Statistical modelling of bladder cancer mortality data from 1955 to 1988 in the Netherlands shows that the increasing temporal trend in men can also be described as a cohort effect. The risk of dying from bladder cancer increases from the 1875 birth cohort to the 1910 birth cohort, but decreases thereafter. It is concluded that this decreasing risk for generations born after 1910 will probably result in a decreasing trend in mortality in the near future, when more and more of these “youngsters” reach the age of 70+.     

Comparison and ranking of cancer mortality rates in the various populations of the RSA in 1970

Age-adjusted mortality rates (MRs) in all four population groups in the RSA (age range 25 - 74 years) for different types of cancer were compared and ranked. Lung and stomach cancer had the highest MRs in white, Indian and coloured males. In white males lung cancer ranked 1st (MR more than twice as high as that for stomach cancer), while in Indian and coloured males stomach cancer ranked 1st and lung cancer 2nd. The MR for lung cancer in coloured males was a little higher than that in white males. In black males oesophageal cancer ranked 1st and liver cancer 2nd. In white females breast cancer ranked 1st and lung cancer 2nd. In coloured females cancer of the cervix ranked 1st followed by cancer of the breast and of the stomach. In black females cancer of the oesophagus and of the liver ranked 2nd and 3rd after cancer of the cervix, and in Indian females the rank order was stomach cancer 1st, breast cancer 2nd, and cervical cancer 3rd. Cancers of the rectum and bladder were low in the rank order in both males and females of all four population groups. The main feature of age-specific MRs for the more common cancers was the fact that MRs for stomach cancer in both coloured males and females were relatively high in the younger age groups. Also, the MRs for cancer of the cervix in coloured and black females were not only higher at all ages (except in the highest age group in blacks) but were particularly high in the younger age groups compared with figures for the other populations.     

大面积（直径≥3 cm）膀胱肿瘤患者TURBT术后膀胱复发的危险因素分析

【摘要】 目的 探讨大面积（直径≥3 cm）膀胱肿瘤患者经尿道膀胱肿瘤电切术（transurethral resection of the bladder tumors，TURBT）后复发的危险因素。方法 回顾性统计2008年1月到2014年9月在本科就诊的107例大面积膀胱癌患者,其中男性75例，女性32例，平均年龄67.8岁（22～90岁），行TURBT及膀胱灌注化疗，定期门诊复诊随访。根据随访期间是否复发将上述患者分为复发组和未复发组，比较两组患者在年龄、性别、BMI、吸烟史、肿瘤数量（单发或多发）、肿瘤形态（是否有蒂）、肿瘤分期和分级及是否维持膀胱灌注化疗等指标的差异，并利用单因素和多因素logistic回归统计学方法，探索大面积膀胱肿瘤TURBT术后膀胱复发的独立危险因素。结果 所有患者均成功随访。其中75例出现膀胱癌复发，32例未复发。两组患者在年龄、性别组成、BMI、吸烟史、肿瘤分期和分级及是否膀胱灌注上的差异无统计学意义。而复发组中多发、宽基底肿瘤的患者数量比例显著高于未复发组（50.7%和25.0%, 93.3% 和25.0%，P<0.05）,多因素logistic回顾分析结果显示：肿瘤多发（95%CI：1.32～9.39,P=0.012）、宽基底（95%CI：1.50～19.84，P=0.010）是大面积膀胱肿瘤TURBT术后膀胱复发的独立危险因素。结论 与单发和有蒂肿瘤相比，多发、宽基底的大面积膀胱肿瘤TURBT术后膀胱复发的风险更高。因此，对于临床上具备上述特征的患者，有必要采取更加积极的治疗策略。     

Declining mortality from bladder cancer in Europe

OBJECTIVE

To update trends in bladder cancer mortality in 32 European countries and the European Union (EU) as a whole, as mortality from bladder cancer has been declining in most of Western Europe since the early 1990s, but it has still been increasing in several central and eastern European countries up to the mid 1990s.

METHODS

We used data from the World Health Organization (WHO) database over the period 1970–2004. Significant changes in mortality rates were identified using join‐point regression analysis.

RESULTS

In the EU overall (27 countries), bladder cancer mortality rates (age‐standardized, world standard population) were stable up to the early 1990s at ≈ 7/100 000 men and 1.5/100 000 women, and declined thereafter by ≈ 16% in men and 12% in women, to reach values of 6 and 1.3/100,000, respectively, in the early years of the present decade. Over recent years, most countries showed decreasing trends, except Croatia and Poland in both sexes, Romania in men and Denmark in women. Truncated rates at age 35–64 years were lower in both sexes and trends for men were more favourable, with an overall decrease by >21% during the last decade. Join point regression analysis indicates that, for most countries, the trends were more favourable over recent calendar periods.

CONCLUSION

The favourable trends in men are partly or largely due to the recent declines in the prevalence of smoking in European men, together with reduced occupational exposure to occupational carcinogens. The decreases in women are more difficult to explain. Better control of urinary tract infections has probably played a role, while the role of diet and other potential urinary tract carcinogens remains undefined.     

Occupational bladder tumors among persons subjected to carcinogenic amino compound exposure: the epidemiology and prevention

The epidemiology of bladder tumors was examined among the subjects exposed to cancerogenic amino compounds such as beta-naphthylamine and benzidine (Group 1). The workers from other chemical shops of the plant were enrolled as a control group (Group 2); those from service shops (Group 3) and white-collar ones (Group 4) were also included. A total examined group comprised 4,624 subjects followed up in 1975-1979. The age- and sex-adjusted bladder tumor morbidity rates in males were 48.3, 11.0, 6.9 in Groups 1, 2, and 3, respectively (the normal rate, 5.6 per 100,000), while the respective figures in females were 75.0 and 18.2 in Groups 1 and 2, respectively (the normal rate, 1.1 per 100,000). No bladder cancer was recorded among the male workers from service shops and female service and white-collar workers (the expected rate was less than 1). Calculating the bladder cancer morbidity rates by the common standard indices indicated that there was no excess of the rates typical of the disease for males as compared to females, which is generally observed on exposure to potent cancerogenic substances. There was an increase in the latent period of urinary bladder cancer progression from 13.0 to 18.6 in males and to 20.4 in females who had been exposed to benzidine, as compared to the 1950s and 1960s. The mean latent period was 24.2 years in females and 21.5 in males who had been exposed to beta-naphthylamine. 42% of all those who had diagnosed bladder cancer had not come in direct contact with the above cancerogenic agents.(ABSTRACT TRUNCATED AT 250 WORDS)     

Chronic inflammation and bladder cancer

The relation between Schistosomiasis and bladder cancer is well-established and accounts for the high rates of bladder cancer in a number of developing countries, including Egypt. In developed countries, transitional cell carcinoma is the predominant type of bladder cancer, whereas in Schistosomiasis-endemic regions, squamous cell carcinoma is the most common type. In this review, experimental and observational data on infection, inflammation, and bladder cancer are summarized with special emphasis on transitional cell carcinoma. Findings from numerous studies suggest that inflammation is likely to have an important role in bladder carcinogenesis in developed countries. Future studies need to focus in greater detail on risk factors that increase inflammation of the bladder, examine genetic susceptibility to inflammatory pathways, and include markers of inflammation measured prior to cancer diagnosis. Understanding the role of inflammation on transitional cell carcinogenesis may provide important insights on how to prevent the sixth most common cancer in the United States.     

Epidemiology of nephrolithiasis

The overall probability of forming stones differs in various parts of the world: 1-5% in Asia, 5-9% in Europe, 13% in North America, 20% in Saudi Arabia. The composition of stones and their location in the urinary tract, bladder or kidneys may also significantly differ in different countries. Moreover, in the same region, the clinical and metabolic patterns of stone disease can change over time. We examined some epidemiological evidence about the main risk factors for stone formation, both individual and environmental. A slightly higher rate of renal stone disease emerged in males than in females, and in white Caucasians than in Blacks. Stones in the upper urinary tract appear to be related to the life-style, being more frequent among affluent people, living in developed countries, with high animal protein consumption. Bladder stones are nowadays mainly seen in the Third World, on account of very poor socio-economic conditions. A high frequency of stone formation among hypertensive patients has been reported, and among those with high body mass as well. There is no evidence of any rise in the risk of stone formation in relation to dietary calcium intake or tap water hardness.     

Current trends in bladder cancer in England and Wales

PURPOSE: We examined trends in bladder cancer (BC) incidence, mortality and survival in England and Wales during a 30-year period. MATERIALS AND METHODS: Age standardized incidence and mortality rates for BC, cohort incidence ratios, and 1 and 5-year relative survival from BC were calculated, and current trends were assessed. RESULTS: Between 1971 and 1998 the total number of cases of BC increased by 57% from around 7,200 to almost 11,400. Between 1971 and 1998 directly age standardized incidence increased by 16% in males and 37% in females. Directly age standardized mortality decreased by 26% in males and showed little change in females during the same period. Five-year relative survival improved by around 15% points in the 1970s and early 1980s. However, there was less improvement in survival thereafter in that 5-year relative survival for patients diagnosed in 1993 to 1995 was 67% in men and 58% in women. CONCLUSIONS: With an almost 60% increased incidence during the last 3 decades, BC incidence remains much higher in men but has increased more rapidly in women. There have been steady decreases in mortality rates, more marked in men than in women. Unusually, women have a significantly lower survival rate than men. Reasons for these patterns and trends are unclear. The trends in bladder cancer incidence by birth cohort suggest that the relationship with smoking may not be that strong and that other factors may be involved. Further research should focus on reasons for the recent increase in bladder cancer incidence in younger female birth cohorts.     

A multicountry ecologic study of risk and risk reduction factors for prostate cancer mortality

OBJECTIVE: The objective of this research is to identify and determine the relative importance of dietary and environmental risk and risk reduction factors for prostate cancer mortality. MATERIALS AND METHODS: A multicountry ecologic approach was used in multivariate regression analyses with prostate cancer mortality rates and dietary factors and solar ultraviolet-B (UV-B) radiation. Prostate cancer mortality rates for 32 predominantly Caucasian countries for the late 1990s were obtained from the World Health Organization. Dietary supply data were obtained from the Food and Agriculture Organization. Annual solar UV-B dose data were obtained from European ground stations and used to estimate values elsewhere. Linear and multiple linear regression analyses were conducted for all 32 countries as well as the 20 European countries. RESULTS: The strongest risk factor for prostate cancer mortality was animal products, with the nonfat portion of milk and alcohol being somewhat weaker; the strongest risk reduction factors were onions, other protective vegetable products (excluding alcohol, oils, and sweeteners), and solar UV-B radiation. Dietary data for 1979-81 yielded the highest correlations. CONCLUSIONS: These results are consistent with insulin-like growth factor-I (IGF-I), being an important risk factor for prostate cancer, with alcohol and calcium being less important risk factors, and with allium family vegetables, and, to a lesser extent, vitamin D being important risk reduction factors. These results should provide guidance for additional studies on dietary and environmental links to prostate cancer.