Tobacco Smoking and Alcohol Drinking as Risk Factors for Stomach Cancer: a Case-Control Study in Uruguay

Objectives: To estimate the risk of stomach cancer associated with alcohol drinking and tobacco smoking in Uruguayan men.Methods: A case-control including 331 cases and 622 controls was conducted in Montevideo, Uruguay, during the period 1992-96. The study was restricted to men, and both cases and controls were patients admitted to the major four hospitals in Montevideo. Response rates were high and similar for both series (92.8 for cases and 92.6 percent for controls). Controls were frequency-matched to cases on age and residence, and patients with conditions related a priori to tobacco smoking and alcohol drinking were considered ineligible for the study. All patients were interviewed shortly after admission using a structured questionnaire by two trained social workers. Relative risks, approximated by the odds ratios (OR), were estimated by unconditional logistic regression in models including major potential confounders.Results: Smoking duration was associated with an increased risk of 2.2 for smokers of more than 50 years, with a significant dose-response pattern, after controlling for major confounders. Quitters of more than 15 years displayed an OR of 1.1, very close to the risk of never-smokers. A younger age at having started smoking was associated with an increased risk, whereas pack-years of cigarettes showed a significant dose-response. Also, alcohol drinking (particularly hard liquor and beer) was associated with an OR of 2.4 (95 percent confidence interval = 1.5-3.9), after controlling for the effect of tobacco, vegetables, and other types of alcohol beverages.Conclusions: These findings add further support to the role of tobacco and alcohol in gastric carcinogenesis. Cancer Causes and Control 1998, 9, 321-329     

Fruit and Vegetable Intake and Stomach Cancer among Male Adults: A Case-Control Study in Northern Viet Nam

Objective: This study investigated the association between fruit and vegetable intake and stomach cancer, with considering the impacts of Helicobacter pylori (H. pylori) infection and tobacco smoking. Methods: A case-control study featuring 80 male incident stomach-cancer cases and 126 male controls was conducted in a general hospital in Viet Nam. A semi-quantitative food frequency and demographic lifestyle questionnaire were used; and venous blood samples were collected to determine H. pylori status by IgG ELISA. The respective associations between fruit and vegetable intake and stomach cancer were examined using unconditional logistic regression analysis with adjustments for possible cofactors. Results: Fruit intake and stomach cancer showed a weak inverse association when this became non-significant after adjusting for H. pylori infection (OR = 0.50, 95%CI: 0.22–1.12, p trend = 0.094). Stratifying by H. pylori status returned a negative trend for fruit intake and stomach cancer among H. pylori-negative participants (OR = 0.21, 95%CI: 0.06–0.69, p trend = 0.010), but no significant interaction for H. pylori-positive participants (OR = 0.76, 95%CI: 0.21–2.68, p trend = 0.670). Vegetable intake and stomach cancer showed no association, regardless of H. pylori status. Compared to ever-smokers with low intake, never-smokers with high vegetable (OR = 0.25, 95% CI: 0.06–0.95) and fruit intake (OR = 0.20, 95%CI: 0.06–0.65) showed the lowest odds of stomach cancer. Conclusions: Fruit, but not vegetable, intake showed a weak inverse association with stomach cancer. H. pylori infection and tobacco-smoking status may influence the protective effects of fruit and vegetable intake on stomach cancer.     

吸烟和环境烟草烟雾暴露与女性肺癌的关系的病例──对照研究

在上海市区进行了女性肺癌病例—对照研究中共调查新病例649例，对照675例。资料分析表明各种组织学类型肺癌都与吸烟有联系．其中鳞癌和小细胞癌与吸烟关系非常密切．OR分别为5.6和9．9，吸烟使腺癌危险性略有增加，OR=1.195％可信阳=0.7～1.7,吸烟对肺癌总的相对危险度为2.4（95％可信限=1.8～3.3）。各类肺癌的危险性均随每日吸烟量的增加、吸烟年限的延长和开始吸烟年龄的提前而增加。鳞癌和小细胞癌危险性上升速度最快，腺癌危险性增加缓慢，且趋势不显著。本研究还发现工作环境中的环境烟草烟雾暴露使女性非吸烟者肺癌危险性增加到1.5倍，95％可信限=1．1～2.0。未发现儿童期父母吸烟和成年期丈夫吸烟增加女性非吸烟者肺癌危险性。     

Case-Control Study for Lung Cancer and Cigarette Smoking in Osaka, Japan: Comparison with the Results from Western Europe

In order to clarify the relation between cigarette smoking and lung cancer, a case-control study was conducted. The case series consisted of 1,376 lung cancer patients (1,082 males and 294 females) who were newly diagnosed and admitted to eight hospitals in Osaka during 1986–88. Smoking histories were compared with those of 2,230 controls (1,141 males and 1,089 females) admitted to the same hospitals during the same period without established smoking-related diseases. Odds ratios of current smoker versus nonsmoker were 18.1, 1.9, 21.4, and 3.8 for squamous, adeno, small, and large cell carcinoma, respectively, for males, and 9.7, 1.3, 12.1, 3.7, respectively, for females. Compared to the results from previous studies in Japan, the magnitude of the odds ratios for squamous and small cell carcinoma is approaching the level of Western Europe in the late 1970s. Population attributable risk of exsmokers has also been increasing to the level of Western Europe. Among male current smokers, smoking intensity, such as number of cigarettes per day or fraction smoked per cigarette, seemed to have a slightly greater influence on squamous cell carcinoma than adenocarcinoma, while factors associated with the spread of cigarette smoke, such as inhalation, seemed to have greater influence on adenocarcinoma. The difference in the distribution of these smoking characteristics between Japan and Western Europe could not fully explain the difference in lung cancer incidence and distribution of histologic types between the two areas.     

Smoking and Cancer Risk in Korean Men and Women

OBJECTIVE: In Korea, male smoking prevalence is among the world's highest, and mortality rates from smoking-caused cancers, particularly lung cancer, are escalating. This cohort study examined the effects of cigarette smoking on the risk of cancer mortality and incidence, and characterized the relationship of cancer risk with the amount and duration of cigarette smoking. METHOD: A nine-year prospective cohort study was carried out on 1,212,906 Koreans, 30-95 years of age. The study population includes participants in a national insurance program, who completed a questionnaire on smoking and other risk factors. The main outcome measures were death from cancer and cancer incidence, obtained through record linkage. At baseline, 472,970 men (57.0%) and 20,548 (5.4%) women were current cigarette smokers. RESULTS: In multivariate Cox proportional hazards models, controlling for age, current smoking among men increased the risks of mortality for cancer of the lung (relative risk (RR), 4.6; 95% confidence interval (CI), 4.0-5.3) and other cancers, including larynx, bile duct, esophagus, liver, stomach, pancreas, bladder, and also leukemia. Current smoking among women increased the risk of lung cancer mortality (RR = 2.5, 95% CI = 2.0-3.1). Similar results were found for incidence among men and women. CONCLUSION: In Korea, smoking is an independent risk factor for a number of major cancers. The findings affirm the need for aggressive tobacco control in Korea in order to minimize the epidemic of smoking-caused disease.     

The Tobacco Endgame—A New Paradigm for Smoking Cessation in Cancer Clinics

Smoking cessation represents an untapped resource for cancer therapy. Many people who smoke and have cancer (tobacco-related or otherwise) struggle to quit and as a result, jeopardise response to treatment, recovery after surgery and long-term survival. Many health care practitioners working in cancer medicine feel undertrained, unprepared and unsupported to provide effective smoking cessation therapy. Many institutions and healthcare systems do provide smoking cessation programs, guidelines and referral pathways for cancer patients, but these may be unevenly applied. The growing body of evidence, from both retrospective and prospective clinical studies, confirms the benefit of smoking cessation and will provide much needed evidence for the best and most effective interventions in cancer clinics. In addition to reducing demand, helping cancer patients quit and treating addiction, a firm commitment to developing smoke free societies may transform cancer medicine in the future. While the Framework Convention for Tobacco Control (FCTC) has dominated global tobacco control for the last two decades, many jurisdictions are starting to develop plans to make their communities tobacco free, to introduce the tobacco endgame. Characterised by downward pressure on tobacco supply, limited sales, limited access and denormalization of smoking, these policies may radically change the milieu in which people with cancer receive treatment, in which health care practitioners refine skills and which may ultimately foster dramatic improvements in cancer outcomes.     

Opportunistic Insights into Occupational Health Hazards Associated with Waterpipe Tobacco Smoking Premises in the United Kingdom

Background: Smokefree laws aim to protect employees and the public from the dangers of secondhandsmoke. Waterpipe premises have significantly increased in number in the last decade, with anecdotal reports ofpoor compliance with the smokefree law. The literature is bereft of information pertaining to waterpipe premiseemployees. This study aimed to opportunistically gather knowledge about the occupational health hazardsassociated with working in waterpipe premises in London, England. Materials and Methods: Employees fromseven convenience-sampled, smokefree-compliant waterpipe premises in London were observed for occupationalactivities. Opportunistic carbon monoxide (CO) measurements were made among those with whom a rapport haddeveloped. Observations were thematically coded and analysed. Results: Occupational hazards mainly includedenvironmental smoke exposure. Waterpipe-serving employees were required to draw several puffs soon afterigniting the coals, thereby providing quality assurance of the product. Median CO levels were 27.5ppm (range21-55ppm) among these employees. Self-reported employee health was poor, with some suggestion that workingpatterns and smoke exposure was a contributory factor. Conclusions: The smokefree law in England does notappear to protect waterpipe premise employees from high levels of CO. Continued concerns surrounding chronicsmoke exposure may contribute to poor self-reported physical and mental wellbeing.     

Systematic Review on International Practices in Controlling Waterpipe Tobacco Smoking

Background: Waterpipe tobacco smoking has becoming popular especially among young people worldwide.Smokers are attracted by its sweeter, smoother smoke, social ambience and the misconception of reduced harm.The objective of this study was to systematically review the effects of waterpipe tobacco policies and practicesin reducing its prevalence. Materials and Methods: A systematic review was conducted electronically using thePubMed, OVID, Science Direct, Proquest and Embase databases. All possible studies from 1980 to 2013 wereinitially screened based on titles and abstracts. The selected articles were subjected to data extraction andquality rating. Results: Three studies met the inclusion criteria and were eligible for this review. Almost allof the waterpipe tobacco products and its accessories did not comply with the regulations on health warninglabelling practices as stipulated under Article 11 of WHO FCTC. In addition, the grisly new warning labels forcigarettes introduced by Food and Drug Administration did not affect hookah tobacco smoking generally. Indoorair quality in smoking lounges was found to be poor and some hookah lounges were operated without smokeshop certification. Conclusions: Our findings revealed the availability of minimal information on the practicesin controlling waterpipe smoking in reducing its prevalence. The lack of comprehensive legislations or practicesin controlling waterpipe smoking warrants further research and policy initiatives to curb this burgeoning globale pidemic, especially among the vulnerable younger population.     

Cigarette Smoking and Prostate Cancer Risk: Negative Results of the Seoul Male Cancer Cohort Study

We evaluated cigarette smoking as a risk factor for prostate cancer in a prospective, population-based cohortstudy. The subjects were 14,450 males among the participants in the Seoul Male Cancer Cohort Study who hadat least 1-year follow-up. They were followed up between 1993 and 2008. During the 16-year follow-up period,87 cases of prostate cancer occurred over the 207,326 person-years of the study. The age-adjusted relative risksof past and current smokers at entry were 0.60 (95%CI: 0.34-1.06) and 0.70 (95%CI: 0.43-1.13), respectively,suggesting that cigarette smoking may not be a risk factor for prostate cancer. The relationship between prostatecancer and other modifiable factors, such as Westernized diet, should be studied with the goal of establishingprevention programs for prostate cancer.     

Habitual Tea Consumption Reduces Prostate Cancer Risk in Vietnamese Men: a Case-Control Study

Background: An upward trend has been noted for the incidence of prostate cancer (PCa) in Vietnam, but information is limited on modifiable factors associated with this form of cancer. This case-control study was conducted to ascertain any relationship between habitual tea consumption and PCa risk. Materials and Methods: Two hundred and fifty-three incident patients with histologically confirmed PCa and 419 (340 community-based and 79 hospital-based) controls, matched by age, were recruited in Ho Chi Minh City during 2013-2015. Information on frequency, quantity and duration of tea consumption, together with demographics, habitual diet and lifestyle characteristics, was obtained by direct interviews using a validated questionnaire. Logistic regression analyses were performed to assess associations between tea consumption variables and PCa risk. Results: The control subjects reported higher tea consumption levels in terms of cumulative exposure, frequency and quantity of tea drank than the PCa patients. After accounting for confounding factors, increasing tea consumption was found to be associated with reduced risk of PCa. The adjusted odds ratios (95% confidence intervals) were 0.52 (95% CI 0.35-0.79) and 0.30 (95% CI 0.18-0.48) for participants drinking 100-500 ml/day and > 500 ml/day, respectively, relative to those drinking < 100 ml/day. Significant inverse dose-response relationships were also observed for years of drinking and number of cups consumed daily (P <0.01). Conclusion: Habitual tea consumption is associated with a reduced risk of PCa in Vietnamese men.     

Tobacco Smoking and Risk of Second Primary Lung Cancer

IntroductionLung cancer survivors are at high risk of developing a second primary lung cancer (SPLC). However, SPLC risk factors have not been established and the impact of tobacco smoking remains controversial. We examined the risk factors for SPLC across multiple epidemiologic cohorts and evaluated the impact of smoking cessation on reducing SPLC risk.MethodsWe analyzed data from 7059 participants in the Multiethnic Cohort (MEC) diagnosed with an initial primary lung cancer (IPLC) between 1993 and 2017. Cause-specific proportional hazards models estimated SPLC risk. We conducted validation studies using the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (N = 3423 IPLC cases) and European Prospective Investigation into Cancer and Nutrition (N = 4731 IPLC cases) cohorts and pooled the SPLC risk estimates using random effects meta-analysis.ResultsOverall, 163 MEC cases (2.3%) developed SPLC. Smoking pack-years (hazard ratio [HR] = 1.18 per 10 pack-years, p < 0.001) and smoking intensity (HR = 1.30 per 10 cigarettes per day, p < 0.001) were significantly associated with increased SPLC risk. Individuals who met the 2013 U.S. Preventive Services Task Force’s screening criteria at IPLC diagnosis also had an increased SPLC risk (HR = 1.92; p < 0.001). Validation studies with the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial and European Prospective Investigation into Cancer and Nutrition revealed consistent results. Meta-analysis yielded pooled HRs of 1.16 per 10 pack-years (p_meta < 0.001), 1.25 per 10 cigarettes per day (p_meta < 0.001), and 1.99 (p_meta < 0.001) for meeting the U.S. Preventive Services Task Force’s criteria. In MEC, smoking cessation after IPLC diagnosis was associated with an 83% reduction in SPLC risk (HR = 0.17; p < 0.001).ConclusionsTobacco smoking is a risk factor for SPLC. Smoking cessation may reduce the risk of SPLC. Additional strategies for SPLC surveillance and screening are warranted.     

Impact of Tobacco Smoking on Outcomes of Radiotherapy: A Narrative Review

The carcinogenic role of tobacco smoking is well recognized, but the detrimental effects of continued smoking after a cancer diagnosis have been underestimated. Radiotherapy is among the main treatment modalities for cancer. We reviewed the literature data concerning the impact of tobacco smoking on treatment outcomes in radiotherapy-managed patients with various malignancies. Most of the analyzed studies demonstrated the detrimental effect of smoking on overall survival, tumor control, quality of life, treatment toxicity, and the incidence of second primary malignancies. Healthcare professionals should use the cancer diagnosis and treatment as a teachable moment and recommend their patients to immediately cease smoking. Wherever possible, cancer patients should undergo an intensive smoking-cessation program, including behavioral and pharmacologic therapy.     

Alcohol Consumption and Risk of Esophageal Cancer in Japan: A Case-control Study in Seven Hospitals

In a multi-center case-control study, we evaluated the riskof esophageal cancer in the Japanese population. All patientsand controls were inpatients in the surgical departments ofseven hospitals nationwide. Patients eligible for the studywere those newly diagnosed as having primary esophageal cancer.One control per case was selected from among patients admittedto the same hospital, and 141 male pairs were analyzed usinglogistic regression analysis. The results showed dose-responserelation between the risk of esophageal cancer and both thequantity (g/week) and frequency (times/week) of alcohol drinking(P value for trend = 0.0001). Altough a statistically significantrisk increase was shown among moderate to heavy smokers (15 cigarette/day < 25) (odds ratio, 4.35:95% confidence interval,1.81-10.49), the dose-response for cigarette smoking was unclear(P value for trend = 0.07). No combined effect of alcohol drinkingand cigarette smoking was found. A frequent intake of fruitwas-associated with a decreased risk (P value for trend = 0.02).After adjustment for alcohol consumption, cigarette smokingand fruit intake were found not to be associated with the risk,whereas a preference for high-temperature food and drink showeda statistically significant positive association (P value fortrend = 0.02). Drinkers who consumed shochu most frequentlyshowed a three-fold increased risk over that for beer consumers,although the association disappeared after adjusting for theamount of alcohol consumed. The present results confirm alcoholintake and a preference for high-temperature food to be associatedwith an increased risk of esophageal cancer and show the amountof alcohol consumed, rather than the type of alcoholic beverage,to be the main risk determinant.     

Association between Smokeless Tobacco Use and Waterpipe Smoking and the Risk of Lung Cancer: A Systematic Review and Meta-Analysis of Current Epidemiological Evidence

Background: Smokeless tobacco and waterpipes are used by hundreds of millions of people worldwide and consumption rates exceed that of cigarette smoking in much of South East Asia and parts of the Middle East. However, the cancer risks of these methods of tobacco consumption are less well-characterized than those of cigarette smoking. The objective of this study was to systematically review the epidemiological evidence on the association between smokeless tobacco use and waterpipe smoking and lung cancer risk. Methods: The MEDLINE, EMBASE, Web of Science and OpenSIGLE databases were searched to identify eligible case-control and cohort studies (published before 1st December 2020 in any language) that adjusted for cigarette smoking or included non-cigarette smokers only. Summary odds ratio/relative risk estimates and confidence intervals were extracted, and pooled risk ratios (RRs) for lung cancer were calculated using random effects meta-analysis. Results: The literature search identified 2,465 publications: of these, 26 studies including 6,903 lung cancer patients were included in the synthesis (20 studies of smokeless tobacco use, five of waterpipe smoking, one of both). Our results suggest that smokeless tobacco use is associated with an increased risk of lung cancer among non-cigarette smokers, and that betel quid tobacco may be particularly hazardous. The random effects meta-analysis showed that exclusive use of any type of smokeless tobacco (pooled RR = 1.53, 95%CI 1.09 – 2.14), betel quid chewing (pooled RR = 1.77, 95%CI 1.06 – 2.95), and waterpipe smoking (pooled RR = 3.25, 95%CI 2.01 – 5.25) were significantly associated with an increased risk of lung cancer. Conclusions: This meta-analysis of case-control/cohort studies supports the hypothesis that use of smokeless tobacco and waterpipe smoking is associated with increased risk of developing lung cancer. Considering the widespread and increasing use of smokeless tobacco in developing countries, and increasing prevalence of waterpipe smoking in almost all societies, these findings inform formulation of public health policy, legislation and tobacco control measures at national and international level to increase awareness and decrease the prevalence of smokeless tobacco use and waterpipe smoking.     

Gastric Cancer: the Roles of Diet,Alcohol Drinking,Smoking and Helicobacter pylori in Northeastern Thailand

The incidence of gastric cancer in the countries of South East Asia is variable, ranging from age-standardized ‍rates of 20.9/105 (men) and 10.4/105 (women) in Hanoi, Vietnam to 4.1/105 (men) and 2.1/105 (women) in Khon Kaen, ‍Thailand. The reasons for these differences are unknown. Possible explanations are differences in dietary habits, ‍alcohol drinking, smoking and/or the prevalence of infection with Helicobacter pylori (H. pylori). A case-control ‍study was conducted in Khon Kaen, Thailand, to study the role of these factors in gastric cancer carcinogenesis. 131 ‍gastric cancer cases and 262 matched controls were recruited for the study. Information on dietary habits, alcohol ‍drinking and smoking were collected by a structured questionnaire. Blood samples were available from 111 cases ‍and 232 controls for H. pylori assay. Using an unconditional logistic regression model controlling for age and sex, we ‍assessed the effects of dietary habits, alcohol drinking, smoking and H. pylori infection on the risk of gastric cancer. ‍A high intake of salt (OR=1.8; 95%CI 1.1-3.0) and fermented foods (OR=1.9; 95%CI 1.1-3.3) was found to be ‍associated with an increased risk. Preference for spicy food was not associated with gastric cancer risk in this ‍population. Although there were negative associations between gastric cancer and vegetable and fruit intake, they ‍were rather weak (OR 0.8 for both) and non significant. There were also weak (non-significant) associations with ‍smoking and alcohol consumption, and no association with H. pylori infection (OR=0.6; 95%CI 0.4-1.0). Infection of ‍H. pylori was associated with various indicators of crowding. ‍     

Preliminary Study of the GSTM1 Null Polymorphism and History of Tobacco Smoking among Oral Cancer Patients in Northeastern Thailand

Risks with GSTM1 genotypes and potential roles of smoking in the susceptibility to oral squamous cell carcinoma (OSCC) were studied in Northeastern Thailand. Study subjects were 79 histologically-confirmed OSCC cases (31 men, 48 women) and 79 age- and sex-matched healthy controls ranging in age from 25 to 84 years. GSTM1 genotyping was achieved by two independent PCR assays. The GSTM1 null allele and the homozygous genotype did not increase risk of OSCC vs the wild type allele and the remaining genotypes. When the focus was on the smoking habit, male subjects who smoked ≥10 or ≥35 years were at significantly increased risk for OSCC with adjusted ORs of 4.88 [95%CI, 1.41-16.87, p=0.012] or 4.94 [95%CI, 1.62-15.12, p=0.005], respectively. A higher risk for OSCC was found for smoking amount; those who smoked >5 or >10 pack-years were at a higher risk with adjusted OR of 4.46 [95%CI; 1.45-13.74, p=0.009] or 3.89 [95%CI; 1.34 11.28, p=0.012], respectively. There are certain smoking patterns that give greater risks and thus both smoking duration and pack-years should be taken into consideration in tobacco related cancer prevention.     

Case-Control Study of Alcohol Usage and Fruit Intake and Stomach Cancer in the North Viet Nam

Background: The aim was to examine the association between alcohol usage, fruit intake and stomach cancer treated in hospitals in the Hanoi city during 2018-2019. Methods: A case-control study was performed for 379 newly incidence cases of stomach cancer and matched 1096 hospital controls for sex and age (+/-5). We used the validated semi-quantitative food frequency questionnaire to collect data on the intake of alcohol and fruits and other food groups. The average amount of total fruits intake (grams per week) was estimated. The adjusted Odds ratio and 95% confidence interval (OR (95%CI) were estimated. Results: Intake of alcohol significantly increased the risk of stomach cancer, the mean frequency of intake per year of 345.1 times vs. non-drinkers, OR (95%CI): 1.51 (1.05, 2.17), p_trend=0.026. In contrast, a higher total of fruits intake was associated with a significantly decreased risk of stomach cancer in both sexes, men, and women, (Q5 vs Q1), OR (95%CI): 0.47 (0.30, 0.72), p_trend=0.000, OR (95%CI): 0.45 (0.26, 0.77), p_trend =0.003, OR (95%CI): 0.52 (0.24, 1.12), p_trend=0.026, respectively. Conclusions: We observed alcohol usage increased the risk of stomach cancers. In contrast, a total of fruits intake was associated with a decreased risk of stomach cancer.     

Modifying Effect of Smoking on GSTM1 and NAT2 in Relation to the Risk of Bladder Cancer in Mongolian Population: A Case-Control Study

Objectives: Tobacco smoking is the predominant risk factor for bladder cancer as it contains cancer-causing chemicals. However, genetic factors may play important role in response towards chemical carcinogens. In this study we aim to investigate genetic polymorphisms of glutathione S-transferase M1 (GSTM1) and N-acetyltransferase 2 (NAT2) as determinants of bladder cancer risk, independently and in combination with tobacco use in the Mongolian population. Materials and Methods: The current study was a hospital-based case-control study including 60 histologically confirmed bladder cancer patients and 60 cancer-free controls. PCR-RFLP assay was used to determine the presence of GSTM1 and NAT2 polymorphisms in bladder cancer patients and controls. GSTM1 and NAT2 were tested using binary logistical regression analysis with adjustment or stratification according to the smoking. Results: There were 46 men and 14 women diagnosed with bladder cancer, with mean age was 58±4. The controls included 37 men and 23 women with a mean age of 57±3. The frequency of GSTM1 null genotype was higher in controls (71.67%) than in bladder cancer patients (58.33%) without statistical significance (OR=0.5534; 95% CI=0.2586-1.1843), (p=0.128). The NAT2 low acetylator phenotype was more common in patients with bladder cancer (15%) than in controls (5%). Furthermore, individuals with NAT2 low acetylator phenotype had a nearly 3.35-fold increased risk to develop bladder cancer (OR=3.35; 95% CI=0.8604-13.0657), (p=0.081) while the risk was even higher when combined with null GSTM1 genotype (OR=4; 95% CI=0.4459-37.5308), (p=0.213) but there was no statistical significance. Prevalence of smoking in bladder cancer patients was higher than controls and increased significantly the risk of bladder cancer (OR=8.31; 95% CI=3.66-18.88). Smokers with GSTM1 null genotype were at 5-fold higher risk of bladder cancer (OR=5.0; 95% CI=1.55-16.16), (p=0.007) while NAT2 low acetylator phenotype increased bladder cancer risk by 20-fold (OR=20.5; 95% CI=2.33-80.86), (p=0.006). Conclusion: The current study shows that tobacco smokers with the NAT2 low acetylator phenotype and GSTM1 null genotype have the highest risk of bladder cancer in the Mongolian population.