Roger Milne

Ph.D

Cancer Council Victoria

Head of Cancer Epidemiology Division

PLCO (Learn more about this study)

PLCO-810

Jul 15, 2021

Establishing risk factors for bladder cancer to inform prevention: a pooled analysis of prospective studies from the NCI Cohort Consortium

Bladder cancer is the 8th most common cancer in Australia and 7th worldwide, with an estimated 260,000 new cases diagnosed annually in men and 76,000 in women. Western Europe, North America and Australia have the highest incidence. Most tumours are non-invasive and treatable but require ongoing monitoring as recurrence is common; this makes bladder cancer one of the malignancies with the highest cost per patient from diagnosis to death. Muscle-invasive bladder cancers (~30%) have a worse outcome and need to be treated more aggressively.
The strongest and most established risk factors for bladder cancer are cigarette smoking, occupational exposure to carcinogens, and drinking water contaminants such as arsenic. The relative risk associated with smoking appears to have increased over the last 20 years for unknown reasons. Physical activity is associated with reduced risk.
Despite extensive research by many studies, it is unclear whether bladder cancer is related to other modifiable factors such as obesity, alcohol and coffee consumption, use of non-steroidal anti-inflammatory drugs (NSAIDs) and diet. Men have up to four times higher risk of bladder cancer than women, which is explained only in part by smoking and occupational exposures; reproductive and exogenous hormonal factors may therefore be important but have yet to be assessed prospectively with adequate power.
The NCI Cohort Consortium offers a unique opportunity to definitively assess associations with these largely modifiable risk factors using the largest sample size available globally.

Our objective is to pool data from several large prospective cohort studies to assess associations with bladder cancer risk for predominantly modifiable lifestyle factors for which findings to date have been inconclusive. Our specific aims are as follows:

Aim 1: to assess associations for smoking habits (over time), body size, alcohol consumption, other beverage consumption, consumption of fruit and vegetables, consumption of red and processed meats, dietary pattern, nutrient intake, use of aspirin and other NSAIDs, reproductive factors and exogenous hormone use

Aim 2: to assess the above associations by sex, smoking status and disease subtype