Occupational risk factors for male bladder cancer: results from a population based case cohort study in the Netherlands

Bowel Obstruction as the Initial Presentation of Urothelial Carcinoma

Bowel obstructions are one of the main causes of hospital admissions for acute abdominal pain. In addition, bladder cancer is one of the most common cancers in the world. This said, bowel obstruction and bladder cancer are very frequent diseases but the same cannot be said about the association between these two pathologies. We report a unique case of an 80-year-old patient admitted to the emergency room with a bowel obstruction caused by a urothelial carcinoma with adrenal metastasis. The patient underwent an urgent laparotomy, and intraoperative inspection of the peritoneal cavity confirmed a large tumorous mass suspected of gastrointestinal etiology. The mass infiltrated the ileum and sigmoid colon and was apparently in contact with the bladder wall. An en-bloc resection of the lesion was performed. An R0 excison was not possible and fragments of the lesion were excised from the bladder wall for separate analysis. Histopathological examination of the resected specimen described a high-grade, undifferentiated urothelial carcinoma that originated in the bladder and invaded the ileum and sigmoid colon. The presence of an invasive urothelial carcinoma presenting with bowel obstruction represents an unexpected diagnosis and, although rare, the surgeon must be aware of this possibility. This case should serve as a reminder that a broad differential diagnosis should be considered when investigating an abdominal tumor.

Diabetes and the risk of bladder cancer subtypes in men and women: results from the Netherlands Cohort Study

Meta-analyses have shown modest positive associations between diabetes mellitus (DM) and bladder cancer risk, but results are heterogeneous. This might be due to lack of distinction between bladder cancer subtypes, between sexes, and possibly between Type 2 and Type 1 DM (T2DM and T1DM). The relationship of T2DM (and secondarily T1DM) characteristics with risk of bladder cancer subtypes (invasive versus noninvasive) was investigated in the Netherlands Cohort Study. In 1986, 120,852 men and women aged 55-69 years provided information on DM and lifestyle data. After 20.3 years of follow-up, multivariable case-cohort analyses were based on 1020 invasive and 1088 noninvasive bladder cancer cases, and 4267 subcohort members with complete data on DM and confounders. While T2DM was not associated with noninvasive bladder cancer, it was statistically significantly associated with invasive bladder cancer risk: the multivariable-adjusted was HR = 1.57 (95% CI 1.04-2.37), comparing participants with T2DM versus without DM. The association was only significant in women, and women showed a stronger association [HR = 2.19 (95% CI 1.10-4.34)] between T2DM and invasive bladder cancer than men [HR = 1.42 (95% CI 0.88-2.30)]; interaction by sex was nonsignificant. Associations were stronger positive in those whose age at diagnosis of T2DM was 55+ years, and in those diagnosed with T2DM less than five years before baseline. T2DM participants using antidiabetic medication had higher invasive bladder cancer risk than those without DM. Exploratory age-sex-adjusted analyses suggested a positive association between T1DM and invasive bladder cancer, but this was based on few cases. These findings suggest that T2DM and possibly T1DM are positively associated with invasive bladder cancer risk.

Association between cigarette smoke exposure and urinary bladder cancer in Scottish terriers in a cohort study

Canine urothelial carcinoma (UC) initially responds favorably to treatment, but is ultimately lethal in most cases. Research to identify modifiable risk factors to prevent the cancer is essential. The high breed-associated risk for UC, e.g. 20-fold higher in Scottish terriers, can facilitate this research. The objective was to identify environmental and host factors associated with UC in a cohort of Scottish terriers. Information was obtained through dog owner questionnaires for 120 Scottish terriers ≥ 6 years old participating in a bladder cancer screening study, with comparisons made between dogs that did or did not develop UC during the 3 years of screening. Univariable models were constructed, and variables with P < 0.20 were included when building the multivariable model, and then removed using a backward stepwise procedure. P < 0.05 was considered statistically significant. Urine cotinine concentrations were measured by liquid chromatography-mass spectrometry to further investigate potential cigarette smoke exposure. Biopsy-confirmed UC which was found in 32 of 120 dogs, was significantly associated with the dogs living in a household with cigarette smokers (odds ratio [OR], 6.34; 95 % confidence intervals [CI], 1.16-34.69; P = 0.033), living within a mile of a marsh or wetland (OR, 21.23; 95 % CI, 3.64-123.69; P = 0.001), and history of previous bladder infections (OR, 3.87; 95 % CI, 1.0-14.98; P = 0.050). UC was diagnosed in 18 of 51 dogs (35.3 %) with quantifiable cotinine concentrations, and six of 40 dogs (15.0 %) without quantifiable cotinine concentrations in their urine (P = 0.0165). In conclusion, the main modifiable risk factor for UC in this cohort of dogs was exposure to second-hand tobacco smoke.

Promoting effect and immunologic role of secretogranin II on bladder cancer progression via regulating MAPK and NF-κB pathways

Bladder cancer (BLCA) is ranked among the top ten most prevalent cancers worldwide and is the second most common malignant tumor within the field of urology. The limited effectiveness of immune targeted therapy in treating BLCA, due to its high metastasis and recurrence rates, necessitates the identification of new therapeutic targets. Secretogranin II (SCG2), a member of the chromaffin granin/secreted granin family, plays a crucial role in the regulated release of peptides and hormones. The role of SCG2 in the tumor microenvironment (TME) of lung adenocarcinoma and colon cancer has been established, but its functional significance in BLCA remains uncertain. This study aimed to investigate SCG2 expression in 15 bladder cancer tissue samples and their corresponding adjacent control tissues. The potential involvement of SCG2 in BLCA progression was assessed using various techniques, including analysis of public databases, immunohistochemistry, Western Blotting, immunofluorescence, wound-healing assay, Transwell assay, and xenograft tumor formation experiments in nude mice. This study provided novel evidence indicating that SCG2 plays a pivotal role in facilitating the proliferation, migration, and invasion of BLCA by activating the MEK/Erk and MEK/IKK/NF-κB signaling pathways, as well as by promoting M2 macrophage polarization. These findings propose the potential of SCG2 as a molecular target for immunotherapy in human BLCA.

Quality of life in bladder cancer: systematic review and meta-analysis

BACKGROUND

Worldwide, bladder cancer (BC) has been regarded as the tenth most common cancer with more than 573 000 new cases in 2020. This research presents a systematic review and meta-analysis of studies examining the quality of life (QOL) among patients with BC.

METHODS

The study was designed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 11 articles were extracted from a literature search conducted through electronic databases including PubMed, EMBASE, Scopus and Web of Science from the onset of January 2000 to June 2022. A random-effects model was applied to estimate the pooled QOL in patients with BC.

RESULTS

We included 11 primary studies in the final meta-analysis. Based on random effect analysis, total score of QOL was 53.92 (95% CI: 47.84 to 60) representing a moderate level of QOL among patients. Based on the analysis, it was found that physical items with a score of 49.82 (95% CI: 45.8 to 53.84) had a lower score in comparison with mental items at a score of 52 (95% CI: 49.54 to 54.47). In addition, the item of role limitations due to physical health with a score of 46.26 (95% CI: 20.11 to 72.41), and social functioning with a score of 46.25 (95% CI: 18.85 to 73.66), respectively, had the lowest QOL in patients with BC.

CONCLUSION

Generally, the QOL among patients with BC was in a moderate condition, which can be improved through determining the influencing factors on QOL as a crucial strategy to define future treatment procedures in an effective manner.

Bladder cancer risk in relation to occupations held in a nationwide case-control study in Iran

Globally, bladder cancer has been identified as one of the most frequent occupational cancers, but our understanding of occupational bladder cancer risk in Iran is less advanced. This study aimed to assess the risk of bladder cancer in relation to occupation in Iran. We used the IROPICAN case-control study data including 717 incident cases and 3477 controls. We assessed the risk of bladder cancer in relation to ever working in major groups of the International Standard Classification of Occupations (ISCO-68) while controlling for cigarette smoking, opium consumption. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CI). In men, decreased ORs for bladder cancer were observed in administrative and managerial workers (OR 0.4; CI: 0.2, 0.9), and clerks (OR 0.6; CI: 0.4, 0.9). Elevated ORs were observed in metal processors (OR 5.4; CI: 1.3, 23.4), and workers in occupations with likely exposure to aromatic amines (OR 2.2; CI: 1.2, 4.0). There was no evidence of interactions between working in aromatic amines-exposed occupations and tobacco smoking or opium use. Elevated risk of bladder cancer in men in metal processors and workers likely exposed to aromatic amines aligns with associations observed outside Iran. Other previously confirmed associations between high-risk occupations and bladder cancer were not observed, possibly due to small numbers or lack of details on exposure. Future epidemiological studies in Iran would benefit from the development of exposure assessment tools such as job exposure matrices, generally applicable for retrospective exposure assessment in epidemiological studies.

Length of employment in workplaces handling hazardous chemicals and risk of cancer among Japanese men

OBJECTIVES

In Japan, the risk of developing cancer among workers employed in workplaces where chemical substances are handled is unclear. This study aimed to assess the association between cancer risk and employment in workplaces handling hazardous chemicals.

METHODS

The Inpatient Clinico-Occupational Survey of the Rosai Hospital Group data of 120 278 male patients with incident cancer and 217 605 hospital controls matched for 5-year age group, hospital (34 hospitals) and year of admission (2005-2019) were analysed. Cancer risk in relation to lifetime employment in workplaces using regulated chemicals was assessed while controlling for age, region and year of diagnosis, smoking, alcohol consumption and occupation. Further analysis stratified by smoking history was performed to examine interaction effects.

RESULTS

In the longest group of employment in tertiles, ORs were increased for all cancers (OR=1.13; 95% CI: 1.07 to 1.19) and lung (OR=1.82; 95% CI: 1.56 to 2.13), oesophageal (OR=1.73; 95% CI: 1.18 to 2.55), pancreatic (OR=2.03; 95% CI: 1.40 to 2.94) and bladder (OR=1.40; 95% CI: 1.12 to 1.74) cancers. Employment of 1+ years was associated with risk for lung cancer; 11+ years for pancreatic and bladder cancers; and 21+ years for all cancers and oesophageal cancer. These positive relationships were particularly obvious among patients with a history of smoking; however, no significant interaction between smoking and length of employment was observed.

CONCLUSIONS

There is a high risk of cancer among workers, especially smokers, employed in workplaces handling regulated chemicals in Japan. Thus, future measures for chemical management in workplaces are needed to prevent avoidable cancers.

PRR11 is a prognostic biomarker and correlates with immune infiltrates in bladder urothelial carcinoma

Abnormal proline-rich protein 11 (PRR11) expression is associated with various tumors. However, there are few reports concerning PRR11 with prognostic risk, immune infiltration, or immunotherapy of bladder urothelial carcinoma (BLCA). This study is based on online databases, such as Oncomine, GEPIA, HPA, LinkedOmics, TIMER, ESTIMATE and TISIDB, and BLCA data downloaded from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus, we employed an array of bioinformatics methods to explore the potential oncogenic roles of PRR11, including analyzing the relationship between PRR11 and prognosis, tumor mutational burden (TMB), microsatellite instability, and immune cell infiltration in BLCA. The results depict that PRR11 is highly expressed in BLCA, and BLCA patients with higher PRR11 expression have worse outcomes. In addition, there was a significant correlation between PRR11 expression and TMB and tumor immune infiltration. These findings suggest that PRR11 can be used as a potential marker for BLCA patient assessment and risk stratification to improve clinical prognosis, and its potential regulatory mechanism in the BLCA tumor microenvironment and targeted therapy is worthy of further investigation.

Risk Factors for Bladder Cancer: Results of a Survey of Hospital Patients

Introduction

Several risk factors have been identified in the occurrence of bladder cancer. These include genetic and hereditary factors, smoking and tobacco use, increased body mass index, occupational exposure to certain chemicals and dyes, medical conditions such as chronic cystitis and infectious diseases such as schistosomiasis. This study aimed to evaluate risk factors in patients with bladder cancer.

Materials and Methods

All patients presenting to the uro-oncology department of the hospital with imaging and histology confirmed bladder cancer were included in the study. Age- and gender-matched patients presenting to the department of urology with benign disorders were prospectively included as controls. All the study subjects and the controls completed a self-administered structured questionnaire.

Results

Seventy-two (67.3%) of the participants with bladder cancer were males. The mean age of participants with bladder cancer was 59.24 ± 16.28 years. Most participants with bladder cancer worked as farmers (35.5%) or industrial workers (24.3%). Recent history of recurrent urinary tract infections was seen in 85 (79.4%) of the participants with bladder cancer and 32 (30.8%) of controls. Diabetes mellitus was more common among participants with bladder cancer. A significant number of participants with bladder cancer used tobacco and smoked compared to controls.

Conclusions

This study highlights numerous potential biological and epidemiological factors that may act as a risk factors for bladder cancer. These factors could explain the gender differences observed in the incidence of bladder cancer. In addition, the study indicates the intense risk of tobacco products and smoking on the incidence of bladder cancer.

The past, present, and future of immunotherapy for bladder tumors

Bladder cancer is a prominent cancer worldwide with a relatively low survival rate for patients with increased stage and metastasis. Current treatments are based on surgical removal, bacillus Calmette-Guerin (BCG) Immunotherapy, and platinum-based chemotherapy. However, treatment resistance due to genetic instability of bladder tumors, as well as intolerance to treatment adverse effects leads to the necessity to further treatment options. New advancements in immunotherapy are on the rise for treatment of various cancers and specifically has shown promise in the treatment of bladder cancer. This review summarizes these new advancements in treatment options involving cytokines and cytokine blockade. Such a study might be helpful for urologists to manage patients with bladder cancer more effectively.

Fine particulate matter induces METTL3-mediated m6A modification of BIRC5 mRNA in bladder cancer

Long-term exposure to fine particulate matter (PM_2.5) is reportedly related to a variety of cancers including bladder cancer. However, little is known about the biological mechanism underlying this association. In the present study, PM_2.5 exposure was significantly associated with increased levels of m⁶A modification in bladder cancer patients and bladder cells. METTL3 expression was aberrantly upregulated after PM_2.5 exposure, and METTL3 was involved in PM_2.5-induced m⁶A methylation. Higher METTL3 expression was observed in bladder cancer tissues and METTL3 knockdown dramatically inhibited bladder cancer cell proliferation, colony formation, migration and invasion, inducing apoptosis and disrupting the cell cycle. Mechanistically, PM_2.5 enhanced the expression of METTL3 by inducing the promoter hypomethylation of its promoter and increasing the binding affinity of the transcription factor HIF1A. BIRC5 was identified as the target of METTL3 through m⁶A sequencing (m⁶A-Seq) and KEGG analysis. The methylated BIRC5 transcript was subsequently recognized by IGF2BP3, which increased its mRNA stability. In particular, PM_2.5 exposure promoted the m⁶A modification of BIRC5 and its recognition by IGF2BP3. In addition, BIRC5 was involved in bladder cancer proliferation and metastasis, as well as VEGFA-regulated angiogenesis_. This comprehensive study revealed that PM_2.5 exposure exerts epigenetic regulatory effects on bladder cancer via the HIF1A/METTL3/IGF2BP3/BIRC5/VEGFA network.

Utility of Contemporary Health Screening in the Diagnosis of Bladder Cancer

BACKGROUND

To evaluate the utility of contemporary health screening (HS) in the diagnosis of bladder cancer (BCa).

METHODS

We retrospectively reviewed 279,683 individuals who underwent HS between February 1995 and April 2015. Among these individuals, 74 were diagnosed with BCa within a year after the HS and were included in the analysis. Screen-detected BCa was defined as when a referral was made to a urologist due to microscopic hematuria (MH) on urinalysis, abnormal imaging, or any urological symptoms observed at the HS. Screen-undetected BCa was defined as when no referral was made to a urologist because of no abnormality observed at the HS, but a visit to a urological outpatient clinic later was followed by a BCa diagnosis. The incidences of screen-detected BCa and BCa in the Korean population were compared. Clinicopathological characteristics were compared between the screen-detected BCa and screen-undetected BCa groups.

RESULTS

The detection rate of BCa was 17.2 per 100,000, which exceeded the 2020 estimated national crude incidence rate of 9.3 per 100,000 by approximately 1.7 times. Among the 74 patients diagnosed with BCa within a year after HS, 48 (64.9%) had screen-detected BCa. The screen-detected BCa group had a higher T stage (p = 0.009) and grade (p = 0.019) than the screen-undetected BCa group. However, the overall survival was not significantly different between the two groups (p = 0.677). A positive correlation between the MH grade and the T stage was identified (p = 0.001).

CONCLUSION

Although HS is not focused on BCa screening, contemporary HS can contribute to the detection of BCa.

Phenanthrene disrupting effects on the thyroid system of Arabian seabream, Acanthopagrus arabicus: In situ and in vivo study

Phenanthrene, a polycyclic aromatic hydrocarbon (PAH), is one of the endocrine disrupting chemicals (EDCs). The present study aimed to evaluate the effects of phenanthrene on histophysiology of thyroid in Arabian seabream (Acanthopagrus arabicus). In this regards, different concentrations of phenanthrene (2, 20 and 40 pg/gbw) were injected to Acanthopagrus arabicus and changes in thyroid tissue structure and the serum levels of triiodothyronine (T3) and Thyroxine (T4) were assessed. The experiment lasted 21 days. Alterations in thyroid tissue structure and T3 and T4 serum levels also were assessed in Acanthopagrus arabicus caught from different stations of the Persian Gulf (Jafari, Samail, Arvand, Zangi, Bahrakan). In addition, the concentration of phenanthrene was measured in the fish muscle and sediment samples from the stations. Phenanthrene concentration reached the maximum level in the muscle of all injected fish after 4 days and then decreased by the end of the experiment. The highest and lowest concentrations of phenanthrene were recorded in the fish muscle and sediment samples collected from Jafari and Bahrakan, respectively. The levels of T3 and T4 decreased dose dependently in phenanthrene-injected fish up to day 7 and then increased by the end of the experiment. The serum level of T3 and T4 in fish collected from different stations was as follows: Jafari<Samail<Arvand<Zangi≤Bahrakan. Some tissue changes observed in fish included decrease in the thickness of thyroid follicle epithelium and increase in follicle diameter. In conclusion, according to the results, phenanthrene significantly affected thyroid function in fish.

Long non-coding RNA SNHG1 promotes bladder cancer progression by upregulating EZH2 and repressing KLF2 transcription

OBJECTIVE

Long Non-Coding RNAs (LncRNAs) act as an indispensable role in cancer development. The study aimed to investigate the role and mechanism of lncRNA Small Nucleolar RNA Host Gene 1 (SNHG1) in Bladder Cancer (BC) progression.

METHOD

The expression, prognostic value, diagnostic value, and correlation of SNHG1, Enhancer of Zeste 2 polycomb repressive complex 2 subunit (EZH2), and Kruppel Like Factor 2 (KLF2) were analyzed through bioinformatics analysis. The expression was also validated in BC tissues and cell lines. Besides, their regulation and binding were tested via qPCR, Western blot, Dual-Luciferase Reporter Assay (DLRA), Argonaute RISC catalytic component 2-RNA Immunoprecipitation (AGO2-RIP), and Chromatin Immunoprecipitation (ChIP). A xenograft model in nude mice was also established.

RESULTS

SNHG1 was significantly overexpressed in BC tissues and cells. Importantly, SNHG1 was associated with poor survival, and ROC curves revealed high diagnostic values. Moreover, by CCK8, wound healing, transwell, and Western blot analysis, SNHG1 knockdown significantly inhibited the proliferation, migration, invasion, and epithelial-mesenchymal transition of BC cells. Additionally, in vivo experiments showed that silencing SNHG1 hindered tumorigenesis and tumor growth. Regarding mechanism, the results of AGO2-RIP, ChIP or DLRA showed that SNHG1 played different roles at diverse subcellular sites. In the cytoplasm, SNHG1 acted as a competing endogenous RNA for miR-137-3p to promote EZH2 expression. In the nucleus, SNHG1 could interact with EZH2 to inhibit KLF2 transcription.

CONCLUSION

Our study elucidated that SNHG1 formed a regulatory network and played an oncogenic role in BC, which provided a novel therapeutic target for BC treatment.

SC66 inhibits the proliferation and induces apoptosis of human bladder cancer cells by targeting the AKT/β-catenin pathway

Bladder cancer (BC) is a major disease of the genitourinary tract, and chemotherapy is one of the main treatments commonly used at present. SC66 is a new type of allosteric AKT inhibitor that is reported to play an effective inhibitory role in the progression of many other types of tumours, but there is no reported research on its role in BC. In this study, we found that SC66 significantly inhibited the proliferation and EMT‐mediated migration and invasion of T24 and 5637 cells. In addition, experiments confirmed that SC66 achieved its antitumour effect by inducing cell apoptosis and affecting the cell cycle. Luciferase assays confirmed that SC66 exerted an antitumour effect through the AKT/β‐catenin signalling pathway, and this inhibitory effect was reversed after the addition of the β‐catenin signalling pathway activator, CHIR‐99021. In addition, animal studies have shown that, compared with the control group, the experimental group with SC66 intraperitoneal injection showed significantly reduced the tumour weight and volume in nude mice with T24 tumours and that SC66 combined with cisplatin achieved better inhibition on tumours. Western blot analysis and immunohistochemistry staining confirmed that SC66 inhibited the EMT process in vivo and induced apoptosis through the AKT/β‐catenin signalling pathway. In conclusion, our study demonstrated that SC66 exerts a significant antitumour effect through the AKT/β‐catenin signalling pathway, thereby providing a new potential treatment for BC.

Cancer Incidence and Mortality among Firefighters: An Overview of Epidemiologic Systematic Reviews

Firefighters are exposed to carcinogens that may increase their risk of developing many types of occupational cancer. Many systematic reviews (SRs) have been produced with sometimes conflicting conclusions. In this overview of reviews, we aim to assess the conclusion consistency across the available systematic reviews on the cancer risk in firefighters. Literature searches were conducted in several indexed databases and grey literature to retrieve systematic reviews aiming to evaluate cancer incidence or cancer mortality in firefighters. Results from included SRs were analyzed according to the tumour site. Out of 1054 records identified by the search in the databases, a total of 11 SRs were ultimately included. The original studies (n = 104) analyzed in the SRs were published between 1959 and 2018. The results consistently reported a significant increase in the incidence of rectal, prostate, bladder and testicular cancers as well as mesothelioma and malignant melanoma in firefighters compared to the general population. The SRs also indicate that death rates from rectal cancer and non-Hodgkin's lymphoma are higher among firefighters. Consistent SR results suggest that several types of cancer may be more frequent in firefighters than in the general population.

Epidemiology of Bladder Cancer

Based on the latest GLOBOCAN data, bladder cancer accounts for 3% of global cancer diagnoses and is especially prevalent in the developed world. In the United States, bladder cancer is the sixth most incident neoplasm. A total of 90% of bladder cancer diagnoses are made in those 55 years of age and older, and the disease is four times more common in men than women. While the average 5-year survival in the US is 77%, the 5-year survival for those with metastatic disease is a measly 5%. The strongest risk factor for bladder cancer is tobacco smoking, which accounts for 50-65% of all cases. Occupational or environmental toxins likewise greatly contribute to disease burden (accounting for an estimated 20% of all cases), though the precise proportion can be obscured by the fact bladder cancer develops decades after exposure, even if the exposure only lasted several years. Schistosomiasis infection is the common cause of bladder cancer in regions of Africa and the Middle East and is considered the second most onerous tropical pathogen after malaria. With 81% of cases attributable to known risk factors (and only 7% to heritable mutations), bladder cancer is a prime candidate for prevention strategies. Smoking cessation, workplace safety practices, weight loss, exercise and schistosomiasis prevention (via water disinfection and mass drug administration) have all been shown to significantly decrease the risk of bladder cancer, which poses a growing burden around the world.

Review of refractory ceramic fiber (RCF) toxicity, epidemiology and occupational exposure

This literature review on refractory ceramic fibers (RCF) summarizes relevant information on manufacturing, processing, applications, occupational exposure, toxicology and epidemiology studies. Rodent toxicology studies conducted in the 1980s showed that RCF caused fibrosis, lung cancer and mesothelioma. Interpretation of these studies was difficult for various reasons (e.g. overload in chronic inhalation bioassays), but spurred the development of a comprehensive product stewardship program under EPA and later OSHA oversight. Epidemiology studies (both morbidity and mortality) were undertaken to learn more about possible health effects resulting from occupational exposure. No chronic animal bioassay studies on RCF have been conducted since the 1980s. The results of the ongoing epidemiology studies confirm that occupational exposure to RCF is associated with the development of pleural plaques and minor decrements in lung function, but no interstitial fibrosis or incremental lung cancer. Evidence supporting a finding that urinary tumors are associated with RCF exposure remains, but is weaker. One reported, but unconfirmed, mesothelioma was found in an individual with prior occupational asbestos exposure. An elevated SMR for leukemia was found, but was absent in the highly exposed group and has not been observed in studies of other mineral fibers. The industry will continue the product stewardship program including the mortality study.

Cancer risks in a population-based study of 70,570 agricultural workers: results from the Canadian census health and Environment cohort (CanCHEC)

BACKGROUND

Agricultural workers may be exposed to potential carcinogens including pesticides, sensitizing agents and solar radiation. Previous studies indicate increased risks of hematopoietic cancers and decreased risks at other sites, possibly due to differences in lifestyle or risk behaviours. We present findings from CanCHEC (Canadian Census Health and Environment Cohort), the largest national population-based cohort of agricultural workers.

METHODS

Statistics Canada created the cohort using deterministic and probabilistic linkage of the 1991 Canadian Long Form Census to National Cancer Registry records for 1992-2010. Self-reported occupations were coded using the Standard Occupational Classification (1991) system. Analyses were restricted to employed persons aged 25-74 years at baseline (N = 2,051,315), with follow-up until December 31, 2010. Hazard ratios (HR) and 95% confidence intervals (CI) were modeled using Cox proportional hazards for all workers in agricultural occupations (n = 70,570; 70.8% male), stratified by sex, and adjusted for age at cohort entry, province of residence, and highest level of education.

RESULTS

A total of 9515 incident cancer cases (7295 in males) occurred in agricultural workers. Among men, increased risks were observed for non-Hodgkin lymphoma (HR = 1.10, 95% CI = 1.00-1.21), prostate (HR = 1.11, 95% CI = 1.06-1.16), melanoma (HR = 1.15, 95% CI = 1.02-1.31), and lip cancer (HR = 2.14, 95% CI = 1.70-2.70). Decreased risks in males were observed for lung, larynx, and liver cancers. Among female agricultural workers there was an increased risk of pancreatic cancer (HR = 1.36, 95% CI = 1.07-1.72). Increased risks of melanoma (HR = 1.79, 95% CI = 1.17-2.73), leukemia (HR = 2.01, 95% CI = 1.24-3.25) and multiple myeloma (HR = 2.25, 95% CI = 1.16-4.37) were observed in a subset of female crop farmers.

CONCLUSIONS

Exposure to pesticides may have contributed to increased risks of hematopoietic cancers, while increased risks of lip cancer and melanoma may be attributed to sun exposure. The array of decreased risks suggests reduced smoking and alcohol consumption in this occupational group compared to the general population.

Spatial Analysis of Ambient PM2.5 Exposure and Bladder Cancer Mortality in Taiwan

Fine particulate matter (PM_2.5) is an air pollutant that is receiving intense regulatory attention in Taiwan. In previous studies, the effect of air pollution on bladder cancer has been explored. This study was conducted to elucidate the effect of atmospheric PM_2.5 and other local risk factors on bladder cancer mortality based on available 13-year mortality data. Geographically weighted regression (GWR) was applied to estimate and interpret the spatial variability of the relationships between bladder cancer mortality and ambient PM_2.5 concentrations, and other variables were covariates used to adjust for the effect of PM_2.5. After applying a GWR model, the concentration of ambient PM_2.5 showed a positive correlation with bladder cancer mortality in males in northern Taiwan and females in most of the townships in Taiwan. This is the first time PM_2.5 has been identified as a risk factor for bladder cancer based on the statistical evidence provided by GWR analysis.

Assessment of urothelial cells atypical changes among petroleum station workers in Saudi Arabia

The aim of the present study was to assess atypical changes in urothelial cells among petroleum station workers. This is a case control study, investigating 300 participants by cytological methods. Of the 300 participants, 150 were cases (exposed to petroleum products) and 150 were controls (non-exposed). Full voided urine was obtained and was cytologically assessed. Cytological atypia was identified in nine (6%) out of the 150 cases and could not be identified in 141/150 (94%) of the cases, whereas, in the control group, cytological atypia was recognized in four (2.7%) of the 150 controls and could not be identified in 146/150 (97.3%). The risk associated with petroleum product exposure, the odds ratio (OR), and 95% confidence interval (CI) was 2.33 (0.7015–7.7378), P = 0.1673. Exposure of petroleum station workers to petroleum products increases the risk of urothelial atypical changes, which may progress to precancerous and cancerous changes.

Genomic Landscape of Experimental Bladder Cancer in Rodents and Its Application to Human Bladder Cancer: Gene Amplification and Potential Overexpression of Cyp2a5/CYP2A6 Are Associated with the Invasive Phenotype

Non-muscle invasive (superficial) bladder cancer is a low-grade malignancy with good prognosis, while muscle invasive (invasive) bladder cancer is a high-grade malignancy with poor prognosis. N-butyl-N-(4-hydroxybutyl)nitrosamine (BBN) induces superficial bladder cancers with papillary morphology in rats and invasive bladder cancers with infiltrating phenotype in mice. In this study, we analyzed genomic landscapes of rodent BBN-induced bladder cancers using array-based comparative genomic hybridization (array CGH). While no significant copy number alterations were detected in superficial bladder tumors in rats, copy number gains in chromosomal regions 2D-E1, 7qA3, 9F2, and 11C-D were detected in invasive bladder tumors in mice. Amplification of representative genes located on 2D-E1 and 7qA3 chromosomal regions was confirmed by quantitative PCR. Cyp2a22 and Cyp2a5 genes but not Cyp2g1, Cyp2a12, and Rab4b genes on mouse chromosome 7qA3 were amplified in invasive bladder cancers. Although the human ortholog gene of Cyp2a22 has not been confirmed, the mouse Cyp2a5 gene is the ortholog of the human CYP2A6 gene located in chromosomal region 19q13.2, and CYP2A6 was identified by database search as one of the closest human homolog to mouse Cyp2a22. Considering a possibility that this region may be related to mouse 7qA3, we analyzed CYP2A6 copy number and expression in human bladder cancer using cell lines and resected tumor specimens. Although only one of eight cell lines showed more than one copy increase of the CYP2A6 gene, CYP2A6 amplification was detected in six out of 18 primary bladder tumors where it was associated with the invasive phenotype. Immunohistochemical analyses of 118 primary bladder tumors revealed that CYP2A6 protein expression was also higher in invasive tumors, especially in those of the scattered type. Together, these findings indicate that the amplification and overexpression of the CYP2A6 gene are characteristic of human bladder cancers with increased malignancy and that CYP2A6 can be a candidate prognostic biomarker in this type of cancer.

Occupation, smoking, opium, and bladder cancer: A case-control study

PURPOSE

The aim of this study was to investigate occupational risk factors associated with bladder cancer.

MATERIALS AND METHODS

In this case-control study, control group included patients who referred to a specialized clinic in the same city and hospitals where patients had been registered. Data were entered into SPSS software. Odds ratios (OR) were calculated for occupational variables and other characteristics. Then, using logistic regression, the association between cancer and drugs was studied while smoking was controlled.

RESULTS

Cigarette smoking, even after quitting, was also associated with bladder cancer (OR = 2.549). Considering the classification of occupations, the OR of working in metal industry in patients was 10.629. Multivariate analysis showed that use of the drug by itself can be a risk factor for bladder cancer. Drug abuse together with the control of smoking increased the risk of bladder cancer by 4.959.

CONCLUSION

According to the findings of this study, contact with metal industries such as welding, and working with tin was found as a risk factor for bladder cancer. In addition, cigarette smoking and opium abuse individually were associated with bladder cancer.

Transitional Cell Carcinoma in the Pediatric Patient: A Review of the Literature

Transitional cell carcinoma (TCC) is extremely rare in children, with fewer than 30 cases reported in patients under 10 years old. It is thought that pediatric TCC is fundamentally different than TCC in adults; however, there are no specific guidelines for management or surveillance. Furthermore, the addition of papillary urothelial neoplasm of low malignant potential as a diagnosis has changed the management of lesions previously considered malignant. This review aims to investigate the difference between TCC in adults and children, to report current strategies for management of pediatric TCC, and to analyze the effects of the new grading system.

Occupational risk factors for prostate cancer in an area of former coal, iron, and steel industries in Germany. Part 1: Results from a study performed in the 1980s

Prostate cancer is the most frequent occurring malignancy in men in many Western countries. Unfortunately, only a few studies on occupational risk factors have been published. Thus, the aim of this study was to investigate possible occupational risk factors in a former center of coal, iron, and steel industries the greater Dortmund area, located in the western part of Germany. In three local departments of urology, a total of 238 prostate cancer cases and 414 patients with benign prostatic hyperplasia as controls were requested to provide information for all jobs ever performed for 6 mo or longer. Jobs performed less than 10 yr prior to diagnosis were excluded from the analysis due to the latency of prostate cancer. In addition, data on smoking habits and age were obtained. Analysis of data was performed by means of logistic regression. Hard coal miners and, based on fewer cases, painters, stratified by age, showed a significantly elevated prostate cancer risk. Smoking history did not influence prostate cancer risk. The causes of the observed increased prostate cancer risk in hard coal miners cannot be explained by merely the risk factor "male sexual hormones." In former decades, underground hard coal miners were exposed to high concentrations of dust and different xenobiotics such as hydraulic oils. Surprisingly, in a study performed about a decade later in the same area, prostate cancer risk in underground hard coal miners was found to be reduced. However, exposure to colorants was associated with an increased prostate cancer risk.

Sex differences in bladder cancer pathology and survival: analysis of a population-based cancer registry

Sex differences in bladder cancer pathology and epidemiology have been the focus of recent research. We investigated the epidemiological characteristics and compared bladder cancer pathology and survival between men and women in Japan. A total of 13,184 patients with primary bladder cancer diagnosed from 1954 to 2010 were identified in a large-scale cancer registry database in Kanagawa Prefecture. Using this database, we compared the odds ratios (ORs) for nonurothelial carcinoma (non-UC) using a multiple logistic regression model adjusted for age and diagnosis periods. We also compared hazard ratios (HRs) for overall death and cancer-specific death using a Cox proportional hazards model adjusted for non-UC, age, and diagnosis period. The proportion of non-UC was significantly higher in female compared with male patients (OR = 2.14, 95% confidence interval [CI]: 1.81-2.52). Furthermore, survival was significantly poorer in female patients than in male patients after adjusting for UC or non-UC (HR for overall death = 1.15, 95% CI: 1.06-1.23; HR for cancer-specific death = 1.39, 95% CI: 1.28-1.52). Sex differences exist in the epidemiological characteristics of bladder cancer in Japan, with female patients having less favorable pathology and poorer survival compared with male patients.

Urinary bladder cancer risk factors: a Lebanese case- control study

BACKGROUND

Bladder cancer is the second most incident malignancy among Lebanese men. The purpose of this study was to investigate potential risk factors associated with this observed high incidence.

METHODS

A case-control study (54 cases and 105 hospital-based controls) was conducted in two major hospitals in Beirut. Cases were randomly selected from patients diagnosed in the period of 2002-2008. Controls were conveniently selected from the same settings. Data were collected using interview questionnaire and blood analysis. Exposure data were collected using a structured face-to-face interview questionnaire. Blood samples were collected to determine N-acetyltransferase1 (NAT1) genotype by PCR-RFLP. Analyses revolved around univariate, bivariate and multivariate logistic regression, along with checks for effect modification.

RESULTS

The odds of having bladder cancer among smokers was 1.02 times significantly higher in cases vs. controls. The odds of exposure to occupational diesel or fuel combustion fumes were 4.1 times significantly higher in cases vs controls. The odds of prostate-related morbidity were 5.6 times significantly higher in cases vs controls. Cases and controls showed different clustering patterns of NAT1 alleles. No significant differences between cases and controls were found for consumption of alcohol, coffee, tea, or artificial sweeteners.

CONCLUSIONS

This is the first case-control study investigating bladder cancer risk factors in the Lebanese context. Results confirmed established risk factors in the literature, particularly smoking and occupational exposure to diesel. The herein observed associations should be used to develop appropriate prevention policies and intervention strategies, in order to control this alarming disease in Lebanon.

Association between the high risk occupations and bladder cancer in Iran: a case-control study

OBJECTIVES

The objective of this work was to identify the high-risk occupations in Iran and to re-inspect occupations that were related to bladder cancer.

MATERIALS AND METHODS

In the study, 300 patients suffering from bladder cancer and 500 control individuals were interviewed. Demographic information, occupational history, and history of exposure to chemical compounds such as aromatic amines for each participant were collected. ORs and 95% CIs were calculated using unconditional logistic regression for each occupation.

RESULTS

There was a significantly increased risk of bladder cancer among truck and bus drivers (OR = 11.3), skilled agricultural, forestry and fishery workers (OR = 6.0), metal industry workers (OR = 6.0), domestic housekeepers (OR = 5.9), and construction workers (OR = 3.8).

CONCLUSIONS

The study showed a strong correlation between truck and bus drivers, skilled agricultural, forestry and fishery workers, metal industry workers, domestic housekeepers, as well as construction workers and the increased risk of bladder cancer in these occupations.

Specific-mutational patterns of p53 gene in bladder transitional cell carcinoma among a group of Iraqi patients exposed to war environmental hazards

Background

To unfold specific-mutational patterns in TP53 gene due to exposures to war environmental hazards and to detect the association of TP53 gene alteration with the depth of bladder cancer.

Methods

Twenty-nine bladder carcinomas were analyzed for TP53 alterations. PCR-single strand conformational polymorphism analysis, DNA sequencing and immunohistochemical analysis using monoclonal mouse anti-human p53 antibody (Clone DO-7) were employed.

Results

TP53 gene mutations occurred in 37.9% of the cases while TP53 overexpression occurred in 58.6%. Both of them were associated with deep invasive-tumors. Single mutations were seen in 63.6%, whereas only 27.3% have shown double mutations. Four mutations were frameshifted (30.8%); two of them showed insertion A after codon 244. There was no significant association between TP53 mutations and protein overexpression (P>0.05), while a significant association was observed between TP53 alterations and tumors progression (P ≤ 0.01).

Conclusion

The infrequent TP53mutations, especially insertion A and 196 hotspot codon, may represent the specific-mutational patterns in bladder carcinoma among the Iraqi patients who were exposed to war environmental hazards. TP53 alteration associated with bladder cancer progression should be analyzed by both mutational and protein expression analysis.

Best practice in the treatment of nonmuscle invasive bladder cancer

Bladder carcinoma is the most common malignancy of the urinary tract. Approximately 75-85% of patients with bladder cancer present with a disease that is confined to the mucosa (stage Ta, carcinoma in situ) or submucosa (stage T1). These categories are grouped as nonmuscle invasive bladder cancer (NMIBC). Although the management of NMIBC tumours has significantly improved during the past few years, it remains difficult to predict the heterogeneous outcome of such tumours, especially if high-grade NMIBC is present. Transurethral resection is the initial treatment of choice for NMIBC. However, the high rates of recurrence and significant risk of progression in higher-grade tumours mandate additional therapy with intravesical agents. We discuss the role of various intravesical agents currently in use, including the immunomodulating agent bacillus Calmette-Guérin (BCG) and chemotherapeutic agents. We also discuss the current guidelines and the role of these therapeutic agents in the context of higher-grade Ta and T1 tumours. Beyond the epidemiology, this article focuses on the risk factors, classification and diagnosis, the prediction of recurrence and progression in NMIBC, and the treatments advocated for this invasive disease.

N-Acetyltransferase 1 (NAT1) Genotype: A Risk Factor for Urinary Bladder Cancer in a Lebanese Population

In Lebanon, bladder cancer is the second most incident cancer among men. This study investigates a possible association between N-acetyltransferase 1 (NAT1) genotype, a drug-metabolizing enzyme coding gene, and bladder cancer in Lebanese men. A case-control study (54 cases and 105 hospital-based controls) was conducted in two major hospitals in Beirut. Cases were randomly selected from patients diagnosed in the period of 2002–2008. Controls were conveniently identified and selected from the same settings. Data was collected using interview questionnaire and blood analysis. NAT1 genotypes were determined by PCR-RFLP. Statistical analysis revolved around univariate, bivariate, and multivariate logistic regression models, along with checks for effect modification. Results showed NAT1^∗14A allele, smoking, occupational exposure to combustion fumes, and prostate-related symptoms, to be risk factors for bladder cancer. The odds of carrying at least one NAT1^∗14A allele are 7 times higher in cases compared to controls (OR = 7.86, 95% CI: 1.53–40.39). A gene-environment interaction was identified for NAT1^∗14A allele with occupational exposure to combustion fumes. Among carriers of NAT1^∗14A allele, the odds of bladder cancer dropped to 2.03 from 3.72. Our study suggests NAT1^∗14A allele as a possible biomarker for bladder cancer. Further research is recommended to confirm this association.

[EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update]

CONTEXT AND OBJECTIVE

To present the 2011 European Association of Urology (EAU) guidelines on non-muscle-invasive bladder cancer (NMIBC).

EVIDENCE ACQUISITION

Literature published between 2004 and 2010 on the diagnosis and treatment of NMIBC was systematically reviewed. Previous guidelines were updated, and the level of evidence and grade of recommendation were assigned.

EVIDENCE SYNTHESIS

Tumours staged as Ta, T1, or carcinoma in situ (CIS) are grouped as NMIBC. Diagnosis depends on cystoscopy and histologic evaluation of the tissue obtained by transurethral resection (TUR) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TUR is essential for the patient's prognosis. Where the initial resection is incomplete or where a high-grade or T1 tumour is detected, a second TUR should be performed within 2-6 wk. In papillary tumours, the risks of both recurrence and progression may be estimated for individual patients using the scoring system and risk tables. The stratification of patients into low-, intermediate-, and high-risk groups (separately for recurrence and progression) is pivotal to recommending adjuvant treatment. For patients with a low risk of tumour recurrence and progression, one immediate instillation of chemotherapy is recommended. Patients with an intermediate or high risk of recurrence and an intermediate risk of progression should receive one immediate instillation of chemotherapy followed by a minimum of 1 yr of bacillus Calmette-Guérin (BCG) intravesical immunotherapy or further instillations of chemotherapy. Papillary tumours with a high risk of progression and CIS should receive intravesical BCG for 1 yr. Cystectomy may be offered to the highest risk patients, and it is at least recommended in BCG failure patients.

CONCLUSIONS

These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice.

Contributions of aryl hydrocarbon receptor genetic variants to the risk of glioma and PAH-DNA adducts

The aryl hydrocarbon receptor (AHR) gene is involved in the response to polycyclic aromatic hydrocarbon (PAH) exposure. To investigate the hypothesis that the genetic variants in the AHR gene might be a causal genetic susceptibility to PAH-DNA adduct formation and glioma risk, we conducted a case-control study of 384 glioma cases and 384 cancer-free controls to explore the association between six common single-nucleotide polymorphisms of the AHR gene and glioma risk. Using PAH-DNA adducts as biomarkers, we then evaluated the association between PAH-DNA adduct levels and glioma risk based on a tissue microarray including 11 controls and 77 glioma patients. We further explored the contributions of the glioma risk-associated AHR polymorphisms to the levels of PAH-DNA adducts in glioma tissues based on 77 glioma patients. We found that PAH-DNA adduct staining existed in normal brain tissues and grades I-IV gliomas, and the staining intensity was significantly associated with the glioma grade. Two AHR polymorphisms (rs2066853 and rs2158041) demonstrated significant association with glioma risk. Intriguingly, we also found statistically significant associations between these two variants and PAH-DNA adduct levels in glioma tissue. These data suggest the contributions of AHR rs2066853 and rs2158041 to glioma risk and the PAH-DNA adduct levels, which shed new light on gene-environment interactions in the etiology of glioma. Further studies with a larger sample size and ethnically diverse populations are required to elucidate the potential biological mechanism for, as well as the impact of, the susceptibility to glioma due to genetic variants of AHR.

EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update

CONTEXT AND OBJECTIVE

To present the 2011 European Association of Urology (EAU) guidelines on non-muscle-invasive bladder cancer (NMIBC).

EVIDENCE ACQUISITION

Literature published between 2004 and 2010 on the diagnosis and treatment of NMIBC was systematically reviewed. Previous guidelines were updated, and the level of evidence (LE) and grade of recommendation (GR) were assigned.

EVIDENCE SYNTHESIS

Tumours staged as Ta, T1, or carcinoma in situ (CIS) are grouped as NMIBC. Diagnosis depends on cystoscopy and histologic evaluation of the tissue obtained by transurethral resection (TUR) in papillary tumours or by multiple bladder biopsies in CIS. In papillary lesions, a complete TUR is essential for the patient's prognosis. Where the initial resection is incomplete or where a high-grade or T1 tumour is detected, a second TUR should be performed within 2-6 wk. In papillary tumours, the risks of both recurrence and progression may be estimated for individual patients using the scoring system and risk tables. The stratification of patients into low-, intermediate-, and high-risk groups-separately for recurrence and progression-is pivotal to recommending adjuvant treatment. For patients with a low risk of tumour recurrence and progression, one immediate instillation of chemotherapy is recommended. Patients with an intermediate or high risk of recurrence and an intermediate risk of progression should receive one immediate instillation of chemotherapy followed by a minimum of 1 yr of bacillus Calmette-Guérin (BCG) intravesical immunotherapy or further instillations of chemotherapy. Papillary tumours with a high risk of progression and CIS should receive intravesical BCG for 1 yr. Cystectomy may be offered to the highest risk patients, and it is at least recommended in BCG failure patients. The long version of the guidelines is available from the EAU Web site (www.uroweb.org).

CONCLUSIONS

These abridged EAU guidelines present updated information on the diagnosis and treatment of NMIBC for incorporation into clinical practice.

Feasibility study of screening for bladder cancer with urinary molecular markers (the BLU-P project)

INTRODUCTION

The prognosis of bladder cancer (BC) depends mainly on its histology, grade, and stage. Patients with superficial BC (70% of the urothelial carcinomas) have a relatively good prognosis, but patients diagnosed with invasive, high grade BC, and those who progress to invasive BC, have a poor prognosis and will not survive their disease in many cases due to their metastases, despite the currently available treatment options. Early detection can only be beneficial regarding mortality if the high risk cancers are recognized and treated at a localized stage.

MATERIALS AND METHODS

Previous pilot studies on early detection consisted of home-based repeated hematuria testing and, in case of hematuria, a urologic evaluation with cytology and cystoscopy was carried out. This design resulted in too many cystoscopies. The recently initiated [Bladder Cancer Urine Marker Project (BLU-P) study www.blu-project.org] assesses the feasibility of a population-based screening for BC and at the same time evaluates a screening algorithm using next to hematuria testing, sensitive specific urine markers for BC (NMP22, FGFR3, MA analyses and MLPa) in an attempt to circumvent the high number of cystoscopies.

RESULTS

So far 1,611 men are included and 23.5% tested positive for hematuria (11.6% had one or more true positive test results). The additional molecular-based screening tests before referring to cystoscopy resulted in a decrease of the number of cystoscopies from 378 to 66 (82.5%). In those men referred for cystoscopy, so far only 1 BC case was detected.

CONCLUSIONS

Further research is needed to evaluate whether this extremely low detection rate is caused by, e.g., a healthy screenee bias or that the additional selection step using the molecular urine tests is too strict and diagnoses are missed.

Cancer morbidity among Danish male urban bus drivers: A historical cohort study

OBJECTIVE

To investigate whether urban bus drivers are at increased risk for cancer.

METHODS

Urban bus drivers in a cohort established in 1978 in the three largest cities of Denmark were followed-up in the Danish Cancer Registry until the end of 2003, and relative risks for cancers were estimated.

RESULTS

Of 2,037 men included 70% reported in 1978 that they smoked. The standardized incidence ratio (SIR) for cancer in comparison with that of other male residents of the three cities was 1.09 [1.0-1.2]. The excess was due mainly to increased risks for cancers of the bladder (SIR, 1.6; 1.2-2.0) and lung (1.2; 1.0-1.4). In an analysis with internal comparisons and adjustment for smoking, we found no significant associations between duration of employment and increased risks for cancers at these two sites.

CONCLUSIONS

In this long-term follow-up study we found little evidence of a causal association between employment as an urban bus driver in Denmark and subsequent cancer.

Meta-analyses of occupational exposure as a painter and lung and bladder cancer morbidity and mortality 1950-2008

The International Agency for Research on Cancer (IARC) classified occupational painting as a human carcinogen based on lung and bladder cancers; however, no specific exposures were implicated. The authors conducted comprehensive meta-analyses of the epidemiological literature on occupational painting and these cancers. The authors abstracted study results and confounder information, and used quantile plots and regression models to evaluate heterogeneity and publication bias. Summary risk estimates were derived and sensitivity analyses performed to evaluate smoking, socioeconomic status (SES), and exposure variables. Where applicable, a Bayesian approach was used to externally adjust for smoking, a major risk factor for both cancers. For lung cancer cohort mortality studies, publication bias and heterogeneity were seen, and earlier studies reported higher risk estimates than later studies. Overall lung cancer summary risk estimates were 1.29 for case-control and 1.22 and 1.36 for cohort morbidity and mortality studies, respectively, and risk estimates for bladder cancer were 1.28 for case-control and 1.14 and 1.27 for cohort morbidity and mortality studies, respectively (all statistically significant). Risks did not differ between painters and mixed occupations. Nonsignificant summary estimates resulted for lung and bladder cancers when controlling for SES, or externally adjusting for smoking in lung cancer studies. Summary risks varied by control source for case-control studies. Residual confounding by smoking and SES, lack of exposure group effect, and publication bias limit the ability of the meta-analyses to explain associations observed between occupational painting and lung and bladder cancers. Given the long latencies for lung and bladder cancers, these weak associations, if real, may not be elucidated through studies of occupational painting today.

Case-control study of high risk occupations for bladder cancer in New Zealand

We conducted a nationwide case-control study of bladder cancer in adult New Zealanders to identify occupations that may contribute to the risk of bladder cancer in the New Zealand population. A total of 213 incident cases of bladder cancer (age 25-70 years) notified to the New Zealand Cancer Registry during 2003 and 2004, and 471 population controls, were interviewed face-to-face. The questionnaire collected demographic information and a full occupational history. The relative risks for bladder cancer associated with ever being employed in particular occupations and industries were calculated by unconditional logistic regression adjusting for age, sex, smoking and socio-economic status. Estimates were subsequently semi-Bayes adjusted to account for the large number of occupations and industries being considered. An elevated bladder cancer risk was observed for hairdressers (odds ratio (OR) 9.15 95% Confidence Interval (95%CI) 1.60-62.22), and sewing machinists (OR 3.07 95%CI 1.35-6.96). Significantly increased risks were not observed for several other occupations that have been reported in previous studies, including sales assistants (OR 1.03 95%CI 0.64-1.67), painters and paperhangers (OR 1.42 95%CI 0.56-3.60), sheet metal workers (OR 0.39, 95%CI 0.15-1.00), printing trades workers (OR 1.11 95%CI 0.41-3.05) and truck drivers (OR 1.36 95%CI 0.60-3.09), although the elevated odds ratios for painters, printers and truck drivers are consistent with excesses observed in other studies. Nonsignificantly increased risks were observed for tailors and dressmakers (OR 2.84 95%CI 0.62-13.05), rubber and plastics products machine operators (OR 2.82 95%CI 0.75-10.67), building workers (OR 2.15, 95%CI 0.68-6.73), and female market farmers and crop growers (OR 2.05 95%CI 0.72-5.83). In conclusion, this study has confirmed that hairdressers and sewing machinists are high risk occupations for bladder cancer in New Zealand, and has identified several other occupations and industries of high bladder cancer risk that merit further study.

Expert assessment of exposure to carcinogens in Norway's offshore petroleum industry

This study presents and evaluates an expert group's assessment of exposure to carcinogens for defined job categories in Norway's offshore petroleum industry, 1970-2005, to provide exposure information for a planned cohort study on cancer. Three university and five industry experts in occupational hygiene individually assessed the likelihood of exposure to 1836 combinations of carcinogens (n=17), job categories (n=27) and time periods (n=4). In subsequent plenary discussions, the experts agreed on exposed combinations. Agreement between the individual and the panel assessments was calculated by Cohen's kappa index. Using the panel assessment as reference, sensitivity and specificity were estimated. The eight experts assessed 63% of the 1836 combinations in plenary, resulting in 265 (14%) convened exposed combinations. Chlorinated hydrocarbons, benzene and inhalation of mineral oils had the highest number of exposed job categories (n=14, 9 and 10, respectively). The job categories classified as exposed to the highest numbers of carcinogens were the mechanics (n=10), derrick workers (n=6) and process technicians (n=5). The agreement between the experts' individual assessments and the panel assessment was kappa=0.53-0.74. The sensitivity was 0.55-0.86 and specificity 0.91-0.97. For these parameters, there were no apparent differences between the university experts and the industry experts. The resulting 265 of 1836 possible exposure combinations convened as "exposed" by expert assessment is presented in this study. The experts' individual ratings highly agreed with the succeeding panel assessment. Correlation was found between years of experience of the raters and agreement with the panel. The university experts and the industry experts' assessments had no apparent differences. Further validation of the exposure assessment is suggested, such as by new sampling data or observational studies.

Risk factors for bladder cancer

AIMS AND BACKGROUND

To summarize risk factors for bladder cancer, emphasizing the role of recently established associations and to present some ongoing debates on the issue.

METHODS

A systematic literature search was performed using MEDLINE database on bladder cancer risk factors between January 1985 and June 2006 and by detailed examination of the references of original articles, reviews and monographs retrieved.

RESULTS

Cigarette smoking is recognized as the main cause of bladder cancer and accounts for about 50% of cases in developed countries. A strong link exists between the amount and duration of cigarette smoking. A high risk of bladder carcinoma has been observed in workers exposed to some aromatic amines. Based on these and other occupational risks, it has been estimated that 5-10% of bladder carcinomas in industrialized countries were due to exposures of occupational origin. Infectious agents have a major influence on bladder cancer risks in the areas of the world where Schistosoma haematobium infestation is endemic. Other potential risk factors for bladder cancer are other urinary tract infections and drinking tap water with chlorination by-products or arsenic. Exposure to certain drugs, like cyclophosphamide used in chemotherapy and heavy consumption of phenacetin-containing analgesics, has been shown to cause bladder cancer in humans. Total fluid intake and high consumption of fruits and vegetables are probably associated with a small decrease in risk.

CONCLUSIONS

Avoidance of tobacco smoking and incriminated occupational exposures, habitual intake of fresh fruits and vegetables, and prevention and control of urinary tract infections should be recommended for bladder cancer prevention. Further studies are required to assess the role of genetic polymorphisms and their modifying effect of lifestyle risk factors for bladder cancer occurrence and to evaluate the benefit of bladder cancer screening, particularly in those at high risk.

Bladder cancer and occupation: a report from the Belgian case-control study on bladder cancer risk

BACKGROUND

The aim of this study was to add to the data on associations between occupation and bladder cancer thereby strengthening the case for focused research on specific occupational categories.

METHODS

Two hundred two cases and 390 controls participated in this population-based case-control study. Age, sex, smoking, and education adjusted odds ratios (ORs) were calculated for each occupation by unconditional logistic regression.

RESULTS

The occupational group of domestic helpers, cleaners, and launderers exhibited a significantly elevated risk of bladder cancer. Elevated non-significant risks (OR > 1.5) were observed for painters and varnishers, electronic equipment assemblers, general laborers, building finishers, carpenters and joiners, architects and engineers, and textile and garment workers.

CONCLUSIONS

This study suggests that domestic helpers, cleaners, and launderers probably experience an increased risk of bladder cancer. Although no other occupations showed significantly increased risks, the non-significantly elevated risks for painters, carpenters, and textile workers could be confirmed by results from earlier studies.

Does occupational exposure to PAHs, diesel and aromatic amines interact with smoking and metabolic genetic polymorphisms to increase the risk on bladder cancer?; The Belgian case control study on bladder cancer risk

To investigate the association between occupational exposure to polycyclic aromatic hydrocarbons, aromatic amines and diesel and bladder cancer risk and the modification by smoking and metabolic polymorphisms, have we recruited 200 cases and 385 population controls. The adjusted OR of bladder cancer was 5.75 (95%CI 2.09-15.83) comparing the highest tertile of the cumulative probability of occupational exposure to aromatic amines with no occupational exposure. A possible interaction between occupational exposures to aromatic amines and smoking was found. The increased ORs of GSTM1, GSTT1, NAT2 and SULT1A1 among those ever occupational exposed was explored by estimating the false-positive report probability. We confirm that occupational exposure to aromatic amines is associated with an increase in bladder cancer risk.

An Updated Review of the Literature: Risk Factors for Bladder Cancer with Focus on Occupational Exposures

Workplace exposures account for 5 to 25% of all bladder cancer cases. A critical review of the literature between 1938 and 2004 was performed, with a focus on occupational exposures. Occupational exposure to bladder carcinogens, particularly to beta-naphthylamine occur in a number of industries, including aromatic amine manufacture, rubber and cable manufacture, and dyestuff manufacture and use. Risks to workers in a number of new occupations and industries are reviewed. Nonoccupational risk factors that are known or at one time have been thought to increase the risk of bladder cancer are also discussed.

Nitrate intake does not influence bladder cancer risk: the Netherlands cohort study

OBJECTIVES

N-nitroso compounds, endogenously formed from nitrate-derived nitrite, are suspected to be important bladder carcinogens. However, the association between nitrate exposure from food or drinking water and bladder cancer has not been substantially investigated in epidemiologic studies.

METHODS

We evaluated the associations between nitrate exposure and bladder cancer in the Netherlands Cohort Study, conducted among 120,852 men and women, 55-69 years of age at entry. Information on nitrate from diet was collected via a food frequency questionnaire in 1986 and a database on nitrate content of foods. Individual nitrate exposures from beverages prepared with tap water were calculated by linking the postal code of individual residence at baseline to water company data. After 9.3 years of follow-up and after excluding subjects with incomplete or inconsistent dietary data, 889 cases and 4,441 subcohort members were available for multivariate analyses. We calculated incidence rate ratios (RR) and corresponding 95% confidence intervals (CIs) using Cox regression analyses. We also evaluated possible effect modification of dietary intake of vitamins C and E (low/high) and cigarette smoking (never/ever).

RESULTS

The multivariate RRs for nitrate exposure from food, drinking water, and estimated total nitrate exposure were 1.06 (95% CI, 0.81-1.31), 1.06 (95% CI, 0.82-1.37), and 1.09 (95% CI, 0.84-1.42), respectively, comparing the highest to the lowest quintiles of intake. Dietary intake of vitamins C and E (low/high) and cigarette smoking (never/ever) had no significant impact on these results.

CONCLUSION

Although the association between nitrate exposure and bladder cancer risk is biologically plausible, our results in this study do not support an association between nitrate exposure and bladder cancer risk.