Risk of bladder cancer in foundry workers: a meta-analysis

Prevalence of current and former smoking in industrial workers worldwide: a systematic review and meta-analysis

OBJECTIVES

One of the health problems in recent decades is the prevalence of smoking in the world. In this study, the global prevalence of smoking in industrial workers was investigated using meta-analysis.

METHOD

The method of the present study was a systematic review and meta-analysis. Three scientific sources, PubMed, Web of Science, and Scopus, were selected for the search, and these databases were searched until September 2020. Random effects method was used for the analysis and then the analysis was performed for the type of smoking (Current, Former), gender, and continent. Heterogeneity was examined in all analyses.

RESULT

A total of 88 studies were included in the meta-analysis. The prevalence of smoking in industrial workers was 41% also the confidence interval was 35-48%. The prevalence of current smoking in industrial workers was 39% also the confidence interval was 29-48%. The prevalence of former smoking in industrial workers was 18% also the confidence interval was 13-22%. I² heterogeneity test was 99.9%.

DISCUSSION

From the findings of the present study, it can be seen that industrial workers are more exposed to smoking compared to the general population, and this can put their health at greater risk.

Occupational exposure of foundry workers assessed by the urinary concentrations of 18 elements and arsenic species

BACKGROUND

Some raw materials applied in Fe foundry industries may contain potentially toxic elements. Thus, foundry worker's occupational exposure is a constant health concern.

METHOD

In this study, 194 urine samples from foundry workers were analyzed by inductively coupled plasma mass spectrometry for biomonitoring of Al, As, Ba, Cd, Co, Cr, Cs, Cu, Fe, I, Mn, Ni, Pb, Sb, Sn, Se, U and Zn. Moreover, arsenic speciation was performed in representative samples of production sector workers (group A) and administration sector workers (group B).

RESULTS

Concentrations of As, Pb, Cd, Cu, Cs, I, Sb in urines from group A were higher than those found for group B. Samples of group A presented Cs, Ni, Mn, Pb, U and Zn concentrations higher than values reported for exposed workers assessed by other studies. Forty-four samples from group A exceed As-reference limits. Group A had approximately seven times more inorganic As (as arsenite) and 14 times more organic As (as dimethyl As) than group B. A statistically significant difference was observed in the elemental concentration in the workers' urine by the time in the function. Moreover, alcohol consumption is probably influencing the urine concentration of As, Ba, Cd, Co, Cu, Fe, I, Se and Zn.

CONCLUSION

The monitored foundry workers are exposed to potentially toxic elements and more attention must be given to their health. Therefore, workplace safety conditions must be improved, and constant biomonitoring is necessary to ensure workers' health.

Silica and asbestos exposure at work and the risk of bladder cancer in Canadian men: a population-based case-control study

Background

Silica and asbestos are recognized lung carcinogens. However, their role in carcinogenesis at other organs is less clear. Clearance of inhaled silica particles and asbestos fibers from the lungs may lead to translocation to sites such as the bladder where they may initiate carcinogenesis. We used data from a Canadian population-based case-control study to evaluate the associations between these workplace exposures and bladder cancer.

Methods

Data from a population-based case-control study were used to characterize associations between workplace exposure to silica and asbestos and bladder cancer among men. Bladder cancer cases (N = 658) and age-frequency matched controls (N = 1360) were recruited within the National Enhanced Cancer Surveillance System from eight Canadian provinces (1994–97). Exposure concentration, frequency and reliability for silica and asbestos were assigned to each job, based on lifetime occupational histories, using a combination of job-exposure profiles and expert review. Exposure was modeled as ever/never, highest attained concentration, duration (years), highest attained frequency (% worktime) and cumulative exposure. Odds ratios (OR) and their 95% confidence intervals (CI) were estimated using adjusted logistic regression.

Results

A modest (approximately 20%) increase in bladder cancer risk was found for ever having been exposed to silica, highest attained concentration and frequency of exposure but this increase was not statistically significant. Relative to unexposed, the odds of bladder cancer were 1.41 (95%CI: 1.01–1.98) times higher among men exposed to silica at work for ≥27 years. For asbestos, relative to unexposed, an increased risk of bladder cancer was observed for those first exposed ≥20 years ago (OR:2.04, 95%CI:1.25–3.34), those with a frequency of exposure of 5–30% of worktime (OR:1.45, 95%CI:1.06–1.98), and for those with < 10 years of exposure at low concentrations (OR:1.75, 95%CI:1.10–2.77) and the lower tertile of cumulative exposure (OR:1.69, 95%CI:1.07–2.65). However, no clear exposure-response relationships emerged.

Conclusions

Our results indicate a slight increase in risk of bladder cancer with exposure to silica and asbestos, suggesting that the effects of these agents are broader than currently recognized. The findings from this study inform evidence-based action to enhance cancer prevention efforts, particularly for workers in industries with regular exposure.

Probabilistic risk-based pollution prevention model for a foundry: a case study of casting

Hazardous air pollutants from industrial activities have long been associated with serious health effects. Traditional health risk assessment uses point estimates of inhalation concentrations based on standard Gaussian diffusion models with steady-state emission rate assumptions. This traditional approach was criticized because it does not account for variability and thus leading to a potential overestimate of the health risk from the batch processes. To overcome this deficiency, a probabilistic risk assessment model is proposed. The foundry industry with processes typically associated with several hazardous air pollutants is identified and iron casting is chosen as a case study to compare risk estimates. Existing data, representing historical proprietary information of the case study, were used to deliver representative risk values and help identify potential replacements or interventions in the manufacturing process. A probability distribution function of emitted concentrations was simulated to model the batch process emissions from mold and core resin binders, a major source of pollution. The same method was applied to exposure factors to feed into the risk model resulting in a probabilistic risk evaluation. Several alternative resin binders in commercial use were examined to offer a risk-based substitute to the resin binder in use. The risk results provided an opportunity to consider newer and environmentally friendlier options. A comparison of the results from this approach and those from the point estimate analysis reveals a gross over estimation of risks. The point estimate risk values were about eight time larger than the mean value and about twice the 95th percentile values of the probabilistic risk approach. The wide range of variability among resin binders associated risk results, close to two orders of magnitude in some cases, presented opportunities to select from a variety of binders with lesser emissions and lower risk. Optimal selection will depend on several pollutants emitted from this process to help address cumulative impacts of multiple pollutants. Investigations are underway for a multi-pollutant strategy including trade-offs, and other quality controls vital to the decision-making.

Molecular targets in urothelial cancer: detection, treatment, and animal models of bladder cancer

Bladder cancer remains one of the most expensive cancers to treat in the United States due to the length of required treatment and degree of recurrence. In order to treat bladder cancer more effectively, targeted therapies are being investigated. In order to use targeted therapy in a patient, it is important to provide a genetic background of the patient. Recent advances in genome sequencing, as well as transcriptome analysis, have identified major pathway components altered in bladder cancer. The purpose of this review is to provide a broad background on bladder cancer, including its causes, diagnosis, stages, treatments, animal models, as well as signaling pathways in bladder cancer. The major focus is given to the PI3K/AKT pathway, p53/pRb signaling pathways, and the histone modification machinery. Because several promising immunological therapies are also emerging in the treatment of bladder cancer, focus is also given on general activation of the immune system for the treatment of bladder cancer.

Modifiable risk factors for the prevention of bladder cancer: a systematic review of meta-analyses

Each year, 430,000 people are diagnosed with bladder cancer. Due to the high recurrence rate of the disease, primary prevention is paramount. Therefore, we reviewed all meta-analyses on modifiable risk factors of primary bladder cancer. PubMed, Embase and Cochrane database were systematically searched for meta-analyses on modifiable risk factors published between 1995 and 2015. When appropriate, meta-analyses (MA) were combined in meta-meta-analysis (MMA). If not, the most comprehensive MA was selected based on the number of primary studies included. Probability of causation was calculated for individual factors and a subset of lifestyle factors combined. Of 1496 articles identified, 5 were combined in MMA and 21 were most comprehensive on a single risk factor. Statistically significant associations were found for current (RR 3.14) or former (RR 1.83) cigarette smoking, pipe (RR 1.9) or cigar (RR 2.3) smoking, antioxidant supplementation (RR 1.52), obesity (RR 1.10), higher physical activity levels (RR 0.86), higher body levels of selenium (RR 0.61) and vitamin D (RR 0.75), and higher intakes of: processed meat (RR 1.22), vitamin A (RR 0.82), vitamin E (RR 0.82), folate (RR 0.84), fruit (RR 0.77), vegetables (RR 0.83), citrus fruit (RR 0.85), and cruciferous vegetables (RR 0.84). Finally, three occupations with the highest risk were tobacco workers (RR 1.72), dye workers (RR 1.58), and chimney sweeps (RR 1.53). The probability of causation for individual factors ranged from 4 to 68 %. The combined probability of causation was 81.8 %. Modification of lifestyle and occupational exposures can considerably reduce the bladder cancer burden. While smoking remains one of the key risk factors, also several diet-related and occupational factors are very relevant.

Occupational risk factors for relapse-free survival in bladder cancer patients

The influence of occupational risk factors on bladder cancer development is well investigated. However, studies on the influence on bladder cancer prognosis are rare. Therefore, it was of interest to investigate the time to first relapse in the follow-ups of three case-control series from Dortmund, Neuss, and Lutherstadt Wittenberg, Germany. Relapse-free survival of in total 794 urinary bladder cancer patients (Dortmund 174, Neuss 407, Lutherstadt Wittenberg 213) was derived from medical records. Cox regression models were used to determine the impact of profession and exposure to bladder carcinogens if the risk factor was present in at least four cases. One or several relapses were observed in 416 cases (52%). Median time to first relapse was 0.94 yr. Ten professions were observed in at least 4 patients. No significant associations were found. However, workers in the leather industry (n = 4), printing industry (n = 4), transportation (n = 43), and chemical industry (n = 40) and locksmiths/mechanics (n = 44) showed shorter relapse-free times. No trend to shorter relapse-free time was observed for miners (n = 42), agriculturists (n = 18), painters/lacquerers (n = 21), colorant production and processing workers (n = 7), foundry workers (n = 5), and persons exposed to aromatic amines (n = 45). Although the follow-up comprised nearly 800 cases, data on occupations and exposures of interest were not sufficient to obtain significant results. However, first results indicated potential associations that are worth further investigations.

Increased cytogenetic abnormalities in exfoliated oral mucosal cells of South Indian foundry workers

Biomonitoring offers a valuable tool to estimate the genetic risk as of exposure to genotoxic agents. Here, we intend to assess the potential cytogenetic damage related with occupational exposure to polycyclic aromatic hydrocarbons by evaluating the genetic damages in exfoliated buccal epithelial cells of foundry workers via counting micronucleus (MNs) and other nuclear abnormalities (NAs). This was a cross-sectional study and all study subjects were male . Exfoliated buccal mucosal cells were obtained from 100 subjects involved in either foundry molding or melting processes, and 100 controls matched for sex, age, and smoking from the area of Coimbatore city, Southern India. For each individual, 2000 exfoliated buccal cells were analyzed. Significantly, there was a higher frequency of MN in the exposed workers than in the controls (P < 0.05). Smoking was associated with the increased frequencies of micronuclei and NAs in the buccal epithelium of both the control and the exposed groups. Smoking represented significant factors in terms of increasing the production of MN when the control and the exposed groups were compared (P < 0.05). The results specify that buccal cells of foundry workers display increased levels of genotoxicity and these biomarker responses may be related to the increased cancer risk. These results conclude that the studied individuals are at a risk group and they require periodical biological monitoring and proper care which is essential for them.

Deposition flux of aerosol particles and 15 polycyclic aromatic hydrocarbons in the North China Plain

The present study examined deposition fluxes of aerosol particles and 15 polycyclic aromatic hydrocarbons (PAHs) associated with the particles in the North China Plain. The annual mean deposition fluxes of aerosol particles and 15 PAHs were 0.69 ± 0.46 g/(m(2) ×d) and 8.5 ± 6.2 μg/(m(2) ×d), respectively. Phenanthrene, fluoranthene, pyrene, chrysene, benzo[b]fluoranthene, and benzo[k]fluoranthene were the dominant PAHs bound to deposited aerosol particles throughout the year. The total concentration of 15 PAHs in the deposited aerosol particles was the highest in winter but lowest in spring. The highest PAH concentration in the deposited aerosol particles in winter was because the heating processes highly increased the concentration in atmospheric aerosol particles. Low temperature and weak sunshine in winter reduced the degradation rate of deposited aerosol particle-bound PAHs, especially for those with low molecular weight. The lowest PAH concentration in deposited aerosol particles in spring resulted from the frequently occurring dust storms, which diluted PAH concentrations. The mean deposition flux of PAHs with aerosol particles in winter (16 μg/[m(2) ×d]) reached 3 times to 5 times that in other seasons (3.5-5.0 μg/[m(2) ×d]). The spatial variation of the deposition flux of PAHs with high molecular weight (e.g., benzo[a]pyrene) was consistent with their concentrations in the atmospheric aerosol particles, whereas such a phenomenon was not observed for those with low molecular weight (e.g., phenanthrene) because of their distinct hydrophobicity, Henry's law constant, and the spatially heterogeneous meteorological conditions.

Cause-specific mortality due to malignant and non-malignant disease in Korean foundry workers

BACKGROUND

Foundry work is associated with serious occupational hazards. Although several studies have investigated the health risks associated with foundry work, the results of these studies have been inconsistent with the exception of an increased lung cancer risk. The current study evaluated the mortality of Korean foundry workers due to malignant and non-malignant diseases.

METHODS

This study is part of an ongoing investigation of Korean foundry workers. To date, we have observed more than 150,000 person-years in male foundry production workers. In the current study, we stratified mortality ratios by the following job categories: melting-pouring, molding-coremaking, fettling, and uncategorized production work. We calculated standard mortality ratios (SMR) of foundry workers compare to general Korean men and relative risk (RR) of mortality of foundry production workers reference to non-production worker, respectively.

RESULTS

Korean foundry production workers had a significantly higher risk of mortality due to malignant disease, including stomach (RR: 3.96; 95% CI: 1.41-11.06) and lung cancer (RR: 2.08; 95% CI: 1.01-4.30), compared with non-production workers. High mortality ratios were also observed for non-malignant diseases, including diseases of the circulatory (RR: 1.92; 95% CI: 1.18-3.14), respiratory (RR: 1.71; 95% CI: 1.52-21.42 for uncategorized production worker), and digestive (RR: 2.27; 95% CI: 1.22-4.24) systems, as well as for injuries (RR: 2.36; 95% CI: 1.52-3.66) including suicide (RR: 3.64; 95% CI: 1.32-10.01).

CONCLUSION

This study suggests that foundry production work significantly increases the risk of mortality due to some kinds of malignant and non-malignant diseases compared with non-production work.

1-hydroxypyrene levels in blood samples of rats after exposure to generator fumes

Polynuclear Aromatic Hydrocarbons (PAHs) are a major component of fuel generator fumes. Carcinogenicity of these compounds has long been established. In this study, 37 Swiss albino rats were exposed to generator fumes at varied distances for 8 hours per day for a period of 42 days and the level of 1-hydroxypyrene in their blood was evaluated. This study also tried to correlate the level of blood 1-hyroxypyrene with the distance from the source of pollution. Plasma was collected by centrifuging the whole blood sample followed by complete hydrolysis of the conjugated 1-hydroxypyrene glucuronide to yield the analyte of interest, 1-hydroxypyrene, which was achieved using beta glucuronidase. High performance liquid chromatography (HPLC) with UV detector was used to determine the 1-hydroxypyrene concentrations in the blood samples. The mobile phase was water:methanol (12:88 v/v) isocratic run at the flow rate of 1.2 mL/min with CI8 stationary phase at 250 nm. After 42 days of exposure, blood concentration level of 1-hydroxypyrene ranged from 34 μg/mL to 26.29 μg/mL depending on the distance from source of exposure. The control group had no 1-hydroxypyrene in their blood. After the period of exposure, percentage of death correlated with the distance from the source of exposure. Percentage of death ranged from 56% to zero depending on the proximity to source of pollution.

Cancer morbidity and quartz exposure in Swedish iron foundries

PURPOSE

The aim of this study was to determine cancer morbidity amongst Swedish iron foundry workers with special reference to quartz exposure. In addition to respirable dust and quartz, phenol, formaldehyde, furfuryl alcohols, polycyclic aromatic hydrocarbons (PAHs), carbon black, isocyanates and asbestos are used or generated by foundry production techniques and exposure to any of these substances could have potentially carcinogenic effects.

METHODS

Cancer morbidity between 1958 and 2004 was evaluated in a cohort of 3,045 male foundry workers employed for >1 year between 1913 and 2005. Standardised incidence ratios (SIRs) with 95 % confidence intervals (95 % CI) were determined by comparing observed numbers of incident cancers with frequencies in the Swedish cancer register. Exposure measures were assessed using information from the personal files of employees and modelling quartz measurement based on a database of 1,667 quartz measurements. Dose responses for lung cancer were determined for duration of employment and cumulative quartz exposure for latency periods >20 years.

RESULTS

Overall cancer morbidity was not increased amongst the foundry workers (SIR 1.00; 95 % CI, 0.90-1.11), but the incidence of lung cancer was significantly elevated (SIR 1.61; 95 % CI, 1.20-2.12). A non-significant negative dose response was determined using external comparison with a latency period of >20 years (SIR 2.05, 1.72 1.26 for the low, medium and high exposure groups), supported by internal comparison data (hazard ratios 1, 1.01, 0.78) for the corresponding groups. For cancers at sites with at least five observed cases and a SIR > 1.25, non-significant risks with SIRs > 1.5 were determined for cancers of the liver, larynx, testis, connective muscle tissue, multiple myeloma plasmacytoma and lymphatic leukaemia.

CONCLUSIONS

A significant overall risk of lung cancer was determined, but using external and internal comparison groups could not confirm any dose response at our cumulative quartz dose levels.

Novel monitor paradigm for real-time exposure assessment

A wearable monitor that can reliably, accurately, and continuously measure personal exposure levels of various toxicants would not only accelerate the current environmental and occupational health and safety studies, but also enable new studies that are not possible with the current monitoring technology. Developing such a monitor has been a difficult challenge, and requires innovative sensing science and creative engineering. We have developed, built, and tested a wearable monitor for real-time detection of toxic hydrocarbons and acids in the environment. The monitor is low-cost, accurate, and user friendly. In addition, it can communicate wirelessly with a cell phone in which the monitoring results can be processed, displayed, stored, and transmitted to a designated computer. We have validated the functions and performance of the monitor, and carried out field tests with workers involving waste management, fire overhaul, and floor-cleaning activities, as well as with first- and second-hand smokers. The averaged exposure levels are in agreement with those determined by the standard NIOSH methods. The monitor provides accurate and real-time exposure assessment for the workers involving different activities. The real-time and continuous monitoring capability makes it possible to correlate the exposure levels with different activities and changes in the microenvironments. The monitor provides unprecedented real-time information that will help advance occupational safety and environmental health studies. It may also be used to better protect workers from occupational overexposure to toxic molecules.

Risk assessment of gaseous/particulate phase PAH exposure in foundry industry

Thirty-seven air samplings in different working areas of two foundry industries were collected to assess polycyclic aromatic hydrocarbon (PAH) levels. The average PAH level inside Foundry A was 19.56 microg/m(3), which was higher than that in Foundry B (8.26 microg/m(3)), whereas for the benzo[a]pyrene toxic equivalent (BaPeq) level (38.81 ng/m(3) vs. 46.52 ng/m(3)). A higher PAH level was found for big moulding process than for the small one, and the chemical binder in the different size moulds was hypothesized to be the main cause. The higher PAH levels were found in the painting area (95.51 microg/m(3)), pouring area (18.42 microg/m(3)), and inside the office (16.48 microg/m(3)); as well as the higher BaPeq level was in the painting area (152.3 ng/m(3)), and the furnace for melting iron (96.9 ng/m(3)). The gas phase (over 90%) was the major contributor of total PAHs in the manufacturing areas. Moreover, health risk assessment of PAHs exposure showed that lung cancer risks were 9.06x10(-4) and 1.09x10(-3) in Foundries A and B, respectively. This study suggests that the workers shall use appropriate respiratory masks in painting, melting, and pouring areas to prevent their occupational exposure to PAHs.

Early results of urothelial carcinoma screening in a risk population of coke workers: urothelial carcinoma among coke workers

OBJECTIVE

To present the protocol and the early results of a urothelial carcinoma (UC) screening analysis performed in a risk population of coke workers.

METHODS

Between June 2006 and October 2008, 171 male workers (mean age 43 years), employed in a Ligurian coke plant (Italiana Coke S.r.l) and exposed to polycyclic aromatic hydrocarbons (PAHs) for a median period of 16 years, underwent screening for UC. Urological evaluation included medical history, physical examination, routine laboratory tests, urine analysis, urinary cytology and uCyt+ assay. In the event of signs and symptoms suggestive of UC or positive urinary tests, the workers were also subjected to urinary ultrasonography and cystoscopy with biopsy of any suspicious lesions.

RESULTS

Regarding the laboratory tests, 19/171 (11%) uCyt+ samples were considered inadequate and were excluded from the outcomes assessment. Overall, urine analysis, cytology and uCyt+ were positive in 18/152 (12%) subjects who showed no evidence of UC at the scheduled check-ups. No significant association was identified between marker positivity and occupational activity.

CONCLUSIONS

Our results fail to show an increased risk of UC among the coke workers evaluated. However, they will need to be confirmed in the future by a larger enrollment and a longer follow-up in order to assess the definitive risk for UC after exposure to coke.

Occupational risk factors

The association between exposure to selected chemical carcinogens, occupations or industries and bladder cancer is well established, and it is estimated that 20-27% of bladder cancers are attributable to occupational exposures. The risk of bladder cancer stemming from an occupational exposure depends not only on compound carcinogenicity, exposure intensity and workplace characteristics, but also on individual susceptibility to these cancers. Regulatory controls in industrialized nations have resulted in a decreased burden of exposure to bladder carcinogens in the workplace. Unfortunately, the same is unlikely in many developing countries, where risky technologies may have been transferred from more developed countries, and where enforcement of regulations and worker protection are likely to be less stringent.

Occupational PAH exposures during prescribed pile burns

Wildland firefighters are exposed to particulate matter and gases containing polycyclic aromatic hydrocarbons (PAHs), many of which are known carcinogens. Our objective was to evaluate the extent of firefighter exposure to particulate and PAHs during prescribed pile burns of mainly ponderosa pine slash and determine whether these exposures were correlated with changes in urinary 1-hydroxypyrene (1-HP), a PAH metabolite. Personal and area sampling for particulate and PAH exposures were conducted on the White Mountain Apache Tribe reservation, working with 21 Bureau of Indian Affairs/Fort Apache Agency wildland firefighters during the fall of 2006. Urine samples were collected pre- and post-exposure and pulmonary function was measured. Personal PAH exposures were detectable for only 3 of 16 PAHs analyzed: naphthalene, phenanthrene, and fluorene, all of which were identified only in vapor-phase samples. Condensed-phase PAHs were detected in PM2.5 area samples (20 of 21 PAHs analyzed were detected, all but naphthalene) at concentrations below 1 microg m(-3). The total PAH/PM2.5 mass fractions were roughly a factor of two higher during smoldering (1.06 +/- 0.15) than ignition (0.55 +/- 0.04 microg mg(-1)). There were no significant changes in urinary 1-HP or pulmonary function following exposure to pile burning. In summary, PAH exposures were low in pile burns, and urinary testing for a PAH metabolite failed to show a significant difference between baseline and post-exposure measurements.

Carcinogenic food contaminants

A large number of scientific studies and reviews have addressed the potential for dietary components to influence the risk of developing cancer. One topic of particular interest has been the impact of food contaminants. Two complementary programs, among others, have reviewed and synthesized information on the carcinogenic potential of food contaminants and judged the degree of evidence linking different food contaminants to the risk of cancer in humans. These programs, the International Agency for Research on Cancer's IARC Monographs on the Evaluation of Carcinogenic Risks to Humans and the US National Toxicology Program's Report of Carcinogens have reviewed hundreds of chemicals, mixtures, and natural products and then graded the cancer risk posed to humans. Contaminants with the highest level of evidence include aflatoxin, alcoholic beverages, 2,3,7,8-tetracholordibenzo-p-dioxin. Agents with a moderate level of evidence include acetaldehyde, polycyclic aromatic hydrocarbons, some nitrosamines, and yerba mate. Agents with a low level of evidence include bracken fern, fumonsin B(1), ochratoxin, and others. This review presents a summary of the evidence for the carcinogenicity of these and other agents and the ranks provided by two important assessment programs.

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.

Imaging of Bladder Cancer

Bladder cancer is a heterogeneous and frequently multifocal disease with a variable clinical course. The management of bladder cancer is therefore challenging and complicated. CT and MR imaging have replaced the traditional excretory urography and are emerging as the imaging modalities of choice for work-up of patients who have bladder cancer. Imaging provides essential diagnostic information for detection, staging, and post-treatment follow-up of bladder cancer.

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.

Bladder cancer: Epidemiology, staging and grading, and diagnosis

Bladder cancer is a heterogeneous disease with a variable natural history. At one end of the spectrum, low-grade Ta tumors have a low progression rate and require initial endoscopic treatment and surveillance but rarely present a threat to the patient. At the other extreme, high-grade tumors have a high malignant potential associated with significant progression and cancer death rates. In the Western world, bladder cancer is the fourth most common malignancy in men and the eighth most common in women. In Europe and the United States, bladder cancer accounts for 5% to 10% of all malignancies in men. The risk of developing bladder cancer at <75 years of age is 2% to 4% for men and 0.5% to 1% in women compared with the risk of lung cancer, for example, which is 8% in men and 2% in women. For the geographic and temporal comparison of bladder cancer incidence, it is crucial to separate the low-grade from the high-grade tumors. In epidemiologic studies on risk factors for bladder cancer, it is important to distinguish the low-grade Ta tumors from high-grade carcinoma in situ (CIS) and tumors >T1. Current studies do not support the routine screening for bladder cancer. However, prospective long-term studies are required to evaluate the benefits of bladder cancer screening, particularly in those at high risk. After assessing all available evidence, the Epidemiology and Diagnosis Committee has made recommendations on various diagnostic issues, including pathologic evaluation, urinary cytology, and imaging studies. Optimal resection techniques, role of repeat transurethral resection in high-grade T1 tumors, random bladder biopsy, and prostatic urethral biopsy are discussed, and appropriate recommendations are made according to the strength of available evidence.

A case?control study of occupational risk factors for bladder cancer in Canada

OBJECTIVE

To investigate occupational risk factors for bladder cancer in seven Canadian provinces.

METHODS

We analysed a population-based case-control dataset of 887 individuals with incident, histologically confirmed bladder cancer between 1994 and 1997. Controls (2847) frequency matched for age and gender were surveyed in 1996. Questionnaires were returned by about 60% of subjects. Odds ratios (ORs) for occupations and self-reported exposures were adjusted for province, age, race, smoking, and several dietary factors, using unconditional logistic regression.

RESULTS

Statistically significant increased risks were observed among men employed as hairdressers (OR = 3.42; 1.09-10.8), primary metal workers (OR = 2.40; 1.29-4.50), miners (OR = 1.94; 1.18-3.17), and automechanics (OR = 1.69; 1.02-2.82). Primary metal workers and automechanics showed evidence of an employment duration-response trend. Modest elevated risks that were not significant were also observed for male government inspectors, printers, firefighters, general labourers, and welders. A duration-response trend was evident for government inspectors and general labourers. For females, significant elevations were observed among lumber processors (OR = 8.78; 1.28-60.1), general labourers (OR = 2.18; 1.05-4.52), nurses (OR = 1.54; 1.03-2.31), and general clerks (OR = 1.48; 1.01-2.17). The latter showed a positive duration-response trend.

CONCLUSIONS

This study found a statistically significant excess risk of bladder cancer, with a duration-response trend, among male primary metal workers and automechanics, and female office workers engaged in general clerical duties.