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Non-Occupational Risk Factors for Bladder Cancer a Case-Control Study
Abstract
The aim of this study was to determine non-occupational risk factors for bladder cancer in Serbia.
A hospital-based, case-control study included 130 newly diagnosed bladder cancer patients and the same number of individually matched controls with respect to sex, age (+/- 2 years) and type of residence (rural or urban), from the Clinical Center of Serbia in Belgrade and from the Clinical Center in Kragujevac in central Serbia. The study took place from June 1997 to March 1999.
According to multivariate logistic regression analysis, there was an association between: frequency of daily urination (OR = 0.18; 95% CI = 0.08-0.39); consumption of liver (OR = 13.81; 95% CI = 2.49-76.69), canned meat (OR = 8.38; 95% CI = 1.74-40.36), fruit juices (OR = 0.08; 95% CI = 0.01-0.56); the highest tertile of pork (OR = 4.55; 95% CI = 1.30-15.93), cabbage (OR = 0.25; 95% CI = 0.06-1.01) and vinegar (OR = 4.41; 95% CI = 1.18-16.50) intake and risk for bladder cancer.
Consumption of liver, canned meat, pork (h vs l tertile) and vinegar (m vs l tertile) was indicated as a risk factor for bladder cancer, whereas frequent daily urination, consumption of fruit juices and cabbage (h vs l tertile) were indicated as protective factors.
... Rezultati anamnesti~ke studije iz Japana govore o smanjenju rizika za nastanak raka mo-kra}ne be{ike u slu~aju unosa zasi}enih masnih kiselina 18 . Na{i rezultati ukazuju da ishrana bogata 'ivotinjskim mastima zna~ajno doprinosi pojavi raka mokra}ne be{ike 19 , ali da je unos suncokretovog ulja, konzumiranog sa salatom (nezasi}ene masti) bio u inverznoj asocijaciji s pojavom ovog malignoma 20 . Gaertner i saradnici navode da je konzumiranje pet ili vi{e obroka pr'ene hrane nedeljno bilo statisti~ki zna~ajno povezano s pove}anjem rizika za nastanak raka mokra}ne be{ike kod mu{karaca, dok je kod 'ena pove}an unos prene hrane dovodio do umerenog, ali statisti~ki nesignifikantnog porasta rizika za rak be{ike 21 . ...
... Izuzetno je redak slu~aj pozitivne korelacije unosa vo}a i povr}a i razvoja neoplazme 50 . Prema na{im rezultatima ishrana bogata povr}em (kupus) i vo}em (vo-}ni sokovi) smanjuje rizik za nastanak raka mokra}ne be-{ike 19 . Velika kanadska studija pokazala je da je konzumiranje vo}a vi{e od 15 puta nedeljno u poredjenju s manje od pet puta nedeljno prepolovilo rizik za pojavu raka mo-kra}ne be{ike, kod 'ena. ...
... Oni su naveli pozitivnu korelaciju izmedju po-ve}anog unosa za~ina i rizika za rak mokra}ne be{ike. Konzumiranje konzervisanog povr}a (tur{ija) i sir}eta predstavljalo je faktore rizika za nastanak neoplazmi urinarne be{ike u na{oj studiji 19,20 . ...
The aim of this paper is to show influence of different foods on bladder cancer appearance, as well as possible consequent ways of prevention. Consuption of food rich in animal fat and cholesterol, fried foods, especially several times used cookin oil for frying, processed meat with additives (nitrates, nitrites, azo-colourrs) can influence bladder cancer occurrence. Regularly, continous consumption of fermented milk products, which contains come types of milky--acids bacterias, is considered as protective factor in developing bladder cancer. Reports that fruit and vegetable are protective food items are pretty consistent. Data about mineral intake and bladder cancer are obscure.
... pylori), salt-preserved foods, dietary nitrite, smoking, alcohol, obesity, radiation, and family history have all been linked to stomach cancer. [48,49] Oncologists have explored the potential synergistic association between salt consumption and H. pylori infection in the development of stomach cancer in three prior epidemiological investigations. High intakes of salt, pickled food, and processed meat are associated with significantly increased risks of gastric cancer; these increased risks are also seen when participants consume moderate amounts of salt. ...
Background of the study:
As many as 10 million people have died from cancer globally in 2020, making it the top cause of mortality in the globe. Cancer develops as a result of the multi-stage process by which normal cells convert into tumor cells, progressing from a precancerous lesion to a malignant tumor. By avoiding risk factors and applying existing evidence-based preventative techniques, 30%-50% of malignancies may be averted. In order to avoid cancer, it is essential to know the specific causes of the disease. Nidanas, or etiologies, are well-described in Ayurvedic science. Here, the causes of cancer have been outlined so that the knowledge may be used effectively to avoid the disease.
Aims:
Identification of cancer etiologies that have been described in classics. Evidence-based understanding of these etiologies and to comprehend the significance of etiologies in cancer prevention.
Materials and methods:
A thorough evaluation of literature, including ancient Ayurvedic classics, modern medical texts, and articles published in reputable journals, was conducted to meet the study's goals and objectives.
Results:
According to Ayurveda, there are three distinct phases of tumorigenesis: chronic inflammation, precancerous development, Granthi (a benign glandular swelli ng), and Arbuda (a precancerous tumor) (definite malignancy). A growing body of evidence suggests that the tumor microenvironment, which is predominantly controlled by inflammatory cells, is an essential player in the neoplastic process.
Conclusion:
Although inflammation is coming into the picture just now in the contemporary world, Ayurveda has described this as a leading cause 5000 years back. It is evident that diet and lifestyle play a crucial role in the etiology of Shoth (inflammation).
... Juices are rich in vitamin B complex, vitamin C, folic acid, citric acid potassium and excellent sources of bioavailable antioxidant, phyto-chemicals (Mathur et al., 1996, Franke et al., 2005, Deshpande et al., 2008, Penniston et al., 2008, Ktare et al., 2011, Milind et al., 2011 [56,35,27,61,46,57] . Juices significantly improves blood lipid profiles in people affected with hypercholesterolemia (Kurowska et al., 2000, Deshpande et al., 2007, Mohale et al., 2008 [48,28,58] , protective against stroke (Feldrnan 2001) [34] ; anti-tumour, antiviral, anti-proliferative and anti-HIV activities (Ahmad et al., 2011) [1] , offset the oxidative stress (Ghanim et al., 2010) [38] and its intake has been consistently associated with reduced risk of many cancer types (Brock et al., 1998, Chan et al., 2005, Kwan et al., 2004, Maserejian 2006, Lewis 2009, Uzcudun et al., 2002, Radosavljevic et al., 2004, Wu et al., 2009 [14,18,49,55,52,98,74,102] . ...
Juice is defined in the most general sense as the extractable fluid contents of cells or tissues. Juices, in general, are good sources of vitamins and minerals and other valuable components to human health. Fruit juices are highly perishable commodity and are thermally processed to aid their preservation. However, heat processing particularly under severe conditions may induce several chemical and physical changes that impair the organoleptic properties and may reduce the content or bioavailability of some bioactive compounds.In pasteurization, sterilization and blanching, the use of heat can destroy nutrients such as thermally labile vitamins and also components responsible for product flavor and taste.Non thermal technologies are preservation treatments that are effective at ambient or sub-lethal temperatures, thereby minimizing negative thermal effects on fruit juice nutritional and quality parameters.High pressure processing (HPP) is a non-thermal food preservation technique for microbial and enzyme inactivation with reduced effects on nutritional and quality parameters when compared to thermal treatments.High Pressure Processing can provide safe product with reduced processing time and maintain maximum fresh-like flavor and taste in the product due to the lower processing temperatures. Moreover, it is environment friendly since it requires only electrical energy and no waste by-products generated. Therefore, High Process-treated fruit juices are superior in fruit juice preservation in the areas of microbial inactivation, sensory improvement and shelf-life extension to those of juices preserved in the traditional way by heat treatment.
... The epidemiologic studies are also limited and provide controversial results. For example, case-control studies conducted in China demonstrated that vinegar ingestion was associated with a decreased risk for esophageal [130] and non-cardia stomach cancer [131], but vinegar ingestion was also associated with a 4.4-fold greater risk of bladder cancer in a case-control study in Serbia [132]. Therefore, a case-by-case evaluation is necessary to assess the anticancer activity of cereal vinegars. ...
Vinegar has been used for its health promoting properties since antiquity. Nowadays, these properties are investigated, scientifically documented, and highlighted. The health benefits of vinegar have been associated with the presence of a variety of bioactive components such as acetic acid and other organic acids, phenolic compounds, amino acids, carotenoids, phytosterols, vitamins, minerals, and alkaloids, etc. These components are known to induce responses in the human body, such as antioxidant, antidiabetic, antimicrobial, antitumor, antiobesity, antihypertensive, and anti-inflammatory effects. The diversity and levels of bioactive components in vinegars depend on the raw material and the production method used. Cereal vinegars, which are more common in the Asia-Pacific region, are usually made from rice, although other cereals, such as millet, sorghum, barley, malt, wheat, corn, rye, oats, bran and chaff, are also used. A variety of bioactive components, such as organic acids, polyphenols, amino acids, vitamins, minerals, alkaloids, melanoidins, butenolides, and specific compounds such as γ-oryzanol, tetramethylpyrazine, γ-aminobutyric acid, etc., have been associated with the health properties of cereal vinegars. In this work, the bioactive components and the related health effects of cereal vinegars are reviewed, and the most recent scientific literature is presented and discussed.
... Research conducted in Lanzhou, China, showed that vinegar intake was linked with reduced risk for abdominal cancer (OR: 0.37). On the other hand, a signifi cant 4.4-fold increase in the risk of bladder cancer was linked with vinegar ingestion in a study conducted in Serbia [72]. ...
While the use of vinegar to fi ght against infections and other crucial conditions dates back to Hippocrates, recent research has foundthat vinegar consumption has a positive effect on biomarkers for diabetes, cancer, and heart diseases. Different types of vinegar have been
used in the world during different time periods. Vinegar is produced by a fermentation process. Foods with a high content of carbohydrates area good source of vinegar. Review of the results of different studies performed on vinegar components reveals that the daily use of these components has a healthy impact on the physiological and chemical structure of the human body. During the era of Hippocrates, people used vinegar as a medicine to treat wounds, which means that vinegar is one of the ancient foods used as folk medicine. The purpose of the current reviewpaper is to provide a detailed summary of the outcome of previous studies emphasizing the role of vinegar in treatment of different diseasesboth in acute and chronic conditions, its in vivo mechanism and the active role of different bacteria.
... The reference lists of the remaining 24 articles were checked for additional pertinent reports, and 5 additional papers were identified. We further excluded 16 additional articles: 8 presented duplicated publications [24][25][26][27][28][29][30][31]; 3 analyzed bladder and other urinary cancer together [32][33][34]; 3 did not report enough data for a dose-response analysis [35][36][37]; and 2 did not report results for red or processed meat consumption [16,38]. Thus, the meta-analysis included 13 independent epidemiological studies [7,8,31,[39][40][41][42][43][44][45][46][47][48][49]. ...
Background/objectives:
Several epidemiological studies have analyzed the associations between red and processed meat and bladder cancer risk but the shape and strength of the associations are still unclear. Therefore, we conducted a dose-response meta-analysis to quantify the potential association between red and processed meat and bladder cancer risk.
Methods:
Relevant studies were identified by searching the PubMed database through January 2016 and reviewing the reference lists of the retrieved articles. Results were combined using random-effects models.
Results:
Five cohort studies with 3262 cases and 1,038,787 participants and 8 cases-control studies with 7009 cases and 27,240 participants met the inclusion criteria. Red meat was linearly associated with bladder cancer risk in case-control studies, with a pooled RR of 1.51 (95% confidence interval (CI) 1.13, 2.02) for every 100 g increase per day, while no association was observed among cohort studies (P heterogeneity across study design = 0.02). Based on both case-control and cohort studies, the pooled relative risk (RR) for every 50 g increase of processed meat per day was 1.20 (95% CI 1.06, 1.37) (P heterogeneity across study design = 0.22).
Conclusions:
This meta-analysis suggests that processed meat may be positively associated with bladder cancer risk. A positive association between red meat and risk of bladder cancer was observed only in case-control studies, while no association was observe in prospective studies.
... We identified 61 articles that examined the risk of bladder cancer with red and/or processed meat consumption published until 2014 May. Upon closer examination, 46 articles were excluded, as they did not provide sufficient information to estimate a summary odds ratio and its 95% confidence intervals or reported a broad classification of meat [13,14], or the studies that the primary outcome of the cases involved other urinary tract cancer besides bladder cancer were excluded [15][16][17]. At last, 14 studies on red meat (involving 9,084 cases) and 11 studies on processed meat (7,562 cases) with a total study population up to 1,558,848 individuals were included in our analysis [4-7, 9, 18-27]. ...
Findings from epidemiologic studies concerning red and processed meat intake and bladder cancer risk remain conflicting. Thus, we conducted this meta-analysis to examine the associations of red and processed meat intake with bladder cancer. Eligible studies published up to May 2014 were retrieved via both computer searches and review of references. Finally, we identified 14 studies on red meat (involving 9,084 cases) and 11 studies on processed meat (7,562 cases) involving up to 1,558,848 individuals. Random-effects models were used to estimate summary relative risk estimates (SRRE) based on high vs. low intake, and heterogeneity between study results was explored through stratified analyses on the basis of red/processed meat category, gender, study design and geographical region. Overall, the SRRE for all studies regarding red meat intake was 1.15 (95% CI: 0.97-1.36). Significant positive association was observed between processed meat consumption and bladder cancer (SRRE = 1.22; 95% CI: 1.04-1.43). Interestingly, increased by 25% and 33% risk of bladder cancer were observed for red meat and processed meat intake respectively in populations from the American continent. In conclusion, our fi ndings showed that there was an absence of an association between red meat intake and bladder cancer, but suggested that high consumption of processed meat probably correlated with rising risk of bladder cancer. In addition, positive relationships were observed regarding people intake of red and processed meat in the American continent. These findings need to be confirmed in future research.
... Esses últimos efeitos são amplamente modificados pela composição e consumo da dieta. Atualmente, há uma visão mais ampla da associação do câncer de bexiga à dieta (2) . ...
More than 60 thousand new cases of bladder cancer are diagnosed each year in the United States, accounting for approximately 13 thousand deaths annually. In recent decades, the overall incidence of bladder cancer seems to be rising and this may be due to the latent effects of tobacco abuse, other non-occupational risk factors, industrial carcinogens, as well as the overall aging of our population. Cultural and socioeconomic factors also contribute substantially to the etiology of bladder cancer and may play an even more important role than the occupational environment. In this paper, it is reviewed the main established or proposed non-occupational factors associated with bladder cancer development.
... About 65% of bladder cancer in men and 30% of female cases in some developed countries are exposed to smoking. Cigarette smoking is the most risk factor for inducing bladder cancer (Radosavljević et al., 2004;Scélo and Brennan, 2007). Several studies showed that smokers were susceptible to a 209-fold to 308-fold increase in the risk for bladder cancer (Asgari et al., 2004;Zeegers et al., 2004). ...
Background:
Bladder cancer is one the most common malignancies of the genitourinary tract. The present study aimed to assess the epidemiology, of bladder cancer in Mazandaran, a large province in northern Iran as high-incidence cancer area, during a 2-year period.
Methods:
The data for this study were obtained from the population-based cancer registry of the Vice-Chancellory for Health Affairs of Mazandaran University of Medical Sciences and Mazandaran hospitals between March 1, 2010 and March 1, 2011. Demographic data, including sex, age, residency and symptoms were investigated through careful review of medical records. Using a questionnaire protocol, several variables were assessed for these cases such as smoking, history of opium, vegetable consumption habits, and history of other cancers.
Results:
A total of 112 cases were analyzed, 98 (87.5%) in men and 14 (12.5%) in women (mean age of 68.0 ± 14.6 years). Urban and rural residence were 60.7% and 39.3%. Tobacco and opium use were found in 45.5% and 21.4% of patients, respectively. Approximately 60% consumed vegetables an average of fewer than one time per day. Hematuria was the first symptom in these cases which were mainly diagnosed as having bladder cancer by ultrasonography.
Conclusion:
The results showed that bladder cancer tends to be found in the elderly and the male to female ratio is high. Macroscopic hematuria is a very important symptom for indicating probably urothelial tumor that should be followed up patients with transabdominal ultrasonography as a routine modality.
... This excessive risk may be related to anatomical differences between men and women, and may be related, especially in older men, with an inability to completely void their bladder (due to prostate enlargement or other conditions) allowing exposures present in residual urine to persist for a longer time. As greater frequency of urination decreases the risk of bladder cancer, this persistence may provide different selective pressures by gender driving these methylation profiles (44)(45)(46). However, further research is needed to further examine this potential mechanism. ...
DNA methylation profiles can be used to define molecular cancer subtypes that may better inform disease etiology and clinical decision-making. This investigation aimed to create DNA methylation profiles of bladder cancer based on CpG methylation from almost 800 cancer-related genes and to then examine the relationship of those profiles with exposures related to risk and clinical characteristics. DNA, derived from formalin-fixed paraffin-embedded tumor samples obtained from incident cases involved in a population-based case-control study of bladder cancer in New Hampshire, was used for methylation profiling on the Illumina GoldenGate Methylation Bead Array. Unsupervised clustering of those loci with the greatest change in methylation between tumor and non-diseased tissue was performed to defined molecular subgroups of disease, and univariate tests of association followed by multinomial logistic regression was used to examine the association between these classes, bladder cancer risk factors and clinical phenotypes. Membership in the two most methylated classes was significantly associated with invasive disease (P < 0.001 for both class 3 and 4). Male gender (P = 0.04) and age >70 years (P = 0.05) was associated with membership in one of the most methylated classes. Finally, average water arsenic levels in the highest percentile predicted membership in an intermediately methylated class of tumors (P = 0.02 for both classes). Exposures and demographic associated with increased risk of bladder cancer specifically associate with particular subgroups of tumors defined by DNA methylation profiling and these subgroups may define more aggressive disease.
... current smoking and age), it is tempting to speculate that chronic exposure of the epithelium to urinary carcinogens due to an inability of older men to completely void (consequent to prostatic hyperplasia or other urinary tract conditions) provides the needed selection pressure. Frequency of urination is associated with bladder cancer, with greater frequency and greater fluid intake being protective for the disease (55)(56)(57). More specific examination of voiding frequency and volume would be necessary to more thoroughly examine this potential link. ...
Hypermethylation of tumor suppressor genes is central to the pathogenesis of human malignancy, yet this alteration's etiology remains unclear, and its clinical impact has not yet been studied using an approach that can yield directly generalizable results. Therefore, we sought to examine both of these issues in bladder cancer, seeking to understand the characteristics of epidemiologically well-defined patient tumors with differing levels of methylation silencing. We analyzed epigenetic silencing of 16 genes in a population-based incident case series of 331 bladder transitional cell carcinomas. We utilized a novel item response theory (IRT) model, to examine, in an unbiased fashion, the relationship of patient characteristics, carcinogen exposure history and tumor characteristics with the underlying propensity for gene hypermethylation. Age, male gender and current cigarette smoking were significantly positively associated with the methylation latent trait. Promoter hypermethylation as a latent trait significantly predicted both non-invasive/high-grade and invasive stage disease and was also significantly associated with survival, with each unit increase in the latent trait resulting in a 30% increase in the risk of death. This work, studying all stages and grades of incident bladder cancer, provides definitive evidence that carcinogen exposures play a critical role in selecting these alterations in tumorous clones and that epigenetic silencing is a strong and significant predictor of tumor stage and overall patient survival. Finally, our novel approach provides insight into the etiology of promoter hypermethylation, suggesting that selected, carcinogen-exposed individuals have a greater propensity for hypermethylation that is associated with more aggressive, fatal disease.
The evidence for the association between meat intake and the risk of bladder cancer (BC) is still inconclusive. A total of 29 studies involving 1,475,125 participants and 18,836 cases of BC were included in the meta-analysis. Among these studies, 11 reported total meat intake, 20 reported red meat intake, 19 reported processed meat intake, 15 reported white meat intake, and 15 reported fish intake. The results suggested that there was an overall increase in BC risk associated with total meat intake (RR = 1.10; 95% confidence interval: 0.92-1.31; I2 = 55.20%; P = 0.014), and a higher red meat (RR = 1.23; 95% CI: 1.08-1.39; I2 = 51.30%; P = 0.004) or processed meat (RR = 1.16; 95% CI: 1.08-1.25; I2 = 28.00%; P = 0.125) intake may increase the risk of BC. In contrast, a higher intake of fish (RR = 0.80; 95% CI: 0.67-0.95; I2 = 62.90%; P = 0.001) was inversely associated with the risk of BC. Moreover, we did not observe an association between white meat (RR = 0.96; 95% CI: 0.83-1.10; I2 = 53.70%; P = 0.007) and the risk of BC. Our findings suggested that dietary intervention may be an effective approach to preventing BC, which still needs to be confirmed by further well-designed observational studies.
This chapter discusses the therapeutic properties, potential health benefits and medicinal uses of vinegar. Vinegar is used to fight infections and other acute conditions for a long time. The acetic acid in vinegar is reported to elicit the beneficial effects by alteration of metabolism in the gastrointestinal tract and in the liver. Vinegar is stated to have antimicrobial properties and has positive influence in cardiovascular diseases, seen as a significant reduction in systolic blood pressure. The antitumor effect of vinegar is shown by the ability of vinegar to induce apoptosis in human leukemia cells as well as inhibiting the proliferation of the cancer cells. The antiglycemic effect of vinegar is explored and vinegar is reported to alter the blood glucose concentration. The ingestion of vinegar is reported to be associated with satiety and decreased intake of subsequent meals; hence it can contribute to weight loss and control obesity. The safety and tolerance of medicinally ingested vinegar is discussed and it states that the high amount of acetic acid may have undesired consequences.
Adulteration of food commodity has become a serious concern of the whole world, causing a lot of problems such as economic fraud, health risk rendered by potential food allergen and erosion of market environment due to unfair competition between honest producer and fraud. Within recent decade fruit juice market has been developing fast.
Purpose: There are many prognostic indicators of bladder tumors inclu-ding clinical, pathological and molecular markers based on tumor-related factors. This study was performed to evaluate the significance of an ele-vated level of serum creatinine for predicting progression and recurrence of superficial bladder tumors. Materials and Methods: One hundred forty-seven patients that initially presented with a superficial bladder tumor (pTa or pT1) except for a car-cinoma in situ were retrospectively analyzed according to several factors such as tumor stage, grade, size, multiplicity and serum creatinine for tumor recurrence and progression after a primary transurethral resection. Results: The elevated serum creatinine group consisted of 20 patients 11 patients experienced recurrence (55.0%) and 3 patients experienced pro-gression (15.0%). The control group consisted of 127 patients 39 patients experienced recurrence (30.7%) and 13 patients experienced progression (10.2%). The presence of an elevated level of serum creatinine and tumor multiplicity were statistically significant prognostic factors for tumor recurrence. Conclusions: These results can be helpful for predicting the prognosis of transitional cell carcinoma of the bladder and for planning therapeutic and follow-up strategies.
Meat consumption is inconsistently associated with the development of bladder cancer in several epidemiological studies. We performed a meta-analysis of evidence for relationships of meat consumption with risk of bladder cancer. Literature searches were conducted to identify peer-reviewed manuscripts published up to October 2010. Twenty publications from 10 cohort studies and 11 case-control studies were included in the analyses. We quantified associations with bladder cancer using meta-analysis of relative risk (RR) associated with the highest versus the lowest category of meat intake using random effect model. Pooled results indicate that overall meat intake was not related to the risk of bladder cancer (RR = 1.04, 95% CI = 0.80-1.27), while high red and processed meat consumer had a significantly increased 17 and 10% risk, respectively, when comparing the highest with the lowest category of meat intake. In subgroup analyses, studies conduced in Unites States/Canada exhibited a positive relationship between high meat intake and bladder cancer risk, and studies using self-administered questionnaires for exposure assessment also showed a significant increased relative risk for high meat consumers. However, because of borderline significance and small number of publications in individual analyses, more studies, particularly well-designed prospective studies, are needed to confirm these findings.
The objective of this study was to assess the risk factors for bladder cancer using PubMed articles from January 2000 to December 2009. The study also aimed to describe the challenges encountered in the methodology of a literature search for bladder cancer risk factors using PubMed. Twenty-six categories of risk factors for bladder cancer were identified using the National Cancer Institute Web site and the Medical Subject Headings (MeSH) Web site. A total of 1,338 PubMed searches were run using the term "urinary bladder cancer" and a risk factor term (e.g., "cigarette smoking") and were screened to identify 260 articles for final analysis. The search strategy had an overall precision of 3.42 percent, relative recall of 12.64 percent, and an F-measure of 5.39 percent. Although search terms derived from MeSH had the highest overall precision and recall, the differences did not reach significance, which indicates that for generalized, free-text searches of the PubMed database, the searchers' own terms are generally as effective as MeSH terms.
Meat could be involved in bladder carcinogenesis via multiple potentially carcinogenic meat-related compounds related to cooking and processing, including nitrate, nitrite, heterocyclic amines (HCAs), and polycyclic aromatic hydrocarbons (PAHs). The authors comprehensively investigated the association between meat and meat components and bladder cancer.
During 7 years of follow-up, 854 transitional cell bladder-cancer cases were identified among 300,933 men and women who had completed a validated food-frequency questionnaire in the large prospective NIH-AARP Diet and Health Study. The authors estimated intake of nitrate and nitrite from processed meat and HCAs and PAHs from cooked meat by using quantitative databases of measured values. Total dietary nitrate and nitrite were calculated based on literature values.
The hazard ratios (HR) and 95% confidence intervals (CI) for red meat (HR for fifth quintile compared with first quintile, 1.22; 95% CI, 0.96-1.54; P(trend) = .07) and the HCA 2-amino-1 methyl-6-phenylimidazo(4,5-b)pyridine (PhIP) (HR, 1.19; 95% CI, 0.95-1.48; P(trend) = .06) conferred a borderline statistically significant increased risk of bladder cancer. Positive associations were observed in the top quintile for total dietary nitrite (HR, 1.28; 95% CI, 1.02-1.61; P(trend) = .06) and nitrate plus nitrite intake from processed meat (HR, 1.29; 95% CI, 1.00-1.67; P(trend) = .11).
These findings provided modest support for an increased risk of bladder cancer with total dietary nitrite and nitrate plus nitrite from processed meat. Results also suggested a positive association between red meat and PhIP and bladder carcinogenesis.
More than 60 thousand new cases of bladder cancer are diagnosedeach year in the United States, accounting for approximately 13thousand deaths annually. In recent decades, the overall incidenceof bladder cancer seems to be rising and this may be due to thelatent effects of tobacco abuse, other non-occupational risk factors,industrial carcinogens, as well as the overall aging of our population.Cultural and socioeconomic factors also contribute substantially tothe etiology of bladder cancer and may play an even more importantrole than the occupational environment. In this paper, it is reviewedthe main established or proposed non-occupational factors associatedwith bladder cancer development.
High meat consumption could potentially increase the risk of bladder cancer, but findings from epidemiologic studies are inconsistent. We prospectively examined the association between meat intake and bladder cancer risk in a population-based cohort study.
We prospectively followed 82,002 Swedish women and men who were free from cancer and completed a food-frequency questionnaire in 1997. Incident cases of bladder cancer were identified in the Swedish cancer registries. Cox proportional hazards models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI), adjusted for age, sex, education, smoking status, pack-years of smoking, and total energy intake.
During a mean follow-up of 9.4 years, 485 incident cases of bladder cancer (76 women and 409 men) were ascertained in the cohort. We observed no association between the intake of total or any specific type of meat and the risk of bladder cancer. The multivariate HRs (95% CIs) comparing the highest and the lowest category of intake were 1.05 (0.71-1.55) for total meat, 1.00 (0.71-1.41) for red meat, 1.01 (0.80-1.28) for processed meats, 0.96 (0.70-1.30) for chicken/poultry, and 0.92 (0.65-1.30) for fried meats/fish. The associations did not vary by sex or smoking status.
These results do not support the hypothesis that intake of red meat, processed meat, poultry, or fried meats/fish is associated with the risk of developing bladder cancer.
A large number of epidemiological studies have reported positive associations between bladder cancer and sales occupations. We investigated whether these findings are likely to be due to chance, confounding or publication bias, or may involve causal associations.
Studies reporting bladder cancer risk-estimates for sales occupations were reviewed. Using meta-analyses we assessed heterogeneity and publication bias, and derived summary estimates.
Eighteen publications were identified, reporting 85 risk-estimates for sales-work. Meta-estimates were elevated for men (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.01-1.21) and women (OR = 1.36, 95% CI = 1.11-1.67). The estimate was heterogeneous for men (p(Q-test) <0.01, women: 0.18) and indicated publication bias for women (p(Egger-test) <0.01, men: 0.40). When including only smoking-adjusted estimates reported irrespective of the strength of the association, the summary estimate for generic groups of sales workers was 0.99 (95% CI 0.90-1.08) for men, and 1.18 (95% CI = 0.99-1.39) for women, without statistically significant heterogeneity or publication bias. For women, risk was positively associated with longer duration of sales-employment in three studies.
Publication bias explained most of the reported increased bladder cancer risk, but sales-work still appeared to be associated with a small risk in women. Possible causal factors include lower frequency of urination and reduced fluid intake.
Vinegar folklore is as colorful as it is practical. Legend states that a courtier in Babylonia (c. 5000 BC) "discovered" wine, formed from unattended grape juice, leading to the eventual discovery of vinegar and its use as a food preservative. Hippocrates (c. 420 BC) used vinegar medicinally to manage wounds. Hannibal of Carthage (c. 200 BC), the great military leader and strategist, used vinegar to dissolve boulders that blocked his army's path. Cleopatra (c. 50 BC) dissolved precious pearls in vinegar and offered her love potion to Anthony. Sung Tse, the 10th century creator of forensic medicine, advocated hand washing with sulfur and vinegar to avoid infection during autopsies. Based on the writings of US medical practitioners dating to the late 18th century, many ailments, from dropsy to poison ivy, croup, and stomachache, were treated with vinegar, and, before the production and marketing of hypoglycemic agents, vinegar "teas" were commonly consumed by diabetics to help manage their chronic aliment. This review examines the scientific evidence for medicinal uses of vinegar, focusing particularly on the recent investigations supporting vinegar's role as an antiglycemic agent. Epidemiologic studies and clinical trials were identified by a MEDLINE title/abstract search with the following search terms: vinegar, glucose; vinegar, cancer; or vinegar, infection. All relevant randomized or case-control trials were included in this review.
The rising incidence of urinary bladder cancer is alarming and potential relationships with different risk factors have been postulated. The purpose of this study was to examine the possible relationship between different environmental risk factors and urinary bladder cancer. All men with urinary bladder cancer who were admitted to the Department of Urology of Reina Sofia University Hospital of Cordoba, Spain over 1 year were included in our study. Men were administered an interview questionnaire, which included data on history of known urinary bladder cancer risk factors. Comparisons between men with urinary bladder cancer (cases) and those with nonmalignant urological disease (controls) were made. The study included 74 cases and 89 controls. The variables associated with malignant lesions on univariate analysis were age, smoking and drinking alcohol. Meanwhile, fish, poultry and beef consumption were proved to be protective factors. The risk factors identified by the logistic regression analysis were age, smoking and fluid intake. The independent protective factors on the multivariate analysis were fish and poultry consumptions. Smoking was found to be the principal independent risk factors for urinary bladder cancer. Our results call for further investigation of urinary bladder cancer risk factors; future studies should preferably be performed on large prospective cohorts, to increase their validity.
Urothelial cancer has been linked with tobacco, phenacetin-containing analgesics and some industrially-related carcinogens. Carotene has been suggested as reducing the risk of urothelial cancer but there is not much information on the relation between diet and the incidence of human urothelial cancer. Furthermore, the magnitude of the risk of urothelial cancer for pipe smokers remains unclear. In a 14-year follow-up of 16477 Swedish twins the rate ratio of urothelial cancer (with 95% confidence interval) for subjects with a moderate/high intake of pork and beef respectively was 1.6 (1.0–2.7) and 1.6 (1.0–2.6). Meat consumption is widespread in Western populations. If the finding is supported by further data, a possible etiologic factor associated with the consumption of beef and pork would account for a substantial proportion of the cases of urothelial cancer. The rate ratio for men smoking a pipe/cigars, but not cigarettes, was 3.3 (95% confidence interval 1.5–7.4).
A cohort of 11,580 residents of a retirement community initially free from cancer were followed from 1981 to 1989. A total of 1,335 incident cancer cases were diagnosed during the period. Relative risks of cancer were calculated for baseline consumption of vegetables, fruits, beta-carotene, dietary vitamin C, and vitamin supplements. After adjustment for age and smoking, no evidence of a protective effect was found for any of the dietary variables in men. However, an inverse association was observed between vitamin C supplement use and bladder cancer risk. In women, reduced cancer risks of all sites combined and of the colon were noted for combined intake of all vegetables and fruits, fruit intake alone, and dietary vitamin C. Supplemental use of vitamins A and C showed a protective effect on colon cancer risk in women. There was some suggestion that beta-carotene intake and supplemental use of vitamin A, C, and E were associated with reduced risk of lung cancer in women, but none of these results were statistically significant. These inverse associations observed in women seem to warrant further investigation, although there was inconsistency in results between the sexes.
The relationship between selected urinary tract and genital diseases and the risk of bladder cancer was analyzed using data from a case-control study of 364 cases of bladder cancer and 447 controls hospitalized for acute, nonneoplastic, nongenital tract conditions, unrelated to known or suspected risk factors for bladder cancer. Cystitis was reported by 20% of the cases and 8% of the controls, corresponding to a multivariate relative risk (RR) of 3.8 (95% confidence interval, 2.4 to 5.9). No association was observed with urinary tract stones (RR = 1.2). With reference to genital diseases, the RR was elevated for gonorrhea (RR = 2.8, 95% confidence interval, 1.0 to 4.5) and condylomata acuminata (RR = 5.9, 95% confidence interval 1.0 to 3.6) but not for syphilis. The risk increased with the number of episodes of cystitis (RR = 5.0 for greater than or equal to 4 episodes, chi 2 for trend = 33.04, P less than 0.001), was higher during the last 15 years after the first episode (RR = 5.1 versus 2.3 for over 15 years), and was not heterogeneous across strata of age and sex. The interaction between urinary tract infections and tobacco appeared multiplicative, with RR = 2.4 for ever smoking, 3.2 for cystitis alone, and 10.3 for both exposures. The present study, besides providing further quantitative evidence of a relationship between urinary tract infections (and, possibly, some genital infections, too) and bladder cancer, indicates that the role of infections is probably in one of the latter (promoting) stages of the process of carcinogenesis and suggests a multiplicative interaction with smoking. In terms of prevention and public health, therefore, it is thus important to avoid at least one exposure for subjects with a history of urinary tract infections who smoke tobacco.
Evidence is accumulating in support of a role for reactive oxygen species in the etiology of cancer. Inflammatory cells, such as neutrophils, macrophages, and eosinophils, are an important endogenous source of oxygen radicals. Stimulation of these cells by tumor promoters or by foreign bodies (parasites, bacteria, etc.) causes the release of reactive oxygen species. Laboratory studies have shown that genetic damage and neoplastic transformation are induced in vitro in cells cocultured with activated inflammatory cells. We have recently begun to study the role of inflammatory reactions in inducing genetic damage in a human population. This paper describes our initial studies of Egyptian patients infected with Schistosoma haematobium. This infection induces chronic inflammation and irritation in the urinary bladder and is associated with increased cancer at this site. We describe a recently completed population study that shows that infected individuals have elevated levels of genetic damage in their bladders, as measured by the exfoliated cell micronucleus test. Treatment that kills the parasite also reduces the micronucleus frequencies. We also explore the hypothesis that altered sensitivity of clones of cells in these patients to reactive oxygen species could be a force that drives the development of neoplasia by facilitating clonal expansion. Evidence is presented for the possible involvement of loci on chromosome 11 in controlling the level of chromosomal breakage caused by oxidative damage. We have shown that bladder carcinoma cells are sensitive to micronucleus induction by promoter-activated neutrophils and that they can be protected from this damage by insertion of a normal chromosome 11. Further work is in progress to define the source of chromosomal breakage in schistosomiasis patients and to begin to develop an understanding of the host factors protecting bladder cells in these individuals from genetic damage.
A hospital based case-control study was conducted between 1992 and 1993 in the province of Brescia, a highly industrialised area in northern Italy, to evaluate occupational risk factors of bladder cancer.
The study evaluated 355 histologically confirmed cases of bladder cancer (275 men, 80 women) and 579 controls affected by urological non-neoplastic diseases (397 men, 182 women). Lifetime occupational history, smoking and drinking habits, and sociodemographic characteristics were recorded by means of a structured questionnaire. Odds ratios (ORs) were computed with adjustment for age, smoking, alcohol and coffee consumption, education, and place of residence.
A significant (P < 0.05) increase of risk of bladder cancer were found in men for labourers in the construction industry (OR 2.1, 95% confidence interval (95% CI) 1.1-3.9) and for recreational and cultural services (OR 5.0, 95% CI 1.3-18.9). Increased risks, although not significant, were found for various other occupations and industries such as machinery mechanics, metal processers and polishers, blacksmiths, gunsmiths, painters; for transport workers, an increased risk with increasing duration of employment was found.
Occupational exposures seem to contribute to bladder cancer risk in the area under study.
Studies in animals have shown that the frequency of urination is inversely associated with the level of potential carcinogens in the urothelium. In humans, an increase in total fluid intake may reduce contact time between carcinogens and urothelium by diluting urinary metabolites and increasing the frequency of voiding. The data on fluid intake in relation to the risk of bladder cancer are inconclusive.
We examined the relation between total fluid intake and the risk of bladder cancer over a period of 10 years among 47,909 participants in the prospective Health Professionals Follow-up Study. There were 252 newly diagnosed cases of bladder cancer during the follow-up period. Information on total fluid intake was derived from the reported frequency of consumption of the 22 types of beverages on the food-frequency questionnaire, which was completed by each of the 47,909 participants who were free of cancer in 1986. Logistic-regression analyses were performed to adjust for known and suspected risk factors for bladder cancer.
Total daily fluid intake was inversely associated with the risk of bladder cancer; the multivariate relative risk was 0.51 (95 percent confidence interval, 0.32 to 0.80) for the highest quintile of total daily fluid intake (>2531 ml per day) as compared with the lowest quintile (<1290 ml per day). The consumption of water contributed to a lower risk (relative risk, 0.49 [95 percent confidence interval, 0.28 to 0.86] for > or =1440 ml [6 cups] per day vs. <240 ml [1 cup] per day), as did the consumption of other fluids (relative risk, 0.63 [95 percent confidence interval, 0.39 to 0.99] for >1831 ml per day vs. <735 ml per day).
A high fluid intake is associated with a decreased risk of bladder cancer in men.
Data derived from laboratory investigations suggest that a number of dietary variables may contribute to bladder carcinogenesis. Although bladder cancer is the fourth leading cause of cancer in men in the United States, dietary studies are few. The authors examined the relations between intakes of macro- and micronutrients and the risk of bladder cancer among men in the prospective Health Professionals Follow-Up Study. Each participant completed a 131-item food frequency questionnaire in 1986 and in 1990, from which nutrient intakes were calculated. During 12 years of follow-up, 320 cases of bladder cancer were diagnosed. No association was observed for total caloric or macronutrient intake and bladder cancer risk. Similarly, we found no relation for dietary intake of potassium, sodium, calcium, magnesium, phosphorus, iron, or water-soluble vitamins and bladder cancer risk. Total vitamin E intake and vitamin E supplements were inversely associated with risk. In addition, a dose-response relation was observed for duration of vitamin E supplement use. A suggestive inverse association was seen with dose of vitamin C supplement use. More studies are needed to determine the role of vitamins E and C supplement intake in bladder carcinogenesis.
We examined the relation between dietary fruit and vegetables, carotenoids and vitamin intakes and the risk of bladder cancer among male smokers in a prospective cohort study. Over a median of 11 years, we followed 27 111 male smokers aged 50–69 years who were initially enrolled in the Alpha-Tocopherol Beta-Carotene Cancer Prevention Study. During this period, 344 men developed bladder cancer. All of these men had completed a 276-food item dietary questionnaire at baseline. Cox proportional hazards models were used to estimate the relative risks and 95% confidence intervals and to simultaneously adjust for age, smoking history, energy intake and intervention group. Consumption of fruits and vegetables was not associated with the risk of bladder cancer (relative risk=1.28; 95% confidence intervals CI: 0.89–1.84, for highest vs lowest quintile). Similarly, no associations were observed for groups of fruits or vegetables (berries and cruciferous vegetables), or for specific fruits and vegetables. Dietary intakes of alpha-carotene, beta-carotene, lycopene, lutein/zeaxanthin, beta-cryptoxanthin, vitamins A, E, and C, and folate were not related to the risk of bladder cancer. These findings suggest that fruit and vegetable intakes are not likely to be associated with bladder cancer risk. However, these results may not be generalisable to non-smokers.
British Journal of Cancer (2002) 87, 960–965. doi:10.1038/sj.bjc.6600604 www.bjcancer.com
© 2002 Cancer Research UK
Recently, disturbingly high levels of acrylamide were unexpectedly detected in widely consumed food items, notably French fries, potato crisps, and bread. Much international public concern arose since acrylamide has been classified as a probable carcinogen, although based chiefly on laboratory evidence; informative human data are largely lacking. We reanalysed a population-based Swedish case-control study encompassing cases with cancer of the large bowel (N=591), bladder (N=263) and kidney (N=133), and 538 healthy controls, assessing dietary acrylamide by linking extensive food frequency data with acrylamide levels in certain food items recorded by the Swedish National Food Administration. Unconditional logistic regression was used to estimate odds ratios, adjusting for potential confounders. We found consistently a lack of an excess risk, or any convincing trend, of cancer of the bowel, bladder, or kidney in high consumers of 14 different food items with a high (range 300-1200 microg kg(-1)) or moderate (range 30-299 microg kg(-1)) acrylamide content. Likewise, when we analysed quartiles of known dietary acrylamide intake, no association was found with cancer of the bladder or kidney. Unexpectedly, an inverse trend was found for large bowel cancer (P for trend 0.01) with a 40% reduced risk in the highest compared to lowest quartile. We found reassuring evidence that dietary exposure to acrylamide in amounts typically ingested by Swedish adults in certain foods has no measurable impact on risk of three major types of cancer. It should be noted, however, that relation of risk to the acrylamide content of all foods could not be studied.
Urine plays a major role in bladder carcinogenesis, acting as a transport mechanism for carcinogens, containing several growth factors stimulating cell proliferation, and indirectly affecting chemicals by alterations in concentrations of normal urinary components such as electrolytes, water and proteins. These latter effects are greatly modified by diet composition and consumption and also by water consumption. Several examples of these effects are presented.
Purpose: This study was undertaken to assess the association of some habits as risk factors for bladder cancer development. Patients and methods: A hospital-based case-control study included 130 newly diagnosed bladder cancer patients and the same number of controls matched with respect to sex, age (±2 years) and type of residence (rural - urban) from the Clinical Center of Serbia in Beograd and from the Clinical Center in Kragujevac in central Serbia. The study took place from June 1997 to March 1999. The same doctor interviewed all the participants using a targeted and detailed questionnaire about their lifestyle. Results: All factors found to be significantly related to bladder cancer according to univariate logistic regression analysis were considered for inclusion in the multivariate logistic regression model. According to conditional logistic regression analysis, significant association with bladder cancer was found for cigarette smoking (odds ratio-OR=1.55; 95% confidence interval-CI=1.17-2.05), beer consumption (OR= 1.15; 95% CI=1.00-1.33), spirits consumption (OR=1.07; 95% CI=1.00-1.15) and coffee consumption (OR=1.06; 95% CI=1.02-1.09). Conclusion: The results of our study showed that some habits (cigarette smoking, beer, spirits and coffee consumption) were significantly associated with bladder cancer. We found no association between artificial sweeteners, wine and tea consumption and risk for bladder cancer development.
This dietary study was based on 195 male and 66 female cases of lower urinary tract cancer, identified in Hawaii between 1977 and 1986. Each case was matched for sex, age, and ethnic group (Caucasian or Japanese) to 2 population-based controls. There was a decrease in risk with increasing levels of consumption of vitamin C in women (p =0.03) and dark green vegetables in men (p =0.02). When examined by quartile, the odds ratios for the highest quartile of intake compared to the lowest quartile were 0.4 for women and 0.6 for men, respectively. Although dark green vegetables are a source of carotenoids, the intake of total carotenoids, retinol and total vitamin A was weakly and inconsistently related to risk in both sexes. Among women only, there was also an inverse association with the consumption of regular ground coffee (p -0.02) but not with other types of coffee. Finally, there were no statistically significant or consistent differences between cases and controls in the intake of artificial sweeteners and tea.
Potential promoting effects of α-linolenic, linoleic and palmitic acids were investigated in a two-stage urinary bladder carcinogenesis model. In experiment 1, male F344 rats were given 0.05% N-butyl-N-(4-hydroxybutyl)nitrosainine (BBN) in their drinking water for 4 weeks and then basal diet containing 10%α-linolenic, 10% linoleic or 10% palmitic acid along with 0.2% butylated hydroxyanisole (BHA) as an antioxidant for 24 weeks. The development of tumors in the urinary bladder was not increased by treatment with any of the fatty acids. In experiment 2, male F344 rats were given 10%α-linolenic, 10% linoleic or 10% palmitic acid along with 0.2% BHA in their diet for 8 weeks without prior BBN treatment. The administration of fatty acids was not associated with any increase in the 5-bromo-2′-deoxyuridine labeling index of the urinary bladder epithelium. Serum and/or urine fatty acid Ievels increased in the cases of α-linolenic and linoleic acid treatments, but not with palmitic acid. Under the present experimental conditions neither the two polyunsaturated nor the one saturated fatty acid exerted any promoting effect on urinary bladder carcinogenesis.
A hospital-based, case-control study of 531 male and 144 female matched pairs was conducted in Germany to analyze the role of nonoccupational and occupational risk factors in the etiology of tumors of the lower urinary tract (bladder cancer). Smoking of cigarettes was associated with an odds ratio (OR) of 3.6 for men and 3.2 for women, compared with not smoking and showed a significant dose- and time-response relationship for both sexes. Heavy pipe smoking significantly increased the risk (OR = 1.9 in men), and smoking of cigars did not alter the risk of bladder cancer. Controlling for smoking, a significantly twofold or more increase in risk was found for heavy consumption of coffee in both sexes and for heavy intake of beer in males. Increasing levels of total fluid intake were associated with increasing, smoking-adjusted risks in men. Significant associations were found for chronic infection of the lower urinary tract (OR = 1.8), familial history of bladder cancer (OR = 2.5), and frequent consumption of high fat meals (OR = 1.4) among men and for frequent consumption of canned food in both sexes (OR = 1.7 for males, 2.4 for females). With regard to occupational history, significantly elevated odds ratios were found for ever-employment in the printing (5.0), plastics and synthetics (2.6), rubber (2.5), mining (2.0), and dyestuffs (1.9) industries, for exposure to spray paints (2.9), zinc (2.3), chromium/chromate (2.2), oils (1.5), petroleum (1.4), stone dust (1.4) and metal dust/fumes (1.3), and for occupation as mining worker (2.0) and truck driver (1.8) among men. Multivariate logistic regression analysis showed significant contribution of coffee and beer drinking, ingestion of canned food, and familial occurrence of urothelial tumors to the risk of bladder cancer in men after accounting for the effects of tobacco smoking, occupational exposures, and a history of bladder infection. These other variables did not influence the risk attributable to occupational exposures.
We examined the relation between consumption of 22 dietary items and subsequent bladder-cancer incidence in a cohort of atomic-bomb survivors in Japan. Subjects were 38,540 people (14,873 men and 23,667 women) who responded to a mail survey carried out between 1979 and 1981 and who had no known cancer diagnosed before the start of follow-up (1 January 1980 for men, 1 February 1981 for women). Consumption frequencies for 22 dietary items were ascertained with pre-coded answers. As of the end of 1993, there were 114 (83 men and 31 women) incident cases of bladder cancer among 450,326 person-years at risk. Statistical analysis was done using Poisson regression for grouped survival data. Consumption of green-yellow vegetables and fruit were protectively associated with risk. Adjusted for gender, age, radiation exposure, smoking status, educational level, body-mass index and calendar time, the relative risk (RR) for those consuming green-yellow vegetables 2–4 times per week and almost everyday was 0.62 [95% confidence interval (CI) 0.39–0.98] and 0.54 (95% CI 0.30–0.94) respectively, as compared with those consuming once per week or less. The corresponding RR for fruit consumption was 0.50 (0.30–0.81) and 0.62 (0.39–0.99) respectively. Chicken consumption was unexpectedly associated with decreased risk, but additional adjustment for consumption did not change the relation of green-yellow vegetables or of fruit to risk. The consumption of the other dietary items, including meat and green tea, was not related to risk. The findings add to evidence that high consumption of vegetables and fruit are protective against bladder cancer. Int. J. Cancer 86:132–138, 2000. © 2000 Wiley-Liss, Inc.
Incidence rates for 27 cancers in 23 countries and mortality rates for 14 cancers in 32 countries have been correlated with a wide range of dietary and other variables. Dietary variables were strongly correlated with several types of cancer, particularly meat consumption with cancer of the colon and fat consumption with cancers of the breast and corpus uteri. The data suggest a possible role for dietary factors in modifying the development of cancer at a number of other sites. The usefulness and limitations of the method are discussed.
We present the dietary epidemiology of bladder cancer while controlling for a number of lifestyle and environmental risk factors in a study of 351 white male cases with histologically confirmed transitional cell carcinoma of the bladder and 855 white male controls selected from Erie, Niagara, and Monroe counties of western New York from 1979 to 1985. Usual diet was estimated by comprehensive interviews with use of a detailed food frequency questionnaire. An increased risk of bladder cancer was associated with higher kilocalorie intake, but only among those under 65 years of age, with the strongest pattern associated with fat intake. Further analyses of fat, carbohydrates, and protein, with adjustment for total kilocalories, resulted in a positive association of risk with fat intake and a decreasing risk with higher protein intake. Of the vitamins, carotenoid consumption appeared to decrease risk with increased consumption for those under 65 years of age. No significant differences between cases and controls were seen for intake of calcium, retinol, thiamin, riboflavin, niacin, vitamin C, vitamin D, and vitamin E. After adjustment for kilocalories and other confounders, higher intake of dietary sodium was associated with increased risk among both age groups, and the trends were statistically significant. The importance of diet in the etiology of bladder cancer is suggested by our findings.
A case-control study on bladder cancer was carried out in 12 hospitals located in 4 regions of Spain. The study included 497 cases and 530 population controls, matched by sex, age and residence. The present paper reports the results regarding the risk for bladder cancer in relation to history of infections and lithiasis of the urinary tract. Increased risk was found for infections starting 4 years or less before diagnosis (OR = 15.00; 95% CL: 6.07-51.66) but no statistically significant increase in risk was observed for infections starting 5 or more years before (OR = 1.44; 95% CL: 0.86-2.47). Our data suggest that the association of urinary infections with bladder cancer is probably not causal and is more likely to be a consequence of cancer, although a weak causal association cannot be excluded. A small but not statistically significant increase in risk was found to be associated with a history of renal lithiasis.
A multi-centre case-control study on bladder cancer and diet was carried out in 5 regions of Spain. We report results on 432 male cases and 792 matched controls. Usual dietary habits were investigated by means of an interview-based dietary history questionnaire. Bladder-cancer cases were selected from the registers of 12 hospitals located in the study areas. Each case was matched by sex, age and area of residence to 2 controls, one identified in the same hospital and one drawn from population lists. Descriptive analyses indicated that the average dietary pattern was typical of Mediterranean populations: a high P/S ratio, high intake of fish, fruits and vegetables and moderate or low intake of meat and dairy products. Relative risks for specific foods and nutrients were adjusted for tobacco smoking and energy intake. Subjects in the highest quarter of intake of saturated fat had a significantly increased risk of bladder cancer (RR for highest quarter = 2.25; 95% CI = 1.42 to 3.55). Moderate increases in risk for high intake of mono-unsaturated fats and calcium, and a slight decrease for iron were also found, but these disappeared after adjustment for saturated fat. Intake of vitamin E was related to slightly reduced risk (RR for highest quarter = 0.72; 95% CI = 0.48 to 1.09) which was not modified by adjustment for fat. No association was found with intake of retinol or carotene. These results, along with those of previous studies, suggest that saturated fat intake may influence the occurrence of bladder cancer.
A cohort study of bladder cancer was conducted in a population of California Seventh-day Adventists. Most Seventh-day Adventists use neither tobacco nor alcohol yet experience a large degree of variation in dietary habits. Therefore, diet and other lifestyle habits were evaluated in this unique population. In 1976, 34,198 non-Hispanic white Seventh-day Adventists in California completed a detailed lifestyle questionnaire which included a 51-item food frequency section. This cohort was then followed until the end of 1982 during which time all newly diagnosed malignancies were detected. In order to evaluate the relation between several variables hypothesized to be associated with altered bladder cancer risk, age-, sex-, and smoking-adjusted relative risks (incidence rate ratios) were calculated using the method of Mantel-Haenszel adopted for person-time data. Multivariate analyses were conducted using the Cox Proportional Hazards Regression model. Between the return of the questionnaire and the end of follow-up, there were 52 histologically confirmed bladder cancers detected in the cohort. Increasing age, male gender, and a history of cigarette smoking were all significantly associated with increased bladder cancer risk. In addition, residence in a rural area was associated with significantly increased risk (relative risk (RR) = 1.80) as was high consumption of meat, poultry, and fish (RR = 2.57).
The relationship between cancer risk and frequency of consumption of green vegetables and fruit has been analyzed using data from an integrated series of case-control studies conducted in northern Italy between 1983 and 1990. The overall dataset included the following histologically confirmed cancers: oral cavity and pharynx, 119; oesophagus, 294; stomach, 564; colon, 673; rectum, 406; liver, 258; gall-bladder, 41; pancreas, 303; larynx, 149; breast, 2,860; endometrium, 567; ovary, 742; prostate, 107; bladder, 365; kidney, 147; thyroid, 120; Hodgkin's disease, 72; non-Hodgkin lymphomas, 173; myelomas, 117; and a total of 6,147 controls admitted to hospital for acute non-neoplastic conditions, unrelated to long-term dietary modifications. Multivariate relative risks (RR) for subsequent tertiles of vegetable and fruit consumption were derived after allowance for age, sex, area of residence, education and smoking. For vegetables, there was a consistent pattern of protection for all epithelial cancers, with RRs in the upper tertile ranging from 0.2 for oesophagus, liver and larynx to 0.7 for breast. All the trends in risk were in the same direction and significant for all carcinomas except gall-bladder. In contrast, no protection was afforded by high vegetable consumption against non-epithelial lymphoid neoplasms. With reference to fruit, strong inverse relationships were observed for cancers of the upper digestive and respiratory tract, with RRs in the upper tertile between 0.2 and 0.3 for oral cavity and pharynx, oesophagus and larynx relative to the lowest tertile. The lower the location of the tumour in the digestive tract, the weaker appeared to be the protection afforded. Significant inverse relationships were observed for liver, pancreas, prostate and urinary sites, but not for rectum, breast and female genital cancers or thyroid. No relationship emerged for lymphomas and myelomas. Even in the absence of a clear biological interpretation, the consistency and strength of the patterns observed indicate that, in this population, frequent green vegetable intake is associated with a substantial reduction of risk for several common epithelial cancers, and that fruit intake has a favourable effect, especially on upper digestive cancers and, probably, also on urinary tract neoplasms.
In a population-based case-referent study of urothelial cancer in Stockholm during 1985-87, information was obtained from 78% of 418 identified cases and 77% of 511 selected referents. The relative risk (with 95% confidence interval) for intake of vitamin A supplements was 0.5 (0.2-1.0), with a dose-response relationship with increasing frequency of consumption. Increased risks of urothelial cancer were seen for several fried foods, for example fried meat [relative risk 1.4 (1.0-1.8) for weekly intake] and fried potatoes [relative risk 1.6 (1.1-2.6) for weekly intake]. Subjects with a high intake of fried foods, as defined by a collapsed variable, had a relative risk of 2.4 (1.4-4.2). A dose-response relationship was also seen with an increasing average daily intake of fat [relative risk 1.7 (1.0-2.8) in the highest quintile], but adjusting for fried foods decreased the relative risk, and it is uncertain whether the adjustment allowed for residual confounding. No association was noted for meat other than fried, but the analysis was based on small numbers.
In a matched case-control study of cancer of the lower urinary tract in northern Germany in which 340 male and 91 female case-control pairs were interviewed between 1977 and 1982, cigarette smokers were found to have an odds ratio of 2.3 for males and 2.9 for females compared with nonsmokers. A significant dose-response relation was observed for increasing cigarette consumption, and a significant decrease in risk was shown for ex-smokers. Employment in rubber, plastics, dye, textiles, and mining industries was associated with a higher risk, and increased odds ratios were also observed for exposure to spray painting, coal pitch, chromium, and zinc. Controlling for smoking, an elevated risk of 2.3 for drinking more than four cups of coffee per day and significant odds ratios of 2.1 and 2.8 for a daily consumption of 0.5-1.0 liter and above 1.0 liter of beer, respectively, were noted among men. A highly significant odds ratio of 4.0 was found for a daily fluid intake of more than 2 liters. Dietary habits such as the frequent consumption of canned food and fatty meals were associated with a higher risk, whereas a regular consumption of fruits and vegetables was associated with a lower risk. Fourteen determinants found to be important in this case-control series were analyzed by using multiple logistic regression.
The existence of a large unexplained portion of attributable risk, and the marked variation in bladder cancer rates globally, have stimulated an interest in the role of nutrition in cancer of the urinary bladder. For this cross-national comparison study, we had complete data available for 50 countries. Using stepwise regression followed by general linear modelling, age-truncated (45-74 years), world-standardised, sex-specific bladder cancer mortality rates were regressed on an array of nutritional and socioeconomic independent variables in an effort to identify important predictors of bladder cancer mortality. Separate principal components analyses were used to summarise the nutritional and the socioeconomic (SES) variables. In the stepwise analyses, using food scores expressed in kcal/day per capita (as opposed to the nutritional components), total fat consistently entered the model first, and explained the greatest share of variability (R2) for both males and females. General linear models were fitted that included total fat, tobacco, alcohol, the three SES components (comprising seven socioeconomic predictors) and two food categories found significant in stepwise modelling, roots/tubers and vegetable oil. The R2 values were 0.84 for male rates and 0.77 for female rates, meaning that these study factors account for 84% of bladder cancer mortality in men and 77% in women. Substitution of the nutritional components for the foods resulted in general linear models with slightly higher R2 values (0.85 for males, 0.77 for females), but with attenuated fat effects. Results are discussed in light of biological plausibility.
The association of diet and smoking with bladder cancer was investigated in a cohort study conducted in Hawaii. The study included 7995 Japanese-American men who were born between 1900 and 1919, and were examined from 1965 to 1968. After 22 years of follow-up, 96 incident cases of bladder cancer were diagnosed. Current cigarette smokers had a 2.9-fold risk of bladder cancer, compared with nonsmokers. A direct dose-response relation was observed, based on pack-years of cigarette smoking. Consumption of fruit was inversely associated with the risk of bladder cancer (P = 0.038). The relative risk was 0.6 among subjects who had the most frequent (> or = 5 times/wk) intake of fruits compared to those with the least intake (< or = 1 time/wk). A weaker inverse association with milk intake was also observed (P = 0.07). Frequent consumption of fried vegetables, pickles, or coffee increased the risk of bladder cancer, but none of these foods showed a significant dose-response relationship. There was no association of other selected foods, alcohol, total calories, protein, fat, or carbohydrates with bladder cancer risk.
Bladder cancer is a common malignancy, and a frequent cause of urological consultation and surgical intervention. Except for smoking and certain occupational exposures, the etiology of bladder cancer is largely unknown. Although the majority of patients with bladder cancer do not have a family history of transitional cell carcinoma of the urinary tract, the study of familial transitional cell carcinoma may lead to knowledge of the pathogenesis of this disease.
To evaluate the current understanding of familial transitional cell carcinoma, we reviewed the contemporary literature for case reports and epidemiological studies about this disease.
Numerous case reports document the clustering of transitional cell carcinoma in families, several of which demonstrate an extremely early age at onset of disease, which argues in favor of a genetic component to familial transitional cell carcinoma. The results of large epidemiological studies also suggest the existence of familial transitional cell carcinoma, and first degree relatives appear to have an increased risk for disease by a factor of 2. Familial clustering of smoking does not appear to be the cause of this increased risk.
Familial transitional cell carcinoma may be the result of a genetically transmitted predisposition to disease, at least in some affected families. Further studies are required to identify candidate genes that may be responsible for this form of bladder cancer.
This population-based case-control study examined the association between selected nutrients, foods, and diet behaviors and bladder cancer. Bladder cancer cases (n = 262) were identified from the Surveillance, Epidemiology, and End Results Program cancer registry for western Washington, and controls (n = 405) were identified through random digit dialing. Cases were diagnosed between January 1987 and June 1990, and eligible subjects were Caucasian, aged 45-65 years, and residents of King, Pierce, or Snohomish counties. Subjects completed a self-administered, 71-item food frequency questionnaire and a structured telephone interview. Analyses were conducted by logistic regression analysis and included adjustment for age, sex, smoking (current, former, never), and county. Odds ratios and their 95% confidence intervals for highest versus lowest level of intake were examined. An inverse association was found between the risk of bladder cancer and dietary retinol (odds ratio (OR) across quartiles: 1.00, 1.09, 0.97, and 0.52; 95% CI 0.29-0.97; trend p value = 0.03) and dietary vitamin C (OR across quartiles: 1.00, 0.96, 0.67, and 0.50; 95% CI 0.28-0.88; trend p value = 0.009), adjusted for calories. The use of multivitamin supplements daily over the 10-year period ending 2 years before diagnosis versus no use was associated with a decreased risk of bladder cancer (OR = 0.39; 95% CI 0.24-0.63) as was use of supplemental vitamin C (OR for > 502 mg/day over the 10 years vs. none = 0.40; 95% CI 0.21-0.76). Increased intake of fruit was associated with a decreased risk of bladder cancer (OR across quartiles: 1.00, 1.24, 0.72, and 0.53; 95% CI 0.30-0.93; trend p value = 0.01, adjusted for calories), while increased use of fried foods was associated with an increased risk of bladder cancer (OR across quartiles: 1.00, 1.51, 1.81, and 2.24; 95% CI 1.25-4.03; trend p value = 0.006). This study provides modest evidence that certain nutrients, foods, and supplementation may affect the incidence of bladder cancer.
The present contribution reviews the epidemiological literature on the risk factors for bladder cancer in humans, pointing to the new leads from the available knowledge and to suggestions on prevention and research needs. Smoking accounts for about 50% of bladder cancer cases in western countries, occupational exposures are second in importance in bladder cancer development. Exposure to aromatic amines in dyestuff manufacture, in the rubber and textile industry, occupations entailing exposure to paints and solvents, leather dust, inks, some metals, PAH, combustion products and diesel exhausts have been identified as risk factors from epidemiological studies. Other investigations have detected increased risk for bladder cancer in association with dietary factors, specifically fats and cholesterol, and with contamination of drinking water by chlorination by-products.
A case-control study, performed in two towns of Serbia (Yugoslavia) from 1990 to 1994, comprised 101 patients with histologically confirmed prostate cancer and 202 hospital controls individually matched by age (+/-2 years), hospital admittance and place of residence. Dietary information was obtained by using a standard questionnaire. After adjustment for possible confounders, risk factors for prostate cancer appeared to be the highest tertile of protein (odds ratio (OR) = 13.54, 95% confidence interval (CI) = 2.38-77.13), saturated fatty acid (OR = 3.63, 95% CI = 1.03-12.79), fibre (OR = 4.02, 95% CI = 1.38-11.73), and vitamin B12 intake (OR = 2.07, 95% CI = 1.08-3.97); a protective effect was found for the highest tertile of alpha-tocopherol (OR = 0.15, 95% CI = 0.05-0.53), calcium (OR = 0.37, 95% CI = 0.14-0.99) and iron intake (OR = 0.34, 95% CI = 0.12-0.95). There were significant (P < 0.05) linear trends in the odds ratios for alpha-tocopherol, vitamin B12, calcium and iron. According to logistic regression step by step analysis, risk factors for prostate cancer were dietary intake of retinol equivalent (OR = 1.64, 95% CI = 1.01-2.67) and vitamin B12 (OR = 1.87, 95% CI = 1.15-3.05), and a protective effect was found for dietary intake of iron (OR = 0.40, 95% CI = 0.27-0.58).
Urine plays a major role in bladder carcinogenesis, acting as a transport mechanism for carcinogens, containing several growth factors stimulating cell proliferation, and indirectly affecting chemicals by alterations in concentrations of normal urinary components such as electrolytes, water and proteins. These latter effects are greatly modified by diet composition and consumption and also by water consumption. Several examples of these effects are presented.
Previous epidemiologic studies of fruit and vegetable intake and bladder cancer risk have yielded inconsistent results, especially with regard to the types of fruits and vegetables consumed. We examined total fruit and vegetable intake, as well as intakes of subtypes of fruits and vegetables, in relation to bladder cancer risk in a large male prospective cohort study.
Two hundred fifty-two cases of incident bladder cancer were diagnosed from 1986 through January 31, 1996, among 47,909 men enrolled in the Health Professionals Follow-up Study. Each participant in this cohort completed a 131-item food-frequency questionnaire in 1986 and subsequently in 1990 and 1994. We used logistic regression analyses to examine fruit and vegetable intake in relation to bladder cancer risk, after adjusting for age, history of cigarette smoking, current smoking status, geographic region, total fluid intake, and caloric intake.
We observed a weak, inverse association that was not statistically significant between total fruit and vegetable intake and bladder cancer risk. Intake of cruciferous vegetables was inversely associated with risk (relative risk = 0.49; 95% confidence interval = 0.32-0.75, for the highest category of cruciferous vegetable intake compared with the lowest), but intakes of yellow or green leafy vegetables or carotenoid-rich vegetables were not associated with risk. Individual cruciferous vegetables, except for coleslaw, were all inversely related to bladder cancer risk, but only the associations for broccoli and cabbage were statistically significant.
Data from this study indicate that high cruciferous vegetable consumption may reduce bladder cancer risk, but other vegetables and fruits may not confer appreciable benefits against this cancer.
An analysis of a previously completed Spanish multicentric case-control study of bladder cancer was carried out using new available data on the contents in foods of specific carotenoids (alpha-carotene, beta-carotene, lutein, and lycopene) and flavonoids (quercetin, kaempferol, myricetin, and luteolin) to investigate the relationship of these phytochemicals with bladder cancer. The study included 497 cases first diagnosed with bladder cancer, 547 neighborhood controls, and 566 hospitals controls, matched by gender, age, area of residence, and hospital. Usual food intake was estimated using a dietary history questionnaire administered by trained interviewers. None of the specific carotenoids and none of the specific flavonoids have been found to be significantly associated with bladder cancer risk in this analysis. The adjusted odds ratios for subjects in the highest quartile of intake with respect to subjects in the lowest quartile were 1.36 (95% confidence interval = 0.94-1.95) for total carotenoid intake and 1.23 (95% confidence interval = 0.85-1.79) for total flavonoid intake. The results of this study does not support the hypothesis that intake of specific carotenoids and flavonoids is protective against bladder cancer risk.
A kind of lactic acid bacteria, Lactobacillus casei strain Shirota, shows antitumor activity in experimental animals. One clinical trial using L. casei showed a significant decrease in the recurrence of superficial bladder cancer. So, to assess the preventive effect of the intake of L. casei, widely taken as fermented milk products in Japan, against bladder cancer, we conducted a case-control study.
A total of 180 cases (mean age: 67 years, SD 10) were selected from 7 hospitals, and 445 population-based controls matched by gender and age were also selected. Interviewers asked them 81 items. The conditional logistic regression was used to estimate adjusted odds ratios (OR).
The OR of smoking was 1.61 (95% confidence interval: 1.10-2.36). Those of previous (10-15 years ago) intake of fermented milk products were 0.46 (0.27-0.79) for 1-2 times/week and 0.61 (0.38-0.99) for 3-4 or more times/week, respectively.
It was strongly suggested that the habitual intake of lactic acid bacteria reduces the risk of bladder cancer.
The relation between alcoholic beverage consumption and bladder cancer risk was investigated using data from a case-control study conducted between 1985 and 1992 in two areas of northern Italy. Cases were 727 patients with incident, histologically confirmed bladder cancer, and controls 1,067 patients admitted to the same network of hospitals for acute, non-neoplastic, nonurologic, or genital tract diseases. Compared to nondrinkers, the odds ratio (OR) was 0.79 (95% confidence interval, CI, 0.58-1.08) for drinkers, and 0.84 (95%CI, 0.58-1.22) for > or =6 drinks/day. The OR was 0.86 (95%CI, 0.60-1.23) for > or =5 wine drinks/day, 0.69 for beer, and 0.85 for spirits. No trend was observed with duration (OR =1.00 for > or =40 years). ORs were consistent across various strata of covariates including age, sex, and smoking habits. Our study, based on a population with high alcohol (mainly wine) intake, found no association between bladder cancer risk and alcohol intake, even at high levels of consumption.
To examine the relation of the total intake of fluids and the types of beverages to the risk of bladder cancer, we conducted a hospital based case-control study with 130 newly diagnosed bladder cancer patients and the same number of matched controls. Information of total fluid intake was derived from the reported frequency of consumption of the different types of beverages on the food frequency questionnaire. Univariate and multivariate logistic regression analyses were performed in statistical analysis. There was no statistically significant difference between the cases and the controls in total daily fluid intake. Multivariate logistic regression model showed consumption of: soda (OR=8.32; 95%CI=3.18-21.76), coffee (OR=1.46; 95%CI=1.05-2.01) and spirits (OR=1.15; 95%CI=1.04-1.28) as statistically significant risk factors, while mineral water (OR=0.52; 95%CI=0.34-0.79), skim milk (OR=0.38; 95%CI=0.16-0.91), yogurt (OR=0.34; 95%CI=0.12-0.97) and frequency of daily urination (OR=0.27; 95%CI=0.18-0.41) were statistically significant protective variables. In our study no statistically significant association was observed for total fluid intake. The findings suggest consumption of soda, coffee and spirits were indicated as a risk factors for bladder cancer, while mineral water, skim milk, yogurt and frequency of urination as protective factors for bladder cancer.
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