Elsevier

European Urology

Volume 66, Issue 1, July 2014, Pages 59-73
European Urology

Platinum Priority – Review – Bladder Cancer
Editorial by Lambertus A. Kiemeney on pp. 74–75 of this issue
International Variations in Bladder Cancer Incidence and Mortality

https://doi.org/10.1016/j.eururo.2013.10.001Get rights and content

Abstract

Context

Previous studies have reported substantial worldwide regional variations in bladder cancer (BCa) incidence and mortality.

Objective

To describe contemporary international variations in BCa incidence and mortality rates and trends using the most recent data from the International Agency for Research on Cancer (IARC).

Evidence acquisition

Estimated 2008 BCa incidence and mortality rates for each country by sex were obtained from GLOBOCAN. Recent trends in incidence for 43 countries and in mortality for 64 countries were assessed by join-point model using data from the IARC's Cancer Incidence in Five Continents and from the World Health Organisation's mortality database, respectively.

Evidence synthesis

The highest incidence rates for both men and women are found in Europe, the United States, and Egypt, and the lowest rates are found in sub-Saharan Africa, Asia, and South America. Mortality rates are highest in parts of Europe and northern Africa and lowest in Asia, Central America, and middle Africa. Incidence rates among men decreased in 11 of 43 countries (46 registries) (North America, western and northern Europe), remained stable in 20, and increased in 12 countries (southern, central, and eastern Europe). Among women, incidence rates decreased in 10 countries, stabilised in 22 countries, and increased in 12 countries. Mortality rates among men decreased in 32 of 65 countries (throughout all world regions except Central and South America), stabilised in 30 countries, and increased in 3 (Romania, Slovenia, and Cuba). Among women, mortality rates decreased in 24 countries, remained stable in 36 countries, and increased in 5 countries (central and eastern Europe).

Conclusions

Incidence and mortality rates in general decreased in most Western countries but increased in some eastern European and developing countries. These patterns in part may reflect differences in the stage and extent of the tobacco epidemic, changes in coding practices, prevalence of schistosomiasis (Africa), and occupational exposure.

Introduction

Bladder cancer (BCa) is the 11th most commonly diagnosed cancer and the 14th leading cause of cancer deaths worldwide, with an estimated 382 700 new cases and 150 300 deaths in 2008 [1]. Incidence and mortality rates vary globally, mainly due to differences in risk factors. Well-established risk factors for BCa include tobacco use, infections with Schistosoma haematobium, and occupational exposures to aromatic amines and polycyclic aromatic hydrocarbons [2], [3]. Other suspected risk factors for BCa include dietary patterns, environmental pollution, and genetic predisposition [3]. While smoking is the predominant cause of BCa in the United States, infection with S. haematobium is the major cause of the disease in most parts of Africa [4].

Previous studies of international patterns in BCa rates are limited because they are confined to specific geographic regions or based on rather old data [5], [6], [7], [8]. In this paper, we present the contemporary information on variation in BCa rates and trends worldwide by using the GLOBOCAN 2008 data [1], Cancer Incidence in Five Continents (CI5) [9], and the World Health Organisation (WHO) mortality data [10] for five continents (Africa, Asia, Oceania, Europe, and the Americas) from the International Association on Research on Cancer (IARC) website [11].

Section snippets

Evidence acquisition

Data on estimated BCa incidence and mortality rates (per 100 000 person-years) for the year 2008 for each country were obtained from GLOBOCAN 2008 [1]. GLOBOCAN is an IARC database that provides estimates of incidence, mortality, prevalence, and disability-adjusted life years for major type of cancers at a national level for 184 countries. These estimates were prepared using methods that are described elsewhere in detail, and they depend on the availability and accuracy of the incidence and

Evidence synthesis

A total of 382 700 new BCa cases (294 400 in men and 88 300 in women) and 150 300 cancer deaths (112 300 in men and 38 100 in women) were estimated to have occurred worldwide (Table 1). Age-standardised rates (per 100 000 person-years) were more than three times as high in men than in women for both incidence (8.9 vs 2.2) and mortality (3.3 vs 0.9). Incidence and mortality rates significantly varied by world region for both men and women. In men, for example, rates ranged from 1.5 in middle

Conclusions

BCa incidence and mortality rates vary substantially across countries due in part to differences in known risk factors, coding, detection and diagnostic practices, and availability of treatments (mortality only). Generally, the highest incidence rates are found in developed nations and some parts of Africa, whereas the highest mortality rates are found in North African and Middle Eastern countries. The decrease in mortality rates in Western countries in part reflects the reduction in smoking

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