Collaborative Review – Bladder CancerEpidemiology of Bladder Cancer: A Systematic Review and Contemporary Update of Risk Factors in 2018
Introduction
Bladder cancer (BC) is the ninth most common cancer worldwide with a yearly incidence of approximately 430 000 cases [1], and it ranks 13th in terms of yearly mortality from cancer [1]. There is a male predominance, and it is the seventh most common cancer worldwide in men [2]. In the USA, BC is the fourth most common cancer in men [3]. BC is a cancer of industrialized nations with an age-standardized incidence rate, which is three-fold greater in high-resource versus low-resource countries [4]. The highest incidence rates are in North America, Europe, and parts of Western Asia. However, mortality rates are greater in developing regions [5].
Urothelial BC is the most common subtype. Approximately 75% of patients present with non–muscle-invasive disease, confined to the bladder mucosa/submucosa. This stage is usually managed with local treatment and surveillance, and has a particularly high prevalence due to the nonaggressive natural history of this disease [6]. The remaining 25% have muscle-invasive disease and often undergo cystectomy, multimodal therapy (transurethral resection, chemotherapy, and radiation therapy), or palliation [7].
In 2013, Burger et al. [8] published a detailed review on the epidemiology of BC and its risk factors. In our work, we have searched contemporary series to compile a current-day picture of BC epidemiology, and provide a discussion of further work that is needed to impact environmental causes of BC.
Section snippets
Evidence acquisition
A systematic review of original articles was performed using PubMed/Medline in December 2017 and again in April 2018. We used the following search terms (Fig. 1): ((Bladder cancer [MeSH terms] and incidence [MeSH terms]) (OR) (Bladder cancer [MeSH terms] and prevalence [MeSH]) (OR) (Bladder cancer [MeSH terms] and risk) (OR) (Bladder cancer [MeSH terms] and risk factor [MeSH terms]) (OR) Bladder cancer [MeSH terms] and hazard)). Manuscripts were excluded if they were not in English, had <50
Evidence synthesis
Our search found 2191 articles, of which 279 full-text manuscripts were included. We separated our manuscripts by the specific risk factor they addressed (PICO [Population Intervention Comparator Outcome]), for example, tobacco smoking (Table 1) [10].
Conclusions
BC is common, and a significant proportion of the cases are attributable to tobacco use as well as occupational and environmental factors (Table 2 summarises the best-known risk factors).
Incidence patterns and trends are dependent on changes in smoking behaviour and shifting occupational and environmental regulations, such as workplace sanctions on known or suspected carcinogens. The evidence is growing for the role of genetic susceptibility and interplay with other risk factors.
One of the
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These authors shared first authorship.