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Epidemiology - Prevalence Bladder Cancer

Bladder Cancer General Considerations

  • This is the second most common urologic malignancy.
  • Ninety percent of the cases are transitional cell carcinoma.
  • Sixty to 75% of lesions are superficial and 10-20 percent of these will progress to muscle invasive disease.
  • The majority of muscle invasive lesions will present de novo.
  • Intravesical therapy can decrease recurrence of superficial disease and BCG may retard the progression of disease over 5 to 10 years.
  • Muscle invasive lesions are classically treated with cystectomy and urinary diversion.
  • Organ sparing approaches can be employed in select cases.
  • Advanced disease responds to cytoreductive chemotherapy, yet sustained complete responses are rare.

Epidemiology

  • Urothelial cancer is a cancer of the environment and age.
  • The incidence and prevalence rates increase with age, especially in the sixth decade and peaking in the 8th decade of life. 
  • There is a strong association between environmental toxins and urothelial cancer formation.
  • There has been a 50% increase in incidence over the past 40 years.
  • Bladder cancer is the 7th most common cancer death in men and 10-12th most common cancer death in women.
  • Male to female approximately 3:1
  • Race difference: twice as common in white vs. African American men. Outcomes generally poorer in black men.
  • African-American women have a 6% lower incidence but a 17% higher death rate than white women in all cancers.
  • Genetics mutations and dysfunction in the genes regulating the cell cycle play a major role in the development of bladder cancer.
  • Initiation of superficial disease is probably due to the alteration of several genes on chromosome 9 including p16 ink/arf. Early events in muscle invasive disease include p53 and Rb alterations as well as expression of p21.
  • The incidence rate is rising the fastest in underdeveloped countries where industrialization has led to carcinogenic exposure.
  • Some evidence for the effectiveness of hematuria screening has be noted in a few small case control studies in higher risk populations, but can not be applied as a general recommendation.
  • According to the latest American Cancer Society statistics, there were 68,810 total cases diagnosed in the United States in 2007.
  • 51,230 men and 17,580 women and accounting for 7% of all cancers.

Prevalence

  • On January 1, 2008, in the United States there were approximately 537,428 men and women alive who had a history of cancer of the urinary bladder -- 398,329 men and 139,099 women. 
  • This includes any person alive on January 1, 2008 who had been diagnosed with cancer of the urinary bladder at any point prior to January 1, 2008 and includes persons with active disease and those who are cured of their disease. 
  • Prevalence can also be expressed as a percentage and it can also be calculated for a specific amount of time prior to January 1, 2008 such as diagnosed within 5 years of January 1, 2008.
  • Bladder cancer is the 9th most common cancer worldwide, with 357,000 cases recorded in 2002.
  • Bladder cancer is the 13th most common cause of death, accounting for 145,000 deaths worldwide 
  • The incidence rate of bladder cancer has been rising in Asia and Russia because of an increased prevalence of smoking. 
  • Sixty-three percent of all bladder cancer cases occur in developed countries, with 55% from North America and Europe. 
  • In the United States, the highest bladder cancer incidence rate is in Rhode Island and the lowest is in the District of Columbia. 
  • 4th most common cancer in men and 10th in women
  • The histologic cell type of bladder cancer is very geographically dependent, but urothelial cancer is the most common. 
  • In North America and Europe, 95% to 97% of cases are urothelial carcinoma; in Africa 60% to 90% are urothelial and 10% to 40% are squamous cell; and Egypt has the highest rate of squamous cell carcinoma because of the endemic infections with Schistosoma species.

References

  • Boffetta P: Tobacco smoking and risk of bladder cancer. Scand J Urol Nephrol Suppl 2008; 218:45-54.
  • Boffetta P, Hashibe M: Alcohol and cancer. Lancet Oncol 2006; 7(2):149-156.
  • Brennan P, Bogillot O, Cordier S, et al: Cigarette smoking and bladder cancer in men: a pooled analysis of 11 case-control studies. Int J Cancer  2000; 86(2):289-294.
  • Brinkman M, Zeegers MP: Nutrition, total fluid and bladder cancer. Scand J Urol Nephrol Suppl  2008; 218:25-36.
  • Cohen SM, Cano M, St John MK, et al: Effect of sodium saccharin on the neonatal rat bladder. Scanning Microsc  1995; 9(1):137-147.
  • Ferlay J, Autier P, Boniol M, et al: Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol  2007; 18(3):581-592.
  • Fletcher O, Easton D, Anderson K, et al: Lifetime risks of common cancers among retinoblastoma survivors. J Natl Cancer Inst  2004; 96(5):357-363.
  • Gandini S, Botteri E, Iodice S, et al: Tobacco smoking and cancer: a meta-analysis. Int J Cancer  2008; 122(1):155-164.
  • Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Waldron W, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA, Edwards BK (eds). SEER Cancer Statistics Review, 1975-2008, National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2008/, based on November 2010 SEER data submission, posted to the SEER web site, 2011.
  • Jemal A, Siegel R, Ward E, et al: Cancer statistics, 2008. CA Cancer J Clin  2008; 58(2):71-96.
  • Parkin DM: The global burden of urinary bladder cancer. Scand J Urol Nephrol Suppl  2008; 218:12-20.
  • Pelucchi C, Tavani A, La Vecchia C: Coffee and alcohol consumption and bladder cancer. Scand J Urol Nephrol Suppl  2008; 218:37-44.
  • Steinmaus CM, Nunez S, Smith AH: Diet and bladder cancer: a meta-analysis of six dietary variables. Am J Epidemiol  2000; 151(7):693-702.