Association Between Smoking and Risk of Bladder Cancer Among Men and Women

Original Contribution
JAMA. 2011;306(7):737-745. doi: 10.1001/jama.2011.1142

Neal D. Freedman, PhD, MPH; Debra T. Silverman, ScD, ScM; Albert R. Hollenbeck, PhD; Arthur Schatzkin, MD, DrPH†; Christian C. Abnet, PhD, MPH
[+] Author Affiliations
Author Affiliations: Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland (Drs Freedman, Silverman, Schatzkin, and Abnet); and AARP, Washington, DC (Dr Hollenbeck).†Died January 20, 2011.
ABSTRACT

Context Previous studies indicate that the population attributable risk (PAR) of bladder cancer for tobacco smoking is 50% to 65% in men and 20% to 30% in women and that current cigarette smoking triples bladder cancer risk relative to never smoking. During the last 30 years, incidence rates have remained stable in the United States in men (123.8 per 100 000 person-years to 142.2 per 100 000 person-years) and women (32.5 per 100 000 person-years to 33.2 per 100 000 person-years); however, changing smoking prevalence and cigarette composition warrant revisiting risk estimates for smoking and bladder cancer.

Objective To evaluate the association between tobacco smoking and bladder cancer.

Design, Setting, and Participants Men (n = 281 394) and women (n = 186 134) of the National Institutes of Health-AARP (NIH-AARP) Diet and Health Study cohort completed a lifestyle questionnaire and were followed up between October 25, 1995, and December 31, 2006. Previous prospective cohort studies of smoking and incident bladder cancer were identified by systematic review and relative risks were estimated from fixed-effects models with heterogeneity assessed by the I2 statistic.

Main Outcome Measures Hazard ratios (HRs), PARs, and number needed to harm (NNH).

Results During 4 518 941 person-years of follow-up, incident bladder cancer occurred in 3896 men (144.0 per 100 000 person-years) and 627 women (34.5 per 100 000 person-years). Former smokers (119.8 per 100 000 person-years; HR, 2.22; 95% confidence interval [CI], 2.03-2.44; NNH, 1250) and current smokers (177.3 per 100 000 person-years; HR, 4.06; 95% CI, 3.66-4.50; NNH, 727) had higher risks of bladder cancer than never smokers (39.8 per 100 000 person-years). In contrast, the summary risk estimate for current smoking in 7 previous studies (initiated between 1963 and 1987) was 2.94 (95% CI, 2.45-3.54; I2 = 0.0%). The PAR for ever smoking in our study was 0.50 (95% CI, 0.45-0.54) in men and 0.52 (95% CI, 0.45-0.59) in women.

Conclusion Compared with a pooled estimate of US data from cohorts initiated between 1963 and 1987, relative risks for smoking in the more recent NIH-AARP Diet and Health Study cohort were higher, with PARs for women comparable with those for men.

KEYWORDS: incidence, men’s health, risk factors, smoking, urinary bladder neoplasms, women’s health.