Epidemiology of Bladder Cancer

Bladder cancer (BC) is the tenth most incident malignancy globally, with substantial morbidity and mortality. Although fourfold more likely to present in males, females have worse oncologic outcomes even when controlling for other known predictors of adverse outcomes such as smoking and delay to treatment. African-American race is also an independent risk factor for advanced disease when diagnosed, as is lower socioeconomic status. Many modifiable risk factors have been associated with BC risk, with tobacco smoking being the leading risk factor and accounting for an estimated 50% of BC cases. Occupational exposures account for 5–10% of BC cases, due to chemicals such as aromatic amines and polycyclic aromatic hydrocarbons. Environmental exposures such as arsenic-containing drinking water, Agent Orange (AO), and residential exposure to hydrocarbons from oil refineries may also increase risk of BC incidence and mortality. Mediterranean diets and fish consumption are among potential protective dietary factors. Genetics also plays a role, with germline mutations in mismatch repair genes and a range of single-nucleotide polymorphisms identified as risk factors (see Chap. 2). In this chapter, we outline the main demographic trends of BC and identify emerging risk factors for incidence, morbidity, and mortality.