The Causal Role of Cigarette Smoking in Bladder Cancer Initiation and Progression, and the Role of Urologists in Smoking Cessation

Purpose: Cigarette smoking is a well established risk factor for bladder cancer. We characterize the changing impact of this exposure throughout the course of bladder cancer from incidence through progression. We also discuss how understanding the risk of bladder cancer attributable to smoking can help urologists effectively communicate with their patients and influence smoking cessation in their patients.

Materials And Methods: A review using the MEDLINE database from 1975 through 2007 was performed to search for studies from the epidemiological and medical literature on cigarette smoking and bladder cancer.

Results: Cigarette smoking accounts for up to 50% of all incident bladder cancer cases, an attributable fraction that may be increasing. The general public is not informed of the association between cigarette smoking and bladder cancer, and physicians do a poor job of counseling patients regarding this risk. Smoking cessation has proven beneficial in decreasing the risk of many smoking related illnesses, including bladder cancer. Simple physician interventions can be effective in triggering patient attempts at quitting smoking.

Conclusions: Bladder cancer is causally related to cigarette smoking but this knowledge may not be well disseminated to patients. Furthermore, cigarette smoking cessation decreases bladder cancer risk and may decrease the recurrence of superficial bladder cancer. Urologists have a vital role in influencing patient knowledge of their smoking risk and in encouraging smoking cessation.