Risk of Bladder Cancer From Smoking Greater Than Previously Reported

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An analysis of data that includes nearly 500,000 individuals indicates that the risk of bladder cancer among smokers is higher than reported from previous population data, and that the risk for women smokers is comparable with that of men, according to a study in the August 17 issue of JAMA.

More than 350,000 individuals are diagnosed with bladder cancer per year worldwide, including more than 70,000 per year in the United States. Tobacco smoking is the best established risk factor for bladder cancer in both men and women, with previous studies indicating that current cigarette smoking triples bladder cancer risk relative to never smoking, according to background information in the article. “However, the composition of cigarettes has changed during the past 50 years, leading to a reduction in tar and nicotine concentrations in cigarette smoke, but also to an apparent increase in the concentration of specific carcinogens, including beta-napthylamine, a known bladder carcinogen…,” the authors write. They add that changing smoking prevalence and cigarette composition warrant revisiting risk estimates for smoking and bladder cancer.

Neal D. Freedman, Ph.D., M.P.H., of the National Cancer Institute, Department of Health and Human Services, Rockville, Md., and colleagues conducted a study to examine the association between tobacco smoking and bladder cancer using data from men (n = 281,394) and women (n = 186,134) in the National Institutes of Health-AARP (NIH-AARP) Diet and Health Study, who completed a lifestyle questionnaire and were followed up between October 1995 and December 2006. Previous studies of smoking and incident bladder cancer were identified by systematic review of the available literature.

During the course of follow-up, 3,896 men and 627 women were newly diagnosed with bladder cancer. Cigarette smoking was a significant risk factor for bladder cancer in both sexes. Relative to never smokers, former and current smokers had increased risk of bladder cancer in both men and women. Analysis of the data indicated that former smokers had a 2.2 times increased risk of bladder cancer and that for current smokers, the risk was about 4 times higher, relative to never smokers. “In contrast, the summary risk estimate for current smoking in 7 previous studies (initiated between 1963 and 1987) was 2.94,” the authors write.

Ever smoking explained a similar proportion of bladder cancer in both sexes, with population attributable risks of 50 percent in men and 52 percent in women.

The researchers write that factors that may have strengthened the cigarette smoking-bladder cancer association include changes in the constituents of cigarette smoke (such as increased concentrations of beta-napthylamine), and increased awareness of bladder cancer risk in smokers, which may prompt earlier diagnostic workup.

“These results support the hypothesis that the risk of bladder cancer associated with cigarette smoking has increased with time in the United States, perhaps a reflection of changing cigarette composition. Prevention efforts should continue to focus on reducing the prevalence of cigarette smoking.”

Should obese, smoking and alcohol consuming women receive assisted reproduction treatment?

The European Society of Human Reproduction and Embryology (ESHRE) has published a position statement on the impact of the life style factors obesity, smoking and alcohol consumption on natural and medically assisted reproduction.

In a literature study the ESHRE Task Force on Ethics and Law summarised the negative effects of obesity, smoking and drinking on the natural reproductive potential of patients, on IVF results, pregnancy complications and outcomes and finally on the health of the future child. The paper was published online on 19 January 2010 in Europe’s leading reproductive medicine journal Human Reproduction. The group made five recommendations.

1) In view of the risks for the future child, fertility doctors should refuse treatment to women used to more than moderate drinking and who are not willing or able to minimize their alcohol consumption.

2) Treating women with severe or morbid obesity required special justification. The available data suggested that weight loss would incur in a positive reproductive effect, although more data was needed to establish whether assisted reproduction should be made conditional upon prior life-style changes for obese and smoking females.

3) Assisted reproduction should only be conditional upon life style changes, if there was strong evidence that without behavioural modifications there was a risk of serious harm to the child or that the treatment became disproportional in terms of cost-effectiveness or obstetric risks.

4) When making assisted reproduction conditional upon life style modifications, fertility doctors should help patients to achieve the necessary results.

5) More data on obesity, smoking and alcohol consumption as well as other life style factors were necessary to assess reproductive effects. Fertility doctors should continue research in this area.

ESHRE acknowledged that this was a complex issue due to personal, patient, professional and societal responsibilities and also in terms of what these responsibilities meant with regard to safety of mother and child and fair and equitable access to treatment. The respect for patient autonomy needed to be balanced with the moral weight of the interests of society and the future child.

Obesity

According to the group obesity negatively affected reproductive potential through interference with hormonal and metabolic mechanisms leading to lower ovulation frequency and reduced chances of conception. The risk of gestational diabetes increased from twofold in overweight women to eightfold for morbidly obese women. The infants of obese mothers were at risk of perinatal death, congenital abnormalities such as neural tube defects (80% increase) and cardiovascular anomalies (30% increase).

Smoking

The risk of infertility was thought to be twice as high in smokers compared to non-smokers. Female smokers needed more time to become pregnant, were less likely to do so spontaneously and had a higher risk of miscarriage. Having an accelerating effect on oocyte depletion, smoking was suggested to lead to an increase in 10 years with regards to IVF outcome. Lower birth weight, a higher risk of oral facial clefts and Sudden Infant Death Syndrome were associated with maternal smoking. Male smokers were at risk of producing sperm of reduced quality and concentration.

Alcohol Consumption

Reduced conception, lower pregnancy rates and higher miscarriage rates were suggested as adverse effects of alcohol consumption. The known effects of alcohol consumption were summarised under Foetal Alcohol Spectrum Disorders (FASD) such as physical anomalies and behavioural and cognitive deficits. Other risks associated with prenatal alcohol consumption were foetal death, preterm labour and compromised foetal growth.

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