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31-10-2011 | General practice | Article

Link between smoking and bladder cancer not well-known in US patients


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MedWire News: The association between smoking and bladder cancer remains less well-known than that between smoking and lung cancer among US patients, report researchers.

Furthermore, although the majority of patients diagnosed with bladder cancer who smoke are advised to stop smoking by their urologist, few are offered any intervention to assist with stopping, the team reports.

"Bladder cancer is the fourth most common cancer afflicting Americans, accounting for approximately 800,000 office visits annually," explain Thomas Guzzo (University of Pennsylvania School of Medicine, Philadelphia, USA) and colleagues.

Given that cigarette smoking is the leading risk factor for the development of bladder cancer in industrialized nations, they add in the journal Urology, urologists should "assume a more active role" in helping their patients to quit.

The team distributed a self-reported smoking knowledge and cessation questionnaire to 71 patients referred to a US hospital for bladder cancer between 2008 and 2009. The questionnaire captured information on patient demographics, and medical and smoking history.

Smoking risk factor knowledge for lung and bladder cancer was assessed using true or false questions, explain Guzzo et al.

The majority of study participants were White (93%), male (72%), and were educated to college level or beyond (71%), and 66% had undergone previous transurethral resection and fulguration.

In all, 72% of the cohort were ever-smokers, 51% had given up before their bladder cancer diagnosis, and 16% had continued to smoke up to the referral. The remainder continued to smoke after the referral. Ever-smokers had mostly smoked more than 10 cigarettes daily (81%), and the majority did so for more than 9 years (89%).

All patients reported being aware of the association between lung cancer and smoking at their referral, while 86% reported knowing about the risk for bladder cancer. Just under half (49%) of patients did not know that smoking was the leading risk factor for bladder cancer.

Among the current smokers at diagnosis (n=17), 88% had received advice from healthcare professionals to quit, yet 38% received no suggestions about cessation methods. In particular, 59% of current or ever-smokers said their urologists had discussed smoking cessation with them, but none were offered nicotine replacement or cessation aids.

Guzzo and co-investigators comment that the most effective prevention of bladder cancer in this context would be lifetime smoking abstinence. However, newly diagnosed bladder cancer patients are an important population to target with cessation counseling.

"Cessation counseling and aids are simple and inexpensive interventions that can increase abstinence to 21.7% from 5.4% in controls at 5 years," write the researchers.

Additionally, stopping smoking induces other health benefits such as reducing the risk for other cancers. It can also reduce the risk for tumor recurrence and could improve survival rates in patients who have already been diagnosed with bladder cancer, observes the team.

By Sarah Guy

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