Bladder cancer is primarily diagnosed as non-muscle invasive bladder cancer (NMIBC) with high recurrence and progression rates. Environmental and occupational exposures to carcinogens are well-known risk factors for developing bladder cancer, yet their effects on prognosis remain unknown. In the Be-Well Study, a population-based prospective cohort study of 1,472 patient with newly diagnosed NMIBC from 2015 to 2019, we examined history of environmental and occupational exposures in relation to tumor stage and grade at initial diagnosis by multivariable logistic regression, and subsequent recurrence and progression by Cox proportional hazards regression. Exposure to environmental and occupational carcinogens was significantly associated with increased risk of progression (HR = 1.79; 95% CI: 1.04, 3.09), specifically increased progression into muscle-invasive disease (HR = 2.28; 95% CI: 1.16, 4.50). Exposure to asbestos and arsenic were associated with increased odds of advanced stage at diagnosis (asbestos: OR = 1.43; 95% CI: 1.11, 1.84; arsenic, OR = 1.27; 95% CI: 1.01, 1.63), and formaldehyde exposure was associated with increased risk of recurrence (HR = 1.38; 95% CI: 1.12, 1.69). Our findings suggest that history of these exposures may benefit current risk stratification systems to tailor clinical care and improve prognosis in patients with NMIBC.
American journal of epidemiology. 2023 Dec 05 [Epub ahead of print]
Zinian Wang, Marilyn L Kwan, Reina Haque, Rachel Pratt, Valerie S Lee, Janise M Roh, Isaac J Ergas, Kimberly L Cannavale, Ronald K Loo, David S Aaronson, Charles P Quesenberry, Christine B Ambrosone, Lawrence H Kushi, Li Tang
Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY., Division of Research, Kaiser Permanente Northern California, Oakland, CA., Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA., Department of Urology, Kaiser Permanente Downey Medical Center, Downey, CA., Department of Urology, Kaiser Permanente Oakland Medical Center, Oakland, CA.