Risk Factors

Cigarette smoking is the most important established risk factor for bladder cancer; cigarette smokers develop bladder cancer at two to three times the rate as nonsmokers. The risk increases with the number of packs per day smoked. Smoking is estimated to cause 47 percent of the bladder cancer deaths among men and 37 percent among women in the U.S. Workers exposed to certain chemicals are also at increased risk of bladder cancer; these chemicals include:
4-aminobiphenyl (workers in the production of 2-aminobiphenyl), aromatic amines such as benzidine (workers in the production of benzidine and benzidine-based dyes and in the garment, leather, rubber manufacturing, polyurethane foam manufacturing, printing, paper and homecraft industries), 2-naphthylamine (laboratory technicians and scientists using it in research), and polycyclic aromatic hydrocarbons from engine exhaust, smelting, and roofing. Other occupations with an increased risk are painters, aluminum workers, machinists, hairdressers, and truck and other motor vehicle drivers. Occupational exposures have been estimated to cause approximately 23 percent of bladder cancers. People living in urban areas are at higher risk of bladder cancer.

Studies of artificial sweeteners have not shown these substances to increase the risk of bladder cancer. The studies of coffee drinking are inconsistent, with some studies showing an association with bladder cancer and others not. Other factors that may cause bladder cancer are bladder infection with a parasitic fluke (Schistosoma haematobium), treatment with the anti-cancer drugs chlornaphazine and cyclophosphamide, long-term use of pain killers containing phenacetin, urinary tract infections and stasis (slowed or stopped flow of urine), dietary factors, tobacco other than in cigarettes, and genetic susceptibility.

Prevention and Control

Not smoking cigarettes and minimizing exposure to hazardous chemicals in the workplace are the best means of preventing bladder cancer. There is no routine screening test for the early detection of bladder cancer.

Incidence and Mortality in the U.S.

Bladder cancer is the sixth most common type of cancer in the U.S. with 54,400 new cases estimated for 1998. The incidence is much greater in men than women and greater among white than black men. Nationally, bladder cancer incidence increased about ten percent between 1973 and 1991. The increase was much greater for black men and women. For 1998, 12,500 deaths due to bladder cancer have been estimated. The five-year survival rate for bladder cancer increased since the 1960s, to 80 percent for whites and 60 percent for blacks. If diagnosed at the localized stage, the five-year survival rate for bladder cancer is 94 percent.

Incidence in New Jersey - 1986-1996

Tables 6 through 9 contain data on the incidence of bladder cancer in New Jersey by county from 1986 to 1996. Figure 5 shows the trends over time in the statewide incidence rates. Statewide, white males had a much higher rate than black males, white females, or black females (see Figure 5). All the counties followed a similar pattern (see Table 9). Statewide, the rates for each race/gender group remained fairly steady over the years, although the rates generally increased for black males and decreased for black females (see Figure 5).

Conclusion

Reducing smoking and minimizing exposure to carcinogens in the workplace should be continued in order to reduce the rates of bladder cancer.

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COUNTY	1986		1987		1988		1989		1990		1991		1992		1993		1994		1995		1996 (Prelim.)
	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate
Atlantic	31	30.7	35	35.0	42	40.5	46	44.7	45	44.1	42	39.2	56	50.4	45	39.9	37	32.3	44	40.3	45	40.7
Bergen	163	35.9	198	43.5	192	41.2	196	42.7	182	38.8	188	40.6	192	40.7	204	42.4	172	35.8	155	32.0	178	36.6
Burlington	54	37.7	43	29.4	67	45.4	53	34.8	75	46.9	67	43.0	69	43.3	63	39.8	56	34.9	73	44.5	63	37.4
Camden	63	31.7	79	40.0	82	41.1	79	37.9	86	41.7	70	33.8	85	42.1	79	37.6	78	37.8	82	39.8	83	39.1
Cape May	21	33.2	22	33.7	31	43.3	28	41.0	25	37.3	26	37.9	23	34.4	25	35.0	29	40.0	34	46.2	22	31.2
Cumberland	20	33.1	23	36.1	19	32.3	21	33.8	19	30.1	17	24.9	25	39.4	16	25.0	25	38.6	24	40.1	20	29.4
Essex	99	34.5	88	31.7	98	36.2	103	37.9	102	39.6	92	35.5	103	40.5	100	38.4	87	33.9	80	31.1	76	31.6
Gloucester	22	27.0	33	40.2	32	37.3	40	45.6	34	39.0	37	39.1	44	45.9	40	42.3	39	39.2	31	32.2	36	36.7
Hudson	92	38.8	93	39.3	102	42.7	86	36.6	66	29.0	103	44.6	81	34.2	81	34.7	81	34.9	78	33.1	73	31.2
Hunterdon	10	24.6	13	31.1	17	39.9	15	32.6	21	45.4	17	37.1	11	21.5	14	28.3	11	20.1	13	24.6	14	27.5
Mercer	45	33.7	56	40.8	55	40.2	62	44.5	61	44.3	51	37.2	58	40.6	53	37.9	53	38.1	62	44.0	59	41.7
Middlesex	107	39.0	97	34.0	109	39.5	104	35.6	103	35.3	107	37.2	116	38.7	123	39.7	111	36.5	114	36.7	104	33.7
Monmouth	104	43.2	79	32.0	116	46.5	95	37.5	96	37.9	87	33.6	111	42.5	108	40.1	108	40.2	106	38.8	95	33.1
Morris	66	38.0	67	36.8	68	37.4	58	32.2	70	38.3	52	28.3	68	36.4	82	43.6	67	34.9	78	39.6	79	40.4
Ocean	133	42.5	138	43.3	151	46.9	135	42.2	153	43.2	150	45.1	151	43.6	164	45.0	136	36.9	160	40.0	134	33.9
Passaic	90	43.9	88	42.4	85	41.5	64	31.9	83	40.5	64	31.9	82	40.3	75	37.7	89	43.5	88	41.6	71	34.3
Salem	8	25.9	9	27.9	11	34.7	14	43.1	19	59.9	21	66.3	10	29.9	14	44.3	5	14.6	14	44.6	11	30.6
Somerset	26	28.8	32	32.5	46	45.0	42	43.1	35	32.8	31	30.3	28	26.5	33	29.4	26	23.3	36	30.6	30	25.1
Sussex	24	49.4	13	27.2	26	54.9	13	25.3	16	30.5	23	47.0	20	38.0	22	42.3	20	37.4	21	38.1	21	41.3
Union	101	40.6	99	39.9	113	45.1	85	33.5	80	32.6	92	38.0	98	39.4	80	32.0	79	31.0	83	33.5	77	30.4
Warren	16	37.7	20	46.6	22	49.0	13	28.7	16	34.4	28	59.3	25	54.3	30	64.4	15	29.7	24	50.4	20	42.1
STATE	1296	37.4	1325	37.8	1485	42.0	1354	38.1	1388	38.8	1366	38.0	1457	40.0	1451	39.1	1324	35.7	1400	37.0	1311	34.6

¹Incidence rates - per 100,000 males, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. Source: New Jersey State Cancer Registry.

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COUNTY	1986		1987		1988		1989		1990		1991		1992		1993		1994		1995		1996 (Prelim.)
	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate	No.	Rate
Atlantic	13	10.1	17	11.2	11	7.2	16	10.8	18	10.7	13	7.8	10	6.8	14	9.5	15	9.9	12	8.4	20	12.2
Bergen	72	11.4	73	11.4	62	9.9	73	11.9	67	10.3	71	10.4	82	13.1	73	10.9	60	8.8	61	9.1	67	10.7
Burlington	23	11.5	9	4.3	16	7.4	20	9.4	24	11.0	25	12.8	19	8.7	23	11.1	21	10.1	21	9.8	19	9.1
Camden	32	11.1	30	10.5	29	9.2	30	9.9	25	7.8	37	12.2	31	10.4	45	16.0	33	11.5	23	7.0	35	11.5
Cape May	---	---	13	13.5	12	13.6	7	8.5	13	12.5	11	10.5	6	8.1	11	10.9	13	13.8	9	9.8	11	11.1
Cumberland	10	10.8	---	---	7	8.2	11	11.1	9	9.3	8	8.9	12	12.8	9	12.1	7	8.6	5	6.4	6	7.4
Essex	37	9.0	30	6.5	39	9.8	38	9.8	32	8.5	44	11.7	35	9.6	46	11.7	32	8.3	35	8.7	45	12.9
Gloucester	13	12.6	7	6.3	9	7.2	12	8.9	6	4.9	17	12.6	15	11.6	6	5.1	16	12.6	9	7.3	7	5.1
Hudson	40	10.5	38	9.8	36	10.3	36	9.6	32	8.4	35	9.0	43	12.2	27	7.7	37	9.7	38	10.7	33	9.4
Mercer	12	6.4	10	5.4	18	8.7	15	7.1	28	15.1	29	14.3	25	12.4	15	8.2	21	10.6	23	12.3	17	10.1
Middlesex	39	10.8	26	7.3	39	10.4	42	11.0	37	9.4	31	7.9	41	10.9	31	7.4	40	10.0	48	11.7	36	8.6
Monmouth	26	7.2	36	9.5	27	8.1	32	9.2	47	13.2	35	9.9	41	11.4	37	9.2	41	12.3	42	11.3	28	6.5
Morris	25	9.9	22	9.0	22	8.4	16	5.9	30	11.0	26	9.3	32	13.4	28	9.7	21	8.0	20	7.5	24	9.0
Ocean	41	9.5	36	8.2	50	10.8	58	12.5	45	12.2	57	11.2	55	11.9	57	11.4	36	6.1	55	12.2	52	9.0
Passaic	30	8.9	33	10.5	35	11.1	32	9.5	35	11.3	15	5.2	29	9.6	16	5.0	29	9.5	25	8.8	30	8.7
Somerset	16	12.6	14	11.0	12	8.5	11	8.6	12	8.9	9	5.8	12	7.5	14	8.5	10	6.4	14	8.2	10	6.7
Sussex	6	10.0	8	13.5	---	---	---	---	---	---	5	7.2	8	10.3	6	8.7	15	21.3	---	---	9	13.5
Union	27	7.3	19	5.0	29	8.6	35	8.8	37	10.5	36	10.1	34	9.0	31	8.4	34	9.8	37	9.4	29	8.8
Warren	6	10.4	6	8.0	---	---	7	9.4	7	10.3	7	11.5	---	---	---	---	11	13.9	12	13.1	8	9.1
STATE	483	9.8	437	8.6	466	9.3	501	9.9	515	10.1	514	9.9	537	10.7	503	9.7	501	9.6	502	9.6	495	9.4

¹Incidence rates - per 100,000 females, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. Counties with six or more years of fewer than five cases each year were removed from the table - Hunterdon and Salem counties. The dashes indicate fewer than five cases. Source: New Jersey State Cancer Registry.

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COUNTY	1986-1990				1991-1996
	MALE		FEMALE		MALE		FEMALE
	Number	Rate2	Number	Rate2	Number	Rate2	Number	Rate2
Atlantic	13	17.1	11	8.5	15	13.7	12	6.6
Bergen	19	25.9	8	6.8	12	12.5	7	4.2
Burlington	18	27.9	5	6.2	17	15.3	10	8.2
Camden	13	11.2	14	8.2	35	19.4	15	5.9
Cape May	5	46.9	5	35.2	---	---	---	---
Cumberland	6	18.7	---	---	---	---	---	---
Essex	64	13.2	53	6.8	98	16.0	45	4.6
Gloucester	7	18.3	---	---	9	15.0	---	---
Hudson	14	15.3	18	11.6	23	17.5	12	5.8
Mercer	11	10.5	9	6.4	24	17.1	8	4.1
Middlesex	14	22.2	8	9.6	8	9.0	6	5.3
Monmouth	9	10.1	8	6.1	22	17.0	---	---
Passaic	10	11.2	8	6.6	21	19.2	7	3.9
Salem	---	---	---	---	---	---	7	19.2
Somerset	---	---	---	---	9	36.1	---	---
Union	25	17.0	9	4.4	35	19.5	25	8.7
STATE	237	15.2	173	7.3	345	16.2	167	5.2

¹Incidence rates - per 100,000 population, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. Counties with fewer than five cases for each gender in each time period were removed from the table - Hunterdon, Morris, Ocean, Sussex, and Warren counties. The dashes indicate fewer than five cases. Source: New Jersey State Cancer Registry.
²Average annual rate.

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COUNTY	MALE				FEMALE
	WHITE		BLACK		WHITE		BLACK
	Number	Rate2	Number	Rate2	Number	Rate2	Number	Rate2
Atlantic	468	40.0	28	15.1	159	9.5	23	7.4
Bergen	2020	39.0	31	18.2	761	10.7	15	5.3
Burlington	683	39.8	35	20.3	220	9.5	15	7.4
Camden	866	38.3	48	16.0	350	10.7	29	6.9
Cape May	286	37.5	9	36.8	109	10.6	6	16.4
Cumberland	229	33.2	8	10.4	88	9.1	6	5.3
Essex	1028	35.3	162	14.8	413	9.6	98	5.5
Gloucester	388	38.7	16	16.1	117	8.5	5	3.6
Hudson	936	36.3	37	16.5	395	9.7	30	8.3
Hunterdon	156	30.1	---	---	44	6.7	---	---
Mercer	615	40.4	35	14.5	213	10.0	17	5.1
Middlesex	1195	37.0	22	14.3	410	9.7	14	7.1
Monmouth	1105	38.6	31	14.1	392	9.8	12	3.8
Morris	755	36.9	5	13.0	266	9.2	---	---
Ocean	1605	41.9	5	14.4	542	10.4	6	11.0
Passaic	879	39.1	31	15.9	309	8.9	15	5.0
Salem	136	38.5	5	9.5	41	8.3	9	13.9
Somerset	365	31.3	12	28.9	134	8.4	---	---
Sussex	219	38.9	---	---	69	9.6	---	---
Union	987	35.9	60	18.5	348	8.7	34	6.9
Warren	229	44.5	---	---	72	9.2	---	---
STATE	15157	38.0	582	15.8	5454	9.7	340	6.1

¹Incidence rates - per 100,000 population, age-adjusted to the 1970 U.S. standard population. Cases of unknown county are included in the State numbers and rates. The dashes indicate fewer than five cases. Source: New Jersey State Cancer Registry.
² Average annual rate.

*1996 data are preliminary. Source: New Jersey State Cancer Registry