title: Smoking and bladder cancer in Spain: effects of tobacco type, timing, environmental tobacco smoke, and gender.
abstract: We examined the effects of dose, type of tobacco, cessation, inhalation, and environmental tobacco smoke exposure on bladder cancer risk among 1,219 patients with newly diagnosed bladder cancer and 1,271 controls recruited from 18 hospitals in Spain. We used unconditional logistic regression to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for the association between bladder cancer risk and various characteristics of cigarette smoking. Current smokers (men: OR, 7.4; 95% CI, 5.3-10.4; women: OR, 5.1; 95% CI, 1.6-16.4) and former smokers (men: OR, 3.8; 95% CI, 2.8-5.3; women: OR, 1.8; 95% CI, 0.5-7.2) had significantly increased risks of bladder cancer compared with nonsmokers. We observed a significant positive trend in risk with increasing duration and amount smoked. After adjustment for duration, risk was only 40% higher in smokers of black tobacco than that in smokers of blond tobacco (OR, 1.4; 95% CI, 0.98-2.0). Compared with risk in current smokers, a significant inverse trend in risk with increasing time since quitting smoking blond tobacco was observed (> or =20 years cessation: OR, 0.2; 95% CI, 0.1-0.9). No trend in risk with cessation of smoking black tobacco was apparent. Compared with men who inhaled into the mouth, risk increased for men who inhaled into the throat (OR, 1.7; 95% CI, 1.1-2.6) and chest (OR, 1.5; 95% CI, 1.1-2.1). Cumulative occupational exposure to environmental tobacco smoke seemed to confer increased risk among female nonsmokers but not among male nonsmokers. After eliminating the effect of cigarette smoking on bladder cancer risk in our study population, the male-to-female incidence ratio decreased from 8.2 to 1.7, suggesting that nearly the entire male excess of bladder cancer observed in Spain is explained by cigarette smoking rather than occupational/environmental exposures to other bladder carcinogens.
authors.affiliation: Division of Cancer Epidemiology and Genetics, National Cancer Institute, Department of Health and Human Services, Bethesda, MD 20892, USA. samanicc@mail.nih.gov
authors.forename: Claudine
authors.initials: C
authors.lastname: Samanic
authors.forename: Manolis
authors.initials: M
authors.lastname: Kogevinas
authors.forename: Mustafa
authors.initials: M
authors.lastname: Dosemeci
authors.forename: Núria
authors.initials: N
authors.lastname: Malats
authors.forename: Francisco X
authors.initials: FX
authors.lastname: Real
authors.forename: Montserrat
authors.initials: M
authors.lastname: Garcia-Closas
authors.forename: Consol
authors.initials: C
authors.lastname: Serra
authors.forename: Alfredo
authors.initials: A
authors.lastname: Carrato
authors.forename: Reina
authors.initials: R
authors.lastname: García-Closas
authors.forename: Maria
authors.initials: M
authors.lastname: Sala
authors.forename: Josep
authors.initials: J
authors.lastname: Lloreta
authors.forename: Adonina
authors.initials: A
authors.lastname: Tardón
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Rothman
authors.forename: Debra T
authors.initials: DT
authors.lastname: Silverman
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D004781:Environmental Exposure; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D013030:Spain; D013997:Time Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D014026:Nicotiana
chemical_list: D014028:Tobacco Smoke Pollution