title: Muscle invasive bladder cancer in Upper Egypt: the shift in risk factors and tumor characteristics.
abstract: BACKGROUND
  In Egypt, where bilharziasis is endemic, bladder cancer is the commonest cancer in males and the 2nd in females; squamous cell carcinoma (SCC) is the commonest type found, with a peculiar mode of presentation. The aim of this study is to identify and rank the risk factors of muscle invasive bladder cancer (MIBC) in Upper Egypt and describe its specific criteria of presentation and histopathology.
  
  
  METHODS
  This is an analytical, hospital based, case controlled study conducted in south Egypt cancer institute through comparing MIBC cases (n = 130) with age, sex and residence matched controls (n = 260) for the presence of risk factors of MIBC. Data was collected by personal interview using a well designed questionnaire. Patients' records were reviewed for histopathology and Radiologic findings.
  
  
  RESULTS
  The risk factors of MIBC were positive family history [Adjusted odds ratio (AOR) = 7.7], exposure to pesticides [AOR = 6.2], bladder stones [AOR = 5], consanguinity [AOR = 3.9], recurrent cystitis [AOR = 3.1], bilharziasis [odds ratio (OR) = 5.8] and smoking [OR = 5.3]. SCC represented 67.6% of cases with burning micturition being the presenting symptom in 73.8%.
  
  
  CONCLUSIONS
  MIBC in Upper Egypt is usually of the SCC type (although its percentage is decreasing), occurs at a younger age and presents with burning micturition rather than hematuria. Unlike the common belief, positive family history, parents' consanguinity, exposure to pesticides and chronic cystitis seem to play now more important roles than bilharziasis and smoking in the development of this disease in this area.
authors.affiliation: Public health department, Faculty of Medicine, Assiut University, Assiut, Egypt. zarzourah@yahoo.com
authors.forename: Ali H
authors.initials: AH
authors.lastname: Zarzour
authors.forename: Mohie
authors.initials: M
authors.lastname: Selim
authors.forename: Alaa A
authors.initials: AA
authors.lastname: Abd-Elsayed
authors.forename: Diaa A
authors.initials: DA
authors.lastname: Hameed
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Abdelaziz