title: Environmental non-occupational risk factors associated with bladder cancer.
abstract: BACKGROUND
  Bladder carcinoma (BC), due its high morbidity and relapsing course, generates significant economic and health care costs. Accordingly, review the environmental nonoccupational risk factors (RF), more or less evidence-based, in the etiology and pathogenesis of BC, because the involvement of urologists is essential for prevention.
  
  
  METHODS
  Review of the peer-reviewed literature (1987-2012) on nonoccupational environmental RF associated with BC retrieved from Medline, Embase and Science Citation Index. The search profiles have been "Risk factors/Epidemiology/Tobacco-smoking/Diet-nutrition-water-liquids/Radiation/Infectious/Farmacological drugs" and "Bladder cancer".
  
  
  RESULTS
  Smoking was associated with 50% of BC in both sexes. Smokers have a 2-5 times higher risk than nonsmokers, directly proportional to the amount and duration of addiction. Drinking water contaminated with arsenic and chromium chlorination byproducts increases the risk of BC. High consumption of red meat and saturated fat may increase the risk, while high intake of fruits and vegetables decreases it. Patients treated with cyclophosphamide, ifosfamide and ionizing radiation have an increased risk of BC. Frequent and prolonged use of hair dyes and Schistosoma haematobium infestation increases the risk of BC.
  
  
  CONCLUSIONS
  The reduction or the cessation of smoking decrease BC. The contaminant-free water consumption with the increase of vegetal foods favour BC prevention. Cancer survivors treated with cyclophosphamide, ifosfamide and radiation therapy should be monitored for early diagnosis of BC.
authors.affiliation: Unitat de Salut Mediambiental Pediàtrica, Unitat d'Oncologia Pediàtrica, Hospital Universitari i Politècnic La Fe, València, España. Electronic address: ferris_jos@gva.es.
authors.forename: J
authors.initials: J
authors.lastname: Ferrís
authors.forename: O
authors.initials: O
authors.lastname: Berbel
authors.forename: J
authors.initials: J
authors.lastname: Alonso-López
authors.forename: J
authors.initials: J
authors.lastname: Garcia
authors.forename: J A
authors.initials: JA
authors.lastname: Ortega
mesh_terms: D004032:Diet / Q000009:adverse effects; D004781:Environmental Exposure / Q000009:adverse effects*; D006801:Humans; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology* / Q000209:etiology*; D014570:Urologic Diseases / Q000150:complications; D014876:Water Pollution / Q000009:adverse effects
keywords: Arsenic; Arsénico; Bladder cancer; Chlorination by-products; Cáncer vesical; Epidemiology; Epidemiología; Factores de riesgo; Risk factors; Schistosoma haematobium; Smoking; Subproductos cloración; Tabaquismo