title: Shortcomings in bladder cancer etiology research and a model for its prevention.
abstract: OBJECTIVE
  Bladder cancer (BC) is the most expensive cancer to treat. Its incidence and mortality have not decreased in the last three decades. Numerous uncertainties are still surrounding the etiology of BC. There is a need for a low-cost screening test for BC that would be applicable for early detection in asymptomatic persons, a test that would preferably be noninvasive and have satisfactory sensitivity and specificity.
  
  
  METHODS
  The first part of this paper addresses critical issues in the research into BC etiology, which we classified as entrances, toxicity and metabolism, amounts, and duration of exposure to carcinogens in the bladder. In the second part, based on the proven risk factors for BC, we present a simple scoring system as part of a new BC screening method.
  
  
  RESULTS
  The heterogeneous results of studies on BC etiology are largely due to a lack of research into the compounds (and their mutual interactions) present in the urinary bladder, carcinogens absorbed through the skin and/or inhaled, and the daily dynamics of exposure to exogenous risk factors. We have calculated a score for BC screening which is an integral component of a new, four-level system of BC prevention.
  
  
  CONCLUSIONS
  Interactions of carcinogens and their daily dynamics deserve more attention in further clarifying BC etiology. New attempts in BC screening should be focused on urine content analyses (carcinogens, antioxidants, vitamins, minerals) and not only on hematuria and currently used biomarkers. We propose a score for BC pre-evaluation and recruitment for screening and a new model of BC prevention.
authors.forename: Vladan
authors.initials: V
authors.lastname: Radosavljevic
authors.forename: Goran
authors.initials: G
authors.lastname: Belojevic
mesh_terms: D001628:Beverages / Q000009:adverse effects; D035843:Biomedical Research; D002273:Carcinogens; D004032:Diet / Q000009:adverse effects; D060766:Drinking Water / Q000009:adverse effects; D055088:Early Detection of Cancer / Q000592:standards; D004781:Environmental Exposure / Q000009:adverse effects; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000592:standards; D016273:Occupational Exposure / Q000009:adverse effects; D011230:Precancerous Conditions / Q000209:etiology / Q000628:therapy; D011322:Primary Prevention / Q000379:methods; D011470:Prostatic Hyperplasia / Q000150:complications; D060737:Reproductive Tract Infections / Q000150:complications; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods; D055512:Tertiary Prevention / Q000379:methods; D014026:Nicotiana / Q000009:adverse effects; D001749:Urinary Bladder Neoplasms / Q000139:chemically induced / Q000209:etiology* / Q000235:genetics / Q000517:prevention & control*; D014552:Urinary Tract Infections / Q000150:complications
chemical_list: D002273:Carcinogens; D060766:Drinking Water