Where there’s no smoke, there’s less bladder cancer

By Sally Robertson, B.Sc.Aug 29 2012

Giving up smoking can significantly improve clinical outcomes in patients with urothelial carcinoma of the bladder (UCB), report US researchers.

"General health care practitioners and urologists may play an important role in informing smokers regarding their risk of UCB development and progression as well as the benefits of smoking cessation," say Shahrokh Shariat (Weill Medical College of Cornell University, New York) and colleagues.

Among patients with non-muscle-invasive bladder cancer (NMIBC), current and heavy long-term smokers were at the greatest risk for disease recurrence and progression, reports the team.

However, this detrimental effect was abrogated among those who had given up smoking for at least 10 years.

In all, 2043 patients with primary NMBIC who underwent transurethral resection of the bladder (TURB) were followed up for an average of 49 months. At the time of TURB, 24% (494) of the individuals were never smokers, 47% (956) were former smokers, and 29% (593) were current smokers.

Among ever smokers, the team found that the heavy, long-term smokers (=20 cigarettes per day [CPD], =20 years) had the worst outcomes, followed by the light, long-term smokers (=19 CPD, =20 years), heavy, short-term smokers (=20 CPD, =19.9 years), and finally the light, short-term smokers (=19 CPD, =19.9 years).

After adjustment for the effects of standard clinicopathologic factors, current smokers were at twice the risk for disease progression than never smokers, while this risk did not significantly differ between never and former smokers.

Furthermore, compared with current smokers, patients who had quit smoking 10 years or more before undergoing TURB had a 34% lower likelihood of disease recurrence and a 58% lower likelihood for disease progression.

Finally, compared with heavy and long-term smokers, light and short-term smokers were at the lowest risk for disease recurrence, progression, and mortality.

"We found a significant dose-response relationship between cumulative smoking exposure, which combines smoking quantity and duration, and clinical outcomes of primary NMIBC patients," remark Shariat et al in European Urology.

The team says the beneficial effect of long-term smoking cessation may be the result of a decrease in the field damage effects, improved repair mechanisms, or recovery of defense mechanisms.

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